Showing papers on "Mental health published in 1990"

Comorbidity of Mental Disorders With Alcohol and Other Drug Abuse. Results From the Epidemiologic Catchment Area (ECA) Study

Abstract: The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20 291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non—substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders. (JAMA. 1990;264:2511-2518)

Adolescent drug use and psychological health: A longitudinal inquiry.

Abstract: The relation between psychological characteristics and drug use was investigated in subjects studied longitudinally, from preschool through age 18. Adolescents who had engaged in some drug experimentation (primarily with marijuana) were the best-adjusted in the sample. Adolescents who used drugs frequently were maladjusted, showing a distinct personality syndrome marked by interpersonal alienation, poor impulse control, and manifest emotional distress. Adolescents who, by age 18, had never experimented with any drug were relatively anxious, emotionally constricted, and lacking in social skills. Psychological differences between frequent drug users, experimenters, and abstainers could be traced to the earliest years of childhood and related to the quality of parenting received. The findings indicate that (a) problem drug use is a symptom, not a cause, of personal and social maladjustment, and (b) the meaning of drug use can be understood only in the context of an individual's personality structure and developmental history. It is suggested that current efforts at drug prevention are misguided to the extent that they focus on symptoms, rather than on the psychological syndrome underlying drug abuse.

Life Transitions, Role Histories, and Mental Health.

Abstract: Major life changes and role transitions are often treated as stressors that create a generalized demand for adjustment by the individual. Empirically, however, these transitions have been shown to produce a wide range of effects on mental health. Two kinds of models have been proposed to explain this variation: differential access to coping resources for dealing with stressful situations, and variation in the characteristics of transitions, such as their undesirability, foreseeability, etc. This paper emphasizes a logically prior issue: the role context within which the transition event occurs, specifically, the level of pre-existing chronic stress in the social role. The model tested envisions life transition events as nonproblematic, or even beneficial to mental health, when preceded by chronic role problems - a case where more "stress" is actually relieffrom existing stress. Nine transition events are studied: job loss, divorce, pre-marital break-up, retirement, widowhood, children moving out of the house, first marriage, job promotion, and having a child. Results support the hypothesis that prior role stress reduces the impact of life transition events on mental health for seven of nine events, with some differences in impact by gender. The findings provide a basic framework for interpreting the effects of varying types of life transitions, and argue against the presumption that life transitions are inherently stressful, suggesting instead a need to specify prior social circumstances that determine whether or not a transition is potentially stressful.

Age at Onset of Selected Mental Disorders in Five Community Populations

Abstract: Using data collected in the National Institute of Mental Health Epidemiologic Catchment Area Program, we examined the reported age at onset of selected mental disorders using life table survival methods. The examination of hazard rates suggests that adolescence and young adulthood are important periods for the development of unipolar major depression, bipolar illness, phobias, and drug and alcohol abuse/dependence. Although there are limitations in using cross-sectional data for this purpose, the findings suggest the need for more attention to the development of mental disorders in childhood and adolescence.

Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents.

Abstract: Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. Despite an increasing prevalence of chronic childhood conditions and heightened concerns for the quality of life of the chronically ill, population-based studies of behavior problems among children with chronic physical conditions are rare. Findings on the epidemiology of behavior problems in a nationally representative sample of 11,699 children and adolescents aged 4 to 17 years in the United States are reported. Data included a 32-item parent-reported behavior problem index, measures of chronic childhood conditions, measures of school placement and performance, and sociodemographic variables. Analyses confirmed that chronic physical conditions were a significant risk factor for behavior problems, independent of sociodemographic variables. Among children these differences were observed across all subscales; among adolescents the largest differences were found for the Depression/Anxiety and Peer Conflict/Social Withdrawal subscales. Rates of extreme behavior problem scores (those in the top 10th percentile) were 1.55 times higher among children with a chronic health condition compared with children without a chronic condition (95% confidence interval 1.29 to 1.86). These independent odds were lowered to 1.44 when covariates for confounding were introduced via a multivariate logistic regression. Other independent risks included the absence of either biologic parent (odds ratio 2.05), male gender (1.53), low vs high family income (1.30), low vs high maternal education (1.51), and young vs old maternal age at childbirth (2.57). Chronic health conditions were also a major risk factor for placement in special education classes and having to repeat grades. Despite evidence for effective interventions, health services for children with chronic conditions--particularly mental health services--remain fragmented, signaling the need for increased attention to behavioral problems and their treatment among all health professionals caring for children.

Use of inpatient mental health services by members of ethnic minority groups.

