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Shippee T, Simon Rosser BR, Wright MM, Aumock C, Moone R, Talley KMC, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. Scoping Literature Review: Experiences of Sexual and Gender Minority Older Adults, With Diagnoses of Dementia, Who Use Residential Long-Term Services and Supports. J Appl Gerontol 2024; 43:562-576. [PMID: 37975683 PMCID: PMC10981565 DOI: 10.1177/07334648231213532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer's disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.
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Affiliation(s)
| | | | | | | | | | | | - Phil Duran
- Aging and Gender Care Access, Saint Paul, MN, USA
| | | | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, MA, USA
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Rosser BRS, Shippee T, Wright MM, Aumock C, Moone R, Talley KM, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. "Going Back in the Closet": Addressing Discrimination Against Sexual and Gender Minority Residents in Long-Term Services and Supports by Providing Culturally Responsive Care. J Aging Soc Policy 2023:1-13. [PMID: 37348486 PMCID: PMC10739643 DOI: 10.1080/08959420.2023.2226300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/27/2022] [Indexed: 06/24/2023]
Abstract
Sexual and gender minority (SGM) older adults face discrimination in long-term services and supports (LTSS). Yet, SGM older adults use LTSS disproportionately higher relative to their non-SGM counterparts. The discrimination is compounded by existing disparities, resulting in worse health outcomes and well-being for SGM older adults. Guided by socioecological model, we posit that training LTSS staff in SGM responsive care and implementing SGM anti-discrimination policies will be needed to improve care. Considering accessibility and turnover challenges, training should be online, interactive, and easily accessible. Studies that assess interventions for SGM responsive care are needed to guide policy and practice.
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Affiliation(s)
- B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tetyana Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Morgan M. Wright
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cailynn Aumock
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rajean Moone
- Long Term Care Administration Program, College of Continuing and Professional Studies, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristine M.C. Talley
- Adult and Gerontological Health Cooperative, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | | | - Carrie Henning-Smith
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jason D. Flatt
- Department of Social and Behavior Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Jaime Slaughter-Acey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samuel Greenwald
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Teresa McCarthy
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael W. Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Greenwald S, Kuchenbecker J, Roberson D, Neitz M, Neitz J. S-opsin Knockout Mouse Models Cone Dysfunction Associated with a Toxic L/M-opsin Interchange Variant. J Vis 2011. [DOI: 10.1167/11.15.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hoonjan B, Dulai R, Ahmed M, Lucey A, Morrissey D, Twycross-Lewis R, Greenwald S. The effect of moderate intensity exercise on arterial stiffness in resistance trained athletes, endurance trained athletes and sedentary controls: a cross-sectional observational study. Br J Sports Med 2011. [DOI: 10.1136/bjsports-2011-090606.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dulai R, Ahmed M, Morrissey D, Twycross-Lewis R, Greenwald S. Arterial stiffness before and after moderate intensity exercise in athletes and controls: a cross-sectional observational study. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2010.081554.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Greenwald S, Horsager A, Humayun M, Greenberg R, McMahon M, Fine I. Brightness as a function of current amplitude in human retinal electrical stimulation. J Vis 2010. [DOI: 10.1167/9.8.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Iosifescu DV, Greenwald S, Devlin P, Perlis RH, Denninger JW, Alpert JE, Fava M. Pretreatment frontal EEG and changes in suicidal ideation during SSRI treatment in major depressive disorder. Acta Psychiatr Scand 2008; 117:271-6. [PMID: 18307587 DOI: 10.1111/j.1600-0447.2008.01156.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We investigated frontal quantitative EEG (QEEG) as predictor of changes in suicidal ideation (SI) during SSRI treatment in major depressive disorder (MDD). METHOD Eighty-two subjects meeting DSM-IV criteria for MDD entered an 8-week, prospective, open-label treatment with flexible dose SSRIs and completed at least 4 weeks of treatment. We assessed MDD severity with the 17-item Hamilton Depression Rating Scale (HAM-D-17); change in SI was measured with HAM-D item no. 3. We recorded four-channel EEGs (F7-Fpz, F8-Fpz, A1-Fpz, A2-Fpz) before treatment. RESULTS During the first 4 weeks of treatment 9 (11%) subjects experienced worsening SI. Left-right asymmetry of combined theta + alpha power correlated significantly with change in SI from baseline, even when adjusting for changes in depression severity (HAM-D-17) and for the SSRI utilized. CONCLUSION Frontal QEEG parameters before treatment may predict worsening SI during SSRI treatment in MDD.
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Affiliation(s)
- D V Iosifescu
- Depression Clinical and Research Program, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114, USA.
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Hillery C, Hassan S, Greenwald S. The effect of distension on the spacing between elastic lamellar units in the pig carotid artery. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)84252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Fine I, Horsager A, Greenwald S. The perceptual effects of retinal electrical stimulation. J Vis 2005. [DOI: 10.1167/5.12.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Oquendo MA, Lizardi D, Greenwald S, Weissman MM, Mann JJ. Rates of lifetime suicide attempt and rates of lifetime major depression in different ethnic groups in the United States. Acta Psychiatr Scand 2004; 110:446-51. [PMID: 15521829 DOI: 10.1111/j.1600-0447.2004.00404.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Rates of major depression and suicide vary across ethnic groups within the US. This also may be true of suicide attempts. METHOD Data on lifetime suicidal behavior and major depression among Mexican American, Cuban American, and Puerto Rican adults who participated in the Hispanic Health and Nutrition Epidemiologic Survey were pooled with Epidemiological Catchment Area Study data for Blacks, Whites and Hispanics. RESULTS Rates of major depression ranged from 9.3 (Puerto Ricans) to 3.24% (Cuban Americans). Puerto Ricans and whites had the highest rates of depression. Similarly, suicide attempt rates ranged from 9.1% for Puerto Ricans to 1.9% for Cuban Americans. Puerto Ricans had higher suicide attempt rates compared with other groups. CONCLUSION This study underscores that there are differences between Hispanic ethnic groups. The impact of the migration process, socioeconomic status, and acculturation may underlie differences in major depression and suicide attempt rates across ethnic groups.
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Affiliation(s)
- M A Oquendo
- New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA.
