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Biomedical subjects

H C Schulberg

Publications and source records attributed to H C Schulberg.

At least 19 recordsLinked to original sources
PubMed1991

Factors affecting service utilization for depression in a white collar population.

The present study examines rates of mental health service utilization among depressed individuals in a large white collar cohort. Clinical and psychosocial features of a recent depressive episode, as well as preexisting psychiatric and psychosocial characteristics, are examined for their ability to distinguish between individuals who (a) did and did not seek help during their episode and (b) chose to consult one professional source rather than another. Results showed that approximately one-third of the sample sought professional help. Respondents consulting mental health specialists were more clinically impaired and had poorer work performance and fewer psychosocial assets than both those consulting nonpsychiatric physicians and those seeking no help. Respondents in the latter two groups were indistinguishable from one another on many of the assessed variables.

Adult↗
PubMed1991

Strategies for evaluating treatments for major depression in primary care patients.

Primary care physicians are being urged to provide patients experiencing a major depression treatments validated with psychiatric patients. The propriety of transferring clinical technologies from one care-giving sector to another is questionable, however, as it has little scientific support. We suggest that clinical trials be initiated so as to expand the available knowledge base. This paper analyzes the methodologic issues involved in pursuing such experimental research and urges that it be conducted despite the possible need for initial design compromises.

Adult↗
PubMed1991

Mental disorders in the primary care setting. Research priorities for the 1990s.

New research directions should be pursued during the coming years if mental illness is to be properly managed in primary medical care practice. Among needed studies are those pertaining to the validity of diagnostic classifications specific to psychiatric morbidity in ambulatory medical settings; the nature of clinical decision-making by primary care physicians; how diagnostic formulations influence treatment choices; and the effectiveness of treatments transferred from the specialist to generalist settings.

Cross-Sectional Studies↗
PubMed1991

Work stress, family stress and depression in professional and managerial employees.

Detailed interviews were conducted with 1523 married professional and managerial employees of a major US corporation to test associations of acute and chronic occupational and domestic stress with DSM-III-R major depression and current depressive symptoms. After controlling for demographic and clinical risk factors, both sources of stress were significantly associated with the two measures of depression. On the other hand, neither the demographic and clinical risk factors, nor several psychosocial characteristics (social support, sense of mastery and organizational commitment) moderated the relationship between stress and depression.

Adaptation, Psychological↗
PubMed1990

Depressive symptomatology and medical co-morbidity in a primary care clinic.

Most primary care patients exhibiting significant depressive symptomatology fail to meet DSM-III criteria for a major depressive disorder (MDD). Yet, such patients have substantial morbidity and dysfunction attributable to their affective syndrome. Since surprisingly little is known about this group's clinical characteristics, we studied 618 general medicine patients aged eighteen to sixty-four years. In this population, fifty-seven (9.2%) scored quite high when screened on the Center for Epidemiological Studies Depression Scale (greater than or equal to 27) while not meeting MDD criteria on the Diagnostic Interview Schedule. Membership in the "depression symptoms only" (DSO) group was predicted by a logistic regression model including female gender, more severe medical illness, higher likelihood of operative procedures, and less frequent cardiovascular diagnoses. Our findings suggest that the DSO state is associated with substantial "medical" morbidity. Prospective studies of subclinical depression in the primary care setting are urged to clarify etiologic and treatment concerns.

Adjustment Disorders↗
PubMed1990

Medical comorbidity of major depressive disorder in a primary medical practice.

Despite much speculation about the relationship between depression and medical comorbidity in primary care settings, few investigators have examined this issue empirically. Using a two-stage screening procedure, we assessed 618 patients aged 18 to 64 years in an academic general medicine clinic. Forty-one patients (6.6%) suffered from a current episode of major depressive disorder (MDD). We compared this group with a 20% random sample of nondepressed patients. While patients with MDD were younger (mean age, 41.1 vs 47.2 years), they were assessed by the Duke University Severity of Illness Scale as having more severe medical illness. Patients with MDD were more likely to have malignant tumors and "ill-defined conditions" than nondepressed patients. The 18 patients with MDD (44%) who were correctly diagnosed by their physicians had less severe medical illness than those whose depression was clinically undetected. A logistic regression model predicting MDD group membership included female gender, younger age, higher Duke University Severity of Illness Scale score, and more frequent inactive ill-defined diagnoses. These findings are consistent with assertions: (1) patients with MDD have more physical illness than nondepressed patients and/or (2) somatic symptoms and disability caused by MDD add to the burden of physical illness.

