The Canadian Journal of Psychiatry

Suicidal ideation and suicide attempts are important indicators of extreme emotional distress. However, little is known about predictors of onset and course of suicidality in the general population. Our study tried to fill this gap by analyzing data from a prospectively followed community sample.

Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a 3-wave cohort study in a representative sample (n = 4848) of the Dutch adult general population.

The 3-year incidence of suicidal ideation and suicide attempts was 2.7% and 0.9%, respectively. Predictors of first-onset suicidal ideation and suicide attempts were sociodemographic variables (especially the negative change in situation variables), life events, personal vulnerability indicators, and emotional (mood and anxiety) disorders. Comparison of the corresponding odds ratios and confidence intervals revealed that predictors for first-onset suicidal ideation and suicide attempts did not differ significantly. One of the strongest predictors of incident suicide attempts was previous suicidal ideation. Regarding the course of suicidal ideation, it was found that 31.3% still endorsed these thoughts and 7.4% reported having made a suicide attempt 2 years later.

Similar predictors were found for first-onset suicidal ideation and suicide attempts. This suggests that suicidal behaviours may be ordered on a continuum and have shared risk factors. While suicidal thoughts may be necessary for, they are not sufficient predictors of, suicidal acts. The course of suicidality in the general population can be characterized by a minority of people having suicidal experiences that develop over time with progressively increasing severity.

In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD.

MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included.

Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors.

This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual.

Numerous surveys have reported associations between major depressive episodes (MDEs) and occupational status, but cross-sectional studies cannot quantify the risks of employment transitions nor clarify their temporal direction. The goal of our study was to estimate the impact of MDE on subsequent employment status in a longitudinal community cohort.

Data from the National Population Health Survey (NPHS) were used. Proportional hazard models and logistic regression were employed to evaluate the effect of MDE on working status during the 1994 to 2004 interval among respondents who reported working at a job or business at baseline.

MDE was associated with an increased risk of movement to nonworking status. People aged 26 to 45 years with MDEs have more than double the risk of this transition (HR = 2.6; 95% CI 1.8 to 3.6, P < 0.001). The probability of transition to nonworking status was higher, but the relative effect was smaller in people aged 46 to 65 years (HR = 1.2; 95% CI 0.7 to 2.0, P = 0.47). Retirement or perceived lack of availability of work did not contribute to the association.

MDE is associated with an elevated risk of transition from working to nonworking status, especially in people aged 26 to 45 years.

To examine the efficacy of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) in patients with comorbid major depressive disorder (MDD).

Participants (n = 29) diagnosed with comorbid OCD and MDD were randomized to receive standard CBT for OCD or integrated CBT that included an exclusive focus on treating MDD in the first phase of treatment and OCD in the second phase of treatment.

Both treatments resulted in statistically significant improvements in OCD and MDD symptoms. Treatment effects and recovery rates in the intent-to-treat sample were lower in both treatments, compared with past studies that excluded patients with MDD. However, among treatment completers, both treatments resulted in statistically significant and clinically meaningful improvements in OCD and MDD symptoms.

CBT holds promise as an efficacious treatment for people with comorbid OCD and MDD. The high treatment dropout rate with comorbid patients suggests that additional treatment strategies are required to enhance retention and optimize clinical outcomes.