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Biomedical subjects

H G Koenig

Publications and source records attributed to H G Koenig.

At least 73 records · Page 4Linked to original sources
PubMed1997

Religious coping in the nursing home: a biopsychosocial model.

OBJECTIVE: To examine psychosocial and physical health correlates of religious coping in medically ill chronically institutionalized older adults. Religious coping is defined as the extent to which persons use religious beliefs and practices to help them to cope. METHOD: This is a cross-sectional cohort study conducted in a 120 bed VA-affiliated and a 125 bed university affiliated community-based nursing home in Durham, North Carolina. Participants were 115 chronic care nursing home residents; mean age of the sample was seventy-nine years, 44 percent were women, and 17 percent were African Americans. Subjects were enrolled for a one-month period during which comprehensive psychosocial and health assessments were performed, including evaluation of cognitive function (Mini-Mental State Exam), physical function (Barthel index), severity of medical comorbidity (Cumulative Illness Rating Scale), self-reported physical pain (vertical verbal descriptor scale), depressive symptoms (Geriatric Depression Scale), social support (social network), and religious coping (Religious Coping Index). RESULTS: Over 43 percent of the sample scored in the depressed range of the Geriatric Depression Scale. Almost 60 percent reported they used religion at least to a large extent when coping with their problems; 34 percent said that it was the most important factor that enabled them to cope. Patients who used religion to cope had greater social support (p = .01), more severe medical illness (p = .04), and better cognitive functioning (p = .02). CONCLUSIONS: Religious beliefs and practices are frequently used by chronically institutionalized older adults to help them to cope. Religious coping is associated with more severe medical illness, higher social support, and better cognitive functioning.

Activities of Daily Living↗
PubMed1997

Modeling the cross-sectional relationships between religion, physical health, social support, and depressive symptoms.

The authors examined models of the relationships between religious activities, physical health, social support, and depressive symptoms in a sample of 4,000 persons age 65 and over. Religious activity was examined first as a single composite construct and then split into three component variables that were examined individually. Religious activity as a single construct was correlated with both social support and good physical health but was unrelated to depression. Split into the three components, model fit was significantly increased. Frequency of church attendance was positively related to physical health and negatively related to depression, but was surprisingly unrelated to social support. Frequent churchgoers were about half as likely to be depressed. Private prayer/Bible reading was negatively correlated with physical health and positively correlated with social support, but unrelated to depression. Religious TV/radio listening was unrelated to social support, negatively related to good physical health, and, unexpectedly, positively associated with depression.

Activities of Daily Living↗
PubMed1997

Psychosocial predictors of mental health in a population of elderly women. Test of an explanatory model.

The understanding of adjustment to aging calls for models that illustrate the interaction of psychosocial and health factors. The authors surveyed a group of retired Catholic sisters, examining the contributions of psychosocial factors and religiousness to life satisfaction, psychological distress, and depression. Life satisfaction was best explained by a four-factor model that included mastery, social support, physical functioning, and religious commitment. General level of distress was best predicted by physical functioning, social support, and mastery, but not religiousness. Depression, on the other hand, was predicted by mastery, social support, and religious commitment. These data are consistent with a proposed model in which internal, external, and coping resources mediate the psychological impact of impaired functional status.

Activities of Daily Living↗
PubMed1997

The Center for Epidemiological Studies-Depression (CES-D) Scale: assessment of depression in the medically ill elderly.

This study examines the use of the Center for Epidemiological Studies-Depression Scale (CES-D) in a sample of elderly, medically ill inpatients. Seventy-six individuals completed the CES-D and a psychiatric interview, from which DSM-III-R diagnoses of depression were obtained. Analyses of sensitivity and specificity indicated that use of an alternative scoring method which more closely approximates current diagnostic criteria for depression may improve the predictive power of the test. Employment of stringent cut-scores was not supported, as sensitivity was compromised. Item analyses demonstrated that seven of the CES-D items failed to discriminate major, minor and nondepressed patients, and that several of these items tapped somatic symptoms. These findings suggest that the validity of the CES-D may be compromised when used with elderly medical patients. and modifications for its use are recommended.

Aged↗
PubMed1996

Attitudes of elderly patients and their families toward physician-assisted suicide.