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11
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Ripamonti C, Bloj M, Greenwald S, Brainard DH. An Equivalent Illumiant Model of How Perceived Lightness Varies with Scene Geometry. J Vis 2004. [DOI: 10.1167/4.8.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Silver JM, Kramer R, Greenwald S, Weissman M. The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Inj 2001; 15:935-45. [PMID: 11689092 DOI: 10.1080/02699050110065295] [Citation(s) in RCA: 237] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PRIMARY OBJECTIVE To determine the association of report of any history of head injury with loss of consciousness or confusion and a lifetime diagnosis of psychiatric disorder in a general population. RESEARCH DESIGN A probability sample of adults from the New Haven portion of the NIMH Epidemiologic Catchment Area programme were administered standardized and validated structured interviews. The main outcome measures were lifetime prevalence of psychiatric disorders and suicide attempt in individuals with and without a history of traumatic brain injury. MAIN OUTCOMES AND RESULTS Among 5034 individuals interviewed, 361 admitted to a history of severe brain trauma with loss of consciousness or confusion (weighted rate of 8.5/100). When controlling for sociodemographic factors, quality of life indicators and alcohol use, risk was increased for major depression, dysthymia, panic disorder, OCD, phobic disorder and drug abuse/dependence. In addition, lifetime risk of suicide attempt was greater in those who had suffered head injury. CONCLUSION Individuals with a history of traumatic brain injury have significantly higher occurrence for psychiatric disorders and suicide attempts in comparison with those without head injury and have a poorer quality of life. Future studies should examine the nature of this relationship, focusing on the severity of the brain injury and the temporal contiguity of the brain injury and psychiatric disorder.
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Affiliation(s)
- J M Silver
- New York University School of Medicine, NY, USA.
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Abstract
OBJECTIVE Suicide rates differ between ethnic groups in the United States. Since suicide is commonly associated with a mood disorder, the authors compared suicide rates relative to depression rates in five ethnic groups in the United States. METHOD Rates of major depression were generated from the Epidemiologic Catchment Area study and the Hispanic Health and Nutrition Epidemiologic Survey. Sociodemographic effects were determined by examining depression rates for respondents who were separated or divorced, earning low incomes, or not working for pay. The survey data were analyzed with age and sex standardization to generate 1-year prevalence rates of major depression. The depression rates of the different ethnic groups were compared and were examined in relation to suicide rates. RESULTS The 1-year prevalence rates of major depression were 3.6% for whites, 3.5% for blacks, 2.8% for Mexican Americans, 2.5% for Cuban Americans, and 6.9% for Puerto Ricans. Compared to the rate for whites, the rate of depression was significantly higher in Puerto Ricans and significantly lower in Mexican Americans. Relative to the depression rates, the annual suicide rates were higher for males than for females. Mexican American and Puerto Rican males had lower relative suicide rates than white males. CONCLUSIONS Identifying reasons for differences in suicide rates relative to depression among ethnic groups and between males and females may suggest interventions to reduce suicide rates. Some possibilities are that depression differs in form or severity or that unidentified factors protect against suicide in different subgroups.
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Affiliation(s)
- M A Oquendo
- Conte Center for the Neuroscience of Mental Disorders, New York State Psychiatric Institute, New York NY 10032, USA
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King RA, Schwab-Stone M, Flisher AJ, Greenwald S, Kramer RA, Goodman SH, Lahey BB, Shaffer D, Gould MS. Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. J Am Acad Child Adolesc Psychiatry 2001; 40:837-46. [PMID: 11437023 DOI: 10.1097/00004583-200107000-00019] [Citation(s) in RCA: 272] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts. METHOD The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. RESULTS Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting. CONCLUSION Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.
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Affiliation(s)
- R A King
- Yale Child Study Center, New Haven, CT 06520-7900, USA
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Rapoport JL, Inoff-Germain G, Weissman MM, Greenwald S, Narrow WE, Jensen PS, Lahey BB, Canino G. Childhood obsessive-compulsive disorder in the NIMH MECA study: parent versus child identification of cases. Methods for the Epidemiology of Child and Adolescent Mental Disorders. J Anxiety Disord 2000; 14:535-48. [PMID: 11918090 DOI: 10.1016/s0887-6185(00)00048-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract-Because as many as 50% of obsessive-compulsive disorder (OCD) cases have had onset by age 15, interest in its detection in childhood is strong. Clinical experience indicates that children often try to keep their OCD secret and that parental report may give marked underestimates. The authors examined the prevalence of childhood OCD in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, a four-site community survey which allowed comparison of both parent and child report of the child's OCD and related symptoms and disorders. OCD cases, based on structured interviews (DISC-2.3 with DSM-III-R criteria) with 1,285 caretaker-child pairs, were identified separately for parent and child (aged 9 through 17) informants from the MECA database. Cases were then examined for demographic characteristics, for obsessive-compulsive symptoms and other diagnoses reported in cases "missed" by one reporter, and for comorbid disorders. Of a total of 35 (2.7%) identified cases, four (0.3%) were identified by the parent and 32 (2.5%) were identified by the child, with only one overlapping case. In general, when OCD cases were "missed" by one reporter, that reporter did not substitute another disorder. These findings support clinical data that children with OCD often hide their illness and underscore the importance of child interviews for its detection.
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Affiliation(s)
- J L Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892-1600, USA.
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Wickramaratne PJ, Greenwald S, Weissman MM. Psychiatric disorders in the relatives of probands with prepubertal-onset or adolescent-onset major depression. J Am Acad Child Adolesc Psychiatry 2000; 39:1396-405. [PMID: 11068895 DOI: 10.1097/00004583-200011000-00014] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether the familial risk of major depressive disorder (MDD) varies with either onset, recurrence, or continuity of MDD in adulthood in prepubertal- compared with adolescent-onset probands. METHOD Seventy-six prepubertal-onset MDD, 59 adolescent-onset MDD, and 78 never psychiatrically ill probands were assessed as children or adolescents and were evaluated 10 to 15 years later as adults, by an independent team that was blind to the initial diagnoses. At follow-up, psychiatric disorders among 731 of their first-degree relatives were assessed using direct interviews and family history methods by investigators who were blind to the clinical status of the probands. RESULTS Both prepubertal- and adolescent-onset MDD were significantly associated with a family history of MDD. The familial rates of MDD and other psychopathology did not vary between the 2 groups. For prepubertal-onset MDD, family history was significantly associated with recurrence and nonsignificantly associated (trend) with continuity into adulthood. In contrast, there was no association between a family history of MDD and either recurrence or continuity into adulthood of adolescent-onset MDD. CONCLUSIONS Prepubertal- and adolescent-onset MDD are both associated with a family history of MDD, but only in prepubertal-onset MDD is familial loading associated with recurrence and continuity of MDD into adulthood.
