Patterns and predictors of treatment seeking after onset of a substance use disorder.

BACKGROUND: We studied survey respondents aged 18 through 54 years to determine consistent predictors of treatment seeking after onset of a DSM-III-R substance use disorder. METHODS: Survey populations included a regional sample in Ontario (n = 6261), a national sample in the United States (n = 5388), and local samples in Fresno, Calif (n = 2874) and Mexico City, Mexico (n = 1734). The analysis examined the effects of demographics, symptoms, and types of substances on treatment seeking. RESULTS: Between 50% (Ontario) and 85% (Fresno) of people with substance use disorders seek treatment but the time lag between onset and treatment seeking averages a decade or more. Consistent predictors of treatment seeking include: (1) late onset of disorder (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.6-5.6 for late [> or =30 years] vs early [1-15 years] age at first symptom of disorder); (2) recency of cohort (OR, 3.4; 95% CI, 2.3-5.0 for most recent [aged 15-24 years at interview] vs earliest [aged > or =45 years] cohorts); (3) 4 specific dependence symptoms (using larger amounts than intended, unsuccessful attempts to cut down use, tolerance, and withdrawal symptoms), with ORs ranging between 1.6 (95% CI, 1.3-2.0) and 2.7 (95% CI, 2.1-3.6) for people with vs without these symptoms; and (4) use vs nonuse of cocaine (OR, 2.1; 95% CI, 1.6-2.7) and heroin (OR, 2.6; 95% CI, 1.1-6.0). CONCLUSIONS: Although most people with substance use disorders eventually seek treatment, treatment seeking often occurs a decade or more after the onset of symptoms of disorder. While treatment seeking has increased in recent years, it is not clear whether this is because of increased access, increased demand, increased societal pressures, or other factors.

[Gender differences in alcohol consumption in Mexico City]. / Diferencias por género en el consumo de alcohol en la Ciudad de México.

OBJECTIVE: The objectives of the present study were: 1) To corroborate the increase in alcohol consumption in the female population registered by results from the National Surveys on Addictions (ENA), 1988 and 1993; and 2) to determine affected age groups, and obtain basic information on age of onset, amount consumed per event and drunkenness frequency in the adult population of Mexico City, as indicators to orient preventive measures. MATERIAL AND METHODS: A multi-stage, stratified household survey was applied. A total of 1,932 interviews was completed, subjects were between 18 and 65 years of age, with a response rate of 60.4%. The instrument was a modified version of the Composite International Psychiatric Interview (CIDI), which is a highly structured instrument, applicable by non-specialized personnel, although limited training is necessary. The alcohol section included questions on the age of the first drink, the frequency and amount consumed during each event and the drunkenness frequency during the last 12 months, among other variables. Median and percentage were obtained by sex and among age-cohorts. RESULTS: Of the total, 96.5% of men and 18.1% of women have consumed at least one drink in their lives. In average, age of onset is 16 years for men, and 18 years for women. Age group comparisons show a clear tendency to begin drinking at an earlier age, particularly in women. The growing trend indicated by ENA with respect to alcohol consumption in the feminine population and at a younger age was corroborated. Results indicated that, in average, 5 years after the age of onset, both men and women reach their highest quantities of alcohol consumption, which tend to be excessive. Additionally, high-risk drinking among women (five or more drinks per event) increased to be four times higher in a period of seven years, and with an apparent tendency to rise. Sixty percent of the drinking population reduced alcohol consumption before the age of 30, however, the remaining 40% continued to drink at the same rate, or even increased consumption, particularly among women. CONCLUSIONS: The age of onset of alcohol consumption has diminished, especially in women, showing tendencies towards abuse. Preventive programs should predominantly focus on young age groups with emphasis on the feminine population.

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology.

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.

Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California.

BACKGROUND: The Mexican American Prevalence and Services Survey presents lifetime prevalence rates for 12 DSM-III-R psychiatric disorders in a sample of 3012 adults of Mexican origin by place of residence and nativity, and compares these results with those of population surveys conducted in the United States and Mexico. METHODS: The stratified random sample included non-institutionalized persons aged 18 to 59 years of Mexican origin, who were residents of Fresno County, California. Psychiatric disorders were assessed using a modified version of the World Health Organization Composite International Diagnostic Interview in face-to-face interviews. RESULTS: Mexican immigrants had lifetime rates similar to those of Mexican citizens, while rates for Mexican Americans were similar to those of the national population of the United States. This difference is attributable to a prevalence rate for any disorder among immigrants of 24.9%, compared with 48.1% among US-born respondents. A higher prevalence for any disorder was reported in urban (35.7%) compared with town (32.1%) or rural (29.8%) areas. Multivariate analyses showed an adjusted effect of country of birth, but not of urban residence. CONCLUSIONS: Despite very low education and income levels, Mexican Americans had lower rates of lifetime psychiatric disorders compared with rates reported for the US population by the National Comorbidity Survey. Psychiatric morbidity among Mexican Americans is primarily influenced by cultural variance rather than socioeconomic status or urban vs rural residence.

[The needs of the population and the development of mental health services]. / Necesidades de la población y desarrollo de servicios de salud mental.

