Biomedical subjects

Douglas K Novins

Publications and source records attributed to Douglas K Novins.

At least 19 recordsLinked to original sources

PubMed2005

Prevalence of DSM-IV disorders and attendant help-seeking in 2 American Indian reservation populations.

BACKGROUND: The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) estimated the mental health burden and associated help-seeking in select American Indian reservation communities. OBJECTIVE: To determine the lifetime and 12-month prevalence of common DSM-IV disorders, their demographic correlates, and patterns of help-seeking in 2 culturally distinct American Indian reservation communities in the Southwest and Northern Plains. DESIGN: Completed between 1997 and 2000, a cross-sectional probability sample survey. SETTING: General community. PARTICIPANTS: Three thousand eighty-four (Southwest = 1446 and Northern Plains = 1638) members, aged 15-54 years, of 2 tribal groups living on or near their home reservations were randomly sampled from the tribal rolls. Response rates were 73.7% and 76.8% for the Southwest and Northern Plains tribes, respectively.Main Outcomes Measures The AI-SUPERPFP Composite International Diagnostic Interview, a culturally adapted version of the University of Michigan version of the Composite International Diagnostic Interview, to assess DSM-IV diagnoses and help-seeking. RESULTS: Overall lifetime prevalence of AI-SUPERPFP DSM-IV disorders ranged from 35.7% for Southwest women to near 50% for both groups of men. Alcohol abuse and dependence were the most common disorders for men, with posttraumatic stress disorder most prevalent for women. Many of those with lifetime alcohol problems or posttraumatic stress disorder no longer met criteria for 12-month diagnoses. Significant levels of comorbidity were found between those with depressive and/or anxiety and substance disorders. Demographic correlates other than tribe, sex, and age were generally unrelated to disorder status. A majority of participants with lifetime disorders had sought help from mental health professionals, other medical personnel, or culturally traditional sources. CONCLUSIONS: Alcohol disorders and posttraumatic stress disorder were more common in these American Indian populations than in other populations using comparable methods. Substantial comorbidity between depressive and/or anxiety and substance disorders suggests the need for greater coordination of treatment for comorbid disorders.

Adolescent↗

PubMed2005

Childhood physical and sexual abuse and subsequent depressive and anxiety disorders for two American Indian tribes.

BACKGROUND: This study examined the relationship of childhood abuse, both physical and sexual, with subsequent lifetime depressive and anxiety disorders--depression or dysthymia, post-traumatic stress disorder (PTSD), and panic or generalized anxiety disorder (GAD)--among American Indians (AIs). METHOD: Three thousand and eighty-four AIs from two tribes--Southwest and Northern Plains--participated in a large-scale, community-based study. Participants were asked about traumatic events and family history, and were administered standard diagnostic measures of depressive/anxiety disorders. RESULTS: Prevalence of childhood physical abuse was approximately 7% for both tribes. The Southwest tribe had higher prevalence of depressive and anxiety disorders, with rates of PTSD being the highest. Childhood physical abuse was significant in bivariate models of depressive/anxiety disorders, and remained so in the multivariate models. CONCLUSIONS: Childhood physical abuse was a significant predictor of all disorder groups for males in both tribes except for panic/GAD for the Northern Plains tribe in multivariate models; females showed a more varied pattern. Childhood sexual abuse did not significantly differ for males and females, and was an independent predictor of PTSD for both tribes, controlling for childhood physical abuse and other factors, and was significant for the other disorder groups only in the Southwest. Additional covariates that increased the odds of depressive/anxiety disorder, were adult physical or sexual victimization, chronic illness, lifetime alcohol or drug disorder, and parental problems with depression, alcohol, or violence. Results provided empirical evidence of childhood and later life risk factors and expanded the population at risk to include males.

Adolescent↗

PubMed2005

Obstacles for rural American Indians seeking alcohol, drug, or mental health treatment.

The purpose of this study was to identify factors associated with 4 clusters of obstacles (self-reliance, privacy issues, quality of care, and communication and trust) to mental health and substance abuse treatment in 3 treatment sectors for residents of 3 reservations in the United States. Participants (N=3,084) disclosed whether they had sought treatment for emotional, drug, or alcohol problems in the past year and, if so, whether they had faced obstacles in obtaining care from Indian Health Services, tribal services, and other public or private systems. Correlates of these obstacles included negative social support, instrumental social support, utility of counselors, utility of family doctors, treatment sector, treatment type, diagnosis of an anxiety disorder, and tribe.

