Showing papers on "Mental health published in 1984"

The NIMH Epidemiologic Catchment Area Program: Historical Context, Major Objectives, and Study Population Characteristics

Abstract: The National Institute of Mental Health multisite Epidemiologic Catchment Area (ECA) program is described in the context of four previous psychiatric epidemiologic surveys that included a combined total of 4,000 subjects from Stirling County, the Baltimore Morbidity Study, Midtown Manhattan, and the New Haven third-wave survey. The ECA program is distinguished by its sample size of at least 3,500 subjects per site (about 20,000 total); the focus on Diagnostic Interview Schedule--defined DSM-III mental disorders; the one-year reinterview-based longitudinal design to obtain incidence and service use data; the linkage of epidemiologic and health service use data; and the replication of design and method in multiple sites. Demographic characteristics of community and sample populations are provided for New Haven, Conn, Baltimore, and St Louis.

Attributions, Beliefs About Control, and Adjustment to Breast Cancer

Abstract: Attributions for cancer and beliefs about control over cancer were examined for their association with adjustment to breast cancer. Although 95% of the respondents made attributions for their cancer, no particular attribution (e.g., stress, diet) was associated with better adjustment. Analyses of attributions of responsibility for the cancer to the self, environment, another person, or chance yielded only a negative relation between adjustment and blaming, another person. In contrast, both the .belief that one could now control one's cancer and the belief that others, (e.g. the physician) could now control the cancer were significantly associated with good adjustment. Of the different types of control, cognitive control was most strongly associated with adjustment, behavior control was less strongly associated with adjustment, and information control and retrospective control were unassociated with adjustment. The theoretical and practical implications of these results are discussed. Social psychologists have become increasingly interested in how individuals adjust to sudden, unexpected, and/or negative events in their environments. Two constructs that have been useful in this analysis are causal attributions and beliefs in control. In the present study, we examined the usefulness of these constructs in understanding adjustment to breast cancer. Breast cancer is a major cause of death among American women, striking approxiThis research was supported by both research funds from the National Institute of Mental Health (MH 34167) and a Research Scientist Development Award (MH 00311) to the first author, and by research funds from the University of California at Los Angeles to all three authors. The third author was also supported by a National Institute of Mental Health training grant. Theauthors are grateful to Barbara Futterman, Patricia Loftus, and Sharon Schuller for their aid in data collection; to Carol Wixom, Alexandra Koltun, and Natasha Hamlin for their aid in data,coding; to Martin Gahart for his help in statistical analyses; and to Alex Pinkston, Project Coordinator. Gratitude is expressed to Avrum Bluming, Robert Leibowitz, and Gary Dosik for making their patients available to us.

Utilization of health and mental health services. Three Epidemiologic Catchment Area sites.

Abstract: • Utilization of health and mental health services by noninstitutionalized persons aged 18 years and older is examined based on interviews with probability samples of 3,000 to 3,500 persons In each of three sites of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) program: New Haven, Conn, Baltimore, and St Louis. In all three ECAs, 6% to 7% of the adults made a visit during the prior six months for mental health reasons; proportions were considerably higher among persons with recent DSM-III disorders covered by the Diagnostic Interview Schedule (DIS) or severe cognitive impairment. Between 24% and 38% of all ambulatory visits by persons with DIS disorders were to mental health specialists. In seeking mental health services, men were more likely to turn to the specialty sector than to the generalist; women used both sectors about equally. The aged infrequently received care from mental health specialists. Visits for mental health reasons varied considerably depending on specific types of DIS disorder.

Coping with chronic illness: a study of illness controllability and the influence of coping strategies on psychological adjustment.

Abstract: Longitudinal data on the coping strategies used by middle-aged and older adults faced with one of four different chronic illnesses (N ~ 151) were used to evaluate the role of coping in the explanation of psychological adjustment. The study distinguished between illnesses that offer few opportunities for control (rheumatoid arthritis and cancer) and those more responsive to individual and medical efforts at control (hypertension and diabetes) and evaluated the emotional consequences of two coping strategies, information seeking and wish-fulfilling fantasy, expected to play different roles in adjustment. Results showed information seeking to have salubrious effects on adjustment and wish-fulfilling fantasy to have deleterious consequences; contrary to expectation, neither strategy's effects were modified by illness controllability. Analyses of the direction of causation between coping and adjustment suggest that wish-fulfilling fantasy is linked to poor adjustment in a mutually reinforcing causal cycle. The modesty of the effects of coping, however, demand replication of results to confirm the conclusions drawn here. Physical health is closely related to emotional and mental health, particularly among middle-aged and older adults, a fact documented by a multitude of studies (see reviews by Larson, 1978; Palmore & Luikart, 1972). Individuals differ in their adjustment to both acute and chronic illness, however. Coping efforts have been proposed as one means of accounting for these differences in adaptation, and numerous studies have documented the importance of individual coping efforts in helping ill adults maintain reasonable levels of emotional well-being (e.g., Cohen & Lazarus, 1979; Moos, 1982). These studies have found typical coping strategies to include: denial, selective ignoring, information seeking, taking refuge in activity, avoidance, learning specific illness-related procedures, engaging in wish-fulfilling fantasy, blaming others, and seeking comfort from others. Unfortunately, many of the studies arguing the importance

