Disability and depressive symptoms in the elderly: the effects of instrumental support and its subjective appraisal.

This article explores the buffering effect of social support on depressive symptoms in a community sample of elderly with varying levels of disability. Baseline interviews were conducted in respondents' homes. Results show that higher levels of disability are associated with higher levels of depression. Instrumental support and subjective appraisal of the network are associated with depressive symptoms, but instrumental support has a weak positive correlation, while subjective appraisals show a negative relationship. Social support mitigates the depressive effect of disability only when the network's efforts are appraised positively. However, no such relationship is shown for instrumental support. One's perception of the network's helpfulness appears to be more potent than the actual help provided by friends and family.

Psychiatric morbidity and physician visits: lessons from Ontario.

OBJECTIVES: The authors examine the association between psychiatric morbidity and visits to general practitioners and family practitioners in Ontario, Canada. METHODS: A nested set of hypotheses were posed to account for different levels of use among persons with differing levels of psychiatric morbidity. The sample of 8,116 is drawn from a comprehensive household survey of physical and mental health that included the UM-CIDI standardized diagnostic interview. RESULTS: The findings suggest that persons with psychiatric disorders make more visits than can be accounted for by sociodemographic factors, medical status, access, or by intentional use of the general medical system for mental health treatment. CONCLUSIONS: Psychiatric morbidity is associated with higher rates of health service use. This effect is strongest among persons with multiple psychiatric disorders.

The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders.

BACKGROUND: The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services. METHODS: A multistage, overlapping cohorts design was used, in which 4500 of the 11758 children aged 9, 11, and 13 years in an 11-county area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n = 1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N = 323 at wave 1). RESULTS: The 3-month prevalence (+/-SE) of any DSM-III-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3% +/- 1.7%. The most common diagnoses were anxiety disorders (5.7% +/- 1.0%), enuresis (5.1% +/- 1.0%), tic disorders (4.2% +/- 0.9%), conduct disorder (3.3% +/- 0.6%), oppositional defiant disorder (2.7% +/- 0.4%), and hyperactivity (1.9% +/- 0.4%). CONCLUSIONS: The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.

The Great Smoky Mountains Study of Youth. Functional impairment and serious emotional disturbance.

BACKGROUND: Federal regulations require states to estimate the prevalence and incidence of serious emotional disturbance (SED) in children, defined as a DSM-III-R diagnosis in the presence of impaired functioning in 1 or more areas. We reviewed the published data on SED and examined rates and correlates of SED in an ongoing epidemiologic study of children. METHODS: Rates of DSM-III-R disorders, functional impairment, and their co-occurrence (SED) were examined in a representative population sample of 9-, 11-, and 13-year-olds from a predominantly rural area of North Carolina. Three measures of functional impairment were used, and their interrelationship and impact on rates of SED were examined. RESULTS: Serious emotional disturbance was identified in 4% to 8% of the study population, depending on the measure of impairment; the rate of DSM-III-R disorder ignoring impairment was 20.3%. One quarter of children identified as having SED on any measure were identified by all 3, and one half by 2 or more. Behavioral disorders, emotional disorders, and comorbidity were associated with a significant increase in the likelihood of SED; enuresis and tic disorders in the absence of comorbidity were not. Diagnosis and impairment made independent contributions to the increase in service use seen in children with SED. Poverty greatly increased the likelihood of SED. CONCLUSIONS: Specific areas of functional impairment should be examined when SED is assessed and treatment is planned. Plans to target mental health care resources to children with SED need to be accompanied by efforts to ensure access to those resources.

Hospital stressors experienced by elderly medical inpatients: developing a Hospital Stress Index.

OBJECTIVE: To develop a long and short version of an index to measure experiences during hospitalization perceived by elderly patients as stressful. SAMPLES AND METHODS: Consecutive patients aged sixty or over admitted to a university teaching hospital were assessed for hospital-related stressors during two separate studies. In the first study, seventy-six patients were asked an open-ended question exploring what they found most stressful about being in the hospital. Responses were grouped into major categories, and questions were developed to address concerns in each category; the resulting forty items were called the Hospital Stress Index (HSI). The HSI was then administered to a separate group of ninety-two patients; data were also collected on functional disability (impaired ADLs), dysfunctional attitudes (DAS), and depressive symptoms (CES-D). RESULTS: Spontaneously reported hospital stressors were grouped into seven categories: 1) adverse effects of diagnostic or therapeutic procedures/treatments, 2) forced life-style changes, 3) relationships with staff, 4) individual psychiatric issues, 5) understanding diagnosis/prognosis, 6) family issues, and 7) the physical environment. The largest category of stressors concerned relationships with doctors and nurses. High HSI scores were significantly more common among Whites than Blacks and among patients with high CES-D, high DAS, or impaired ADLs scores. A number of potentially modifiable hospital-related stressors and individual patient issues were identified. Finally, an abbreviated fifteen-item HSI was developed to maximize patient discriminability, highlight individual differences, and enhance the detection of modifiable stressors. CONCLUSIONS: Hospital-reported stressors may contribute to the emotional distress that elderly inpatients experience. We have developed an index to identify such stressors.

Depression-related impairment: estimating concurrent and lingering effects.

This article examines the effects of depression in the sphere of social functioning. On the basis of previous research, it is hypothesized that a major depressive episode has both concurrent and lingering effects and that these effects are a function of the clinical features associated with the episode. This hypothesis is examined using a large community sample and a non-linear model containing both concurrent and lingering effect parameters. The results corroborate the hypothesized effects. Limitations of the current study are discussed and suggestions are offered regarding appropriate research designs. It is suggested that the most general limitation is theoretical. The existence of lingering effects is a phenomenon which presents a theoretical challenge that may prove strategic in understanding the nature and course of depression.

Racial congruity as a contextual correlate of mental disorder.

The effects of exposure to racially dissonant residential environments on depressive psychopathology are explored. Epidemiological survey data are shown to support the hypothesis that an inverse relationship exists between racial congruity and depression. Limitations of the analysis are discussed, as are the social implications of the findings.