RESUMEN

The majority of alcoholics who recover do so without the benefit of treatment, yet little is known about these individuals and the factors associated with their success. A better understanding is needed of the self-initiated and maintained change processes ("natural recovery") associated with such recoveries. In the current study, initiated in 1997, we followed up alcoholics identified in four previous community surveys and conducted a brief physical examination and an in-depth interview assessing factors thought to be associated with "natural recovery" or entry into treatment. Here we present the study model, describe our sample of 83 "naturally recovered" and 138 "hazardous problem drinkers," and report factors associated with "natural recovery." During the period when their drinking was at its most problematic, those who naturally recovered had discussed their alcohol-use associated problems with fewer network members and had been advised to stop drinking or to drink less by fewer network members. In addition to older age, "natural recovery" was associated with marriage, lower levels of avoidant coping, higher self-esteem, social networks with members who drank less, and a history of less frequent drug use and lower frequencies of intoxication. Rates of "natural recovery'' may be increased by encouraging the development of these attributes in hazardous problem drinkers who do not already have them.

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Longitudinal relations between depressive symptoms and alcohol problems have been examined infrequently in community-based studies, and gender-specific findings to date appear to be inconclusive. Study hypotheses were that depressive symptoms predicted subsequent alcohol problems for females, whereas alcohol problems predicted subsequent depressive symptoms for males. The authors examined these relations in a random sample of household adults (aged 19 years or more) from Erie County, New York, assessed in 1986, 1989, and 1993 (n = 1,306). Measures of alcohol problems (in the previous year) incorporated an alcohol abuse/dependence diagnosis and a heavy alcohol use index. The Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms over a 1-month time frame. Comprehensive logistic regression models incorporated prior depressive symptoms, prior alcohol problems and sociodemographic variables (age, race, education, marital status, employment, total family income, and number of children living at home). For females, depressive symptoms predicted subsequent alcohol problems over 3 years (odds ratio = 3.04, 95% confidence interval 1.35-6.80, p < 0.01) and 4 years (odds ratio = 2.42, 95% confidence interval 1.14-5.12, p < 0.05), but not for 7 years. There was no evidence to support the hypothesis for males. This study clarifies and extends prior investigations of relations between these two prevalent mental health problems in a community-based sample.

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The purpose of this study is to provide prevalence estimates of the sociodemographic characteristics and extent of speaking and hearing disabilities among a community-based sample of adults (15 years and older) who have survived traumatic brain injury (TBI). This report is based on the Canadian Health and Activity Limitation Survey (1986-87), a national household survey of self-reported disabilities. Results indicate that adults with TBI with speaking or hearing difficulties tend to be male, middle-aged and older, urban dwellers, of relatively low income levels who are limited at work. Over 75% of adults with speaking difficulties report difficulty being understood by people outside their immediate family context. Hearing difficulties rise dramatically from 75% occurring with one communication partner to over 96% occurring with three partners. The mean duration of disabilities is 12.7 years for speaking and 13.5 years for hearing. More than 80% of adults with communicative difficulties have co-occurring disabilities of mobility and agility. Results have specific implications for functional assessment of adults with TBI and service delivery decision-making.

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RESUMEN

The purpose of this study was to establish national point prevalence rates for traumatic brain injury, resulting in recognizable disability among adults living in institutions or in the community. The report is based on the Canadian Health and Activity Limitation Surveys (1986-1987), conducted in households and in institutions by Statistics Canada. These surveys used multi-stage cluster design with stratification, unequal probabilities of selection and computer linkage to the 1986 census of the population (households only). A combined representative sample of 632 adults with disabilities resulting from an injury to the brain provides a total population estimate of 15 000 adults. Participation rate by potential respondents was 90% in the household survey, and 97% for the institutional survey. The overall national prevalence rate of traumatic brain injury is 74.3 per 100 000 (95% CI 66.3-82.4) adults. Prevalence rates are highest in the 45-64 age range. Gender specific rates are 96.9 per 100 000 males and 52.9 per 100 000 females, with a 1.8:1 male to female ratio. The vast majority (84%) of adults with traumatic brain injury reside in household, rather than institutional settings. Prevalence rates allow estimates of the national public health burden of traumatic brain injury. Findings point to the health care burden of middle aged individuals living primarily in community settings.

RESUMEN

This original point prevalence study provides sociodemographic characteristics and Canadian household prevalence rates of adults (15 years and older) with disability who have survived a traumatic brain injury (TBI) and the type, number, and prevalence rates of co-occurring disabilities. This report is based on the Health and Activity Limitation Survey, a national survey conducted by Statistics Canada in 1986-87. The overall household prevalence rate of TBI is 62.3/100,000 adults (95% confidence interval = 54.0, 70.5). Gender-specific rates are 81.3/100,000 males and 44.2/100,000 females, with a 1.8:1 male-to-female ratio. Rates are highest in the 45-64 age range, 3 times those in the 15-24 age group. Eighty-four percent of adults with TBI have co-occurring disabilities (median = 2), the most prevalent being limited mobility and agility.

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