Adolescent↗

PubMed2005

Disparities in patterns of alcohol use among reservation-based and geographically dispersed American Indian populations.

BACKGROUND: High rates of alcohol use and alcohol-related morbidity and mortality among American Indians (AI) are major public health concerns. The purpose of this paper is to describe patterns of alcohol consumption among three distinct samples of American Indians (AIs) compared to a U.S reference population. METHODS: Data were drawn from two epidemiologic studies: 1) a study of 2,927 AIs living on or near reservations from two culturally distinct tribes in the Southwest (SW-AI) and Northern Plains (NP-AI); and 2) the National Longitudinal Alcohol Epidemiologic Study (NLAES), which included data from a geographically dispersed sample of AIs (n = 780) as well as the US reference population (all-race excluding AIs, n = 30,063). Multivariate analyses were used to assess drinking patterns. RESULTS: After controlling for demographic characteristics, the prevalence of drinking during the past year was similar among males in the NP-AI, NLAES-AI, and the US populations. SW-AI males and females were significantly less likely to drink during the past year (Odds Ratios of 0.74 and 0.41, respectively), while the odds of NP-AI females being current drinkers were twice that of US females. Among those who drank during the past year, the AIs consumed a larger quantity of alcohol per drinking day than the US reference population. However, the reservation-based AIs consumed alcohol less frequently (Odds Ratios between 0.18-0.40, p < 0.01) than the NLAES-AI and US populations. CONCLUSIONS: Patterns of alcohol consumption varied substantially between the two reservation-based AI populations, the geographically dispersed sample of AIs, and the US reference population. Careful consideration of these variations may improve the effectiveness of alcohol prevention and treatment programs as they may reflect important underlying differences in the cultures of alcohol consumption across these populations.

Adolescent↗

PubMed2005

Methods for addressing missing data in psychiatric and developmental research.

OBJECTIVE: First, to provide information about best practices in handling missing data so that readers can judge the quality of research studies. Second, to provide more detailed information about missing data analysis techniques and software on the Journal's Web site at www.jaacap.com. METHOD: We focus our review of techniques on those that are based on the "Missing at Random" assumption and are either extremely popular because of their convenience or that are harder to employ but yield more precise inferences. RESULTS: The literature regarding missing data indicates that deletion of observations with missing data can yield biased findings. Other popular methods for handling missing data, notably replacing missing values with means, can lead to confidence intervals that are too narrow as well as false identifications of significant differences (type I statistical errors). Methods such as multiple imputation and direct maximum likelihood estimation are often superior to deleting observations and other popular methods for handling missing data problems. CONCLUSIONS: Psychiatric and developmental researchers should consider using multiple imputation and direct maximum likelihood estimation rather than deleting observations with missing values.

Adolescent↗

PubMed2005

Prevalence of major depressive episode in two American Indian reservation populations: unexpected findings with a structured interview.

OBJECTIVE: American Indian populations have often been considered to be at greater risk for major depressive episode than are other groups in the United States. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP), completed between 1997 and 1999, was designed to allow comparisons with the baseline National Comorbidity Survey (NCS), conducted in 1990-1992. The prevalence of lifetime and 12-month DSM-III-R major depressive episode was compared between the AI-SUPERPFP and NCS samples. METHOD: A total of 3,084 tribal members (1,446 in a Southwest tribe [73.7% of eligible participants] and 1,638 in a Northern Plains tribe [76.8% of eligible participants]) age 15-54 years living on or near their home reservations were interviewed. An adaptation of the University of Michigan Composite International Diagnostic Interview and the NCS algorithm for diagnosis were used to estimate the prevalence of lifetime and 12-month major depressive episode in these groups. RESULTS: The prevalence estimates for lifetime and 12-month major depressive episode were substantially lower in the American Indian samples, compared to the NCS sample. Detailed analyses indicated differential endorsement of lifetime symptoms between the American Indian groups and the NCS participants. Furthermore, American Indians were substantially less likely than NCS participants to indicate that depressive symptoms had co-occurred during an episode lasting at least 2 weeks. The lifetime prevalence estimates based on the NCS algorithm ranged from 3.8% to 7.9% for men and women in the two tribes. The analogous rates based on an adapted AI-SUPERPFP algorithm ranged from 7.2% and 14.3%. Few tribe, age, and gender differences were found. CONCLUSIONS: The findings underscore the need for careful examination of diagnostic instruments cross-culturally. Adaptation of the NCS algorithm for diagnosis appears necessary for estimation of the prevalence of major depressive episode in the American Indian populations included in this study. In striving to better reflect the clinical diagnostic process in epidemiological and services research, careful consideration of the resulting complexity becomes increasingly critical.