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Affiliation(s)
- P J Wickramaratne
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Abstract
OBJECTIVE To replicate previous findings among adults of an inverse association between religiosity and substance use among a nationally representative sample of adolescents. METHOD Subjects were 676 (328 female and 348 male) adolescents in the National Comorbidity Survey who were assessed for substance use and abuse with the Composite International Diagnostic Interview. Religiosity was assessed through affiliation with religious denomination and through response to 7 questions concerning belief and practice. RESULTS Confirmatory factor analyses replicated in adolescents the 2 religiosity factors of personal devotion and personal conservatism previously identified by Kendler among adults, although the 2 factors were more highly correlated in adolescents than in adults. Personal devotion (a personal relationship with the Divine) and affiliation with more fundamentalist religious denominations were inversely associated with substance use and substance dependence or abuse across a range of substances (alcohol, marijuana, cocaine, or any contraband drug). Personal conservatism (a personal commitment to teaching and living according to creed) was inversely associated with use of alcohol only. CONCLUSION Low levels of religiosity may be associated with adolescent onset of substance use and abuse.
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Affiliation(s)
- L Miller
- Division of Clinical and Genetic Epidemiology, Columbia University, New York, USA.
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Flisher AJ, Kramer RA, Hoven CW, King RA, Bird HR, Davies M, Gould MS, Greenwald S, Lahey BB, Regier DA, Schwab-Stone M, Shaffer D. Risk behavior in a community sample of children and adolescents. J Am Acad Child Adolesc Psychiatry 2000; 39:881-7. [PMID: 10892230 DOI: 10.1097/00004583-200007000-00017] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES First, to investigate whether there is covariation between risk behaviors, including suicidality, in a community probability sample of children and adolescents; and second, to investigate whether risk behavior is associated with selected potential correlates. METHOD A sample of 9- to 17-year-old youths (N = 1,285) and their caretakers were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The risk behaviors were marijuana smoking, alcohol use, intercourse, fighting, cigarette smoking, and suicidal ideation/attempts. Relationships between the risk behaviors were described using odds ratios. Linear regression analyses of an index of risk behavior on the selected potential correlates of risk behavior were conducted. RESULTS There were significant relationships between all pairs of risk behaviors. The score on the index of risk behavior was associated with stressors, lack of resources, family psychiatric disorder, psychopathology, and functional impairment. CONCLUSIONS Clinicians should be alerted to the possibility of risk behaviors, especially in children and adolescents engaging in other risk behaviors and those with inadequate resources, stressors, functional impairment, or psychopathology.
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Abstract
OBJECTIVE The authors' goal was to investigate the suggestion of previous investigations that prenatal viral exposures might increase the later risk of psychotic disorders. METHOD They conducted a follow-up study in young adulthood of a birth cohort that was previously documented, by clinical examination and serological testing, to have in utero rubella exposure during the 1964 rubella epidemic. Data were also obtained from an unexposed birth cohort and from the Epidemiological Catchment Area survey. Young adult subjects were administered a standard psychiatric diagnostic interview. The authors compared the proportions of subjects with nonaffective psychosis in the exposed and unexposed cohorts. RESULTS The rubella-exposed subjects, most of whom were exposed in the first trimester, demonstrated a substantially greater risk for nonaffective psychosis than the subjects who were not exposed to rubella (relative risk=5.2). CONCLUSIONS There is an association between clinically and serologically diagnosed prenatal viral infection and nonaffective psychosis in adulthood.
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Affiliation(s)
- A S Brown
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Weissman MM, Wolk S, Wickramaratne P, Goldstein RB, Adams P, Greenwald S, Ryan ND, Dahl RE, Steinberg D. Children with prepubertal-onset major depressive disorder and anxiety grown up. Arch Gen Psychiatry 1999; 56:794-801. [PMID: 12884885 DOI: 10.1001/archpsyc.56.9.794] [Citation(s) in RCA: 284] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The continuity in adulthood of major depressive disorder (MDD) first arising before puberty is largely unknown. This information could guide early treatment and clarify the appropriateness of including children with MDD in genetic studies. METHODS Eighty-three subjects with onset of MDD, 44 subjects with anxiety disorder and no MDD, and 91 subjects with no evidence of past or current psychiatric disorders were assessed by two psychiatrists before puberty (Tanner stage < III) and were evaluated 10 to 15 years later as adults by an independent team without knowledge of the initial diagnosis. RESULTS The clinical outcome of children with prepubertal-onset MDD in adulthood includes a high risk of suicide attempts (nearly 3-fold compared with normal controls and 2-fold compared with children with anxiety) and bipolar disorder. Compared with controls, both the children with MDD and those with anxiety went on to have increased risk of substance abuse and conduct disorder but not other disorders, increased use of longterm psychiatric and medical services, and overall impaired functioning. Children with prepubertal-onset MDD with a recurrence of MDD during follow-up had higher rates of MDD in their first-degree relatives. CONCLUSIONS There is high morbidity in clinically referred children with prepubertal-onset MDD and anxiety, but continuity and specificity of MDD or anxiety disorder in adulthood is less clear. Caution is warranted in selecting clinically referred children with prepubertal-onset MDD for inclusion in genetic studies unless they have a family history of MDD and recurrence of MDD over time.