OBJECTIVES: To examine and compare attitudes of elderly outpatients and their families toward physician-assisted suicide (PAS), explore sociodemographic and health correlates of these attitudes, assess family members' ability to predict patients' attitudes toward PAS, and determine family members' ability to agree on these predictions. SUBJECTS AND METHODS: Elderly patients with medical and psychiatric problems (n = 168; mean age, 75.8 years) who were attending a geriatrics specialty clinic, along with accompanying family members (n = 146), were systematically surveyed on their attitudes toward PAS in case of terminal illness, chronic illness, and mental incompetence. Relatives were also asked to predict patients' responses to items on the questionnaire. Patients and relatives were blinded to each others' responses. RESULTS: Favorable attitudes toward PAS were reported by 39.9% of the patients and 59.3% of the relatives (P < .001) in case of terminal illness, 18.2% and 25.3%, respectively, in case of chronic illness, 13.5% and 15.4%, respectively, in case of mental incompetence, and 34.0% and 55.6% (P < .001), respectively, for legalization of PAS. Family members showed a marginal ability to predict patients' attitudes toward PAS with kappa values of agreement that ranged from 0.09 to 0.41. Family members also had difficulty agreeing with each other on how they thought patients would respond (range of kappa values, 0.18-0.47). Patients who opposed PAS were women, black individuals, and those with less education, low incomes, and dementia or cognitive impairment. CONCLUSIONS: While many frail elderly patients favored PAS in cases of terminal illness, the proportion that opposed it was significantly higher than that among relatives; relatives, in turn, displayed only a marginal ability either to predict patients' attitudes or to agree among themselves. Patients who oppose PAS represent a particularly vulnerable element of society (elderly persons, women, black individuals, and poor, uneducated, and demented persons), and such patients may warrant special protection.

Aged↗
PubMed1996

Posttraumatic stress, mental health professionals, and the clergy: a need for collaboration, training, and research.

This article addresses the need for improved clergy-mental health professional collaboration in the assessment and treatment of posttraumatic stress disorder (PTSD). Tens of millions of North Americans with personal problems seek the counsel of clergy. There is an absence of research on the function of clergy as helpers with the traumatized and on the psychological dynamics of religious coping among the traumatized. Psychological trauma presents the mental health and religious communities with unique opportunities to work together in the best interest of those they serve.

Community Health Planning↗
PubMed1996

Depression and medical illness in late life: report of a symposium.

The high comorbidity of medical illnesses and late life depression poses both challenges and opportunities. Challenges in assessment techniques, diagnosis, and specific prognosis affect clinical care and research methodology alike. However, investigations that turn this vexing "confound" into research questions may prove fruitful. For clinicians working with older persons, recognizing the prognostic import of comorbid medical illnesses in late-life depression is essential to treatment planning. This comorbidity also poses difficulties in diagnosing depression inasmuch as symptoms of the medical conditions may overlap with those of an affective disorder. Symptom assessments must strike a balance between overly inclusive (e.g., mistakenly treating the psychomotor slowing of Parkinson's disease as depression) and overly exclusive (e.g., erroneously dismissing the patient's mood symptoms as "understandable"). Clinicians also should be sensitive to the broad range of symptomatic presentations with varying severities of both mood and medical disorders, as exemplified by variability across treatment settings. For researchers, similar issues are of relevance in planning investigative strategies. Consideration should be given to the following: 1. Case identification is a crucial first step; the approach to depressive symptoms potentially confounded by medical illnesses must be defined explicitly. Choice of an inclusive approach avoids premature exclusion of relevant phenomena; exploratory analyses can examine the effects of other approaches to the relationships of interest. 2. The use of similar research instruments across sample sites would greatly facilitate comparisons of results. Each subject group offers its own "leverage" for answering particular questions. Psychiatric inpatients will highlight the contributions of severe psychopathology (useful, for example, in identifying biologic markers). Medical inpatients are well suited to studies examining validity of different approaches to case identification, investigating health service utilization, or highlighting the contribution of acute, severe, life-threatening medical disorders to affective illness. Long-term care residents lend themselves to issues that benefit from compression of health processes over time. Medical outpatients have many advantages regarding generalizability and public health significance. Community samples are needed to determine the biases of all the above groups, which are each defined by service utilization. 3. Study of the relationships between depression and medical illness may further understanding of pathogenic mechanisms in late life mood disorders. Research questions might be guided by the biopsychosocial conceptual context described above. On the one hand, this context demands multidimensional study methodology to identify the routes by which medical illness influences depression in particular patient groups. Multivariate models should examine direct and indirect effects of medical illness on depression while, at the same time, considering intervening variables such as functional disability, personality, and social support. Guided multiple regressions or structural equation modeling will allow for determination of strengths of associations. 4. At the same time, and of particular importance if complex multivariate analyses are used, specific theoretic models should help direct focused investigations. The development and testing of such models is a major challenge that should be addressed by current research. Finally, from a societal perspective, the comorbidity of depression and medical illness likely has a tremendous impact on both health and health care delivery for older adults. Further study is needed to identify more specific approaches to treatment. Yet existing data clearly support a policy of routine psychiatric assessment of older people in general medical settings...