Adolescent↗

PubMed2005

Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context.

OBJECTIVE: The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) provided estimates of the prevalence of DSM-III-R disorders and utilization of services for help with those disorders in American Indian populations. Completed between 1997 and 1999, the AI-SUPERPFP was designed to allow comparison of findings with the results of the baseline National Comorbidity Survey (NCS), conducted in 1990-1992, which reflected the general United States population. METHOD: A total of 3,084 tribal members (1,446 in a Southwest tribe and 1,638 in a Northern Plains tribe) age 15-54 years living on or near their home reservations were interviewed with an adaptation of the University of Michigan Composite International Diagnostic Interview. The lifetime and 12-month prevalences of nine DSM-III-R disorders were estimated, and patterns of help-seeking for symptoms of mental disorders were examined. RESULTS: The most common lifetime diagnoses in the American Indian populations were alcohol dependence, posttraumatic stress disorder (PTSD), and major depressive episode. Compared with NCS results, lifetime PTSD rates were higher in all American Indian samples, lifetime alcohol dependence rates were higher for all but Southwest women, and lifetime major depressive episode rates were lower for Northern Plains men and women. Fewer disparities for 12-month rates emerged. After differences in demographic variables were accounted for, both American Indian samples were at heightened risk for PTSD and alcohol dependence but at lower risk for major depressive episode, compared with the NCS sample. American Indian men were more likely than those in NCS to seek help for substance use problems from specialty providers; American Indian women were less likely to talk to nonspecialty providers about emotional problems. Help-seeking from traditional healers was common in both American Indian populations and was especially common in the Southwest. CONCLUSIONS: The results suggest that these American Indian populations had comparable, and in some cases greater, mental health service needs, compared with the general population of the United States.

Adolescent↗

PubMed2005

The relationship of gender and trauma characteristics to posttraumatic stress disorder in a community sample of traumatized northern plains American Indian adolescents and young adults.

OBJECTIVE: Previous studies have identified a high prevalence (25%-80%) of trauma among American Indian and non-American Indian adolescents and adults. However, only a fraction of traumatized individuals develop posttraumatic stress disorder (PTSD). This article examines the relationships of gender and trauma characteristics to a diagnosis of PTSD among a community sample of traumatized American Indian adolescents and young adults. METHOD: Complete data were collected from 349 American Indians aged 15 to 24 years who participated in a cross-sectional community-based study from July 1997 to December 1999 and reported experiencing at least 1 traumatic event. Traumatic events and PTSD were assessed using a version of the Composite International Diagnostic Interview. Logistic regression determined the relationships of gender, trauma type, age at first trauma, and number of traumas to the development of PTSD. RESULTS: Forty-two participants (12.0% of those who experienced a traumatic event) met criteria for lifetime PTSD. While all 4 of the independent variables noted above demonstrated univariate associations with PTSD, multivariate logistic regression analyses indicated that only experiencing a sexual trauma (odds ratio [OR] = 4.45, 95% confidence interval [CI] = 1.76 to 11.28) and having experienced 6 or more traumas (OR = 2.53, 95% CI = 1.06 to 6.04) were independent predictors of meeting criteria for PTSD. CONCLUSION: American Indian children and adolescents who experience sexual trauma and multiple traumatic experiences may be at particularly high risk for developing PTSD.

Adolescent↗

PubMed2004

Contextual issues for strategic planning and evaluation of systems of care for American Indian and Alaska Native communities: an introduction to Circles of Care.

This introduction to the evaluation component of the Circles of Care initiative includes background on the nature of the initiative, Center for Mental Health Services support for developing systems of care for youth with emotional disturbances, and an overview of the systems of care approach. The prevalence, unique challenges, and the historical, political, and cultural context of health care delivery for American Indian and Alaska Native peoples are also discussed.

Adolescent↗

PubMed2004

Describing community needs: examples from the Circles of Care initiative.