Adult↗
PubMed1990

Epidemiology of depression and alcohol abuse/dependence in a managerial and professional work force.

Detailed clinical interviews focusing on depression and alcohol abuse/dependence were conducted with 1870 managers and professionals drawn from a major US corporation. Among men, the lifetime and 1-year prevalence rates of DSM-III-R major depression were 23% and 9%, respectively. Among women, the rates were 36% and 17%, respectively. Lifetime and 1-year prevalence rates of DSM-III-R alcohol abuse/dependence were 16% and 4% for men, and 9% and 4% for women. Imposing a requirement that alcohol-related symptoms cluster together in time reduced the lifetime and 1-year prevalence rates to 11% and 3% for men and 5% and 2% for women. The odds ratio for the lifetime occurrence of depression and alcohol abuse/dependence with such clustering was 2.28. The three most important risk factors for depression were being female, separated or divorced, and having a family history of depression. For alcohol abuse/dependence, the most important risk factors were being male, unmarried, and having a family history of alcoholism. Manager/professional status, length of employment, hours worked per day, and supervisory responsibility were not statistically associated with either DSM-III-R major depression or alcohol abuse/dependence.

Administrative Personnel↗
PubMed1989

Treating depression in primary care practice. An application of decision analysis.

Decision analysis approaches complex treatment issues by considering alternative strategies in an explicit and logical manner, and examining their outcomes in the face of varied assumptions. Significant data gaps impede full application of this framework to the treatment of depressed primary care patients. Nevertheless, decision analysis already can be useful in emphasizing needed clinical information in treating these patients and highlighting future directions for research.

Curriculum↗
PubMed1988

Mental disorders in primary care: epidemiologic, diagnostic, and treatment research directions.

An extensive series of investigations over the past 2 decades clearly demonstrate that mental disorders are present in approximately 25% of primary care patients and that physicians underdiagnose these illnesses. The factors producing this bias are poorly understood and should be focused upon in future research. Also requiring much more study is the efficacy of pharmacologic and psychosocial treatments initially validated with psychiatric populations. Clinical trials should determine whether standardized interventions can be utilized with medical patients whose symptom profiles and organic comorbidity may differ from those of psychiatric populations.

Cross-Sectional Studies↗
PubMed1988

Symptom patterns of depression in ambulatory medical and psychiatric patients.

The failure of primary care physicians to recognize depressive disorders in medical patients has been attributed to the differing clinical syndromes presented by these persons in comparison with psychiatric patients. Earlier British studies have found intersector difference in the prevalence and severity of somatic, affective, and cognitive symptoms. Our investigation with American patients did not replicate these findings. The need for further research along these lines is discussed, as are the implications for assessing depression in generalist and specialist practices.

Adult↗
PubMed1987

A comparative analysis of two community stressors' long-term mental health effects.

The investigation directly compared the long-term mental health consequences of two community-wide stressors, the Three Mile Island (TMI) nuclear accident and widespread unemployment due to layoff, in demographically comparable samples of women. Results showed a marked degree of similarity in the stressors' effects: Levels of subclinical symptomatology were elevated to similar degrees in each sample during the year following stressor onset, and symptom levels remained elevated in each sample 2 to 3 1/2 years later. Moreover, variables identified as predictors of enduring psychological distress were virtually identical for the two samples. Additional analyses revealed that the mental health status of unemployed husbands mediated the negative psychological effects of layoff on their wives. Implications of these results for understanding the long-term consequences of exposure to community-wide stress are discussed.