Psychosocial status in chronic illness. A comparative analysis of six diagnostic groups.

Abstract: Assumptions that psychological attributes are specific to particular diagnoses characterize many investigations of chronically ill patients. We studied 758 patients, each of whom had one of six different chronic illnesses, to determine and compare their scores on the Mental Health Index. Five groups of physically ill patients (with arthritis, diabetes, cancer, renal disease, or dermatologic disorders) did not differ significantly from one another or from the general public, but all had significantly higher scores for psychological status when compared with the sixth group, patients under treatment for depression. There was a significant direct relation between higher mental-health scores and advancing age across all patient populations. Patients with recently diagnosed illness in all groups had poorer mental-health scores than did patients whose illness had been diagnosed more than four months previously. A direct relation between declining physical status and mental-health scores was observed. These results suggest that psychological adaptation among patients with chronic illnesses is remarkably effective and fundamentally independent of specific diagnosis.

Prevalence of Depression among Asian-Americans

Abstract: The dearth of population-based studies and epidemiological investigations on the mental health problems of Asian-Americans, especially since the change in the immigration laws in 1965, has led to contradictory speculations about the prevalence rates of mental illness and the general mental health st

Psychiatric disorders in the relatives of probands with affective disorders. The Yale University--National Institute of Mental Health Collaborative Study.

Abstract: A family study of psychiatric disorders in 2,003 first-degree relatives of 335 probands found increased rates of bipolar I disorder and major depression (MD) in the relatives of probands with bipolar disorder and increased rates of MD in the relatives of probands with MD. There was a similarity in rates of affective disorders in the relatives of ambulatory and of hospitalized depressed probands (suggesting that ambulatory depressed patients may be as suitable as hospitalized ones for biological studies) and a comparability of rates of illness in relatives between centers for most disorders when comparable diagnostic criteria and procedures were used.

A new look at evidence about reduced cost of medical utilization following mental health treatment.

Abstract: Meta-analysis of 58 controlled studies and analysis of the claims files for the Blue Cross and Blue Shield Federal Employees Plan for 1974-1978 provide mutually supporting evidence of the cost-offset effects of outpatient mental health treatment. These two complementary resources provide a powerful tool for investigating the nature of associations between mental health services and subsequent reductions in the use of other medical services. The authors found that the reductions in use of medical services are associated with inpatient rather than with outpatient utilization and tend to be larger for persons over 55 years of age.

Is homelessness a mental health problem

Abstract: Seventy-eight homeless men, women, and children staying at an emergency shelter were interviewed. The vast majority were found to have severe psychological illnesses that largely remained untreated. Approximately 91% were given primary psychiatric diagnoses: About 40% had psychoses, 29% were chronic alcoholics, and 21% had personality disorders. Approximately one-third had been hospitalized for psychiatric care. The authors discuss the relationship of mental health policy to the homeless and suggest that shelters have become alternative institutions to meet the needs of mentally ill people who are no longer cared for by departments of mental health.

Predicting the vocational capacity of the chronically mentally ill. Research and policy implications.

Abstract: In response to the growing recognition that adequately trained personnel and appropriate in- tervention techniques were not available to meet the rehabilitation needs of psychiatrical ly disabled per- sons, the first Rehabilitation Research and Training Center in Mental Health was established in August 1979. Because the Center's mandate is to focus on problems of national scope and because the chronically mentally ill have recently been severely adversely af- fected by Social Security Administration actions that have terminated disability benefits, a review of the research literature surrounding the vocational capacity of psychiatrical ly disabled persons was undertaken. This article details results of that review, identifies needed research in the area of employability of the chronically mentally ill, and notes implications for policy.

Methodology in behavioral and psychosocial cancer research. Conceptualizing disease impact and treatment outcomes.