Abstract: National data on psychiatric hospitalization point to marked ethnic-related differences. Blacks and Native Americans are considerably more likely than Whites to be hospitalized; Blacks are more likely than Whites to be admitted as schizophrenic and less likely to be diagnosed as having an affective disorder; Asian Americans/Pacific Islanders are less likely than Whites to be admitted, but remain for a lengthier stay, at least in state and county mental hospitals. These differences are clear-cut, but they ignore a major source of care: psychiatric hospitalization in placements other than psychiatric units and hospitals. Explanations for observed minority-White differences in hospitalization can be evaluated only partially or not at all: Such explanations include ethnic-related differences in socioeconomic standing and in the prevalence of major psychopathology; differential stigma, or capacity to tolerate or support a dysfunctional significant other; access and use of alternative services; and bias in the behavior of gatekeepers, especially practitioners assigning diagnostic labels and making involuntary commitment decisions. More research is needed to help explain these striking differences in utilization.

Stress and Social Support—in Search of Optimal Matching

Abstract: Theoretical and practical advantages are discussed of a model that specifies the type of social support that is most beneficial (i.e., most effective in preventing deleterious physical or mental health consequences) following different kinds of stressful life events. Prior attempts to specify such optimal combinations of stress and social support are reviewed, and a new optimal matching model is proposed. Issues that must be addressed in the validation of optimal stress-support models are discussed, and methodological suggestions for future research endeavors in this area are offered.

Mental Health Professionals' Perception of the Utility of Children, Mothers, and Teachers as Informants on Childhood Psychopathology

Abstract: Surveyed clinicians' and researchers' perceptions of the relative usefulness of prepubertal children, their mothers, and teachers as informants on children's problem behavior. Findings showed a high level of agreement within types of informants surveyed. Children were seen as the least useful informants on their own hyperactivity, attention problems, and oppositional behavior. Teachers were judged superior to mothers as informants on children's hyperactivity/inattentiveness; these relative ratings were reversed for oppositional child behavior. Children and mothers were perceived as more useful informants than teachers, on children's internalizing problems, with mothers scoring higher than children in all but one area–worrying. The survey results largely agree with those of other studies using different methods.

The Duke Health Profile. A 17-item measure of health and dysfunction.

Abstract: The Duke Health Profile (DUKE) is a 17-item generic self-report instrument containing six health measures (physical, mental, social, general, perceived health, and self-esteem), and four dysfunction measures (anxiety, depression, pain, and disability). Items were derived from the 63-item Duke-UNC Health Profile, based upon face validity and item-remainder correlations. The study population included 683 primary care adult patients. Reliability was supported by Cronbach's alphas (0.55 to 0.78) and test-retest correlations (0.30 to 0.78). Convergent and discriminant validity were demonstrated by score correlations between the DUKE and the Sickness Impact Profile, the Tennessee Self-Concept Scale, and the Zung Self-Rating Depression Scale. Clinical validity was supported by differences between the health scores of patients with clinically different health problems. Patients with painful physical problems had a DUKE physical health mean score of 58.1, while patients with only health maintenance problems had a mean score of 83.9 (scale: 0.0 = poorest health and 100.0 = best health). Patients with mental health problems had a DUKE mental health mean score of 49.2, in contrast to 75.7 for patients with painful physical problems and 79.2 for those with health maintenance. The DUKE is presented as a brief technique for measuring health as an outcome of medical intervention and health promotion.

Violence and Victimization of Lesbians and Gay Men Mental Health Consequences

Abstract: This article describes some of the major psychosocial challenges faced by lesbian and gay male survivors of hate crimes, their significant others, and the gay community as a whole. When an individual is attacked because she or he is perceived to be gay, the negative mental health consequences of victimization converge with those resulting from societal heterosexism to create a unique set of problems. Such victimization represents a crisis for the individual, creating opportunities for growth as well as risks for impairment. The principal risk associated with anti-gay victimization is that the survivor's homosexuality becomes directly linked to her or his newly heightened sense of vulnerability. The problems faced by lesbian and gay male victims of sexual assault, and the psychological impact of verbal abuse also are discussed. Suggestions are offered to assist practitioners in helping the survivors of anti-gay hate crimes.

Exercise and Mental Health

Abstract: Physical exercise is increasingly being advocated as a means to maintain and enhance good mental health. In general, findings from research indicate that exercise is associated with improvements in mental health including mood state and self-esteem, although a causal link has not been established. Research on acute exercise indicates that 20 to 40 minutes of aerobic activity results in improvements in state anxiety and mood that persist for several hours. These transitory changes in mood occur in both individuals with normal or elevated levels of anxiety, but appear to be limited to aerobic forms of exercise.

Facial disfigurement: problems and management of social interaction and implications for mental health.

