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Biomedical subjects

B G Link

Publications and source records attributed to B G Link.

At least 37 records · Page 2Linked to original sources
PubMed1998

Social epidemiology and the fundamental cause concept: on the structuring of effective cancer screens by socioeconomic status.

Since the early 1800s, studies have consistently demonstrated that people higher in the socioeconomic hierarchy live longer than people of lower rank. One hypothesis for the persistence of this association is that people who are relatively better off are more able to avoid risks by adopting currently available protective strategies. In a partial test of this idea, the social distributions of two cancer screening tests--Pap smears and mammography--were examined. A review of the literature and an analysis of Behavioral Risk Factor Surveillance System (BRFSS) data showed a consistent association between indicators of socioeconomic status and recent screening. These findings support the theory that societies create and shape patterns of disease. Innovations beneficial to health are carried out within the context of inequalities that shape the distribution of the health benefit, thereby affecting patterns of morality.

Adolescent↗
PubMed1998

Outcomes of homeless mentally ill chemical abusers in community residences and a therapeutic community.

OBJECTIVES: The feasibility and effectiveness of treating homeless mentally ill chemical abusers in community residences compared with a therapeutic community were evaluated. METHODS: A total of 694 homeless mentally ill chemical abusers were randomly referred to two community residences or a therapeutic community. All programs were enhanced to treat persons with dual diagnoses. Subjects' attrition, substance use, and psychopathology were measured at two, six, and 12 months. RESULTS: Forty-two percent of the 694 referred subjects were admitted to their assigned program and showed up for treatment, and 13 percent completed 12 months or more. Clients retained at both types of program showed reductions in substance use and psychopathology, but reductions were greater at the therapeutic community. Compared with subjects in the community residences, those in the therapeutic community were more likely to be drug free, as measured by urine analysis and self-reports, and showed greater improvement in psychiatric symptoms, as measured by the Center for Epidemiological Studies--Depression Scale and the Brief Psychiatric Rating Scale. Their functioning also improved, as measured by the Global Assessment of Functioning scale. CONCLUSIONS: Homeless mentally ill chemical abusers who are retained in community-based residential programs, especially in therapeutic communities, can be successfully treated.

Adult↗
PubMed1998

HIV infection risks among homeless, mentally ill, chemical misusing men.

This study attempts to identify the specific role that each of three conditions afflicting homeless, mentally ill, chemically misusing (HMICM) men plays in exposing these men to the risk of HIV infection. Three hundred and fifteen HMICM men (33 of whom were HIV+) were interviewed on intravenous drug use (IVDU) and sex practices. Two scales of risky IVDU practices and sex conducts were constructed and analyzed in relation to HIV status. The severity of homelessness, mental illness, and chemical misuse, then, were analyzed as possible predictors of risky IVDU and sex practices. Strong correlations were found between IVDU practices and HIV seropositivity, and between risky sex conduct and HIV seropositivity. Serious depression was the strongest predictor of risky IVDU practices. Prolonged homelessness was the condition most associated with risky sexual conduct. This study concludes that HMICM men are at high risk for HIV infection, stemming, predominately, from two conditions: depression, leading to risky IVDU practices, and homelessness, leading to risky sex conduct with two separate types of risky behavior.

Adult↗
PubMed1997

Violence and psychiatric disorders: results from an epidemiological study of young adults in Israel.

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.

Adult↗
PubMed1997

On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse.

Numerous studies have demonstrated a strong connection between the experience of stigma and the well-being of the stigmatized. But in the area of mental illness there has been controversy surrounding the magnitude and duration of the effects of labeling and stigma. One of the arguments that has been used to downplay the importance of these factors is the substantial body of evidence suggesting that labeling leads to positive effects through mental health treatment. However, as Rosenfield (1997) points out, labeling can simultaneously induce both positive consequences through treatment and negative consequences through stigma. In this study we test whether stigma has enduring effects on well-being by interviewing 84 men with dual diagnoses of mental disorder and substance abuse at two points in time--at entry into treatment, when they were addicted to drugs and had many psychiatric symptoms and then again after a year of treatment, when they were far less symptomatic and largely drug- and alcohol-free. We found a relatively strong and enduring effect of stigma on well-being. This finding indicates that stigma continues to complicate the lives of the stigmatized even as treatment improves their symptoms and functioning. It follows that if health professionals want to maximize the well-being of the people they treat, they must address stigma as a separate and important factor in its own right.

Adult↗
PubMed1995

Public knowledge, attitudes, and beliefs about homeless people: evidence for compassion fatigue.