Age Factors↗
PubMed1996

Minor depression: a review of the literature.

OBJECTIVE: The clinical experience of the authors has suggested there is a significant group of elderly and individuals with medical illness and depressive symptoms who do not meet DSM-IV criteria for major depression. We were interested in all available data regarding minor depression in both the medically ill and community individuals. METHODS: MEDLINE was searched from 1965 to 1995, using the terms "depressive disorders" and "medical illness," as well as "atypical depression" and "elderly." Relevant references from these primary articles were also utilized. RESULTS: In medical patients, depressive symptoms were associated with decreased likelihood of discharge to home. Although diagnostic criteria vary, some suggest anhedonia as the central feature. From 3 to 16 percent of medical outpatients suffer from minor depression. Up to 64 percent of medical inpatients will complain of depressed mood. Studies in community samples found that minor depression was responsible for 9 to 16 percent of total disability days, and was associated with absenteeism from work, as well as separation and divorce. Little is known about the natural history and prognosis of minor depression. CONCLUSIONS: Minor depression is both common and has a significant impact on the health care system, and therefore deserves further study.

Adult↗
PubMed1995

Assessing diagnostic approaches to depression in medically ill older adults: how reliably can mental health professionals make judgments about the cause of symptoms?

OBJECTIVE: To evaluate the reliability of the DSM-IV approach and five other schemes for counting symptoms toward the diagnosis of depression in hospitalized medically ill older patients and to examine whether mental health professionals can reliably make judgments about the etiology (medical or psychological) of depressive symptoms. METHOD: A sample of 38 patients aged 60 years or older admitted to the general medicine, cardiology, or neurology services at Duke University Medical Center were evaluated for depression using a structured psychiatric interview and the Hamilton Depression Scale. Interrater reliability for the diagnostic schemes, for unstructured clinical diagnoses, and for determinations of the causes of individual depressive symptoms was assessed by three pairs of mental health professionals. RESULTS: Agreement between raters for structured diagnoses was high regardless of diagnostic strategy, with the DSM-IV approach being only slightly less reliable than the strict inclusive approach (Kappa 0.88 vs Kappa 1.0, respectively). For all diagnostic approaches, there was perfect agreement between raters for eight cases of major depression. Agreement for unstructured clinical diagnoses of depression (K = 0.50) was much lower than for the structured diagnoses. Agreement between raters on the etiology of individual depression criterion symptoms assessed by structured interview was greater than 80% for 14 of 19 symptoms. Correlation between raters' depression severity ratings on the Hamilton Scale using the DSM-IV etiologic approach was equivalent to that using the strict inclusive approach (0.98 vs 0.95, respectively). CONCLUSIONS: Mental health professionals can be trained to make judgments reliably about the cause (medical or psychological) of symptoms in hospitalized older medical patients. The "strict inclusive" and other diagnostic schemes for counting symptoms toward the diagnosis of depression have only marginal, if any, benefit compared with the current DSM-IV approach.

Age Factors↗
PubMed1995

Depression and anxiety disorder among older male inmates at a federal correctional facility.

The conditions of incarceration and the sociodemographic and health characteristics of 95 older male inmates of a federal correctional facility were studied to determine the relationship of such variables to rates of psychiatric disorder among older male inmates. A total of 51 inmates (53.7 percent) met one-month criteria for psychiatric disorder, a much higher rate than among a community sample of men in the same geographic area. Compared with inmates without such disorders, inmates with disorders were likely to be younger, to have a history of psychiatric disorder and substance abuse, to have poorer physical health, to have impaired social support, and to be serving a determinate sentence with no possibility of parole. Few were receiving treatment while incarcerated.

