Showing papers on "Mental health published in 1994"

Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care: The PRIME-MD 1000 Study

Abstract: Objective. —To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians. Design. —Survey; criterion standard. Setting. —Four primary care clinics. Subjects. —A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians. Main Outcome Measures. —PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/ referral decisions. Results. —Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, κ=0.71; overall accuracy rate=88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P Conclusion. —PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research. ( JAMA . 1994;272:1749-1756)

DSM-IV: Diagnostic and Statistical Manual of Mental Disorders

Abstract: Diagnostic Criteria From DSM-IV, by the American Psychiatric Association, 358 pp, spiral-bound, $22.50, ISBN 0-89042-064-5, Washington, DC, American Psychiatric Press Inc, 1994. DSM-IV Sourcebook , vol 1, edited by Thomas A. Widiger, Allen J. Frances, Harold Alan Pincus, Michael B. First, Ruth Ross, and Wendy Davis, 768 pp, $112.50, ISBN 0-89042-065-3, Washington, DC, American Psychiatric Association, 1994. DSM-IV: Diagnostic and Statistical Manual of Mental Disorders , fourth edition, was developed with a great deal of input from mental health professionals and professional organizations. In addition, there was a significant collaboration between the American Psychiatric Association (APA) and the World Health Organization, as it developed the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) . As a result, DSM-IV is a great improvement over the third edition (DSM-III) and the third edition, revised (DSM-III-R) . The Task Force on DSM-IV and 13 work groups (each responsible for a section

Does mental practice enhance performance

Abstract: Mental practice is the cognitive rehearsal of a task prior to performance. Although most researchers contend that mental practice is an effective means of enhancing performance, a clear consensus is precluded because (a) mental practice is often denned so loosely as to include almost any type of mental preparation and (b) empirical results are inconclusive. A meta-analysis of the literature on mental practice was conducted to determine the effect of mental practice on performance and to identify conditions under which mental practice is most effective. Results indicated that mental practice has a positive and significant effect on performance, and the effectiveness of mental practice was moderated by the type of task, the retention interval between practice and performance, and the length or duration of the mental practice intervention. Mental practice refers to the cognitive rehearsal of a task in the absence of overt physical movement. When a musician practices a passage by thinking it through or when an athlete prepares for an event by visualizing the steps required to perform the task, he or she is engaging in mental practice. A number of studies have examined the effects of mental practice on performance. Whereas the research of Kelsey (1961) and Ryan and Simons (1982) supports the efficacy of mental practice for enhancing performance, Beasley (1978) reported negative results. An astute reviewer may be able to estimate the direction and magnitude of effect of the relationship between mental practice and performance from the preponderance of evidence across the majority of studies. For example, Richardson (1967a) concluded that most studies support the efficacy of mental practice on performance. However, Richardson, and later Corbin (1972), noted that this evidence was inconclusive. Because different studies use different types of tasks, with different types of subjects, and report different study statistics, it is difficult if not impossible to integrate these disparate research studies on an intuitive level to draw firm conclusions on the effectiveness of mental practice. The purpose of this study was to integrate the literature on mental practice, summarize the overall effects of mental practice on performance, and specify the conditions under which mental practice is most effective.

The International Personality Disorder Examination: The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration International Pilot Study of Personality Disorders

Abstract: Background: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision , and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. Methods: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. Results: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. Conclusion: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

The Impact of Fatigue on Patients with Multiple Sclerosis

Abstract: Although fatigue is recognized as a symptom of MS, there have been insufficient methods for evaluating this symptom We administered the Fatigue Impact Scale to 85 MS patients and 20 hypertensive patients Neurologic impairment, mental health, and general health status were also assessed MS patients reported significantly higher fatigue impact than hypertensive patients Most MS patients reported fatigue as either their worst (14%), or one of their worst (55%) symptoms Disease classification and neurologic impairment had little bearing on Fatigue Impact Scale scores in the MS sample The best predictive models for mental health and general health status in the MS sample both included the Fatigue Impact Scale as a significant factor This study demonstrates that: 1) fatigue is a very prevalent and severe problem in MS, 2) fatigue impact cannot be predicted by clinical measures of neurologic impairment, 3) fatigue has a significant effect on the mental health and general health status of MS patients

The Life Cycle Completed: A Review

Abstract: This text is based on an long introduction which the National Institute of Mental Health asked the author to contribute for "The Course of Life: Psychoanalytical Contributions Toward Understanding Personality Development". It places Erikson's famous theories - the identity crisis, the interdependence of history and life history, the life cycle, and the concept that maturity is not the end of psychological growth - in their historical and autobiographical contexts.