Abstract: The focus of assessment of disease impact is moving beyond survival and biomedical outcomes to include a comprehensive set of health status and quality of life concepts. We have discussed four socially relevant concepts that can be thought of as dimensions of health status or well being: physiologic status, personal (physical) functioning, mental health, and social well-being. Quality of life was also discussed briefly as a very global concept encompassing these health status dimensions and a broader set of concepts including finances, housing, and employment. Five categories of measures based on manifest content were also discussed, including measures of disease/diagnostic status, personal functioning, mental health, general health perceptions, and social/role functioning. The physiologic dimension of health is very heterogeneous and includes many concepts and measures that vary largely independently of each other and that differ in terms of their impact on the other dimensions of health status. The physical, mental, and social dimensions of health and well-being also can be measured many different ways, and each can be broken down into distinct concepts that may vary in importance from one study to another. Of these three concepts, social well-being is the most heterogeneous. To assist investigators searching for valid measures of specific health status and quality of life concepts, we recommended formal estimations of measurement models. A preliminary model of 15 health status measures was presented to illustrate the usefulness of such a model.

The social and emotional adjustment of immigrant children: a review of the literature.

Abstract: This article reviews the existing research on the prevalence of social and emotional adjustment problems among immigrant children examines the findings on the kinds of adjustment problems exacerbated by migration or particular to immigrant school children and reviews and assesses effectiveness of intervention programs developed specifically to aid such children. Also considered is a theoretical framework which would facilitate conceptualizing the process of immigration among children their particular needs and how these might best be met by primary and secondary preventive mental health interventions. (authors)

Prevalence and correlates of the long-term regular use of anxiolytics.

Abstract: Long-term use of anxiolytics has been a cause for concern because of the possibility of dependency and other adverse consequences. In a nationally representative probability survey of adults conducted in 1979, we found that long-term use (defined as regular daily use for a year or longer) was relatively rare, occurring among 15% of all anxiolytic users—a rate of 1.6% of all adults between the ages of 18 and 79 years in the general population. The data indicate that long-term regular users tend to be older persons with high levels of emotional distress and chronic somatic health problems. They are preponderantly women, and many are sufficiently distressed to seek out other sources of help (mental health professionals and other psychotherapeutic medications) as well. The sizable majority of long-term users is being monitored by their physicians at reasonably frequent intervals. The data give little support to current stereotypes of long-term users and suggest, instead, that such use is associated with bona fide health problems that are being treated within the broader context of the health system. ( JAMA 1984;251:375-379)

Health Status and the Use of Outpatient Mental Health Services

Abstract: Using data from the RAND Corporation's Health Insurance Study, the authors have linked mental health status (self-reported psychological distress and psychological well-being) to the subsequent use outpatient mental health services delivered by formally trained mental health specialists and general medical providers.

The impact of care-giving on care-givers: factors associated with the psychological well-being of people supporting a dementing relative in the community.

Abstract: The aim of this paper is to present findings concerning a variety of factors expected to influence, either directly or indirectly as mediators, the psychological well-being of persons caring for a dementing relative in the community. The sample included both co-resident and non-resident supporters and the data were collected via a semi-structured interview. Only sex of dependant, sex of supporter, satisfaction with help from relatives, blood/role relationship, duration of care, frequency of visits from a home help and community nurse were significantly correlated with supporters' morale and mental health. The directions of these correlations were, however, not always as expected, e.g. the longer the duration of care-giving the higher the supporters' morale and the better the supporters' mental health. It was interesting to find that level of impairment and help from family and friends were not significantly associated with morale and mental health of supporters.

Deinstitutionalization and the homeless mentally ill.

Abstract: Although homelessness among the chronically mentally ill is closely linked with deinstitutionalization, it is not the result of deinstitutionalization per se but of the way deinstitutionalization has been carried out. The lack of planning for structured living arrangements and for adequate treatment and rehabilitative services in the community has led to many unforeseen consequences such as homelessness, the tendency for many chronic patients to become drifters, and the shunting of many of the mentally ill into the criminal justice system. It has become clear after two decades of deinstitutionalization that what is needed is a vast expansion of community housing and other services and a whole revamping of the mental health system to meet the needs of the chronically mentally ill for support and stability. In addition, mental health professionals must accept the full extent of the dependency needs of many chronic patients.

The prevalence and correlates of anxiety symptoms in older adults.

Abstract: Summary An anxiety symptom scale was administered to a community sample of 713 males and 1338 females representative of persons aged 55 and older in Kentucky and quite similar to that of the US population in that age range. On the basis of a cutting point established previously, 17.1% of the males and 21.5% of the females were estimated to experience sufficient anxiety-symptoms to place them at risk so as to require some form of intervention. In addition to gender and marital status differences, the study found a systematic but complex relationship between anxiety and age within this age range. Anxiety was inversely associated with socioeconomic status, education, and urban dwelling. Anxiety was inversely and highly correlated with physical health, and related to the presence of nine specific medical conditions and the need for and use of a number of medical services. The implications of the findings regarding the use of medical services for early diagnosis and treatment for mental health needs are discussed.

