Background
The aim was to assess the relationships between social and material deprivation and the use of tobacco, excessive alcohol and psychotropic drugs by both sexes and in various age groups. Greater knowledge concerning these issues may help public health policy-makers design more effective means of preventing substance abuse.

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Associations of social and material deprivation with tobacco, alcohol, and psychotropic drug use, and gender: a population-based study

Alain Brunet, PhD1, Vivian Akerib, MA2, Philippe Birmes, MD, PhD3 (Can J Psychiatry 2007;52:501-502) In the aftermath of the terrorist attacks on the World Trade Center, some media "experts" predicted that up to 1 out of 5 New Yorkers would suffer from full-blown posttraumatic stress disorder (PTSD). In fact, 2 months after the attacks, among a random sample of 1008 adults living in Manhattan, only 7.5% reported symptoms consistent with a diagnosis of acute PTSD.1 It is relatively easy these days to find instances among the media and the general public where the concept of psychological trauma is overapplied or misrepresented, giving the impression that PTSD must be rampant and therefore overdiagnosed. Despite the popular use of this term, actual prevalence rates demonstrate that PTSD is not overdiagnosed by those whose job it is to diagnose: the epidemiologists and the mental health professionals. If we consider the evolution in the field of trauma research, there are at least 2 major tendencies: on the one hand, the criteria for diagnosing PTSD have become stricter, while, on the other hand, our ability to detect and correctly assess trauma exposure and PTSD has improved, thereby leading to the identification of new, previously undiagnosed cases. The net result of these 2 tendencies is a remarkably stable rate of PTSD in the epidemiologic surveys of the last decade. Changes in the Diagnostic Criteria of PTSD The diagnostic criteria of PTSD have undergone many minor changes since they were introduced in the DSM-III (1980). With the publication of DSM-IV (1994), however, a major change was introduced: the definition of what constitutes a traumatic event shifted from a nomothetic to an idiographic one. From that point on, trauma was no longer defined as an objective event but rather as a life-threatening experience that must, in addition, be appraised by the exposed individual with fear, helplessness, or horror. In the absence of such distress, the event was no longer considered traumatic. In many instances, this change dramatically reduced the number of individuals typically considered as having been exposed to a traumatic event.2 In addition, the emergence of the social impairment criterion in the DSM-IV (for all mental disorders) decreased the prevalence rate of PTSD up to 24%, according to a recent study.3 Changes in Epidemiologic Survey Methodology Although the criteria for diagnosing PTSD have evolved toward being more restrictive, our ability to detect and assess trauma has also improved. For instance, in epidemiologic surveys, lists of potentially qualifying events (and the use of explicit definitions, as in the case of sexual abuse) to prime the memory of the participants are now routinely used, something which was not done in the earlier surveys. As a result of this and other methodological improvements, the rates of PTSD did go up. For instance, in 1987 Helzer et al4 found in the Epidemiological Catchment Area study a lifetime rate of PTSD of only 1%. Since then, however, large surveys conducted in the United States have found higher but remarkably similar rates of lifetime PTSD: 7.5% and 6.6% in 2 representative samples of the US population5'6 and a conditional risk of 9.1% among the exposed in a sample of young urban US adults.7 This stabilization of the PTSD rate in carefully designed epidemiologic surveys argues strongly against the idea that PTSD is overdiagnosed. Another example of the crucial role played by the survey methodology comes from Thompson et al.8 In a reexamination of the National Vietnam Veterans Readjustment Study (NVVRS) and the Vietnam Experience Study (VES), Thompson et al managed to reconcile the 2 studies' quite different prevalence rates (15.2% and 2.2%, respectively) by applying each study's definitions related to diagnosis. Since the NVVRS made use of multiple standardized and well-validated diagnostic instruments and used many more PTSD symptom probes than the VES, the former's statistical results were deemed more reliable. …

Don't throw out the baby with the bathwater (PTSD is not overdiagnosed).