Social support and social structure: a descriptive epidemiology

Abstract: Despite a very large and growing literature demonstrating the significance of social support for health and well-being, surprisingly little is known about the social distribution of this crucial resource. This paper presents data on the distribution of social support and support resources across social class, marital status, age and gender, with the aims of contributing toward an understanding of the impact of social structures on processes of social support, and of assessing the hypothesis that epidemiological variations in mental health arise partially from social support differences. The epidemiology of perceived social support was found to correspond closely to the epidemiology of psychological distress and disorder. The single exception involved gender, where a positive rather than negative relationship was observed, with women demonstrating the highest levels of both social support and psychological distress. The observed patterns of variation in social support link this significant adaptive resource to one's locations in the social structure and reinforce the conclusion that it represents a promising intervention target. The practical importance of these results, however, are not matched by theoretical significance. Except in the case of marital status, our findings largely discount the hypothesis that the social distribution of mental health is partially attributable to social support differences.

Development of an Acculturative Stress Scale for International Students: preliminary findings.

Abstract: Description of the development and testing of a new 36-item scale in Likert format, designed to assess the acculturative stress of international students, includes perceived discrimination, homesickness, fear, guilt, perceived hatred, and stress due to change (cultural shock), identified as major contributing factors. The psychometric properties of this instrument and implications for use by mental health practitioners are discussed.

The SF-36 Health Survey: Development and use in mental-health research and the IQOLA project

Abstract: (1994). The SF-36 Health Survey: Development and Use in Mental Health Research and the IQOLA Project. International Journal of Mental Health: Vol. 23, Quality of Life Assessment Cross-cultural Issues—1, pp. 49-73.

Stress and mental health: Contemporary issues and prospects for the future.

Abstract: Introduction: Introduction and Overview W.R. Avision, I.H. Gotlib. Stressful Life Events: Unravelling Complexity D.E. McLean, B.G. Link. Measuring Life Stress and Assessing its Impact on Mental Health S.M. Monroe, J.R. McQuaid. Chronic Strains: Sampling the Stress Universe B. Wheaton. The Daily Grind E.G. Menaghan. Psychosocial Resources and Mediators: General and Specific Perceptions of Social Support I.G. Sarason, et al. Psychosocial Resources and the Stress Process R.J. Turner, P. Roszell. Vulnerability to Stress: Life Stressors and Mental Health C.J. Holahan, R.H. Moos. The Disaggregation of Vulnerability to Depression as a Function of the Determinants of Onset and Recurrence R.G. Kessler, W.J. Magee. The Dependent Variable in Stress Research: The Advantages of Indexes over Diagnoses in Scientific Assessment J. Mirowsky. Psychophysiological and Behavioral Measurement of Stress N. Lester, et al. Conclusion: Future Prospects for Stress Research W.R. Avison, I.H. Gotlib. Index.

Healthy Mind; Healthy Organization— A Proactive Approach to Occupational Stress

Abstract: Against a background of mounting research evidence (Cooper & Payne, 1988), there can be little dispute that stress has a dysfunctional impact on both individual and organizational outcomes. Links have been demonstrated between stress and the incidence of Coronary Heart Disease, mental breakdown, poor health behaviors, job dissatisfaction, accidents, family problems and certain forms of cancer (e.g., McLean, 1980; Frese, 1985; Cooper & Watson, 1991). Almost half of all premature deaths in the U.K. are attributed to lifestyle and stress-related illnesses (Palmer, 1989).

Effects of Limiting Medicaid Drug-Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia

Abstract: Background We examined the effects of a three-prescription monthly payment limit (cap) on the use of psychotropic drugs and acute mental health care by noninstitutionalized patients with schizophrenia. We hypothesized that reducing access to such drugs would increase the use of emergency mental health services and the rate of partial hospitalizations (full-day or half-day treatment programs) and psychiatric-hospital admissions. Methods We linked Medicaid claims data for a period of 42 months with clinical records from two community mental health centers (CMHCs) and the single state psychiatric hospital in New Hampshire, where Medicaid imposed a three-prescription limit on reimbursement for drugs during 11 months (months 15 through 25) of the study. For comparison, we used Medicaid claims for a period of 42 months in New Jersey, which had no limit on drug reimbursement. The study patients (n = 268) and the comparison patients (n = 1959) were permanently disabled, noninstitutionalized patients with schizoph...

National Lesbian Health Care Survey: implications for mental health care.

