Random Community Sample Research Articles

Lifestyle and the risk of acute myocardial infarction in a Gulf Arab population.

Recent statistics indicate that acute myocardial infarction (AMI) is becoming very common in the State of Bahrain. A population-based case-control study was carried out to explore the importance of lifestyle in the occurrence of AMI in Bahrain among those aged 30-79 years. Seventy consecutive cases with a first episode of AMI were identified from a register, which included all hospital admissions, during the period 1 February 1992 to 31 July 1992, and compared with 516 subjects obtained from a random sample of the same community. Multiple logistic regression was used to control for demographic variables as well as for the mutual confounding effects of the investigated risk factors. Of the patients with first-time AMI, 64% did not walk regularly for exercise compared with 34% of community controls (adjusted odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.24-5.15). In all, 12% of community controls has a history of hypertension and 9% had diabetes. The comparative figures for AMI patients were 44% for hypertension (adjusted OR = 5.04, 95% CI: 2.82-9.00) and 22% for diabetes (adjusted OR = 3.28, CI: 1.73-6.20). Cigarette smoking and infrequent consumption of fruits and vegetables also appeared to be associated with an increased risk of AMI. There is scope for lifestyle change in reducing AMI risk, by changes in physical activity, smoking and dietary habits. In addition, measures to control hypertension and diabetes should be given a high priority in any national health policy to prevent AMI.

Adult children of alcoholic or mentally ill parents: alcohol consumption and psychological distress in a tri-ethnic community study.

Data from a racially and ethnically heterogeneous random community sample of 1,784 adults were used to compare effects of reported parental alcoholism, parental mental illness, both alcoholism and mental illness, or no parental pathology. No parental history differences were observed among males with regard to psychological distress (depression, anxiety, and somatization) or drinking patterns (drinking, quantity, frequency, or total weekly consumption). Among females, the parental-mental-illness-only group consistently reported more problems than did the no-pathology group on depression, anxiety, somatization, and drinking quantity, even after statistical controls for demographic factors, social desirability, and possible coping resources such as fatalism, religiosity, and self-esteem. While parental alcoholism appeared to have little impact upon psychological distress dimensions relative to the no pathology group, further analyses conducted separately for current drinkers vs. nondrinkers indicated consistently lower levels of depression, anxiety, and somatization among male nondrinkers than drinkers from families involving parental alcoholism. The specificity of these effects to males reporting parental alcoholism may reflect either the resilience of male Adult Children of Alcoholics (ACOAs) who do not drink and/or the role of drinking as a mediator of parental alcoholism. Possible reasons for the general lack of parental alcoholism and racial/ethnic differences are discussed.

Jealousy: a community study.

This study represents the first attempt to study sexual jealousy in a random community sample. Jealousy was reported by all subjects. Men, when jealous, were particularly concerned about the potential loss of the partner, whereas women were more concerned with the effects of infidelity on the quality of the relationship. Behaviours such as searching the partner's belongings or inspecting their clothes for signs of sexual activity correlated with unusually intense jealousy. Men tended to cope with jealousy by using denial and avoidance, whereas women were more likely to express their distress and to try to make themselves more attractive to their erring partner. Greater jealousy concerns were expressed by young men who had either married early or were now living without a partner. Heavy drinkers and those reporting more psychiatric symptoms were also more prone to jealousy. A clear correlation emerged between lowered self-esteem and increased jealousy, which was particularly marked in women, for whom robust self-esteem was virtually incompatible with high jealousy concerns. The study supported the prosaic notion that those who are satisfied with their romantic attachments are less prone to jealous suspicions. This study offers a starting point for the clinician seeking information about the experience of jealousy in the community.

Cognitive Impairment and Depressive Symptomatology in a Random Community Sample of Nonagenerians in South Wales

Cognitive Impairment and Depressive Symptomatology in a Random Community Sample of Nonagenerians in South Wales

Otago Women's Health Survey 30-month follow-up. I: Onset patterns of non-psychotic psychiatric disorder.

