Biomedical subjects
J H Boyd
Publications and source records attributed to J H Boyd.
One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites.
One-month prevalence results were determined from 18,571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemiologic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (less than age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.
The use of ambulatory services by persons with and without phobia.
The delivery of ambulatory mental health and general health services to persons with phobias (unweighted n = 1,689) and without phobias during a 6-month period are examined. The phobics were part of a larger study of 18,572 subjects, drawn as a representative sample of the population in five locations, as part of the Epidemiologic Catchment Area Program (ECA). Among phobic conditions, agoraphobia most often leads to use of services related to emotional problems, especially in the specialty mental health sector. There were no significant differences between male and female subjects in their use of the various sectors for a mental health reason. The highest age group of agoraphobics that used health services most often was 25-44 years old, and the group that used them least often was 65 years and older. Agoraphobics with four or more symptoms of panic use services in higher proportions than agoraphobics with zero to three panic symptoms. The authors observe that a very large proportion of phobics report seeking no help from any source.
Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults.
Data from the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program, an epidemiologic survey of five communities, showed that four major disorders commonly begin in late adolescence or young adulthood. The median age at onset for anxiety disorders is 15 years; for major depressive episode, 24 years; for drug abuse or dependence, 19 years; and for alcohol abuse or dependence, 21 years. Findings also suggest that for respondents 18-30 years old, having a major depressive episode or anxiety disorder doubles the risk for later drug abuse or dependence.
The couch and the cloth: the need for linkage.
Data from the Epidemiologic Catchment Area study were used to compare the demographic characteristics and psychiatric symptomatology of persons classified into four groups based on source of mental health services: clergy only, mental health specialists only, both clergy and mental health specialists, and neither source. Those receiving services from both clergy and mental health specialists were more likely to have major affective and panic disorders than those who sought services from clergy or mental health specialists only or who sought services from neither. Those in the care of mental health specialists were more likely to have substance abuse disorders. Those in the care of clergy only were as likely as those seeing mental health specialists only to have serious mental disorders. The data make clear the need for formal linkages between clergy and mental health professionals.
Lifetime prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles.
The lifetime prevalence of specific DSM-III-defined psychiatric disorders among 1243 Mexican-American and 1309 non-Hispanic white residents of two Los Angeles communities is reported from the Los Angeles site of the Epidemiologic Catchment Area (ECA) research study. Results from household interviews in response to the National Institute of Mental Health Diagnostic Interview Schedule revealed overall rates of disorders for the total Los Angeles sample and ethnic subsamples that were similar to rates reported from the initial three ECA sites. Non-Hispanic whites reported far more drug abuse/dependence and more major depressive episodes than Mexican Americans. Young non-Hispanic white women reported high rates of major depressive episodes and drug abuse/dependence. Alcohol abuse/dependence is highly prevalent among Mexican-American and non-Hispanic white men of any age. Mexican-American women infrequently abuse or become dependent on drugs or alcohol at any age. Dysthymia, panic disorder, and phobia are somewhat more prevalent among Mexican-American women over 40 years of age compared with both non-Hispanic white women over and Mexican-American women under 40 years of age. Antisocial personality is predominantly a disorder of young men of both ethnic groups.
Intimal integrity and fibrinolytic potential of reversed and in situ vein grafts.
The improved patency rates of in situ vein grafts are attributed to better flow characteristics, anastomotic "fit," and intimal preservation. This study compared the early changes in intimal morphology and fibrinolytic activity of in situ and reversed vein bypass grafts from mongrel dogs. Four to six centimeter in situ and reversed vein segments were used to bypass left and right femoral and internal carotid arteries, respectively. Heparin (100 U/kg) was administered before arterial clamping. Anastomoses were fashioned end to side and the intervening artery was ligated. Fifty-two grafts were harvested at day 1 (12 grafts), day 7 (16 grafts), day 14 (12 grafts), and 12 weeks (12 grafts). The veins were analyzed for histologic changes by light microscopy and scanning electron microscopy. The fibrinolytic activity of the grafts was assayed by the fibrin slide and fibrin plate techniques. There were no significant differences in morphology or fibrinolytic activity between the reversed and in situ grafts at any time period. These findings indicate that the improved patency rates associated with in situ grafts are not dependent on improved preservation of intimal structure or fibrinolytic activity.
