Beyond rose colored glasses: the adaptive role of depressive and anxious symptoms among individuals with heart failure who were evaluated for transplantation.

The prospect of and the evaluative period for transplantation can be stressful for individuals with heart failure (HF). Little is known about the impact of psychosocial factors on service utilization and health outcomes. The current study examined the impact of depression, dysthymia, and anxiety on two-yr hospitalization and mortality among 96 individuals with HF who were evaluated for transplantation. Results revealed that only a small percentage of individuals endorsed sufficient symptomatology to meet criteria for a psychiatric, Axis I disorder (3.1% = anxiety; 2.1% = depression; 1.0% = dysthymia) although a significant proportion of the sample was prescribed an antidepressant or an anxiolytic (37%). Multivariable regression analysis was conducted to examine the association between significant independent demographic, medical, and psychiatric predictors and total duration of hospitalizations; logistic regression analysis was used to examine the relation between predictors and mortality. An increase in anxious symptoms was associated with a decrease in total number of days hospitalized during the two-yr period following the initial evaluation. Similarly, as depressive symptoms increased, risk of two-yr mortality decreased. Future research should assess communication between the patient and providers to further elucidate the potential relationship between psychiatric symptoms, service utilization/hospitalization, and mortality in this patient population.

Program evaluation research in ongoing alcoholism treatment: a summary of the Tuscaloosa VA project.

Early in 1980 a Veterans Administration Medical Center initiated a comprehensive program evaluation project of its Alcohol Treatment Unit. The project has resulted in numerous publications detailing the major findings; however, many outcomes of interest have not been reported, and no report is extant which summarizes the outcome of the program evaluation. In this paper, many results are reported for the first time, and previously published results are briefly described. Additionally, the problems encountered in program evaluation are discussed, as are the implications of the results of the project.

The association of alcoholic subtype with treatment outcome: an 18-month follow-up.

The present paper reports upon the association between alcoholic subtype and treatment response. The subjects participated in an inpatient alcohol treatment program at the Tuscaloosa Veterans Administration Medical Center. Following discharge, the subjects were contacted at 1, 6, 12, and 18 months to evaluate current drinking status and psychosocial outcome. Results indicate that drinking outcome is only moderately associated with alcoholic subtype. However, psychosocial outcome is consistently related to the subtypes. Specifically, Type III (chronic-organic) and Type V (bright-unrealistic) alcoholics do poorly while Type II (impulsive) report few problems. The need to develop better "fits" of treatment and alcoholic is discussed, as are possible adjunctive treatments for the typology presented.

Denial: predictor of outcome following coronary bypass surgery.

Using a modified version of the Hackett-Cassem denial scale we measured preoperative denial in 121 patients scheduled for CABG surgery. A significant inverse relationship was found between the denial scale and Hamilton Anxiety measures four days postoperatively (p less than .02). Longitudinal assessments were carried out using the Spielberger State Anxiety Inventory (SSAI), the Zung Self-Rating Depression Scale (Zung SDS) and the Psychosocial Adjustment to Illness Scale (PAIS). Six months following the surgery, significant negative relationships between denial and these self-report outcome measures were observed as follows: denial and SSAI (p less than .001), denial and Zung SDS (p less than .01), and denial and PAIS (p less than .01). However, the same analysis at twelve months showed no statistically significant correlations between denial and these psychologic outcome measures. Our findings suggest that denial serves as an adaptive mechanism, especially in the immediate postoperative period. Furthermore, higher levels of denial may be predictive of improved psychologic outcome for up to six months following surgery. Subsequently, however, other events, unrelated to the surgery, may be of greater importance than preoperative denial in determining psychological outcome from CABG surgery.

An Eating Disorder Inventory-based typology of outpatient obese individuals.

