The appeal cycle in three cultures: an exploratory comparison of child development.

Mother-child behaviors were studied in three cultural groups: Caucasian American (CA), overseas Japanese (JPN), and Chinese Vietnamese (CVN) immigrants. The children were sixteen to twenty-five months old, and the appeal cycle, with its descriptive analytic method, was the research paradigm. Group differences were found in appeal cycle occurrence and phase frequencies. CA mothers promoted independence through encouragement of decision making and toddler-initiated play, and through nonintrusive interactions. Neither JPN nor CVN mothers encouraged independence. JPN mothers were subtly directive; CVN mothers overtly so. Generally, CA toddlers played independently, evincing a beginning capacity for self-regulation. JPN and CVN toddlers reacted to separation by staying close to their mothers, and fewer were observed to play independently than in the CA group. CVN toddlers played independently more frequently than JPN toddlers, but less frequently than CA toddlers. Quantitative measures of dyadic behaviors generally support the descriptive findings, though methodological constraints did not permit comparison of phase sequencing. The findings reflect cultural differences in child development thought to influence psychic structure formation.

Symptomatic depression in elderly medical outpatients. I. Prevalence, demography, and health service utilization.

The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty-four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1% reported receiving mental health treatment by a specialist. Self-reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic disease.

Screening for depression in geriatric medical patients.

Depression, a common and treatable psychiatric disorder in later life, is often overlooked in geriatric medical patients. The authors evaluated the validity of two self-rating depression scales, the Zung Self-Rating Depression Scale and the Popoff Index of Depression, for 55 elderly patients. They compared these ratings with the diagnosis assigned by a psychiatrist who was blind to scale results and who interviewed these patients using DSM-III criteria. The two scales correctly classified 80% and 69% of the subjects, respectively. The authors identify six items from the two scales that may serve as a simple screening instrument for the detection of depression in geriatric medical patients.

Screening for depression in hospitalized geriatric medical patients.

As part of an effort to improve the detection of depression in geriatric hospitalized medical patients, the validity of two self-rating depression scales, the Zung Self-rating Depression Scale (SDS) and the Popoff Index of Depression (ID), was evaluated. These two scales were completed by 42 medical inpatients whose mean age was 68 years. A psychiatrist who was "blind" to scale results interviewed each patient and diagnosed the presence or absence of depression according to the Diagnostic and Statistical Manual-III (DSM-III) criteria for Major Depressive Episode. On both the SDS and the ID, there was significant agreement between the scale results and the interview diagnosis. Compared with the interview diagnosis, the SDS had a sensitivity of 58 per cent and a specificity of 87 per cent, and it correctly identified 74 per cent of the patients as being either depressed or nondepressed. The ID had a sensitivity of 88 per cent and a specificity of 52 per cent, and it correctly identified 66 per cent of the patients. Although performance on both scales is reduced compared with that of younger depressed patients, these self-rating scales appear to be useful aids for the detection of depression in geriatric medical patients.

Recognition of depression in a university-based family medicine residency program.

Physicians diagnosed depression in 4.5 percent (59/1,321) of all patient encounters in this study conducted in a university based family medicine residency program. A subset of residents permitted the investigators to interview those patients who were diagnosed as depressed or who were judged to be at high risk for a missed diagnosis of depression. Of the six patients whom the residents diagnosed as depressed and who agreed to be interviewed, two did not meet the criteria for depression but in neither case was this discrepancy judged clinically significant. Of the 24 patients at high risk for a missed diagnosis who agreed to be interviewed, four met the diagnostic criteria and three of these four missed diagnoses were judged as possibly of clinical significance. While the physicians in this study diagnosed depression more frequently than in previous similar studies, this does not appear to represent over-diagnosis, although the small number of patients interviewed requires that interpretations be made cautiously. The authors suggest that if a primary care physician diagnoses depression in less than 2 percent of patient encounters, he or she should consider the possibility of missed diagnoses.