In 1988, the World Health Organization (WHO) invited the Mexican Institute of Psychiatry to participate in a multicentric collaborative four year programme including two basic projects. The first, entitled "Pathway study" for which a geographical area of Mexico city was selected, in which two psychiatric services of different institutions served the population. All new patients seen in a five week period were interviewed by an assistant researcher obtaining information about the following: a) onset of the actual episode of illness; b) the first and subsequent decisions to seek care; c) symptoms presented on each decision; d) treatments offered; e) time elapsed since onset of the disorder until the first decision to seek care; f) time elapsed from the latter until arriving to the psychiatric service and g) psychiatric diagnosis. This report presents the results, comparing both institutions, which differed on the socioeconomic status of the population served, as well as on some of the pathology presented. The time elapsed between the onset of the disorder and the first decision to seek care was different for the disorders and the kind of population. The delay between the first seek of care and the arrival to psychiatric services also showed differences. Strategies for intervention for both institutions are discussed as well as the utility of the research model used.

[Inter-clinician reliability of the Mexican version of Goldberg's "Standardized Psychiatric Interview"]. / Confiabilidad entre clínicos utilizando la "Entrevista Psiquiátrica Estandarizada" de Goldberg en una versión mexicana.

The Standardized Psychiatric Interview (SPI) was developed by Goldberg et al., for use in community surveys. The authors made the translation and adaptation of this instrument to Spanish and in this paper they present the inter-rater reliability study of different clinicians using the SPI in a sample of 30 women psychiatric out-patients. The raters were 4 psychiatrists and 2 clinical psychologists. A one week training course was developed before the study in order to get acquainted with the instrument, discuss it and use the standard technique to elicit and record psychiatric symptoms on 5 audiotapes and 10 subjects with different degrees of pathology. The inter-rater reliability was tested using the product-moment correlation, the statistic Kappa and a descriptive index of association in order to show the agreement between raters when the symptom was present or absent. A two-way analysis of variance was also carried out in order to test if there were any differences among the raters. The results show a mean product-moment correlation of 0.90 and a mean Kappa of 0.82. In 20 of the interviews a psychiatrist and a psychologist acted as raters and the results were almost the same. The authors conclude that the SPI is an useful technique for further studies in general practice and community surveys in the hands of mental health personnel trained in the use of Standardized Psychiatric Interview.

Confiabilidad entre clinicos utilizando la "entrevista psiquiatrica estandarizada" de Goldberg en una version mexicana. / Reliability among clinicians using \"Goldberg's standardized psychiatric interview\" translated in Mexico

Los autores realizaron la traduccion y adaptacion a la poblacion de Mexico de la Entrevista Psiquiatrica Estructurada desarrollada por Goldberg y cols., para hacer diagnosticos psiquiatricos en estudios de comunidad. Este trabajo presenta el estudio de confiabilidad entrevistador-observador utilizando este metodo en donde participaron 4 psiquiatras y 2 psicologas clinicas aplicando el instrumento a 30 pacientes femeninos de consulta externa de psiquiatria. La media de correlacion producto-momento fue de 0.90 y la media del Kappa fue de 0.82. Los autores concluyen que el instrumento es util para futuros estudios en consulta general y comunidad pudiendo ser empleado por personal de la salud capacitado a traves de un curso previo en el empleo de la entrevista

Confiabilidad entre clinicos utilizando la "entrevista psiquiatrica estandarizada" de Goldberg en una version mexicana. / Reliability among clinicians using "Goldbergs standardized psychiatric interview" translated in Mexico

Los autores realizaron la traduccion y adaptacion a la poblacion de Mexico de la Entrevista Psiquiatrica Estructurada desarrollada por Goldberg y cols., para hacer diagnosticos psiquiatricos en estudios de comunidad. Este trabajo presenta el estudio de confiabilidad entrevistador-observador utilizando este metodo en donde participaron 4 psiquiatras y 2 psicologas clinicas aplicando el instrumento a 30 pacientes femeninos de consulta externa de psiquiatria. La media de correlacion producto-momento fue de 0.90 y la media del Kappa fue de 0.82. Los autores concluyen que el instrumento es util para futuros estudios en consulta general y comunidad pudiendo ser empleado por personal de la salud capacitado a traves de un curso previo en el empleo de la entrevista

Confiabilidad entre clínicos utilizando la [quot ]Entrevista Psiquiátrica Estandarizada[quot ] de Goldberg en una versión mexicana. / [Inter-clinician reliability of the Mexican version of Goldbergs [quot ]Standardized Psychiatric Interview[quot ]]

The Standardized Psychiatric Interview (SPI) was developed by Goldberg et al., for use in community surveys. The authors made the translation and adaptation of this instrument to Spanish and in this paper they present the inter-rater reliability study of different clinicians using the SPI in a sample of 30 women psychiatric out-patients. The raters were 4 psychiatrists and 2 clinical psychologists. A one week training course was developed before the study in order to get acquainted with the instrument, discuss it and use the standard technique to elicit and record psychiatric symptoms on 5 audiotapes and 10 subjects with different degrees of pathology. The inter-rater reliability was tested using the product-moment correlation, the statistic Kappa and a descriptive index of association in order to show the agreement between raters when the symptom was present or absent. A two-way analysis of variance was also carried out in order to test if there were any differences among the raters. The results show a mean product-moment correlation of 0.90 and a mean Kappa of 0.82. In 20 of the interviews a psychiatrist and a psychologist acted as raters and the results were almost the same. The authors conclude that the SPI is an useful technique for further studies in general practice and community surveys in the hands of mental health personnel trained in the use of Standardized Psychiatric Interview.