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Affiliation(s)
- M M Weissman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Abstract
CONTEXT Major depressive disorder (MDD) that arises in adolescence impairs functioning and is associated with suicide risk, but little is known about its continuity into adulthood. OBJECTIVE To describe the clinical course of adolescent-onset MDD into adulthood. DESIGN AND PARTICIPANTS Prospective case-control study. Seventy-three subjects had onset of MDD based on systematic clinical assessment during adolescence (Tanner stage III-V) and 37 controls had no evidence of past or current psychiatric disorders, and also were assessed in adolescence (assessment years: 1977-1985). Follow-up was conducted 10 to 15 years after the initial assessment by an independent team without knowledge of initial diagnosis (follow-up years: 1992-1996). SETTING Cases were identified at Columbia Presbyterian Hospital, New York City, NY; controls were recruited from the community. MAIN OUTCOME MEASURES Suicide and suicide attempts, psychiatric diagnoses, treatment utilization, and social functioning. RESULTS Clinical outcomes of adolescent-onset MDD into adulthood compared with control subjects without psychiatric illness include a high rate of suicide (7.7%); a 5-fold increased risk for first suicide attempt; a 2-fold increased risk of MDD, but not other psychiatric disorders; an increased occurrence of psychiatric and medical hospitalization; and impaired functioning in work, social, and family life. Thirty-seven percent of those with adolescent MDD survived without an episode of MDD in adulthood vs 69% of the control participants (relative risk, 2.2 [95% confidence interval, 1.0-4.7; P<.05]). CONCLUSION There is substantial continuity, specificity, morbidity, and potential mortality from suicide into adulthood in adolescent-onset MDD patients. Now that empirically based guides to their treatment are becoming available, early identification and treatment seems warranted.
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Affiliation(s)
- M M Weissman
- Division of Clinical and Genetic Epidemiology, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York 10032, USA.
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Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lepine JP, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen HU, Yeh EK. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 1999; 29:9-17. [PMID: 10077289 DOI: 10.1017/s0033291798007867] [Citation(s) in RCA: 401] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. METHODS Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. RESULTS The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. CONCLUSIONS While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.
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Affiliation(s)
- M M Weissman
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York 10032, USA
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Gould MS, King R, Greenwald S, Fisher P, Schwab-Stone M, Kramer R, Flisher AJ, Goodman S, Canino G, Shaffer D. Psychopathology associated with suicidal ideation and attempts among children and adolescents. J Am Acad Child Adolesc Psychiatry 1998; 37:915-23. [PMID: 9735611 DOI: 10.1097/00004583-199809000-00011] [Citation(s) in RCA: 435] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the independent and differential diagnostic and symptom correlates of suicidal ideation and suicide attempts and determine whether there are gender- and age-specific diagnostic profiles. METHOD The relationships between suicidal ideation, suicide attempts, and psychiatric disorders were examined among 1,285 randomly selected children and adolescents, aged 9 to 17 years, of whom 42 had attempted suicide and 67 had expressed suicidal ideation only. Youths and their parents were interviewed as part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, using the Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3). RESULTS Logistic regression analyses indicated that mood, anxiety, and substance abuse/dependence disorders independently increased the risk of suicide attempts, after controlling for sociodemographic characteristics. There was no significant independent contribution of disruptive disorders to suicide attempts, although its association with suicidal ideation was significant. Substance abuse/dependence independently differentiated suicide attempters from ideators. Noncriterion symptoms that remained significant predictors of suicide risk, after adjusting for psychiatric disorder, included panic attacks and aggressiveness. Perfectionism did not significantly increase suicide risk after adjusting for psychiatric disorder. The association of specific disorders and noncriterion symptoms with suicidality varied as a function of gender and age. CONCLUSION A monolithic diagnostic risk profile for suicidality, ignoring gender- and age-specific risks, is inadequate. The contribution of substance abuse/dependence in the escalation from suicidal thoughts to suicide attempts is underscored.
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Affiliation(s)
- M S Gould
- Division of Child Psychiatry, Columbia University, New York, NY 10032, USA
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24
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Flisher AJ, Kramer RA, Grosser RC, Alegria M, Bird HR, Bourdon KH, Goodman SH, Greenwald S, Horwitz SM, Moore RE, Narrow WE, Hoven CW. Correlates of unmet need for mental health services by children and adolescents. Psychol Med 1997; 27:1145-1154. [PMID: 9300518 DOI: 10.1017/s0033291797005412] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little is known about the extent and correlates of unmet need for mental health services in community samples of children and adolescents. METHODS Data were obtained from the 1285 parent/youth pairs interviewed at four sites in the USA and Puerto Rico in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Unmet need was defined to exist if psychopathology and associated functional impairment were present but no mental health services had been received in the previous 6 months. RESULTS Of the total sample, 17.1% had unmet need. Adjusting for demographic variables, logistic regression analyses revealed that unmet need was significantly associated with: indicators of economic disadvantage, such as being on public assistance and not being covered by health insurance; opinions of the parents and children or adolescents that the latter had poor mental health; parental psychopathology; poor school grades; and parent-reported access barriers such as concern that the child would want to solve the problem unassisted, would refuse to attend mental health services, or would be hospitalized or taken away against the parent's will. No youth-reported access barriers were significantly associated with unmet need. CONCLUSIONS The economic correlates of unmet need may attain increased importance in the light of current reform in health care financing in the USA. Access may be facilitated by increasing parental knowledge of mental health services and enabling children and adolescents to initiate contact with services independently of their families.
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Affiliation(s)
- A J Flisher
- Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, USA
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25
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Berney DM, Desai M, Palmer DJ, Greenwald S, Brown A, Hales CN, Berry CL. The effects of maternal protein deprivation on the fetal rat pancreas: major structural changes and their recuperation. J Pathol 1997; 183:109-15. [PMID: 9370956 DOI: 10.1002/(sici)1096-9896(199709)183:1<109::aid-path1091>3.0.co;2-b] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is evidence that low birth weight and poor growth in early life cause a long-term predisposition to non-insulin-dependent diabetes. Morphological changes were assessed in fetal rat pancreas subjected to both pre- and post-natal maternal protein deprivation (LP). Further groups were subjected to purely prenatal maternal protein deprivation (preLP) and purely postnatal maternal protein deprivation (postLP), as well as a control group. The results show that the LP and postLP groups had fewer but larger islets than the control group, while the preLP group had more numerous, smaller islets. All three low protein groups had more irregularly shaped islets than the control group. There was a reduction in the amount of beta cells within each islet in all three protein-deprived groups. The LP and postLP groups showed a reduction in the percentage of islet tissue and beta cells per pancreas, but the percentage of islet tissue expressed per unit body weight was similar in all four groups. These results show that in maternal protein deprivation, homeostatic mechanisms ensure a constant amount of pancreatic endocrine tissue per unit of body weight. However, there remain major structural changes in the size, shape, and composition of the islets. These results support the theory that early development profoundly affects the structure of the pancreas and may play a role in the later development of adult diseases, such as non-insulin-dependent diabetes mellitus.