Age Factors↗
PubMed1995

Hospital stressors experienced by elderly medical inpatients: developing a Hospital Stress Index.

OBJECTIVE: To develop a long and short version of an index to measure experiences during hospitalization perceived by elderly patients as stressful. SAMPLES AND METHODS: Consecutive patients aged sixty or over admitted to a university teaching hospital were assessed for hospital-related stressors during two separate studies. In the first study, seventy-six patients were asked an open-ended question exploring what they found most stressful about being in the hospital. Responses were grouped into major categories, and questions were developed to address concerns in each category; the resulting forty items were called the Hospital Stress Index (HSI). The HSI was then administered to a separate group of ninety-two patients; data were also collected on functional disability (impaired ADLs), dysfunctional attitudes (DAS), and depressive symptoms (CES-D). RESULTS: Spontaneously reported hospital stressors were grouped into seven categories: 1) adverse effects of diagnostic or therapeutic procedures/treatments, 2) forced life-style changes, 3) relationships with staff, 4) individual psychiatric issues, 5) understanding diagnosis/prognosis, 6) family issues, and 7) the physical environment. The largest category of stressors concerned relationships with doctors and nurses. High HSI scores were significantly more common among Whites than Blacks and among patients with high CES-D, high DAS, or impaired ADLs scores. A number of potentially modifiable hospital-related stressors and individual patient issues were identified. Finally, an abbreviated fifteen-item HSI was developed to maximize patient discriminability, highlight individual differences, and enhance the detection of modifiable stressors. CONCLUSIONS: Hospital-reported stressors may contribute to the emotional distress that elderly inpatients experience. We have developed an index to identify such stressors.

Activities of Daily Living↗
PubMed1995

Anxiety in medically ill older patients: a review and update.

OBJECTIVE: The authors review the evaluation and treatment of anxiety symptoms in elderly patients, with particular emphasis on elderly patients with chronic medical illness. METHODS: A computer search for articles addressing anxiety symptoms in patients sixty-five and older was supplemented by the authors' clinical experience and knowledge of other literature and textbooks relevant to the topic. RESULTS: Ten to 20 percent of older patients experience clinically significant symptoms of anxiety. Anxiety complaints may represent the physiological consequence of treatable medical illness, the result of psychiatric illness, or an exaggerated or normal response to life events. Both psychopharmacologic and nonpharmacologic treatments can be effective in relieving symptoms. CONCLUSIONS: Careful differential diagnosis is an essential preliminary step to successful treatment. Non-pharmacologic interventions (behavioral treatments, in particular) may be effective for many patients. Consideration of both the benefits and the risks of medication management is recommended, as elderly patients are especially vulnerable to side effects.

Aged↗
PubMed1994

Mental health care for older adults in the year 2020: a dangerous and avoided topic.

Low Medicare reimbursement rates are already causing some mental health professionals to turn away elderly patients, restricting access to care. Where will funds come from to pay for the mental health needs of older adults in the year 2020, when 80 million baby boomers pass age 65? This cohort, in contrast to elders today, have high rates of psychiatric illness, and are also much more likely than older adults to seek mental health services. Seemingly oblivious to these trends, plans are being made to cut, rather than expand, the Medicare budget. We are projecting an increasing gap over the next 25 years between need and availability of geriatric mental health services.

Adolescent↗
PubMed1994

Religious practices and alcoholism in a southern adult population.

OBJECTIVE: The study examined associations between religious variables and alcohol abuse and dependence among 2,969 North Carolina residents aged 18 to 97 who participated in the 1983-1984 National Institute of Mental Health Epidemiologic Catchment Area survey at its Piedmont location. METHODS: Six-month and lifetime prevalence of alcohol disorders were compared among participants reporting varying levels of religious activity. Data were collected on frequency of Bible reading, prayer, and church attendance; time spent watching or listening to religious programming on television or radio; importance of religion; religious denomination; and identification as "born-again" Christians. RESULTS: Recent and lifetime alcohol disorders were less common among weekly churchgoers and those who considered themselves born again. Recent, but not lifetime, alcohol disorders were also less common among respondents who frequently read the Bible or prayed privately. Alcohol disorders were more common among those who frequently watched or listened to religious television and radio. Lifetime, but not recent, alcohol disorders were more prevalent among members of Pentecostal denominations. CONCLUSIONS: Longitudinal study is necessary to further clarify and explain these relationships between religious practices and alcohol disorders.

