A self-administered instrument to measure psychiatric discomfort of persons with serious mental illness.

The author describes the development and evaluation of the Psychiatric Discomfort Scale, a self-report instrument that provides a quantitative measurement of patients' discomfort with psychiatric symptoms that change over time. Initially, a 60-item instrument was evaluated with 55 psychiatric inpatients in a Veterans Affairs (VA) medical center and a comparison group of 71 medical outpatients in the VA system. It was revised and tested again with 292 outpatients in treatment for psychosis. The resulting 23-item instrument was found to be internally consistent and responsive to changes in a patient's condition over time.

Psychiatric epidemiology: facts and myths on mental health and illness.

1. The World Health Organization conducted a prevalence study in 17 countries and found that schizophrenia occurred in all countries covered by their investigation. 2. A study conducted in the United States indicated that approximately 15% of the population suffers from a mental disorder within a given year. Only 40% of those with a lifetime diagnosis of schizophrenia reported ever being admitted to a mental hospital. 3. A large epidemiologic study conducted in Israel found no support for the social causation theory as an etiologic factor for schizophrenia. 4. It is time to reevaluate nursing's belief that mental disorders lie on a continuum, from mental health to severe mental disorders, and are the consequence of poor mental health.

Proportional mortality analysis of wastewater treatment system workers by birthplace with comments on amyotrophic lateral sclerosis.

There is concern that wastewater treatment system workers are at risk for cancers and diseases affecting the neurological and digestive systems. However, these diseases have also been linked to early exposures. A proportional mortality study was conducted on a large cohort of wastewater treatment system workers who were divided into two groups, migrants and nonmigrants, by place of birth as reported on their death certificates. The migrant worker group was significantly higher than the US white male population for cancer of the stomach, leukemia, and all lymphopoietic cancers. Migrant workers also had an elevated ratio for all diseases of the nervous system and sense organs. No cases of amyotrophic lateral sclerosis were found. The American-born workers had an elevated rate of death for arteriosclerotic heart disease compared with the US white male population. We suggest that place of birth may present a confounding factor when evaluating exposures in employee groups.

Birthplace as a risk factor in motor neurone disease and Parkinson's disease.

A proportional mortality study was conducted to determine if state of birth is a risk factor associated with motor neurone disease (MND) and Parkinson's disease (PD) using US death certificate information for 1981. State of birth was used as a surrogate variable for location of early childhood environment. A gradient of risk by geographical area in the US was found for MND and PD. Cerebral vascular accident (CVA) deaths served as a comparison group. Multiple sclerosis (MS) deaths were analysed to validate the methods used. A geographical relationship between latitude proportional mortality ratios for MND, PD and MS by state of birth, and a geographical relationship between latitude and proportional mortality ratios for MND and MS by state of birth were found. Statistical modelling was used to compare the deaths from MND, PD, MS, CVA to all other deaths in the US by state of birth. The resulting models were evaluated to determine if any individual states were not well represented by the model for each disease. As predicted, no pattern was evident for CVA. The geographical gradient observed for MS was as predicted by other studies. The geographical pattern found for MND has a northwest to southeast gradient and the pattern found for PD has a west to east gradient.

Hospital characteristics, diagnoses, and staff reasons associated with use of seclusion and restraint.

OBJECTIVE: Patterns of seclusion and restraint over a one-year period at 82 Veterans Affairs medical centers were examined to determine whether use of these interventions was influenced by hospital characteristics (such as geographic location, per diem cost, patient-staff ratio, and university affiliation), patient diagnoses, or reasons for use. METHODS: For comparison, medical centers were grouped into seven geographic regions and into three frequency-of-use groups. Mean use rates and hospital characteristics were examined by rank correlational analysis. RESULTS: Among hospital characteristics, only geographic location was associated with differences in use of seclusion and restraint. Mean rates of use in the Pacific and Mid-Atlantic regions were significantly lower than those in other regions. Total hours of seclusion and restraint at the 20 highest-use centers differed from those at the 20 lowest-use centers by a factor of ten. Patients with schizophrenic disorders were secluded or restrained most frequently. Centers with the highest rates used these interventions most frequently for reasons not associated with violent or potentially violent behaviors. CONCLUSIONS: The large geographic variations in use of seclusion and restraint may be a function of different standards of practice or of different state laws.

Length of time spent in seclusion and restraint by patients at 82 VA medical centers.

Analysis of data from 82 Veterans Affairs medical centers showed that during a one-year period in 1987-88, VA psychiatric inpatients spent about 240,000 hours in seclusion or restraint, with about half of that time in mechanical restraints. The median length of time patients in each medical center spent in seclusion and restraint was used to classify centers as having "higher" or "usual" rates of use of those techniques. In the 20 centers classified as higher users, patients spent two to three times longer in seclusion and restraint per incident than patients in the 62 centers classified as usual users. Time spent by patients in seclusion and restraint in centers with usual rates of use was consistent with reports from other U.S. studies. The longer time in seclusion and restraint per incident in higher-user centers may be due to characteristics of the medical center or of the patient population.