Women who showed new psychiatric morbidity after a 30-month follow-up of a random community sample of New Zealand women were compared with those who were free of psychiatric disorder at follow-up. There were 25 new cases among the 215 women who were originally not psychiatric cases and who were re-interviewed. Using the weighted back population data to obtain prevalence figures for the general population, 6.9% became new cases over the two and a half years. Those who developed psychiatric disorder initially showed more psychiatric symptoms at a subdiagnostic level. Baseline factors that preceded the onset of psychiatric disorder were being separated or divorced, coming from a large family, having poor social networks, living alone, having few social role responsibilities such as paid employment or motherhood, and having poor physical health. An additional cross-sectional association at follow-up was poor financial security. Good social networks were closely linked with the number of a woman's social roles and appeared to protect her against the onset of psychiatric disorder. Consistent with the initial cross-sectional study, the follow-up data provide no support for marriage and child-care being risk factors for female psychiatric disorder. However, in New Zealand, these factors indicate social integration and are associated with superior mental health.

Otago Women's Health Survey 30-month follow-up. II: Remission patterns of non-psychotic psychiatric disorder.

The follow-up phase of a random community sample of New Zealand women contrasted the social, demographic, and clinical characteristics of those women whose initial psychiatric disorder had remitted with those who continued to describe significant psychiatric morbidity, two-and-a-half years later. Of 272 women studied at baseline and reinterviewed, 57 had originally been psychiatric cases. Twenty-five of those women (44%) were still cases at follow-up. Using figures that statistically reconstructed the original population from the stratified sample, the remission rate in the parent population was 61% over the two-and-a-half years (an average of 24% per annum). Women less likely to experience remission of their psychiatric disorder were of mid-age (45-64 years), with poor finances and with poor social relationships at the initial assessment. Although the age finding replicates a previous report from an Epidemiological Catchment Area study, it is not clear whether it is a universal relationship, true for all cultures. The alterations in social roles faced by women after child-rearing is a possible explanation, at least for New Zealand.

Childhood Sexual Abuse and Mental Health in Adult Life

The relationship between childhood sexual abuse and mental health in adult life was investigated in a random community sample of women. There was a positive correlation between reporting abuse and greater levels of psychopathology on a range of measures. Substance abuse and suicidal behaviour were also more commonly reported by the abused group. Childhood sexual abuse was more frequent in women from disrupted homes as well as in those who had been exposed to inadequate parenting or physical abuse. While elements in the individual's childhood which increased the risks of sexual abuse were also directly associated to higher rates of adult psychopathology, abuse emerged from logistic regression as a direct contributor to adult psychopathology. Severity of abuse reported was related to the degree of adult psychopathology. The overlap between the possible effects of sexual abuse and the effects of the matrix of disadvantage from which it so often emerges were, however, so considerable as to raise doubts about how often, in practice, it operates as an independent causal element. Further, many of those reporting childhood sexual abuse did not show a measurable long-term impairment of their mental health. Abuse correlated with an increased risk for a range of mental health problems, but in most cases its effects could only be understood in relationship to the context from which it emerged.

Alcohol use and blood pressure in an unacculturated society.

Alcohol intake has been associated with higher blood pressure in acculturated populations but not in unacculturated societies. We performed a cross-sectional survey of a random community sample of 5023 male Yi rural farmers and 1656 Yi and 2173 Han men living in an urban setting. Average alcohol intake among drinkers was 36.4 g/d in Yi farmers, 56.5 g/d in Yi migrants, and 38.7 g/d in Han men. Age-adjusted mean diastolic blood pressure was 66.9, 70.5, and 71.7 mm Hg, respectively. Diastolic blood pressure was higher at higher alcohol intakes in all three groups (all P < .001). After adjustment for age, body mass index, heart rate, smoking, and physical activity, the change (95% confidence interval) in diastolic blood pressure for each standard drink was 0.50 (0.38-0.62), 0.31 (0.18-0.43), and 0.24 (0.07-0.40) mm Hg for Yi farmers, Yi migrants, and Han men, respectively. The percentage of variance in diastolic blood pressure explained by alcohol intake was 5% for Yi farmers, 4% for Yi migrants, and 2% for Han men. In a random sample of 831 men, these associations were independent of urinary sodium, potassium, calcium, and magnesium and sodium-potassium ratio. In the Yi farmers, associations were less strong for systolic blood pressure and no longer significant after adjustment. Approximately 33% of hypertension could be attributed to daily alcohol use in the Yi groups compared with 9.5% in the Han people.(ABSTRACT TRUNCATED AT 250 WORDS)