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Affiliation(s)
- D M Berney
- Department of Morbid Anatomy and Histopathology, Medical and Dental School of St. Bartholomew's, U.K
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26
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Berney DM, Desai M, Palmer DJ, Greenwald S, Brown A, Hales CN, Berry CL. The effects of maternal protein deprivation on the fetal rat pancreas: major structural changes and their recuperation. J Pathol 1997. [DOI: 10.1002/(sici)1096-9896(199709)183:1%3c109::aid-path1091%3e3.0.co;2-b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
The morbidity of sleep problems has been well documented; however, they are frequently associated with and are symptomatic of several psychiatric disorders. It is unclear how much of the morbidity can be accounted for by the associated psychiatric and substance abuse disorders and medical problems, and how much by the sleep problems per se. Sleep problems may also be an early sign of a psychiatric problem. This paper reports data from an epidemiologic community survey of over 10,000 adults living in three U.S. communities. A structured diagnostic assessment of psychiatric disorders as well as assessment of the presence of insomnia not due to medical conditions, medication, drug or alcohol abuse, and a 1-year follow-up were completed. Persons with insomnia in the past year without any psychiatric disorders ever (uncomplicated insomnia); with a psychiatric disorder in the past year (complicated insomnia); and with neither insomnia nor psychiatric disorders ever were compared on treatment utilization and the first onset of a psychiatric disorder in the subsequent year. Eight percent of those with uncomplicated as compared with 14.9% with complicated insomnia and 2.5% with neither had sought treatment from the general medical sector for emotional problems in the 6 months prior to the interview. The rates of treatment sought from the psychiatric specialty sector were 3.8%, 9.4%, and 1.2%, respectively. These differences were significant after controlling for sociodemographic characteristics and were sustained when the persons were interviewed 1 year later. Uncomplicated insomnia was also associated with an increase in risk for first onset of major depression, panic disorder, and alcohol abuse over the following year. Insomnia, even in the absence of psychiatric disorders, is associated with increased use of general medical and mental health treatment for emotional problems and for the subsequent first onset in the following year of some psychiatric disorders. Early diagnosis and treatment of uncomplicated insomnia may be useful.
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Affiliation(s)
- M M Weissman
- Columbia University College of Physicians and Surgeons, New York, New York, USA
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Weissman MM, Greenwald S, Wickramaratne P, Bland RC, Newman SC, Canino GJ, Rubio-Stipec M, Lépine JP, Lellouch J, Hwu HG, Yeh EK, Lee CK, Joyce PR, Wells JE. What happens to depressed men? Application of the Stirling County criteria. Harv Rev Psychiatry 1997; 5:1-6. [PMID: 9385014 DOI: 10.3109/10673229709034719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In a recent issue of the Harvard Review of Psychiatry, results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when "gender-fair" criteria were used and help-seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross-nationally, except in Puerto Rico. Excluding help-seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using "gender-fair" criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.
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Affiliation(s)
- M M Weissman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, N.Y., USA
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29
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Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lépine JP, Newman SC, Oakley-Browne MA, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen HU, Yeh EK. The cross-national epidemiology of panic disorder. Arch Gen Psychiatry 1997; 54:305-9. [PMID: 9107146 DOI: 10.1001/archpsyc.1997.01830160021003] [Citation(s) in RCA: 235] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures. METHOD Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries. RESULTS The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries. CONCLUSIONS Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.
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Affiliation(s)
- M M Weissman
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York 10032, USA.
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30
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Flisher AJ, Kramer RA, Hoven CW, Greenwald S, Alegria M, Bird HR, Canino G, Connell R, Moore RE. Psychosocial characteristics of physically abused children and adolescents. J Am Acad Child Adolesc Psychiatry 1997; 36:123-31. [PMID: 9000790 DOI: 10.1097/00004583-199701000-00026] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association between physical abuse and selected psychosocial measures in a community-based probability sample of children and adolescents. METHOD A sample of 9- through 17-year-olds (N = 665) and their caretakers in New York State and Puerto Rico were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Assessments included the Columbia Impairment Scale, the Instrumental and Social Competence Scale, the Diagnostic Interview Schedule for Children, the Peabody Picture Vocabulary Test, and questions regarding physical abuse. Regression analyses were conducted controlling for family income, family psychiatric history, perinatal problems, physical health, and sexual abuse. RESULTS A history of physical abuse was reported in 172 (25.9%) of the sample. It was significantly associated with global impairment, poor social competence, major depression, conduct disorder, oppositional defiant disorder, agoraphobia, overanxious disorder, and generalized anxiety disorder but not with suicidality, school grades, or receptive language ability. CONCLUSION A community probability sample of children and adolescents demonstrated significant associations between physical abuse and psychopathology, after controlling for potential confounders. This supports comprehensive screening for psychopathology among physically abused children and for physical abuse among those with psychopathology. Interventions aimed at improving social competence may be indicated.
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31
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Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lépine JP, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen H, Yeh EK. Cross-national epidemiology of major depression and bipolar disorder. JAMA 1996. [PMID: 8656541 DOI: 10.1001/jama.1996.03540040037030] [Citation(s) in RCA: 1007] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the rates and patterns of major depression and bipolar disorder based on cross-national epidemiologic surveys. DESIGN AND SETTING Population-based epidemiologic studies using similar methods from 10 countries: the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand. PARTICIPANTS Approximately 38000 community subjects. OUTCOME MEASURES Rates, demographics, and age at onset of major depression and bipolar disorder. Symptom profiles, comorbidity, and marital status with major depression. RESULTS The lifetime rates for major depression vary widely across countries, ranging from 1.5 cases per 100 adults in the sample in Taiwan to 19.0 cases per 100 adults in Beirut. The annual rates ranged from 0.8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The mean age at onset shows less variation (range, 24.8-34.8 years). In every country, the rates of major depression were higher for women than men. By contrast, the lifetime rates of bipolar disorder are more consistent across countries (0.3/100 in Taiwan to 1.5/100 in New Zealand); the sex ratios are nearly equal; and the age at first onset is earlier (average, 6 years) than the onset of major depression. Insomnia and loss of energy occurred in most persons with major depression at each site. Persons with major depression were also at increased risk for comorbidity with substance abuse and anxiety disorders at all sites. Persons who were separated or divorced had significantly higher rates of major depression than married persons in most of the countries, and the risk was somewhat greater for divorced or separated men than women in most countries. CONCLUSIONS There are striking similarities across countries in patterns of major depression and of bipolar disorder. The differences in rates for major depression across countries suggest that cultural differences or different risk factors affect the expression of the disorder.