The assessment of community needs was one of the key foundations of the Circles of Care planning effort. Grantees identified a range of needs at the child, adolescent, family, programmatic, and community levels. This information, along with an emphasis on the importance of each community's history and culture, served as an important guide for each program as they developed their model systems of care.

Adolescent↗

PubMed2004

Words have power: (re)-defining serious emotional disturbance for American Indian and Alaska Native children and their families.

Circles of Care grantees were provided the opportunity to develop a locally relevant definition of serious emotional disturbance that would be used to define what type of emotional, behavioral, and mental disability would be required to receive services. After conducting detailed assessments of the definition in the guidance for applicants GFA and the definitions used by others in their respective states, seven of the nine grantees developed their own local, project-specific definitions through the participation of community focus groups and Advisory Councils. The six definitions for SED developed by rural grantees all included American Indian and Alaska Native concepts specific to each tribal community's culture; the urban grantee's definition was purposely focused for reaching out to non-professional members of the community. This opportunity for the communities to redefine SED not only provided each community with a definition which would be more culturally specific, but also proved to be an extraordinarily exercise in empowerment and self-determination.

Adolescent↗

PubMed2004

Developing a plan for measuring outcomes in model systems of care for American Indian and Alaska Native children and youth.

The Circles of Care initiative emphasized the importance of developing an outcomes measurement plan that was consonant with the model system of care as well as community values and priorities. This analysis suggests that the Circles of Care grantees achieved this key programmatic objective, but that a major constraint was the tendency of funders, including the Substance Abuse and Mental Health Services Administration (the funder of Circles of Care), to mandate their own outcomes measurement plans. Funders are encouraged to balance their needs for commonality of measures across programs for their own evaluation purposes with the needs of service providers to utilize measures that meet their unique programmatic and community contexts.

Adolescent↗

PubMed2004

Challenges in operationalizing the DSM-IV clinical significance criterion.

BACKGROUND: An explicit clinical significance (CS) criterion was added to many DSM-IV diagnoses in an attempt to more closely approximate the clinical diagnostic process and reduce the proportion of false positives in epidemiological studies. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) offered a unique opportunity to examine the success of this effort. OBJECTIVE: To determine the impact of distress, impairment, and help-seeking reported in a lay structured interview on concordance with a clinical reappraisal. Further, to test the efficacy of 5 operationalizations of CS on the concordance and prevalence of DSM-IV lifetime disorders. DESIGN: Completed between 1997 and 2000, a cross-sectional probability sample survey with clinical reappraisal of approximately 10% of participants. SETTING: General community. PARTICIPANTS: A population-based sample of 3084 members of 2 American Indian tribal groups, who were between the ages of 15 and 54 years and resided on or near their home reservations, were randomly sampled from the tribal rolls and participated in structured psychiatric interviews. Clinical reappraisals were conducted with approximately 10% of the lay-interview participants. The response rate for the lay interview was 75%, and for the clinical reappraisal it was 72%. MAIN OUTCOMES MEASURES: The AI-SUPERPFP Composite International Diagnostic Interview (CIDI), a culturally adapted version of the CIDI, University of Michigan version. Adapted to assess DSM-IV diagnoses, questions assessing the CS criterion were inserted in all diagnostic modules. The Structured Clinical Interview for DSM-III-R (SCID) was used in the clinical reappraisal. RESULTS: Most participants who qualified as having AI-SUPERPFP CIDI lifetime disorders reported at least moderate levels of distress or impairment. Evidence of increased concordance between the CIDI and the SCID was lacking when more restrictive operationalizations of CS were used; indeed, the CIDI was very likely to underdiagnose disorders compared with the SCID (false negatives). Concomitantly, the CS operationalizations affected prevalence rates dramatically. CONCLUSION: The CS criterion, at least as operationalized to date, demonstrates little effectiveness in increasing the validity of diagnoses using lay-administered structured interviews.

Algorithms↗

PubMed2004

American Indian substance use: the hazards for substance use initiation and progression for adolescents aged 14 to 20 years.