Abstract: This article presents demographic, lifestyle, and mental health information about 1,925 lesbians from all 50 states who participated as respondents in the National Lesbian Health Care Survey (1984-1985), the most comprehensive study on U.S. lesbians to date. Over half the sample had had thoughts about suicide at some time, and 18% had attempted suicide. Thirty-seven percent had been physically abused as a child or adult, 32% had been raped or sexually attacked, and 19% had been involved in incestuous relationships while growing up. Almost one third used tobacco on a daily basis, and about 30% drank alcohol more than once a week, 6% daily. About three fourths had received counseling at some time, and half had done so for reasons of sadness and depression. Lesbians in the survey also were socially connected and had a variety of social supports, mostly within the lesbian community. However, few had come out to all family members and coworkers. Level of openness about lesbianism was associated with less fear of exposure and with more choices about mental health counseling.

Do positive illusions foster mental health ? An examination of the Taylor and Brown formulation

Abstract: The proposition recently offered by S. E. Taylor and J. D. Brown (1988) that positive illusions foster mental health has garnered considerable attention and acceptance. However, the significant theoretical and applied implications of their view for mental health require a critical evaluation of their argument. An examination of the logic and empirical evidence used to relate mental health to three key positive illusions--unrealistically positive views of the self, illusions of control, and unrealistic optimism--failed to substantiate Taylor and Brown's thesis. Further survey of more recent studies on positive illusions and mental health also failed to lend support to the Taylor and Brown generalization. Close consideration of several assumptions underlying the formulation raises further questions regarding their thesis. The present article concludes that it remains unproven that positive illusions foster mental health.

A conceptual framework for the study of work and mental health

Abstract: The key features which influence mental health both in jobs and unemployment are brought together within a single perspective. Three principal axes of affective well-being are identified as warranting investigation, and it is suggested that nine environmental features are of primary importance. The impact of these features on mental health is viewed as analogous to the influence of vitamins on physical health, with an explicit non-linearity in the relationship. This ‘vitamin model’ is extended to permit examination of individual differences (for example, in terms of baseline values and specific matching characteristics), and empirical evidence is summarized. It is concluded from previous research that job features do not interact synergistically in relation to employee well-being, although this possibility may not yet have been adequately tested. The framework is suggested to be adequately comprehensive, but, as is the case with other models, it requires development in respect of the specific mec...

Measuring health-related quality of life for public health surveillance.

Abstract: In public health research and practice, quality of life is increasingly acknowledged as a valid and appropriate indicator of service need and intervention outcomes. Health-related quality of life measures, including objective and subjective assessments of health, are particularly useful for evaluating efforts in the prevention of disabling chronic diseases. Such data can inform health policy, planning, and practice. Mechanisms for routinely monitoring quality of life of populations at the State and local levels are currently lacking, however. This article discusses the rationale for and concepts measured by four quality of life questions developed for the 1993 Behavioral Risk Factor Surveillance System, a State-based telephone surveillance system. To encourage quality of life surveillance by States, the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion held two related workshops, one in December 1991 and the other in June 1992. The workshops convened experts in quality of life and functional status measurement and resulted in the formulation of items for the Behavioral Risk Factor Surveillance System on self-perceived health, recent physical and mental health, and recent limitation in usual activities. The criteria, including feasibility and generalizability, considered by the Centers for Disease Control and Prevention and the workshop participants in the selection and development of these items are discussed. A model that conceptualizes the relationship of quality of life domains measured by the four survey items is presented and validated with preliminary data from the 1993 Behavioral Risk Factor Surveillance System. Finally, how States can use these measures to track progress towards the Year 2000 goal of improving quality of life is discussed.

Subsyndromal symptomatic depression: a new mood disorder?

Abstract: Secondary analyses in a subsample (N = 9160) of the National Institute of Mental Health Epidemiologic Catchment Area Program data base revealed that 19.6% of the general population reported one or more depressive symptoms in the previous month. One-year prevalence of two or more depressive symptoms in the general population was 11.8%, a prevalence figure exceeding the 9.5% 1-year prevalence for all the DSM-III mood disorders combined. We have labeled this potential clinical condition as subsyndromal symptomatic depression (SSD), defining it as any two or more simultaneous symptoms of depression, present for most or all of the time, at least 2 weeks in duration, associated with evidence of social dysfunction, occurring in individuals who do not meet criteria for diagnoses of minor depression, major depression, and/or dysthymia. SSD has a 1-year prevalence in the general population of 8.4%, two thirds of whom are women (63.4%). The most common SSD symptoms reported are insomnia (44.7%), feeling tired out all the time (42.1%), recurrent thoughts of death (31.0%), trouble concentrating (22.7%), significant weight gain (18.5%), slowed thinking (15.1%), and hypersomnia (15.1%). Increased prevalence of disability and welfare benefits was found in SSD as compared with respondents with no depressive symptoms. SSD represents a significant clinical population not covered by any DSM-III, DSM-III-R, or DSM-IV mood disorder diagnosis. Since SSD is also associated with significant increases in social dysfunction and disability, we feel there is good evidence to conclude that SSD is an unrecognized clinical condition of considerable public health importance that is deserving of further characterization and study.