Nocturnal Motor Activity in a Community Sample Erkki Kronholm, Erkki Alanen and Markku T. Hyyppä

The relationships between nocturnal motor activity and daytime psychophysiological activation were investigated in a random community sample of 199 subjects aged 35-55 years. Nocturnal motor activity was recorded with the static charge sensitive bed (SCSB, Bio-Matt). The association of nocturnal motor activity with demographic features, health status, laboratory blood values, afternoon electrodermal activity (EDA) and psychological distress was studied. A model for nocturnal motor activity was constructed and statistically analyzed. The analysis revealed that psychological distress, breathing disturbance, plasma glucose level and sympathetic activity were related significantly and independently to nocturnal motor activity. Their relations and the associations of sex, age, body mass index (BMI), sleep latency and health status with nocturnal motor activity were discussed in the context of the arousal theory of poor sleep.

Diagnostic comorbidity in persons with suicidal ideation and behavior

An initial finding of heightened risk of suicidal ideation or behavior among individuals in a random community sample who met diagnostic criteria for panic disorder or panic attacks was not replicated in later studies of both general and specific groups of psychiatric outpatients. The present study represented another effort to validate the finding. The participants included 209 outpatients who had attempted suicide or were at high risk for continued suicidal behavior or eventual suicide. All subjects were evaluated with a structured clinical interview for assigning DSM-III-R diagnoses, the Modified Scale for Suicidal Ideation, the suicidal ideation subscale of the Suicide Probability Scale, and the Beck Hopelessness Scale. The findings indicated the relative complexity and importance of diagnostic comorbidity among these suicidal subjects. Mood disorders were the most frequent primary diagnoses, followed by phobias, posttraumatic stress disorder (PTSD), generalized anxiety disorder, and panic disorder. Panic disorder was not present as an isolated, independent diagnosis; on the contrary, all of the patients with panic disorder also received at least one additional comorbid diagnosis. Mean scores for suicidal ideation and hopelessness were greatest for patients with current comorbid primary mood disorder and panic disorder. However, a critical and equally important role was played by comorbid PTSD, generalized anxiety disorder, and phobias. The findings represent another failure to validate, with a specific clinical group, panic disorder as an independent risk factor for suicidal ideation or behavior. However, they highlight the possibility that panic disorder and other anxiety disorders are risk factors when they co-occur with a primary mood disorder.

The social networks of bipolar affective disorder patients

The social interaction parameters of a carefully delineated group of bipolar patients were compared to those of a random New Zealand community sample. The bipolar subjects had significantly lower scores for perceived availability and adequacy of both intimate and diffuse social relationships. Their mean scores did not differ from those of the subgroup in the random community survey who were classified as showing psychiatric morbidity, most of whom were depressed. Social interaction scores were negatively correlated with the bipolar patients' age and duration of illness. Those bipolar subjects with a predominance of manic episodes had lower mean values for their social interaction indices than those with more depressions. The results may suggest that the longer the illness continues, the greater is the impoverishment of the sufferer's social interaction patterns. Overall, manic episodes appeared to have a more deleterious effect on social relationships than depressive episodes.

The natural history of neurotic disorder in an elderly urban population. Findings from the Liverpool longitudinal study of continuing health in the community.

A random community sample of 1070 subjects aged 65 years and over was interviewed at home using the GMS-AGECAT package and followed up three years later. Neurotic symptoms were common, but symptoms sufficient to reach 'case' level were much less frequent. The overall prevalence of neurotic 'cases' was 2.4% in year 0 and 1.4% in year 3. The incidence was estimated as a minimum of 4.4 per 1000 per year over the age of 65. Women were more likely to be 'cases' than men but not 'subcases', and there was a general decline in prevalence with increasing age, particularly for 'subcases'. Anxiety was the commonest neurotic subtype. After three years, 'cases' were shown not to persist, but this did not reflect wellness. There was a tendency still to have some symptoms, but the predominant symptom appeared to change, suggesting a possible chronic neurotic disorder with changing presentation over time. Depressive symptoms were closely associated with this presentation, suggesting that depression may be an important and integral part of a general, changing neurotic disorder.