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Affiliation(s)
- M M Weissman
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, USA.
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Weissman MM, Bland RC, Canino GJ, Greenwald S, Lee CK, Newman SC, Rubio-Stipec M, Wickramaratne PJ. The cross-national epidemiology of social phobia: a preliminary report. Int Clin Psychopharmacol 1996; 11 Suppl 3:9-14. [PMID: 8923104 DOI: 10.1097/00004850-199606003-00003] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present a preliminary report on cross-national rates, age at onset, comorbidity, suicide attempts and symptom profiles of social phobia. These data are based on epidemiologic community surveys using similar methods from the United States, Canada, Puerto Rico and Korea. The lifetime rate of social phobia (cases per 100 persons) varies by country, from 2.6 in the United States to 0.5 in Korea. Rates are higher in females than in males in all countries. The age of onset for any phobia is mid-teens to early twenties, and social phobia usually has its first onset before other psychiatric disorders. Only a third or fewer cases of social phobia are uncomplicated by another psychiatric disorder. The presence of social phobia increases the risk of suicide attempts in persons with any other psychiatric disorder. Symptom profiles vary by country. Our data indicate consistent patterns but different cultural expressions of social phobia in the countries studied. The early age of onset of social phobia followed subsequently by another psychiatric disorder raises the possibility that early treatment of social phobia could prevent the onset of other psychiatric disorders.
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Affiliation(s)
- M M Weissman
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
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Abstract
This study investigated lifetime prevalence rates, demographic characteristics, childhood conduct disorder and adult antisocial features, suicide attempts, and cognitive impairment in individuals with obsessive-compulsive disorder (OCD) uncomplicated by or comorbid with any other psychiatric disorder. The data are from the NIMH Epidemiologic Catchment Area (ECA) study, and the current analyses compared subjects with uncomplicated OCD (no history of any other lifetime psychiatric disorder), comorbid OCD (with any other lifetime disorder), other lifetime psychiatric disorders, and no lifetime psychiatric disorders across these variables. OCD in its uncomplicated and comorbid form had significantly higher rates of childhood conduct symptoms, adult antisocial personality disorder problems, and of suicide attempts than did no or other disorders. Comorbid OCD subjects had higher rates of mild cognitive impairment on the Mini-Mental Status Exam than did subjects with other disorders. These findings suggest that a subgroup of OCD patients may have impulsive features, including childhood conduct disorder symptoms and an increased rate of suicide attempts; wider clinical attention to these outcomes is needed.
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Affiliation(s)
- E Hollander
- Columbia University, College of Physicians and Surgeons, New York, USA
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Abstract
When ring segments of artery free of external loads are cut longitudinally, they spring open. This property which has been termed residual strain, is a manifestation of an underlying residual stress and may be quantified by measuring the degree to which the cut ring springs open. Residual stress serves to redistribute the forces in the media and to minimize the stress gradient between its inner and outer margins. Its magnitude and distribution are closely related to vascular growth and development. We have measured the degree of opening (in terms of an opening angle, see below for its definition) in 168 rings removed from six positions along aortae obtained at autopsy from 30 subjects aged between 3 months and 87 years. At all ages, there was an overall increase in opening angle along the aorta away from the heart. At all positions, the opening angle increased with age and was higher in vessels with visible atheroma. At all ages, the opening angle was significantly greater in males than in females. This difference persisted when allowance was made for the greater incidence of atheroma in males. We have found a similar age-related increase in rats, although there was no difference between males and females. These observations are consistent with a recently proposed 'stress-growth' law in which remodelling of the arterial wall is driven by the non-uniform distribution of stress across it and may be associated with known sex-related differences in the aetiology of cardiovascular disease.
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Affiliation(s)
- A Saini
- Department of Morbid Anatomy, London Hospital Medical College, UK
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35
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Abstract
A number of studies have reported links between experiencing low parental care and subsequent depressive experience. As the majority have involved patient samples, links may reflect anomalous parenting disposing to help-seeking behaviour (and patient status) rather than directly to depression. We, therefore, report a community study, so redressing any such artefact emerging from a patient sample and, additionally, quantify the relevance of low parental care to depression in comparison to several other risk factors (i.e., age, gender, educational level, socioeconomic status and marital status). Subjects were drawn from the ECA study and comprised those assessed at the 1-year follow-up interview undertaken at the New Haven site, with parental care being assessed by a key item from the Parental Bonding Instrument (PBI). Those reaching criteria for a lifetime episode of major depressive disorder were significantly more likely to report low care from both parents as well as to be female, divorced or separated, and younger. Low parental care (along with age and mental status but not female sex) appeared pathoplastic in being linked with an increased chance of psychopathology in general, rather than demonstrating specificity to major depressive disorder.
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Affiliation(s)
- G Parker
- Mood Disorders Unit, Prince Henry Hospital, Sydney, New South Wales, Australia
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Abstract
OBJECTIVES To examine the relation between disproportionate fetal growth and adult blood pressure and to investigate whether arterial compliance in adult life is related to early development. DESIGN A follow up study of a group of men and women whose birth weights and other measurements of body size had been recorded at birth. SETTING Home and outpatient study. SUBJECTS 337 men and women born in the Jessop Hospital, Sheffield, between 1939 and 1940. MAIN OUTCOME Adult systolic and diastolic blood pressures and arterial compliance as measured by pulse wave velocity in two arterial segments. RESULTS Both systolic and diastolic blood pressures were higher in people whose birth weight was low, who were short or who had small abdominal or head circumferences at birth. Systolic blood pressure decreased by 2.7 mm Hg (95% CI 0.8 to 4.6) for each pound (454 g) gain in birth weight and by 3.4 mm Hg (95% CI 1.4 to 5.4) for each inch (2.54 cm) increase in crown-heel length. Diastolic pressure fell by 1.9 mm Hg (95% CI 0.9 to 2.9) for each pound (454 g) gain in birth weight and by 2.4 mm Hg (95% CI 1.4 to 3.5) for each inch (2.54 cm) increase in length. Systolic blood pressure was also higher in individuals whose mother's intercristal pelvic diameter was small or whose mother's blood pressure had been raised during pregnancy but these effects were statistically independent of the effects of low birth weight and other measurements that indicate fetal growth retardation. Arterial compliance was lower in those who had been small at birth. CONCLUSION Impairment of fetal growth is associated with raised blood pressure in adult life and decreased compliance in the conduit arteries of the trunk and legs.