The literature regarding the association of personality with obesity has been generally confusing and contradictory with very different pictures of the obese person emerging. An alternative to identifying either personality types or personality traits associated with the condition is to construct a typology of obese individuals. Rather than seeking the "obesity personality," the method utilized in the current research sought to differentiate the obese population of an outpatient weight-control clinic into distinct subgroups. For purposes of this study, the Eating Disorder Inventory (EDI) was employed as the measure of personality. The typing procedure using the eight EDI factor scores yielded four distinct subgroups: normal obese, normal/drive-for-thinness group, normal/perfectionist group, and distressed/bulimic group. Issues regarding treatment format, treatment needs, and treatment outcome are discussed.

The efficacy of AA attendance for aftercare of inpatient alcoholics: some follow-up data.

Inpatient alcoholics (N = 145) were followed at 6-month intervals for 18 months postdischarge. The drinking outcomes were compared based on overall degree of AA attendance. Results did indicate higher percentages of abstinence for AA attenders, but only at 18 months. AA attenders also indicated fewer days drinking during the first 6 months, with fewer days drunk for AA attenders at 18 months. Those subjects attending AA for the entire 18 months reported a total abstinence rate of 50%.

Cost/benefit estimates from ongoing alcoholism outcome research: a working paper.

There is an increasing emphasis on cost-effectiveness for all forms of treatment, occurring in parallel with constraints on research dollars. It would therefore seem useful for investigators to try to use ongoing research data as a basis for demonstrating a positive economic impact when outcome data are available. Some thoughts and figures are presented from a large alcoholism project, for which there were also some treatment outcomes. These data permitted dollar estimates, in terms of community impact, which are offered as a basis for further discussion. Although crude, these types of estimates are seen as vital in making the economic arguments, which parallel those for the human misery side of substance abuse.

An MMPI-based clinical typology for inpatient alcoholic males: derivation and interpretation.

A "customized" clinical typology of six types (for 10% to 30% of the sample each) was derived on 150 inpatient alcoholic veterans as part of a more comprehensive clinical research project. The types were derived on 18 variates, which included the 13 clinical and validity scales of the MMPI, 2 intellectual estimates, 2 perceptual estimates, and an employment rating, using Ward's procedure. The MMPI clinical profiles for the types matched closely known MMPI actuarial patterns, as well as those from prior alcoholism typing research. The non-MMPI variates seemed to add importantly to the clinical meaningfulness of the derived types. Type contrasts on a number of demographic and index variables were also significant and provided additional descriptive and validation data. The desirability and utility of combining several common measures as a basis for types that would be a central part of ongoing clinical programming and research are discussed.

Pretreatment MMPI profiles of A.A. members and nonmembers.

Historically, researchers in alcoholism have focused a large amount of energy on the search for "the alcoholic personality." From this effort to identify a particular type of personality prone to the development of alcoholism arose the idea that alcoholics are not a homogeneous group. Subsequently, a number of authors reported the existence of alcoholic subtypes. Recently, research has begun to examine the relationship of personality to treatment outcome. In particular, Alcoholics Anonymous (A.A.) has come under greater scrutiny since high success rates have been ascribed to A.A. attendance. Moreover, the personality characteristics of A.A. members have been compared to alcoholics not attending A.A. Improving on earlier studies, the present research compared the pretreatment Minnesota Multiphasic Personality Inventory (MMPI) profiles of alcoholics who later elected to attend A.A. and those who did not attend. Additionally, alcoholics attending A.A. were sorted by drinking outcome and the MMPI profiles of sober and drinking A.A. members were contrasted. Although no personality differences emerged between A.A. attenders and nonmembers, there were several trends within the A.A. attending group, suggesting that successful A.A. members were less depressed, less anxious and less socially isolated than unsuccessfull A.A. members.

Development and validation of an automatic treatment referral system.

The alcoholism literature abounds with reports of the alcoholic personality and alcoholic subtypes. However, very minimal research on the relationship between the subtypes and treatment procedures is available. With the power of computer technology now accessible so readily, it is possible to apply sophisticated statistical methods to determine the extent of the association. The present paper describes the development of an automatic referral system (Autorf) on an inpatient alcohol and day unit (N = 150). More importantly, preliminary results with regard to the validity of the Autorf system are reported. Implications for treatment of alcoholics and program efficiency are discussed.