Customary Physical Activity, Psychological Well-being and Successful Ageing

ABSTRACTProfiles of customary physical activity (CPA) and psychological wellbeing were obtained from a random community sample of 1,042 individuals aged 65 years and over. Activities were assessed with regard to their estimated minimum energy cost and/or their assumed contribution to functional capacity. The structure of CPA, and associations between activity levels, morale and mental health were then investigated. Women and men showed clear differences in the organisation of their activity patterns, and these differences were reflected in activity–affect relationships. For men, factor scores derived from the first principal component of CPA emerged as significant, though modest, predictors of well-being in regression and discriminant analyses. For women, however, activity factor scores failed significantly to predict levels of morale or mental health when medical and demographic factors were controlled. The results indicate that, among the present cohort of retired and elderly people, relationships between customary physical activity levels and psychological well-being are weak, indirect and gender-specific.

"Important" Life Events and Depression among Older Adults

The current article examines the role of psychosocial factors in the relationship of life events and depression among older adults by focusing on a single "most important" life event. Using data from a random community sample of older adults, the study finds that although health-related events do exacerbate the level of depression resulting from an undesirable life event, their exclusion from the analysis still results in a significant relationship between non-health-related events and depressive symptomatology. Controlling for both types of undesirable life events, the study further documents that psychological resources are more effective than social resources in predicting subsequent level of depression for those experiencing health-related events. For those experiencing non-health-related life events, social resources are most important in predicting subsequent symptomatology. Implications are discussed.

Epidemiology of colonic symptoms and the irritable bowel syndrome

Functional gastrointestinal disease is believed to be very common, but reports of its prevalence have not usually evaluated random community samples, and validated questionnaires have not been used to elicit symptoms. The prevalence of specific colonic symptoms and the irritable bowel syndrome among representative middle-aged whites was determined from a defined population, and the impact of these symptoms on presentation for medical care was measured. An age-and sex-stratified random sample of 1021 residents of Olmsted County, Minnesota, aged 30–64 years, was obtained. All subjects were mailed a valid self-report questionnaire that identified gastrointestinal symptoms and functional gastrointestinal disorders. The response rate was 82% (n = 835). The age-and sex-adjusted prevalence of abdominal pain (more than six times in the prior year) was 26.2 per 100 (95% confidence interval, 23.1–29.2). The prevalence of chronic constipation (hard stools and straining and/or < 3 stools per week > 25% of the time) was 17.4 (95% confidence interval, 14.8–20.0), whereas the prevalence of chronic diarrhea (loose watery stools, and/or > 3 stools per day > 25% of the time) was 17.9 (95% confidence interval, 15.3–20.5). The prevalence of abdominal pain and disturbed defecation was similar in women and men, except that infrequent defecation and straining at stool were more common in women. Using the Manning symptom criteria to identify irritable bowel syndrome (≥ 2 of 6 symptoms in those with abdominal pain more than six times in the prior year), the prevalence of irritable bowel syndrome was 17.0 per 100 (95% confidence interval, 14.4–19.6). Overall, 71 persons (9%) reported visiting a physician for abdominal pain or disturbed defecation in the prior year; a subset of variables related to pain severity were the best predictors of health care seeking after adjustment for age and gender. However, these accounted for only 22% of the log likelihood. In conclusion, more than one third of an unselected middle-aged population reported chronic abdominal pain or disturbed defecation, and more than one in six had symptoms compatible with the irritable bowel syndrome. Only a minority had presented for medical evaluation; moreover, the characteristics of the abdominal complaints did not explain the seeking of health care in most cases.

Nutritional Epidemiology of Postmenopausal Breast Cancer in Western New York

The authors studied 439 postmenopausal breast cancer cases, identified in hospitals throughout western New York, with an interview schedule that considered frequency and amount ingested of 172 foods and provided data for an estimate of total calories ingested. These were compared with age-matched controls comprising a random sample of the same communities as the cases. The extensive interviews, requiring 2.0 hours on average to administer, also covered alcohol ingestion, Quetelet index, and a wide variety of reproductive factors. The authors found, as have most investigators over the past 25 years, that risk increased with increases in age at first pregnancy, decreased with increases in numbers of children and pregnancies, and increased in those with history of benign breast disease and in those with female relatives previously affected with breast cancer. Risk adjusted for potential confounders was highest among women with the lowest ingestion of carotene or a substance correlated with its ingestion. Risk was not associated with retinol ingestion. It increased with increases in Quetelet index. Fat intake, whether studied in terms of quantity or the proportion of total calories derived from fat, was not associated with risk of breast cancer. Our analyses of these factors were adjusted for age, education, and the reproductive history traits described above.