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Affiliation(s)
- C N Martyn
- MRC Environmental Epidemiology Unit, Southampton General Hospital
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Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Lee CK, Newman SC, Oakley-Browne MA, Rubio-Stipec M, Wickramaratne PJ. The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry 1994; 55 Suppl:5-10. [PMID: 8077177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.
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Affiliation(s)
- M M Weissman
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, N.Y
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Lydiard RB, Greenwald S, Weissman MM, Johnson J, Drossman DA, Ballenger JC. Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area project. Am J Psychiatry 1994; 151:64-70. [PMID: 8267136 DOI: 10.1176/ajp.151.1.64] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Clinical experience and recent reports suggest that there is a high prevalence of gastrointestinal symptoms in patients with panic disorder and that there is a high prevalence of panic disorder in patients with irritable bowel syndrome, a functional gastrointestinal disorder. To assess gastrointestinal symptoms in a nonpatient, community-based sample, the authors surveyed the prevalence of gastrointestinal symptoms in individuals with panic disorder and other or no psychiatric disorders obtained in a national community survey. METHOD Subjects were 13,537 respondents at four sites of the National Institute of Mental Health (NIMH) Epidemiological Catchment Area project. DSM-III diagnoses were determined by using the NIMH Diagnostic Interview Schedule (DIS). Gastrointestinal symptoms were assessed from the somatization disorder section of the DIS. RESULTS Individuals with panic disorder had a significantly higher rate of endorsing gastrointestinal symptoms, including those typically associated with irritable bowel syndrome, than those with other or no psychiatric diagnosis. CONCLUSIONS Findings suggest a diagnostic overlap between panic disorder and irritable bowel syndrome, with similar demographic and clinical characteristics of patients. Limitations of the study are discussed in terms of medical assessment and self-report inventories. Practical and theoretical implications are discussed.
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Affiliation(s)
- R B Lydiard
- Institute of Psychiatry, Medical University of South Carolina, Charleston 29425
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Abstract
Data from the Epidemiologic Catchment Area Study showed that the overall lifetime rate of psychiatric disorder among Jews did not differ from the rate among non-Jews. However, there was a significant difference between Jewish and non-Jewish samples when comparing the distribution of specific psychiatric disorders. Compared with Catholics and Protestants, Jews had significantly higher rates of major depression and dysthymia, but lower rates of alcohol abuse. Jews were more likely than Catholics or Protestants to seek treatment with mental health specialists and general practitioners. These differences remained statistically significant after adjusting for sex, age, race and socioeconomic status.
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Affiliation(s)
- P P Yeung
- College of Physicians and Surgeons, Columbia University, Chesire
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40
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Scotchford CA, Greenwald S, Ali SY. Calcium phosphate crystal distribution in the superficial zone of human femoral head articular cartilage. J Anat 1992; 181 ( Pt 2):293-300. [PMID: 1295867 PMCID: PMC1259724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The distribution of cuboid crystals in articular cartilage was examined by image analysis of electron micrographs. The specimens were considered to be functionally normal articular cartilage from femoral heads resected either because of femoral neck fracture or tumour in the distal femur. The study was restricted to the superficial region between 0 and 50 microns depth. Crystals were present in all specimens regardless of the age of the patient. The crystal profile area density was significantly greater in superior region samples than inferior region samples and this difference was less in older specimens. A band of microcrystals 10-20 microns below the articular surface was observed in superior samples. A significant correlation between mean individual crystal profile area and age was observed. It is noted that crystals are present in regions of cartilage subject to high mechanical stress.
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Affiliation(s)
- C A Scotchford
- Institute of Orthopaedics UCMSM, Royal National Orthopaedic Hospital, Stanmore, UK
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41
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Weissman MM, Prusoff B, Sholomskas AJ, Greenwald S. A double-blind clinical trial of alprazolam, imipramine, or placebo in the depressed elderly. J Clin Psychopharmacol 1992; 12:175-82. [PMID: 1629383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The efficacy and safety of alprazolam as compared to imipramine or a placebo added to weekly interpersonal psychotherapy was compared in a 6-week double-blind randomized clinical trial of 35 ambulatory elderly patients with major depression. The average maximum dosage of alprazolam was 2.2 mg and the average maximum dosage of imipramine was 97.5 mg. The findings showed a rapid onset of action of alprazolam within 1 week on symptoms of depression and anxiety. The effects for imipramine were seen later in the study. There were no serious side effects that interfered with treatment. The anticholinergic effects of imipramine were the ones that most commonly interfered with treatment. Alprazolam produced the greatest number of symptoms with discontinuation, most of which were alleviated within a week. We conclude that alprazolam may be useful as an antidepressant for the elderly. More clinical trials are needed to test its efficacy in the depressed elderly with concomitant medical problems, using plasma levels. A double-blind discontinuation study of alprazolam is needed to determine the degree of symptom return.
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Affiliation(s)
- M M Weissman
- College of Physicians and Surgeons, Columbia University, New York, New York 10032
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42
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Abstract
Eighteen child therapy outcome studies, containing 26 treatment/control comparisons on at least one language measure, were evaluated. Four questions were addressed: (a) Does child therapy positively impact children's language proficiencies, and are its effects comparable to those obtained on nonlanguage outcome measures? (b) Do outcome effects vary across individual versus group treatment? (c) Does the type of emphasis on verbal process in treatment affect the degree of gain in the children's language proficiencies at outcome? and (d) Do effect sizes on language measures differ depending on type of presenting problem? Results indicate that child therapy has a significant positive impact on children's language proficiencies and that individual is superior to group treatment. Several trends emerged suggesting relationships between the magnitude of language change and type of emphasis on verbal processes in therapy and the childs' presenting problems. Further research on language variables is recommended.