OBJECTIVE: To describe the risks and risk factors for substance use initiation and progression among a large sample of American Indian (AI) adolescents. METHOD: Data came from surveys completed by 2,356 AI adolescents aged 14 to 20 years who participated in two or more consecutive waves of a longitudinal study between 1993 and 1996 (response rate 74%). Discrete-time survival analysis was used to describe the risks and risk factors for substance use initiation and progression. RESULTS: The risk for initiating use of any substance accelerated in early adolescence and peaked at age 18. The risk for progression from use of alcohol, marijuana, and/or inhalants to the use of other illicit drugs (e.g., cocaine) increased over the first 4.5 years after initiating substance use, then diminished in subsequent years. The risk of substance use initiation and progression varied across the four participating communities and by season of the year. Compared to adolescents who initiated substance use with alcohol only, adolescents who initiated substance use with marijuana or inhalants were more likely to progress to use other illicit drugs. CONCLUSIONS: Prevention programs for AI communities should be designed to address these community, age, and seasonal variations in the risks for substance use initiation and progression.

Adolescent↗

PubMed2004

Imputing missing data.

Explore the source record for details and available documents.

Data Interpretation, Statistical↗

PubMed2004

Use of biomedical services and traditional healing options among American Indians: sociodemographic correlates, spirituality, and ethnic identity.

OBJECTIVE: The objective of this study was to describe the use of biomedical services and traditional healing options among a reservation-based sample of American Indians from 2 culturally distinct tribes METHODS: Participants were 2595 American Indian adolescents and adults ages 15 to 57 randomly selected to represent 2 tribes living on or near their rural reservations. First, we examined the prevalence and correlates of use of biomedical services and traditional healing for both physical health and psychiatric problems. Second, we developed logistic regression models predicting the independent and combined use of biomedical services and traditional healing RESULTS: The prevalence of combined and independent use of biomedical services and traditional healing varied by tribe. The prevalence of biomedical service use ranged from 40.9% to 59.1% for physical health problems and 6.4% to 6.8% for psychiatric problems. The prevalence of the use of traditional healing ranged from 8.4% to 22.9% for physical health problems and 3.2% to 7.8% for psychiatric problems. Although combined use of both types of services was common (10.4-22.6% of service users), many used only traditional healing (3.5-40.0%). Correlates of service use included age, educational level, and ethnic identity. For example, use of traditional healing was correlated with higher scores on a scale measuring identification with American Indian culture CONCLUSIONS: Both biomedical services and traditional healing are important sources of care in American Indian communities, and are used both independently and in combination with one another.

Adolescent↗

PubMed2004

The prevalence of suicidal behaviors among Northern Plains American Indians.

This study examined the prevalence of suicidal behaviors among 1,638 Northern Plains American Indians ages 15-57. Age and gender patterns were investigated as was comorbidity with psychiatric and substance use disorders. Data from a population-based survey indicated that suicidal behaviors were more frequently reported among females than males and among younger respondents than older respondents. In addition, suicidal behaviors were associated with depressive disorders, PTSD, substance abuse/dependence, and violent ideation/aggression. Results underscore the importance of effective and acceptable alcohol, drug, and mental health services in reducing the rates of suicidal behaviors in American Indian communities.

Adolescent↗

PubMed2004

Childhood physical and sexual abuse and subsequent alcohol and drug use disorders in two American-Indian tribes.

OBJECTIVE: The purpose of this study was to examine the relationship of childhood physical and sexual abuse to subsequent lifetime alcohol or drug use disorders among American Indians (AIs) by using cross-sectional and retrospective data collected from a structured epidemiological interview. METHOD: A sample of 3,084 AIs from two tribal populations-Southwest and Northern Plains--participated in a large-scale, community-based study. Participants were asked about traumatic events and family history and were administered standard diagnostic measures of substance use disorders. RESULTS: Prevalence of childhood physical abuse was approximately 7% for both tribes, and childhood sexual abuse was 4%-5%, much higher for females. The Northern Plains tribe had higher prevalences of substance use disorders. Childhood physical abuse had a significant main effect in bivariate models of substance dependence, but remained significant only in the multivariate models of substance dependence for the Northern Plains tribe. Correlates of disorder were psychiatric and medical comorbidity, parental alcohol problems and adult experience of physical attacks. CONCLUSIONS: Childhood physical abuse had a stronger effect than childhood sexual abuse on lifetime substance dependence. Childhood sexual abuse, on the other hand, was more associated with lifetime substance abuse. Females more commonly experienced childhood abuse but were less likely than males to develop substance use disorders. Although additional covariates reduced the main effect on disorder, results provide clinical guidance to constellations of risk factors and expand the population at risk to include males.

Adolescent↗