African Self-Consciousness and the Mental Health of African-Americans:

Abstract: Today we hear that conventional forms of mental illness (e.g., neurotic and psychotic reactions, drug addiction and abuse, suicidal behavior, deviant sexual behavior, and emotional stress generally) among African-Americans are approaching alarmingly high rates. Current estimates suggest that 1 out of every 20 to 25 urban Blacks is likely to encounter one of the traditional Western treatment-correctional institutions each year. Beyond these alarming statistics, consider the sociopolitical plight of Black people throughout the world today, amd especially in Africa and America, much of which has psychological implications itself. For example, Blacks are being oppressed by Europeans (and have been for some time) throughout the world. We are almost totally economically dependent on Europeans and our life-support resources

The role of the black church in community medicine.

Abstract: Historically, the black church has been the preserver and the perpetuator of the black ethos, the radix from which its defining values and norms have been generated, and the autonomous social institution that has provided order and meaning to the black experience in the United States. The traditional ethic of community-oriented service in the black ethos is highly compatible with the communitarian ethic of community medicine. Given this congruence and the much-documented fact that black Americans are an at-risk and under-served group regarding health status indicators and the provision of preventive health care, respectively, the black church is an extremely relevant locus for the practice of community medicine. A number of health programs based in or affiliated with the black church have operated throughout the United States, and these programs, along with the corpus of literature comprising conceptual articles favorable toward such a role for the black church, are reviewed within four areas of community medicine: primary care delivery, community mental health, health promotion and disease prevention, and health policy.

Education and Subjective Well-Being: A Meta-Analysis

Abstract: What is the relation between formal educational attainment and adults' subjective well-being? What factors account for variation in the estimates of this relation? Does education contribute to adult subjective well-being by increasing income or occupational status? To address these questions, we performed a metaanalytic research synthesis. Dependent variables were zeroand first-order correlations between educational attainment and subjective well-being, and independent variables were sample, measure, and study quality characteristics. We found that education is significantly positively related to adult subjective well-being, accounting for 1 to 3% of the variance. The relation is stronger in samples of women than men and in older than younger adults, but no differences were found between whites and blacks. The strength of the relation has not changed significantly over a span of nearly five decades. When occupational status, but not income, was the control variable the education/subjective well-being relation was reduced. Overall, education is a small but positive contributor to adult subjective wellbeing.

Adolescence, stress, and psychological well-being.

Abstract: The present study analyzes the mental-health consequences of stress in a sample of 1,038 adolescents (526 females and 512 males) from a Canadian prairie city. The study examined the relationship between perceived stress in family, school, and peer-group situations and four measures of psychological well-being, i.e., anxiety, depression, social dysfunction, and anergia. The moderator effects of locus of control orientation (mastery) on stress-outcome relationships were also examined, as were the sex differences in health and the perception of stress. All three sources of stress were found to be related to the four measures of mental health, with family stress having the strongest negative health impact. The health-protective role of locus of control was limited for the large part to the stresses emanating from school and peer groups. Substantial sex differences were found in the perception of family- and peer-related stresses as well as in levels of psychological distress. A tentative explanation of these differences was examined with reference to prevailing structural conditions and differences in locus of control orientation, with female adolescents showing greater externality. Implications of the results are drawn for the long-standing debate on the relative impact of stress and its sources on adolescents' psychosocial development and for a current controversy in adolescent theory between proponents of “classical” and proponents of “empirical” conceptions of adolescence.

The Social Activity/Subjective Well-Being Relation: A Quantitative Synthesis

Abstract: Meta-analytic techniques were used to synthesize findings on the social activity/subjective well-being relation. We chose zero-order and first order associations as our dependent variables and several different measure, sample, and study quality characteristics as our independent variables. We found that social activity is positively and significantly related to subjective well-being. Contrary to activity theory, informal activities and activities with friends were not related to subjective well-being consistently more strongly than were formal activities and activities with neighbors. In addition, the remaining measure, sample, and study quality characteristics were not adequate predictors of variation in activity/subjective well-being associations.

A Comparative Outcome Study of Group Psychotherapy vs. Exercise Treatments for Depression

Abstract: (1984). A Comparative Outcome Study of Group Psychotherapy vs. Exercise Treatments for Depression. International Journal of Mental Health: Vol. 13, Group Psychotherapies for Depression, pp. 148-176.