Specific alcoholic beverages and physical and mental health among adolescents.

OBJECTIVE: This study investigated the longitudinal inter-relationships among the consumption of specific alcoholic beverages (beer, wine and distilled spirits), physical symptoms and psychological distress. Two causal processes were examined for each type of beverage: (1) the use of alcohol to cope with pre-existing psychological distress and physical symptoms; (2) the impairment effects of alcohol on subsequent physical and mental health. METHOD: Data were collected at three points in time (baseline, 3-year follow-up, 6-year follow-up) from a household sample of 1,270 youths who were ages 12, 15 and 18 at the baseline interview. RESULTS: Consumption of all three beverages increased through early adolescence and leveled off at ages 18 and 21, and males reported more beer use than females. Structural equation models showed that the use of all three alcoholic beverages contributed significantly to longitudinal increases in physical symptoms, but not to changes in psychological distress. In contrast, no evidence supported the coping hypothesis. Finally, there were no significant interaction effects involving beverage type, gender or age on physical symptoms. CONCLUSIONS: The results suggested that the physical impairment process operated similarly for beer, wine and distilled spirits, for males and females, and for adolescents of different ages.

Combined medical and psychological symptoms: impact on disability and health care utilization of patients with arthritis.

OBJECTIVES: Many reports indicate that patients with combined chronic illness and depressive symptomatology have more disability than those with illness alone, which may influence physician visits. Studies suggest that these combined conditions are unevenly accommodated by the delivery system and nonpsychiatric physicians often fail to recognize or treat these symptoms. To address this need, this study aimed to provide further information on combined conditions and report on relations found among arthritis disease symptoms, depression, and disability. METHODS: The data was derived from a series of statewide surveys assessing the influence of psychosocial factors on disease course and treatment in a community sample of 277 patients under the care of a rheumatologist. A multivariate model was developed to assess these interrelationships, using measures of symptom severity, depression (CESD), disability (activities of daily living, days of restrictive activities, days in bed), service utilizations, and a few personal and health variables. RESULTS: Even after removing somatic items from the CESD to reduce the risk of inflation due to physical disease, evidence was found for additive impact of depression on one measure of disability, days of restrictive activities. Patients with comorbid conditions also were a high-service utilization group. Very few patients reported receiving help in dealing with emotional problems, suggesting presence of substantial unmet need. CONCLUSIONS: Nonpsychiatric physicians need to be aware of the mental health status of chronically ill patients. Although the association between medication use and depression suggests some awareness of the need to treat depression, especially in physically compromised patients, there may be some need to dispense psychological and psychosocial support to those in need.

Primary therapists' views of managed care.

To assess the system's comprehensiveness in provision of public managed mental health care South Beach Psychiatric Center surveyed a sample (n = 54) of its primary therapists employed in its outpatient departments which have recently been reconfigured as key components of the New York State Office of Mental Health Prepaid Mental Health Plan. They are intended to be comprehensive resource and treatment centers which optimize recovery in a deregulated, capitated environment. As key informants, the primary therapists were asked to rate the difficulty they experience in providing or arranging adequate services and support groups in 19 areas. They were also asked to indicate if the fundamental problem was one of access, information, quality, or supply. The five areas with the highest ratings of difficulty were housing or residential services, substance-abuse services, dental care, general health care, and employment or vocational services. The reason for difficulty most endorsed for these areas was supply. It is suggested that capitated managed care contracts can create incentives to increase the supply of such services.