Panic disorder and suicidal ideation and behavior: discrepant findings in psychiatric outpatients

Previous investigators found that persons who had ever met criteria for panic disorder or panic attacks reported more lifetime suicide attempts and ideation than persons who had ever met criteria for other psychiatric disorders. To determine whether outpatients with current panic disorders also report such differences, this study examined the suicide attempt rates, levels of suicidal ideation, and levels of hopelessness among four groups of psychiatric outpatients. Structured clinical interviews were used to assign diagnoses to 900 consecutive psychiatric outpatients. These patients were administered the Scale for Suicide Ideation and the Beck Hopelessness Scale and were also questioned in detail about previous suicide attempts and past and present suicidal ideation. None (0.0%) of the 73 patients with primary panic disorder without agoraphobia reported having made suicide attempts during their lifetimes. One (1.3%) of the 78 patients who had panic disorder with agoraphobia, 34 (7.0%) of the 485 patients who had mood disorders, and four (1.5%) of the 264 patients who had other psychiatric disorders reported suicide attempts. The mean scores on the Scale for Suicide Ideation and the Beck Hopelessness Scale of the patients with panic disorders and other disorders were significantly lower than the mean scores of the patients with mood disorders. The rates of suicidal ideation and behavior for psychiatric outpatients who had panic disorders were discrepant with those reported by the earlier group of investigators for a random community sample of persons who reported ever having had panic attacks or met criteria for panic disorders.

Heavy Drinking as a Risk Factor for Depression and Dementia in Elderly Men

A random community sample of subjects aged 65 and over was re-interviewed after three years by psychiatrists using the GMS and HAS. The relationship between drinking history and current psychiatric morbidity was examined. Men with a history of heavy drinking for five years or more at some time in their lives were found to have a greater than fivefold risk of suffering from a psychiatric disorder at the time of the interview. Among this group past alcohol consumption was significantly higher for those with a current psychiatric diagnosis compared with those who were well. This association between heavy alcohol consumption in earlier years and psychiatric morbidity in later life is not explained by current drinking habits.

Mental well‐being of good sleepers in a random population sample

It is generally assumed that a good night's sleep has a beneficial effect on mood. The present survey aimed to evaluate what a good night's sleep means for mental well-being and psychic functional capacity. A random community sample of 670 adult subjects was divided into three groups: good, intermediate and poor sleepers according to a sleep habit questionnaire based on self-reports. Their cognitive, emotional and personality features were assessed with various psychometric and personality tests, and differences between the groups were evaluated statistically. In the age- and gender-adjusted population the average good sleeper turned out to be a person who falls asleep in 10 minutes, after which his/her 7.5 hours' sleep is serene and without parasomnias. Immediately on awakening in the morning and later during the day he/she is mentally alert without distress or emotional problems. Definite mood and personality differences between good and other sleepers in the adult population surveyed revealed that good sleepers are psychologically capable of maintaining a self-esteem which is in functional balance with their life-goals and mental well-being.

Using General Practitioners to Measure Community Morbidity

Randomly-selected patients drawn from randomly-selected General Practitioners (GPs) (two-stage cluster sample) were compared with a sample of the general population, who had visited a GP, selected using close approximations to standard household survey methods (area probability) of the Australian Bureau of Statistics. If GP patients drawn in this way resemble a random sample of the Australian community who have recently used GP services, then confidence should increase in this much cheaper method as a source of morbidity statistics. Interviews focused upon each person's last visit to the GP, with questions about reasons for attending, diagnoses and treatments, and various demographic items. In univariate analyses of 22 demographic items, 17 consultation items and 27 diagnoses and treatments, only five items were differently distributed between the GP patients and the area sample. Pairs of data items were also similar in the two groups. Items were examined using multidiscriminant analysis, to determine those that discriminated between the two groups and to calculate predicted group membership on the basis of these items. This analysis correctly classified only 56.7% of study subjects into their true group (GP patient or area sample) when based on items that were differently distributed between the groups, and 53.3% when all items were used, indicating that discrimination was only slightly better than chance. This result increases the confidence with which GP patients can be used to estimate levels of morbidity in the community if random selection is used to select GPs and if their patients are also randomly selected.