Media reports suggest that the public is becoming impatient with the homeless--that so-called "compassion fatigue" has gripped the nation. This characterization of public sentiment could have important policy consequences-- restrictive measures can be justified by growing public impatience, and progressive housing policies seem feasible within a hostile climate of opinion. But evidence to support the compassion fatigue notion is anecdotal. We examine the issue by tracking the results of public opinion polls and by reporting detailed evidence from a nationwide random-digit dial telephone survey (N = 1,507) concerning knowledge attitudes and beliefs about homeless people. To be sure, the public sees homelessness as an undesirable social problem and wants something done about it. However, although the homeless are clearly stigmatized, there is little evidence to suggest that the public has lost compassion and is unwilling to support policies to help homeless people.

Adolescent↗
PubMed1995

When social problems converge: homeless, mentally ill, chemical misusing men in New York City.

Despite their pervasiveness in large American cities, homeless, mentally ill, chemical misusing (HMICM) people have rarely been studied as a sociological phenomenon. In this study, 518 HMICM men who sought community-based treatment were interviewed at length on their psychosocial characteristics, family background, and childhood history. The findings show these HMICM men to have severe psychiatric and substance misuse problems. Examination of their family background reveals a common pattern represented by the absence of their fathers and often of their mothers from very early age. Fatherlessness and social rootlessness are hypothesized as related to the HMICM syndrome.

Adult↗
PubMed1995

Social conditions as fundamental causes of disease.

Over the last several decades, epidemiological studies have been enormously successful in identifying risk factors for major diseases. However, most of this research has focused attention on risk factors that are relatively proximal causes of disease such as diet, cholesterol level, exercise and the like. We question the emphasis on such individually-based risk factors and argue that greater attention must be paid to basic social conditions if health reform is to have its maximum effect in the time ahead. There are two reasons for this claim. First we argue that individually-based risk factors must be contextualized, by examining what puts people at risk of risks, if we are to craft effective interventions and improve the nation's health. Second, we argue that social factors such as socioeconomic status and social support are likely "fundamental causes" of disease that, because they embody access to important resources, affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change. Without careful attention to these possibilities, we run the risk of imposing individually-based intervention strategies that are ineffective and of missing opportunities to adopt broad-based societal interventions that could produce substantial health benefits for our citizens.

Disease↗
PubMed1994

Lifetime and five-year prevalence of homelessness in the United States.

OBJECTIVE: Intense debate exists concerning the number of homeless people in the United States. Previous studies, counting currently homeless people, have provided point-prevalence estimates of homelessness but have been criticized on methodological grounds. This study reports lifetime and 5-year prevalence estimates of homelessness using a different methodological approach. METHODS: Random-digit dialing was used to interview 1507 adults living in households with telephones in the 48 contiguous states in the fall of 1990. Respondents were asked whether they had ever been homeless and if so, where they had slept while homeless. RESULTS: Lifetime and 5-year prevalence of all types of homelessness combined were 14.0% (26 million people) and 4.6% (8.5 million people), respectively. Lifetime "literal homelessness" (sleeping in shelters, abandoned buildings, bus and train stations, etc.) was 7.4% (13.5 million people). Five-year (1985 through 1990) prevalence of self-reported homelessness among those who had ever been literally homeless was 3.1% (5.7 million people). CONCLUSIONS: The magnitude of the problem of homelessness is much greater than most previous attempts to enumerate homeless people have led us to believe. This finding requires reconsideration of inferences about the causes of homelessness that were derived from point-prevalence studies of currently homeless people.

Adolescent↗
PubMed1993

An epidemiological study of mental disorders in a 10-year cohort of young adults in Israel.

This is an overview of a two-phase epidemiological study of mental disorders among young adults in a ten-year birth cohort (1949-58) conducted in Israel. A sample of 4914 Israel-born offspring of Jewish immigrants was obtained by full probability sampling procedures and screened for caseness using psychometric symptom scales from the Psychiatric Epidemiology Research Interview (PERI). Those screened positive and almost a fifth of the negatives (N = 2741) were interviewed by psychiatrists using the Schedule for Affective Disorders and Schizophrenia, Israel version (SADS-I), in order to determine prevalence rates of specific disorders as defined by the Research Diagnostic Criteria (RDC). The completion rates for each interview phase were 94.5% and 90.7% respectively. Six-month prevalence rates are presented by gender, ethnic origin, and education. Approximately one-fifth of the birth cohort met current RDC criteria for a disorder at the definite level, excluding the RDC category of 'other psychiatric disorder'. Generalized anxiety disorder and major depressive disorder were the most commonly found types. The striking findings centre on alcoholism and drug use disorder which were exceedingly rare, and the unusually similar rates of major depression for males and females. The results from this study are discussed in comparison with those obtained from other epidemiological studies.

Adult↗
PubMed1993

Psychosocial consequences of rejection and stigma feelings in psoriasis patients.