This study assesses the effects of individual and family characteristics on psychotropic drug use among male and female adolescents. The sample included 2,396 subjects attending two middle schools and two high schools. Respondents completed self-administered questionnaires covering gender, age, body mass index, smoking, alcohol use, illicit drug use, tiredness during the daytime, self- reported personality traits, family conditions, and psycho- tropic drug use. The data were analyzed using logistic models. The prevalence of frequent psychotropic drug use (for headache, tiredness, nervousness, anxiety, insomnia) was 43.0% overall; twice as high among girls than boys. Among the girls, frequent psychotropic drug use was associated with frequent tiredness during the daytime (adjusted odds ratio OR 2.03, 95% CI 1.61-2.57), smoking (2.02, 1.50-2.71), alcohol use (1.34, 1.04-1.74), higher body mass index (>18 kg/m 2 , 1.54, 1.16-2.04), poor family atmosphere (1.33, 1.03-1.72), and being worried (1.93, 1.53-2.43) or easily becoming irritable (1.28, 1.01-1.62). In boys the factors with significant ORs were frequent tiredness during the daytime (2.21, 1.67-2.93), alcohol use (1.52, 1.15-2.01), and being worried (1.70, 1.28-2.26) or easily becoming irritable (1.42, 1.06-1.89); univariate analysis revealed a significant relationship with smoking and family atmosphere. An association was also observed for illicit drugs in both sexes and for age≥17 years in girls. Individual and family characteristics have marked influence on psychotropic drug use among both male and female adolescents. Preventive measures should be taken to make adolescents and their parents more aware of the risks and to improve their living conditions.

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Do male and female adolescents differ in the effect of individual and family characteristics on their use of psychotropic drugs

This study assessed the role of certain individual characteristics in school injury among male and female adolescents. The sample included 2,398 subjects attending middle schools and high schools. Respondents completed a self-administered questionnaire at the beginning of the school year. School nurse completed a questionnaire on injury for each school injury occurred during the school year. The data was analyzed with the adjusted odds ratios (ORa) computed via the logistic models. The school injury was common (13% for both sexes). Sports/physical training injury was more frequent among girls (8.8% vs. 6.6%, P < 0.05) contrarily to the other types of injury (4.6% vs. 8.8%, P = 0.001). Sports/physical training injury was strongly associated with age <15 years (ORa 3.42) and presence of previous injury (2.63) among boys, and with age <15 years (2.02), presence of previous injury (2.94), not easily irritated (1.89), and irresponsible (1.59) among girls. The other types of injury were highly related to age <15 years (ORa 4.18), frequent use of psychotropic drugs (1.76), not living with both parents (1.65), being not calm (2.03), and presence of previous injury (1.82) among boys, and to age <15 years (2.59), obesity (3.24), and being not calm (1.84) among girls. The present study identified a number of potential risk factors for school injury among male and female adolescents. Preventive measures should be taken to make adolescents, their parents and teachers more aware of the risks and to find remedial measures.

https://www.jstor.org/stable/info/27822772

School injury and gender differentials: a prospective cohort study

Purpose

This 10-year review of Asian Americans focuses on factors that impede adequate psychiatric diagnosis and treatment.



Conclusion

Asian Americans are the fastest growing ethnic group in the United States, with a high prevalence of domestic violence, alcohol abuse, and significant distress. However, Asian Americans consistently underutilize mental health services because of stigma, misconceptions of Western treatment, and cultural interpretations of mental health problems.



Practice Implications

Knowledge of the diversity of the Asian American population and an understanding of cultural interpretations of psychiatry will better prepare clinicians to treat and engage these patients.

Factors That Influence the Diagnoses of Asian Americans in Mental Health: An Exploration

The regulatory bodies of both the United States and United Kingdom have issued cautionary statements about prescribing antidepressant medications to treat major depressive disorder (MDD) in children younger than age 18. Despite these cautions, antidepressant agents, particularly SSRIs and serotonin activators, are regularly used to treat MDD in this age group, and increasingly so in very young children. This article considers the possible effects of antidepressant agents on the growth and development of children younger than age 18 and provides recommendations for the use and careful monitoring of these medications, including screening for physiological effects, selfinjurious behavior, and suicidal ideation. Guidelines for use of antidepressant agents with these populations include incorporating medications into comprehensive, holistic treatment, assessing for onset of severe akathesia as a marker of increased risk for self-harm, and advocating for more clinical trials of these medications in different childhood age groupings.

Potential effects of antidepressant agents on the growth and development of children and adolescents.

The cultures of racial and ethnic minorities influence many aspects of mental illness, including communication styles, symptoms, coping strategies, family and community support, and willingness to seek treatment. This article presents the effects of Asian American/Pacific Islanders' beliefs and behaviors related to mental health. Strategies to enhance the process and outcomes of the psychiatric interview with members of this populatior are addressed.

Sue Barrett

Papers

Potential effects of antidepressant agents on the growth and development of children and adolescents.

Interviewing techniques for the Asian-American population.