Abstract: The concern of this article is with the impact of facial disfigurement on social interaction during brief encounters, the ramifications of which have the potential for psychological and social destruction. Largely ignored by those interested in the social and psychological problems and rehabilitation of the functionally impaired, such as the blind, the deaf, the amputee, the intent here is to point up the major problems associated with facial disfigurement and to explore some of the ways of dealing with them. The data on which this article is based were collected over many years and are no longer new, but this attempt to synthesize them for a particular purpose is.

The SF-36 Health Survey

Abstract: The SF-36 consists of 36 questions in eight subscales: Physical Functioning; Role Physical; Bodily Pain; General Health; Vitality; Social Functioniing; Role Emotional; Mental Health.

Prevention of work-related psychological disorders. A national strategy proposed by the National Institute for Occupational Safety and Health (NIOSH).

Abstract: The National Institute for Occupational Safety and Health (NIOSH) recognizes psychological disorders as a leading occupational health problem. This document, developed by a NIOSH working group led by the present authors, represents a first attempt to fashion a comprehensive national strategy to protect and promote the psychological health of workers. Roles are identified for industry, labor, government, and academia. Key initiatives include (a) steps to improve working conditions and employee mental health services and (b) increased research and surveillance to advance understanding of the problem. Because work-related psychological disorders appear to be a rapidly developing problem lacking complete definition in terms of scope and etiology, this strategy is not to be considered a final statement of NIOSH policy.

Community mental health and ethnic minority populations.

Abstract: National trends in minority utilization of mental health services are reviewed, and recommendations are made for needed research In relation to their representation in the population, blacks use services more than expected, and Asian American/Pacific Islanders use services less; Hispanics and Native American/Alaska Islander use varies according to type of service Hospitalization accounts for part of the increase in minority utilization; this trend is problematic Disruptions in service continue to plague minority clients, possibly stemming from inadequacies in the organization and financing of care, and from cultural incongruity Much more must be learned about these problems in utilization, as well as about other key issues

Recognition, management and outcome of psychological disorders in primary care : a naturalistic follow-up study

Abstract: This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and the association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS). Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 'new' patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrollment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders. Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

The process of recovery from breast cancer for younger and older patients. Changes during the first year

Abstract: A representative community sample of 274 breast cancer (BC) patients from the Metropolitan Detroit Cancer-Surveillance System was studied longitudinally during the year after their BC diagnosis. The adjustment of these patients to their disease was examined in terms of (1) the changes in their physical and mental health functioning; and (2) the factors that predict or facilitate the recovery process, including the independent and interactive effects of age. Comparison of the outcomes at 4 and 10 months after diagnosis manifested a significant and consistent improvement in physical functioning. In contrast, there was an absence of any improvement in indicators of mental health and well-being. Whereas the cross-sectional analyses demonstrated that stage of disease had an impact on physical impairment, the longitudinal analyses revealed that physical impairment at time 1 was the significant predictor of deteriorating mental health at time 2. Furthermore, younger age was shown to exacerbate the impact of impairment on mental health. The more seriously impaired younger patients experienced significantly greater deterioration in their mental health and well-being than similarly impaired older patients. However, older age was found to exacerbate the impact of more extensive surgery on symptoms that produce limitations in activity.

Counseling Intervention and American Indian Tradition: An Integrative Approach

Abstract: The training of American Indian counseling and community psychologists should move away from conventional counseling tenets toward the use of culturally sensitive mental health approaches that maintain American Indian values. In this article, unique American Indian social and psychological perspectives concerning the process and theory of counseling are contrasted with the individualistic focus, style, and outcomes of therapy as practiced in America today. Empirical studies are reviewed concerning the role of social influences in the counseling process as perceived by American Indians and the types of problems Indians present in counseling. The under use of mental health services by American Indian is is associated with the tension surrounding power differentials in counseling relationships and perceived conflicting goals for acculturation between counselors and Indian clients. In addition, three types of psychological intervention-social learning, behavioral, and network -are reviewed and summarized for ...

The women's mental health research agenda. Violence against women.

Abstract: The focus of this article is violence against women: scope, impact, community response, clinical treatment, and prevention. Conclusions include the following: (a) Nationally representative data on the scope of violence are lacking. (b) The mental health implications of violence are not currently addressed by the practices of mental health professionals. (c) Discontinuity exists between clinical understanding of the impact of violence and empirical treatment research. (d) Victim services are proceeding in program development without direction from empirical data. (e) Prevention efforts have been isolated from the social context in which violence against women occurs. Nine directions for future research are highlighted that intersect with the stated priorities of the National Institute of Mental Health.