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Affiliation(s)
- R L Russell
- New School for Social Research, New York, New York
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43
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Abstract
The development of the glial reaction in human closed head injury has been investigated using morphometry and statistical analysis. The brains of eight individuals that survived less than 48 h following closed head injury were analysed using immunoperoxidase for glial fibrillary acidic protein (GFAP). Controls were eight patients without neurological disease. The density of reactive astrocytes was estimated in 25 fields in each of 10 different areas sampled bilaterally avoiding the subpial and subependymal zones, and the perivascular white matter. There was great variation between the zones within and between groups, and considerable variation between individuals. The raw data were expressed as logarithms averaged and analysed using the median and non-parametric statistics. The corpus callosum in the head injury group showed the highest densities of reactive astrocytes, particularly in the splenium which achieved statistical significance using the non-parametric tests. This pattern was not reproduced in the control group. Although there was overlap between the head injured and control individuals, the head injury group had relatively higher densities in all zones, and showed an overall increase in the density of reactive astrocytes. This achieved statistical significance in the corpus callosum, the occipital subcortical white matter, and the cerebellum. This study has shown that the glial reaction is often prominent in the corpus callosum irrespective of the presence of a primary lesion although the pattern varies from case to case.
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Affiliation(s)
- D A Crooks
- Department of Morbid Anatomy, Royal London Hospital
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44
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Klerman GL, Weissman MM, Ouellette R, Johnson J, Greenwald S. Panic attacks in the community. Social morbidity and health care utilization. JAMA 1991; 265:742-6. [PMID: 1990190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article focuses on social morbidity and health care utilization in persons with panic attacks not meeting full diagnostic criteria for panic disorder. The findings are based on data from a random sample of over 18,000 adults drawn from five US communities. Panic attacks not meeting full criteria for panic disorder have a relatively high lifetime prevalence (3.6% of the adult population). Persons with panic attacks had impairment in perceived physical and emotional health, and in occupational and financial functioning, increased use of health care facilities, emergency departments, and psychoactive drugs. Persons with panic attacks were intermediate in severity between those with panic disorder and those with other psychiatric disorders. The findings could not be explained by comorbidity with other psychiatric disorders. We conclude that panic attacks have clinical significance and are associated with substantial morbidity.
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Affiliation(s)
- G L Klerman
- Department of Psychiatry, Cornell University Medical College, Payne Whitney Psychiatric Clinic, New York, NY 10021
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45
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Abstract
Eighteen child therapy outcome studies, containing 26 treatment/control comparisons on at least one language measure, were evaluated. Four questions were addressed: (a) Does child therapy positively impact children's language proficiencies, and are its effects comparable to those obtained on nonlanguage outcome measures? (b) Do outcome effects vary across individual versus group treatment? (c) Does the type of emphasis on verbal process in treatment affect the degree of gain in the children's language proficiencies at outcome? and (d) Do effect sizes on language measures differ depending on type of presenting problem? Results indicate that child therapy has a significant positive impact on children's language proficiencies and that individual is superior to group treatment. Several trends emerged suggesting relationships between the magnitude of language change and type of emphasis on verbal processes in therapy and the childs' presenting problems. Further research on language variables is recommended.
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Affiliation(s)
- R L Russell
- New School for Social Research, New York, New York
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46
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Abstract
Follow-up studies of psychiatric patients with panic disorder have shown an abnormally high mortality rate in men due to cardiovascular and cerebrovascular events. The authors report that in the New Haven portion of the Epidemiologic Catchment Area program the risk for stroke in persons with lifetime diagnoses of panic disorder was over twice that in persons with other psychiatric disorders or no psychiatric disorder. After adjustments for demographic differences between groups, the risk was even higher. While the results should be interpreted cautiously because of the small sample and absence of medical examinations, these findings are consistent with clinical studies showing an association between panic disorder and cardiovascular/cerebrovascular events.
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Affiliation(s)
- M M Weissman
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
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47
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Mark RG, Greenwald S. Finding QRS complexes in severe noise by intelligent use of context and experience. J Electrocardiol 1990; 23 Suppl:198-9. [PMID: 1708806 DOI: 10.1016/0022-0736(90)90101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- R G Mark
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge 02139
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48
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Goldberger AL, Rigney DR, Mietus J, Antman EM, Greenwald S. Nonlinear dynamics in sudden cardiac death syndrome: heartrate oscillations and bifurcations. Experientia 1988; 44:983-7. [PMID: 3197810 DOI: 10.1007/bf01939894] [Citation(s) in RCA: 113] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients at high risk of sudden cardiac death show evidence of nonlinear heartrate dynamics, including abrupt spectral changes (bifurcations) and sustained low frequency (.01-.04 Hz) oscillations in heartrate.
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Affiliation(s)
- A L Goldberger
- Cardiovascular Division, Beth Israel Hospital & Harvard Medical School, Boston, Massachusetts 02215
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49
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Greenwald S. The future--alternative healthcare. Comput Healthc 1988; 9:42-3. [PMID: 10287581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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50
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Petersen GM, Rotter JI, Cantor RM, Field LL, Greenwald S, Lim JS, Roy C, Schoenfeld V, Lowden JA, Kaback MM. The Tay-Sachs disease gene in North American Jewish populations: geographic variations and origin. Am J Hum Genet 1983; 35:1258-69. [PMID: 6650504 PMCID: PMC1685967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
From data collected in a North American Tay-Sachs disease (TSD) heterozygote screening program, the TSD carrier frequency among 46,304 Jewish individuals was found to be .0324 (1 in 31 individuals). This frequency is consistent with earlier estimates based on TSD incidence data. TSD carrier frequencies were then examined by single country and single region of origin in 28,029 Jews within this sample for whom such data were available for analysis. Jews with Polish and/or Russian ancestry constituted 88% of this sample and had a TSD carrier frequency of .0327. No TSD carriers were observed among the 166 Jews of Near Eastern origins. Relative to Jews of Polish and Russian origins, there was at least a twofold increase in the TSD carrier frequency in Jews of Austrian, Hungarian, and Czechoslovakian origins (P less than .005). These findings suggest that the TSD gene proliferated among the antecedents of modern Ashkenazi Jewry after the Second Diaspora (70 A.D.) and before their major migrations to regions of Poland and Russia (before 1100 A.D.).
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