Somatic symptoms, social support, and treatment seeking among sexual assault victims

Abstract: In an effort to clarify the relationship between the experience of sexual assault and physical health, rape victims and a matched comparison group were repeatedly assessed for somatic symptoms, psychological distress, health care use, and self-rated health perceptions during the year immediately after the assault. Women who experienced sexual assault reported more somatic complaints, poorer perceptions of physical health, greater psychological distress, and increased use of medical services. However, victims did not show a significantly higher use of mental health services and continued to seek medical attention at the end of the year after the assault, when health perceptions and somatic symptoms were no longer significantly elevated. The use of mental health services and social support as moderating variables are examined, and implications for the medical and psychological treatment of sexual assault victims are discussed. Language: en

Creativity and psychopathology. A study of 291 world-famous men.

Abstract: Background This investigation sought to determine the prevalences of various psychopathologies in outstandingly creative individuals, and to test a hypothesis that the high prevalence of mental abnormalities reported in prominent living creative persons would not be found in those who had achieved and retained world status. Method The family background, physical health, personality, psychosexuality and mental health of 291 famous men in science, thought, politics, and art were investigated. The membership of the six series of scientists and inventors, thinkers and scholars, statesmen and national leaders, painters and sculptors, composers, and of novelists and playwrights was determined by the availability of sufficiently adequate biographies. Extracted data were transformed into diagnoses in accordance with DSM–III–R criteria, when appropriate. Results All excelled not only by virtue of their abilities and originality, but also of their drive, perseverance, industry, and meticulousness. With a few exceptions, these men were emotionally warm, with a gift for friendship and sociability. Most had unusual personality characteristics and, in addition, minor ‘neurotic’ abnormalities were probably more common than in the general population. Severe personality deviations were unduly frequent only in the case of visual artists and writers. Functional psychoses were probably less frequent than psychiatric epidemiology would suggest, and they were entirely restricted to the affective varieties. Among other functional disorders, only depressive conditions, alcoholism, and, less reliably, psychosexual problems were more prevalent than expected in some professional categories, but strikingly so in writers. Conclusions Similar findings have been reported for living artists and writers, and this suggests that certain pathological personality characteristics, as well as tendencies towards depression and alcoholism, are causally linked to some kinds of valuable creativity.

Individualism-Collectivism, Social-Network Orientation, and Acculturation as Predictors of Attitudes Toward Seeking Professional Psychological Help Among Chinese Americans

Abstract: Several culturally based variables were used to predict the patterns of help-seeking attitudes among a sample of Chinese-American students (TV = 219) in a large midwestern university. Cultural values operationalized by H. C. Triandis, R. Bontempo, M. J. Villareal, M. Asai, and N. Lucca's (1988) Individualism-Collectivism Scale, social support attitudes operationalized by A. Vaux's (1985) Network Orientation Scale, and the continuous variable of acculturation operationalized by the Suinn-Lew Asian Self-Identity Acculturation Scale (R. M. Suinn, K. Rickard-Figueroa, S. Lew, & P. Vigil, 1987) were selected as predictors of attitudes as measured by E. H. Fischer and J. L. Turner's (1970) Attitudes Toward Seeking Professional Psychological Help Scale. Each of the 4 independent variables were found to be significant predictors of attitudes towards seeking professional psychological help. The counseling and research implications of the results are discussed. Research on cross-cultural issues that have an impact on counseling and psychotherapy has gained an impetus only since the 1970s (Atkinson, 1985). Atkinson (1985) examined reviews that had critically summarized studies dealing with the relationship between cultural and counseling variables (Atkinson, 1983; Harrison, 1975; Sattler, 1977). Three important characteristics of the studies conducted before 1985 stood out. First, most of the research had focused on relations between African Americans and Caucasians and had not examined other racial and ethnic groups. Second, the settings in which a large proportion of the studies had been conducted were mental health outpatient clinics or psychiatric hospital inpatient units, not college counseling centers. Third, either a survey or an archival research design had been used in a majority of the studies. These observations can also be made about a large number of studies that have examined the role of ethnic and racial variables in areas of psychology other than those of counseling and psychotherapy. Atkinson (1985) recommended that researchers study a number of different ethnic and racial groups, investigate within-group variables, such as self-designated identity and cultural commitment, and do more research in college settings. These recommendations are valuable for studies on a number of psychological issues and processes. Some of these issues include attitudes, values, experiences, expectations, beliefs, and social-support systems of members of different ethnic groups (Root, 1985). These factors affect a number of behaviors, one of which is the act of seeking professional psychological help. Research has shown that members of non-Caucasian ethnic groups

Carers Perceived: Policy and Practice in Informal Care

Abstract: Informal care carers in the service system the carers' experience social services the health sector services in a mixed setting services for people with learning disabilities carers of adults with mental health problems mediating structuring carers in the policy arena.

