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Biomedical subjects

H Dilling

Publications and source records attributed to H Dilling.

At least 73 records · Page 4Linked to original sources
PubMed1983

Psychotherapy services and the prevalence of mental disorders in urban and rural areas.

This study addresses the issue of need for and provision of psychotherapy care in urban and rural areas. In the first part, prevalence of mental disorders based on epidemiological field studies in the county of Traunstein and the city of Mannheim are discussed. Among patients of general practitioners the prevalence of mental disorders was slightly higher in Mannheim than in Traunstein. Concerning the provision of care, results of a questionnaire survey of a random sample of 1542 nonmedical counsellors or psychotherapists in Traunstein, Mannheim and the metropolitan area of West Berlin are presented. The rate of nonmedical therapists/100,000 inhabitants was the same for Traunstein and Mannheim. A more detailed analysis of their service capacity revealed that it was by 17% to 20% higher for Mannheim than for Traunstein; the prevalence of mental disorders in patients of general practitioners was shown to be about 10% higher in Mannheim than in Traunstein. Under the assumption that there is a linear relationship between prevalence and need for care, there appears to be a slight, but not marked undersupply of services by doctors and nonmedical counsellors or psychotherapists in Traunstein as compared to Mannheim. In comparison, the districts of West Berlin were classified into those with high and those with a low percentage of blue collar workers. The rate of nonmedical counsellors or psychotherapists in the "upper class" districts in West Berlin was almost four times higher than that for the "lower class" districts of West Berlin, in Mannheim and Traunstein. The rate/100,000 for the service capacity of nonmedical counsellors or psychotherapists in the "upper class" districts of West Berlin was much higher, and in the "lower class" districts of West Berlin much lower, than in Traunstein or Mannheim. Our data show that there are some discrepancies in the provision of care between rural and urban areas, which however are not large when Traunstein is compared with Mannheim; there were however, substantial discrepancies in the provision of care between cities (Mannheim and West Berlin) and between districts within the same city (West Berlin).

Community Health Services↗
PubMed1982

[Problems in case identification using a semi-structured psychiatric interview as exemplified by an epidemiological study in general practices (author's transl)].

From 1973 to 1974 research psychiatrists studied 1,274 patients in general practices in the county of Traunstein (FRG). On the basis of an interview developed by Goldberg et al. (1970), it could be shown that objective symptoms registered by the interviewers generally differentiate better between cases and non-cases than do subjective symptoms. According to the weighting suggested by the developers of the interview, singly weighting the subjective and doubly weighting the objective symptoms, a total score was compared with the psychiatric diagnosis made by the interviewer. At a cut-off of 20 points, the overall agreement reached an optimum of 83.1% and increased only slightly due to a-posterior weighting of the items. A cluster analysis of the symptoms showed that patients demonstrate significantly different combinations of symptoms according to the nature of their mental disorder.

Diagnosis, Differential↗
PubMed1982

Some problems concerning the reliability and structure of the scales in the inpatient multidimensional psychiatric scale (IMPS).

Two problems concerning the IMPS are revealed. First, the importance of an appropriate reliability measure is demonstrated in a sample of 124 inpatients. Widely divergent results are found using three different intraclass correlation coefficients. The one producing the highest results was used by Klett and McNair (1966) and by Behrends et al. (1971). However, the results from this measure only apply to certain types of investigation. A measure more applicable to most investigations in psychiatric research (the intraclass correlation coefficient of individual ratings with between-rater variance included) produced results that were clearly lower, although still acceptable, with an average correlation of 0.72 between the 12 scales. Secondly, the multiplication of item scores by 2 or 8 when forming the scale scores is shown to lead to unusual and undesirable scale distributions in a sample of 1932 inpatients. The resulting implications for assessing change scores on some of the IMPS scales are discussed.

Adolescent↗
PubMed1981

[Appearance and frequency of mental diseases. Epidemiological investigations (author's transl)].

After a survey of the earlier psychiatric epidemiological studies carried out in Munich, particularly the work of Brugger, three investigations carried out by the Munich Psychiatric Hospital in the last decade are described: a study to determine the administrative prevalence and incidence in the afflux area of the Gabersee District Hospital, an investigation to determine the frequency of psychic disorders among the patients of doctors in private practise and finally a field study which served to establish the true morbidity in the population. For mental disorders needing therapy a prevalence of 18.5% was found which is primarily based diagnostically on neurotic and psychosomatic diseases. To cover the need for treatment it is not proposed that specialist care should be extended but rather that the competence of the practising physician with regard to psychiatric diseases be considerably strengthened.

Adolescent↗
PubMed1980

Incidence and prevalence of treated mental disorders. Health care planning in a small-town-rural region of Upper Bavaria.

An analysis of those to be cared for and those destined to provide the care is necessary, in order to develop an effective system of mental health care. Such an analysis is given here for a rural-small-town region of Upper Bavaria with 424,000 residents. The treated incidence and prevalence are presented according to sex, age and diagnosis. The morbidity rates for patients from communities of various sizes and distances from the institution of treatment are discussed as an example of ecological analysis. The future planning for the research area should be based on varied community-centred possibilities for psychiatric care.

Adolescent↗
PubMed1978

[Epidemiology of mental disorders and psychiatric care. Part 2. Discussion of results].

A prior analysis of treated patients is required in order to develop effectively a system of psychiatric health services. Data are presented respectively for a rural small town area of Upper Bavaria with 424,000 residents. Incidence and prevalence rates of treated mental illness are considered according to various criteria, especially diagnosis. Morbidity rates for localities of varying size are cited as an example of ecological approach. When planning, one must conclude the necessity for differentiated psychiatric treatment within the community, with emphasis on outpatient services.

Adult↗
PubMed1978

[On the importance of the geographical position of psychiatric hospitals for the admission rates and hospitalization period (author's transl)].

Rates of admission, duration of hospitalization, chances of discharge and legal basis of admissions are analyzed with reference to the distances between the patients' domiciles and the hospital, basing on the figures which apply to the district hospitals Gabersee in Upper Bavaria. More patients from nearby are admitted, and also given long-term treatment, than from the more distant zones; in the long run, chances of discharge are not more favorable for patients living nearby; there is no variation regarding the share of voluntary admissions in relation to the distances between the respective domiciles and the hospital. These results show that there must be increased cooperation between hospitals or wards for inpatients, partial inpatients, and outpatients, in view of the expected increased hospitalization frequency in future psychiatric practice located in the immediate vicinity of the individual districts. Under no circumstances should it happen that instead of the expected saving in the number of hospital beds, the overall capacity of the hospitals is increased.

Geography↗
PubMed1978

[Requirement and need of treatment - deliberations on psychiatric care (author's transl)].

The article defines the terms "requirement", "need" and "need of treatment", and explains their significance in the field of psychiatric care. The fundamentals of assessing the requirement are discussed, as well as the associated problems: recording and registration of patients in need of treatment, their readiness to undergo such treatment, and possible alternatives of hospitalisation. For establishing criteria required to determine the need treatment symptoms from two semi-standardised psychiatric interviews are examined for suitability (Present State Examination and Goldberg Interview); likewise, the severity of the disease, the stress from which the patient suffers, and the impairment of social relations, are also examined for suitability. It is suggested to take these criteria as basis and to operationalise the need of treatment on these lines. Relevant studies to assess the usefulness of these criteria are under way in two research projects of the Special Research Division 166 "Psychiatric Epidemiology".

Humans↗