This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.

IntroductionHousing First is a complex housing and support intervention for homeless individuals with mental health problems. It has a sufficient knowledge base and interest to warrant a test of wide-scale implementation in various settings. This protocol describes the quantitative design of a Canadian five city, $110 million demonstration project and provides the rationale for key scientific decisions.MethodsA pragmatic, mixed methods, multi-site field trial of the effectiveness of Housing First in Vancouver, Winnipeg, Toronto, Montreal and Moncton, is randomising approximately 2500 participants, stratified by high and moderate need levels, into intervention and treatment as usual groups. Quantitative outcome measures are being collected over a 2-year period and a qualitative process evaluation is being completed. Primary outcomes are housing stability, social functioning and, for the economic analyses, quality of life. Hierarchical linear modelling is the primary data analytic strategy.Ethics and disseminationResearch ethics board approval has been obtained from 11 institutions and a safety and adverse events committee is in place. The results of the multi-site analyses of outcomes at 12 months and 2 years will be reported in a series of core scientific journal papers. Extensive knowledge exchange activities with non-academic audiences will occur throughout the duration of the project.Trial registration numberThis study has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374.

Objective: To present the results of a systematic review of literature published between 1980 and 2004 reporting findings of the prevalence and incidence of anxiety disorders in the general population.Method: A literature search of epidemiologic studies of anxiety disorders was conducted, using MEDLINE and HealthSTAR databases, canvassing English-language publications. Eligible publications were restricted to studies that examined age ranges covering the adult population. A set of predetermined inclusion and exclusion criteria were used to identify relevant studies. Prevalence and incidence data were extracted and analyzed for heterogeneity.Results: A total of 41 prevalence and 5 incidence studies met eligibility criteria. We found heterogeneity across 1-year and lifetime prevalence rates of all anxiety disorder categories. Pooled 1-year and lifetime prevalence rates for total anxiety disorders were 10.6% and 16.6%. Pooled rates for individual disorders varied widely. Women had generally higher prevalence rates across all anxiety disorder categories, compared with men, but the magnitude of this difference varied. Conclusion:The international prevalence of anxiety disorders varies greatly between published epidemiologic reports. The variability associated with all anxiety disorders is considerably smaller than the variability associated with individual disorders.Women report higher rates of anxiety disorders than men. Several factors were found to be associated with heterogeneity among rates, including diagnostic criteria, diagnostic instrument, sample size, country studied, and response rate. Clinical Implications · Significant heterogeneity in the prevalence of anxiety disorders signals the need for population-specific health policies and planning. · The prevalence of anxiety disorders eclipses the capacity of specialized mental health services. · Anxiety disorders remain prevalent throughout ages 18 to 64 years. Limitations· The observed heterogeneity may be related to environmental or cultural factors associated with the location of each contributing investigation. · Variance owing to methods of diagnosis and measurement account for a limited portion of the observed heterogeneity. · An insufficient number of incidence studies are available to clarify details concerning the onset of symptoms.

The prevalence of mood disorders reported in high-quality studies is generally lower than rates commonly reported in the general psychiatric literature. When controlled for common methodological confounds, variation in prevalence rates persists across studies and deserves continued study. Methodological variation among studies that have examined the prevalence of depression in primary health care services is so large that comparative analyses cannot be achieved.

Housing First with ACT is an effective approach in various contexts for assisting individuals with serious mental illness to rapidly exit homelessness.