BACKGROUND: Many studies as well as clinical experience indicate that patients often feel stigmatized by their psoriasis and may experience rejection due to their skin disease. METHODS: In this study of connections between feelings about having psoriasis, rejection by others, and the impact on work experience, alcohol use, and psychiatric help-seeking, 100 adults with moderate to severe psoriasis responded to a specially designed questionnaire. Multiple regression analysis is used to determine whether, and how, rejection experience and stigma feelings are associated with the three psychosocial outcomes after controlling for psoriasis severity. RESULTS: Nineteen percent of the subjects experienced 50 episodes of gross rejection as a result of their psoriasis, most often from a gym, pool, hairdresser, or job. Rejection experience leads to feeling stigmatized, which is then associated with help seeking and, to some degree, with interference with work. Rejection can lead to feeling stigmatized and to increased alcohol consumption, but the data show that patients may drink without conscious awareness of their feelings. CONCLUSIONS: When patients experience psoriasis-related rejection, they may feel stigmatized and suffer further adverse effects on their emotional and occupational life. It is urgent that ways of helping people deal with the impact of psoriasis, its stigmatizing potential, and the consequences of psoriasis-induced rejection be emphasized.

Adult↗
PubMed1992

Socioeconomic status and psychiatric disorders: the causation-selection issue.

Are inverse relations between psychiatric disorders and socioeconomic status due more to social causation (adversity and stress) or social selection (downward mobility of genetically predisposed)? This classical epidemiological issue is tested by focusing on ethnic status in relation to socioeconomic status. Ethnic status cannot be an effect of disorder because it is present at birth whereas socioeconomic status depends on educational and occupational attainment. A birth cohort sample of 4914 young, Israel-born adults of European and North African background was selected from the country's population register, screened, and diagnosed by psychiatrists. Results indicate that social selection may be more important for schizophrenia and that social causation may be more important for depression in women and for antisocial personality and substance use disorders in men.

Education↗
PubMed1992

The control group conundrum in chronic pain case/control studies.

The choice of an appropriate control group has been recognized as one of the most difficult problems in the methodology of case/control studies, both in theory and in practice. In the study of chronic pain, a "well control group" has frequently been employed. Although this design has intuitive appeal, it contains the potential for bias and error. In order to obtain the proper control group, the same exclusion criteria should be applied to cases and controls. Second, controls should be selected independently of exposure to the putative risk factors under investigation. To illustrate the nature of this problem we present two numerical examples, using a chronic pain disorder.

Case-Control Studies↗
PubMed1991

[Variation of response structures in relation to degree of personal involvement--a methodologic study exemplified by the "Discrimination Devaluation Scale"].

When comparing results from different populations there is an underlying assumption that the response patterns elicited by the instrument used are stabile across the study groups. But it remains an open question whether this assumption is correct or not--especially in the case when the populations are involved to a different degree into the problem which is the object of the investigation. In fact, we are able to show that the dimensional structure of an instrument developed for the evaluation of stigma psychiatric patients are exposed to, varies depending on the degree of personal involvement with psychiatric disorder. This leads us to the conclusion that a quantitative comparison of parameters appears not warranted as long as the dimensional stability of the instrument over the various populations has not been shown.

Adult↗
PubMed1991

The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided?

Recent research has assigned a prominent role to labeling and stigma as factors that impair the social and psychological functioning of people officially labeled mentally ill. But can the effects of labeling and stigma be overcome by adopting a few simple approaches to coping with these problems? If so, the stigma-induced problems of social awkwardness, demoralization and unemployment emphasized by recent research may not be as severe as claimed. Using a sample of psychiatric patients, we examine this issue by assessing whether patients can ameliorate labeling effects by keeping their history of treatment a secret, educating others about their situation, or avoiding situations in which rejection might occur. None of these coping orientations were effective in diminishing negative labeling effects on unemployment or on psychological distress/demoralization. In fact, the three coping strategies show consistent effects in the direction of producing more harm than good, and with respect to withdrawal-avoidance this effect is significant. Based on these results we argue that stigma is powerfully reinforced by culture and that its effects are not easily overcome by the coping actions of individuals. Using C. Wright Mills's (1967) distinction we conclude that labeling and stigma are "social problems" not "individual troubles."

Adaptation, Psychological↗
PubMed1990

Losing face: sources of stigma as perceived by chronic facial pain patients.

The purpose of this paper is to identify potential sources of estrangement and feeling psychologically flawed as perceived by temporomandibular pain and dysfunction syndrome (TMPDS) patients. It is our hypothesis that a primary source of patients' perceived stigma results from pejorative labeling by clinicians. The data come from a study of 151 women TMPDS patients. The results show that the lack of a known etiology or pathogenesis for the condition allows the possibility of pejorative labeling by influential others such as physicians and dentists that in turn causes TMPDS sufferers to feel stigmatized. Stigmatization is not the result of clinical factors per se or personality problems. Perceived stigma associated with TMPDS leads to the same sorts of strained interactions and feeling estranged that have been shown to be typical of people with other stigmatized conditions. These strains and feelings in turn may contribute to ill health.

Adaptation, Psychological↗