Accidents↗
PubMed1987

Ambulatory mental health liaison research: a review and preview.

Mental health liaison in primary care is a complex technology requiring scientific study and validation if we are to know when, where, and how to utilize it. Earlier studies have raised as many questions as they have resolved. Recommendations for future research are presented in relation to such issues as: How should mental health consultation/liaison be defined? How should consultation/liaison studies be prioritized? What aspects of consultation/liaison should be studied? What methodologies are appropriate?

Ambulatory Care Facilities↗
PubMed1987

A conceptual model for educating primary care providers in the diagnosis and treatment of depression.

Primary care physicians consistently have been found to under-recognize or misdiagnose depressive disorders. However, it remains unclear whether diagnostic accuracy is related to the physician's knowledge base, interviewing skills and behavior, problem solving ability, and/or attitudes towards these disorders. As strategies are contemplated for improving physician recognition of depression, it is clear that psychiatric education must be guided by a comprehensive conceptual model. Such a model is proposed based upon the several educational domains intrinsic to the mastery of clinical diagnosis.

Attitude of Health Personnel↗
PubMed1987

Screening procedures in psychiatric care. A practice whose time has come.

The papers by Cleary et al. and Koran et al. extend the boundaries of psychiatric screening practice in several significant directions. They illustrate procedures for resolving both scientific and practical issues intrinsic to the construction of screening procedures and, thereby, advance the state of the art. It is hoped that ROC analyses will be used more commonly to establish cohort-specific screening cutpoints and that diagnostic prediction rules will increasingly utilize fiscal as well as clinical parameters. If these developments should come to pass, the contributions by these authors are certain to be recalled for the critical impetus they have provided.

Diagnosis↗
PubMed1987

Mental health effects of the Three Mile Island nuclear reactor restart.

Controversy over potential mental health effects of the Three Mile Island Unit-1 restart led the authors to examine prospectively the pattern of psychiatric symptoms in a sample of Three Mile Island area mothers of young children. Symptom levels after restart were elevated over previous levels; a sizable subcohort of the sample reported relatively serious degrees of postrestart distress. History of diagnosable major depression and generalized anxiety following the Three Mile Island accident, plus symptoms and beliefs about personal risk prior to the restart, best predicted postrestart symptoms.

Accidents↗
PubMed1987

Recognition of alcoholism and substance abuse in primary care patients.

Alcohol and other substance abuse are frequently seen in primary medical practice but are underdiagnosed. Forty-two (14%) of 294 adult primary care patients suffered from alcohol or other substance abuse, as diagnosed by a structured psychiatric interview. Primary care physicians identified 17 (40%) of these patients, as well as another patient identified during a six-month follow-up period, as having a substance abuse problem at initial clinical evaluation. Clinically identified substance abusers were older, more likely to be married, and more often used multiple drugs. They more frequently had antisocial personality disorders, while patients not clinically recognized were often depressed. Logistic regression analysis indicated that the presence of antisocial personality, the absence of a coexisting depressive disorder, and better social functioning scores were the factors most strongly associated with clinical recognition. The study suggests clinical judgment issues, which may be useful to physicians in training to improve their recognition and treatment of substance abuse disorders.

Alcoholism↗
PubMed1986

Long-term reliability of diagnosing lifetime major depression in a community sample.

Limited information is available on the reliability of diagnostic assessments in community populations. This study analyzed the 18-month test-retest stability of lifetime major depression determined from the Schedule for Affective Disorders and Schizophrenia-Lifetime Version using the Research Diagnostic Criteria. Overall, the reliability among the 391 female subjects was poor. Clinical status during the 18-month interval influenced reliability, while demographic, psychosocial, and interviewer characteristics were unrelated. The women who reliably reported lifetime episodes of depression were consistent about details such as medication use, but were inconsistent about other features, eg, number of episodes, length of longest episode, and age at first episode. The results suggest the need for caution in analyzing data on the lifetime prevalence of depression in community samples.

Adult↗