Mental health and law enforcement professionals: Trauma history, psychological symptoms, and impact of providing services to child sexual abuse survivors

Abstract: A survey of 558 mental health and law enforcement professionals assessed current and past trauma experiences, exposure to traumatic client material, and the sequelae of both types of personal and professional trauma experiences. Results indicated that 29.8% of therapists and 19.6% of officers reported experiencing some form of childhood trauma.

Ethnicity and the use of outpatient mental health services in a national insured population.

Abstract: OBJECTIVES. Factors affecting ethnic differences in the use of outpatient mental health services are analyzed in an insured, nonpoor population to determine if lower use by Blacks and Hispanics persists when socioeconomic and other factors are controlled. METHODS. To identify significant predictors of the probability and amount of use, insurance claims data for a population of 1.2 million federal employees insured by Blue Cross/Blue Shield in 1983 were analyzed with the Andersen and Newman model of health service utilization. Logistic and ordinary least squares regression models were estimated for each ethnic group. RESULTS. Blacks and Hispanics had lower probabilities and amounts of use when compared with Whites after controlling for a number of variables. CONCLUSIONS. Since ethnic differences in the use of outpatient mental health services exist even in an insured, nonpoor population, factors other than lower socioeconomic status or insurance coverage--for example, cultural or attitudinal factors and se...

Assessing and Treating Culturally Diverse Clients: A Practical Guide

Abstract: Minority, Multicultural, Race, and Ethnicity Concepts General Guidelines for the Assessment and Treatment of Multicultural Groups Guidelines for the Assessment and Treatment of African American Clients Guidelines for the Assessment and Treatment of Hispanic Clients Guidelines for the Assessment and Treatment of Asian Clients Guidelines for the Assessment and Treatment of American Indian Clients Guidelines for the Prevention of Attrition of African American, American Indian, Asian and Hispanic Clients Guidelines for Evaluating and Using the Epidemiological Mental Health Literature with Multicultural Groups Using Culturally Biased Instruments Using Cultural Variables in the Diagnostic and Statistical Manual of Mental Disorders

Ethnic-minority lesbians and gay men: mental health and treatment issues.

Abstract: Clinical psychological research has been a part of a significant growth of scholarly literature in mental health that appropriately explores relevant cultural variables and their effects on both the mental health and treatment of ethnic minority group members. A similar expansion of material seeking to develop affirmative perspectives in the treatment of gay men and lesbians has also found its way into the psychological literature. Scarcely any research seeks to explore the particular psychological strengths and vulnerabilities of men and women who are members of both groups. This article reviews literature pertinent to the cultural proscriptions of several ethnic minority groups and their relevance to mental health issues and treatment of gay and lesbian members, as well as a review of potential countertransference dilemmas for therapists.

Assessing the Health Status of Children Entering Foster Care

Abstract: Objective. Most research on health problems of children in foster care has been cross-sectional, resulting in overselection of children who have been in care long-term and underrepresentation of children who are in care for a short time. Methodology. This paper reports on the health of a large cohort of children who had complete health examinations at the time of entry into foster care in a middle-size city during a 2-year period. Results. Results indicate that >90% of the children had an abnormality in atleast one body system, 25% failed the vision screen, and 15% failed the hearing screen. The children were also lighter and shorter than the norm. Mental health screening revealed that 75% had a family history of mental illness or drug or alcohol abuse. Of children older than 3 years of age, 15% admitted to or were suspect for suicidal ideation and 7% for homicidal ideation. Of the children younger than 5 years of age, 23% had abnormal or suspect results on developmental screening examinations. At the time of entry into foster care, 12% of the children required an antibiotic. More than half needed urgent or nonurgent referrals for medical services and, for children >3 years of age, more than half needed urgent or nonurgent referrals for dental and mental health services. Just 12% of the children required only routine follow-up care. Conclusions. The high prevalence and broad range of health needs of children at the time they enter foster care necessitate the design and implementation of better models of health care delivery for children in foster care.