Deinstitutionalization: An Appraisal of Reform

Abstract: The number of inpatients in US public mental hospitals declined from 559,000 in 1955 to approximately 110,000 at present. Reductions resulted from release or transfer of long-term inpatients and from entrance barriers to new admissions. The timing and pace of deinstitutionalization substantially varied by state, but three quarters of the national reduction followed the expansion of welfare programs in the middle 1960s. The establishment of community care alternatives was highly inadequate, leaving many severely and persistently mentally ill people without essential services. Problems of care were exacerbated by the contraction of welfare programs in the 1980s, which resulted in serious neglect and homelessness. Plagued by underfinancing and fragmentation of care, new strategies in developing mental health care systems include capitation, case-management approaches, and the development of strong local mental health authorities.

Physical fitness and enhanced psychological health

Abstract: A great deal of attention has been given to the association between physical fitness and psychological health. The purpose of this view is to examine recent developments in the burgeoning exercise and psychological health literature and to explore avenues for future research. The current review focuses on research that has examined enhancement of psychological health and well-being among nonclinical populations since 1980. Four areas of psychological functioning are reviewed: (1) psychological well-being and mood, (2) personality and self-concept, (3) physiological stress responsivity and (4) cognition. Exercise appears to improve mood and psychological well-being as well as enhancing self-concept and self-esteem. Exercise appears to do little for personality functioning. Furthermore, mixed empirical support exists to suggest that exercise influences stress responsivity and cognitive functioning. However better research designs and procedures are still needed. Theories regarding the connection between exercise and psychological functioning as well as suggestions for future research are offered.

Life stressors, resistance factors, and improved psychological functioning: an extension of the stress resistance paradigm.

Abstract: This study applied a set of factors previously identified as being linked with stress resistance to the prediction of both stable and improved psychological functioning over a 1-year interval with more than 400 community-resident adults. Stable psychological functioning under high stressors is predicted at the beginning of the year by personal and social resources that are linked to functioning through their influence on increased approach coping during the year. In contrast, improved psychological functioning under low stressors is predicted directly by initial resources. As predicted by crisis theory, improved functioning under high stressors is related to an increase in resources during the year. The findings are discussed in the context of an extension of the stress-resistance paradigm beyond illness prevention toward a general, adaptively oriented health framework.

Stress at work and mental health status among female hospital workers.

Abstract: Relations between working conditions and mental health status of female hospital workers were studied in a sample of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff, mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in interventions aimed at improving the working conditions of hospital workers.

Health psychology. The science and the field.

Abstract: Reviews scientific and professional trends in the field of health psychology. I discuss recent research on health promotion, psychological factors in the development of illness, cognitive representations of health and illness, stress and coping, social support, interventions to promote coping, and trends that will affect progress in the field, such as the need for cost containment and the aging of the population.

Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults.

Abstract: This study describes use of medical, mental health, alcohol, and drug services by 832 adult residents of the New York City homeless shelter system and examines associations between service use during the past three months and an array of predisposing, enabling, and need factors. Utilization rates were 23% for medical services, 13% for mental health services, and 10 and 7.5% for alcohol and drug treatment services, respectively. Service contacts were more often hospitals than ambulatory care clinics. Logistic regression analyses revealed that need factors were stronger predictors of all four types of service use. Predisposing factors other than education and black ethnic status were not significant, and the enabling factor of enrollment in Medicaid and/or Medicare was significant only for use of medical and drug services. Among the need factors, measures of mental health status were analyzed as indices of distress to test a stress-utilization model of prediction for all four types of service use. While these measures did not predict use of nonmental health services, physical health problems were associated with use of all four types of services. Implications for future health services research and for service delivery to the homeless are discussed, including the need for more information on availability of services and on psychosocial and cultural characteristics of homeless persons that may affect their help-seeking behavior.

Who are the dually diagnosed

Abstract: The evaluation of mental health problems among persons with mental retardation is complicated by difficulties in diagnosis as well as by system variables that may also determine who will be assigned a dual diagnosis. In this study a state data base of 78,603 individuals with mental retardation receiving state services was examined. The relations of observed behavior problems, other characteristics of the individual, and residential placement patterns to the likelihood of being given a dual diagnosis were examined. Extrapunitive maladaptive behaviors, cognitive abilities, and social skills were associated with diagnoses of mental health problems among persons with mental retardation. The different perspectives from which these results could be interpreted were discussed.

Alzheimer's disease treatment and family stress : directions for research

Abstract: Part 1 Issues in Alzheimer's disease and family research: the family at risk, E. Brody guardianship of the cognitively impaired elderly - directions for research, G. Grossberg et al. Part 2 Caregiver stress - research issues in the mental health/health interface: coping and the mediation of caregiver stress, L. Pearlin et al caregiving, mental health and immune function, J. Klecolt-Glaser and R. Glaser. Part 3 Research issues in the treatment and management of Alzheimer's disease patients: behaviour problems in the demented, P. Rabins. Part 4 Issues and directions for mental health research: services research - research problems and possibilities, L. George.