Adolescent↗
PubMed1994

Religious affiliation and psychiatric disorder among Protestant baby boomers.

OBJECTIVE: The authors examined the relationship between religious affiliation and psychiatric disorder among Protestant members of the baby-boom generation (those born between 1945 and 1966) who resided in the Piedmont area of North Carolina. METHODS: Data were obtained on six-month and lifetime rates of major psychiatric disorders among 853 Protestant baby boomers during wave II of the National Institute of Mental Health's Epidemiologic Catchment Area survey, conducted in 1983-1984. Participants were grouped into three categories based on religious affiliation: mainline Protestants, conservative Protestants, and Pentecostals. Rates of disorder were compared across denominational groups, controlling for sex, race, physical health status, and socioeconomic status and stratifying by frequency of church attendance. The analyses were repeated for 1,826 middle-aged and older Protestants born between 1889 and 1944, and the results were compared with the findings for baby boomers. RESULTS: Among the baby boomers, Pentecostals had significantly higher six-month and lifetime rates of depressive disorder, anxiety disorder, and any DSM-III disorder. Mainline Protestants had the lowest six-month and lifetime rates of anxiety disorder and the lowest six-month rates of any DSM-III disorder, whereas conservative Protestants had the lowest six-month and lifetime rates of depressive disorder and the lowest lifetime rates of any DSM-III disorder. These relationships among baby boomers were weaker among middle-aged and older Protestants, although a new association with alcohol abuse or dependence emerged among older Pentecostals. When analyses were stratified by frequency of church attendance, associations between psychiatric disorder and Pentecostal affiliation were strongest among infrequent churchgoers, a group also unlikely to seek help from mental health professionals. CONCLUSIONS: Young adult Pentecostals in the Peidmont area experienced high rates of psychiatric disorder, which was not generally true for Pentecostals who were middle aged or older. Infrequent churchgoers appeared to be at greatest risk, although they seldom sought professional help for their problems.

Adult↗
PubMed1993

Profile of depressive symptoms in younger and older medical inpatients with major depression.

OBJECTIVE: To examine and compare the profile of cognitive symptoms, somatic symptoms, and somatic complaints in younger and older medical inpatients diagnosed with major depressive disorder (MDD). DESIGN: Cross-sectional cohort. PATIENTS AND SETTING: Male patients aged 20-39 years (n = 116) and aged 70-102 years (n = 332), consecutively admitted to the medical and neurological services of a VA medical center, underwent psychiatric evaluations for depression. MEASUREMENTS: Depressive symptoms were measured using the observer-rated Hamilton Depression Scale and the self-rated Geriatric Depression Scale using an "inclusive" approach (symptoms rated regardless of etiology). Data on 12 common somatic complaints were also collected. Clinical diagnoses of MDD were made by a psychiatrist based on the Diagnostic Interview Schedule and other psychiatric and physical health data. RESULTS: After controlling for severity of medical illness, functional status, and alcohol use, symptoms that discriminated MDD best among younger men were loss of interest, feelings of guilt or of being a burden, suicidal thoughts, and depressed mood (primarily cognitive and affective symptoms). Among older men, loss of interest, insomnia, suicidal thoughts, and hypochondriasis most strongly differentiated depressed from non-depressed patients (mixture of cognitive and somatic symptoms); fatigue, weight loss, genital symptoms, and somatic anxiety were weakly related or unrelated to MDD. Number of somatic complaints (headache, dizziness, palpitations, etc.) helped differentiate patients with MDD; although equally common among depressed young and older patients, a distinct pattern of complaints emerged in each age group. CONCLUSIONS: Cognitive symptoms of depression can help to distinguish medical inpatients with and without MDD. In older adults, however, somatic symptoms cannot be ignored and may be more important for diagnosing MDD than previously realized. These findings will help clinicians identify patients with MDD and differentiate them from non-depressed patients with medical illness.

Activities of Daily Living↗