Natural course of the human bite wound: incidence of infection and complications in 434 bites and 803 lacerations in the same group of patients.
Human bites and common lacerations are frequent in certain residential groups in institutions for the care of developmentally disabled individuals. We screened the records of such an institution and studied the course and outcome of 434 human bite wounds and 803 lacerations in the same group of clients. Infection developed in 13.4% of the lacerations, and 17.7% of the bite wounds (chi 2 = 3.474; p greater than 0.06). Prophylactic antibiotics were administered after 14.0% of the bite wounds, and 3.2% of the lacerations. Infection supervened after prophylactic antibiotics in 29.5% of the bites and 34.6% of the lacerations. No patient with a bite wound required debridement, initial or subsequent surgical intervention other than wound closure, admission to hospital, or intravenous antibiotics. There is no recorded instance of a bite wound complication other than immediate loss of tissue. These data substantiate a higher incidence of infection in human bite wounds, but they are scant support for admonition that such wounds are indication for routine antimicrobial prophylaxis or aggressive surgical intervention.
Season of birth: schizophrenia and bipolar disorder.
Studies investigating the association between the risk of schizophrenia and season of birth are reviewed and the association clearly established. This association cannot be explained on the basis of age-incidence or age-prevalence artifacts. Other studies suggest there may be an association between bipolar disorder and season of birth. The leading theory in explaining the season of birth phenomenon is that a seasonal factor (such as viral infection, malnutrition, vitamin deficiency, prenatal or obstetrical complications, or ambient temperature) can damage an infant's brain and thereby predispose the child to later development of psychosis. Evidence suggests that the seasonal effect is associated with a subgroup of schizophrenics who have early onset of psychosis, less genetic loading than other schizophrenics, and better prognosis. Case-control studies are needed comparing winterborn to nonwinter-born schizophrenics.
Use of mental health services for the treatment of panic disorder.
The author reports the results of five studies of panic disorder undertaken as part of the Epidemiologic Catchment Area Program of the National Institute of Mental Health (NIMH). This program involves community samples in New Haven, Conn. (N = 5,034), Baltimore (N = 3,481), St. Louis (N = 3,004), Durham, N.C. (N = 3,921), and Los Angeles (N = 3,132). Diagnoses were based on the NIMH Diagnostic Interview Schedule and DSM-III. Panic disorder led the list of disorders for which subjects in the five studies received ambulatory mental health services. Treatment rates for panic disorder were as high as or higher than those for somatization disorder, schizophrenia, and major affective disorders. Furthermore, panic attacks may have been the reason that many subjects with other disorders sought treatment.
Firearms and youth suicide.
The firearm suicide rate for persons aged 10 to 24 has increased from 2.3 per 100,000 in 1933 to 5.5 per 100,000 in 1982. Over the same period, the suicide rate for this age group by all methods other than firearms has only risen from 2.5 to 3.3. The most dramatic rise in the firearm suicide rate has occurred primarily since 1970, notably among males aged 15 to 24. During the 1960s and 1970s there was a substantial increase in the number of civilian firearms in the United States.
The relationship between panic disorder and agoraphobia: an epidemiologic perspective.
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Organomercuric poisoning in fat cattle.
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The design of the Epidemiologic Catchment Area surveys. The control and measurement of error.
Several methods are used to minimize and measure error in the NIMH Epidemiologic Catchment Area program. Sampling methods involve the inclusion of group quarters such as prisons, nursing homes, and mental hospitals in the sample frame and the use of probability sampling throughout. Interviewing, methods include use of identical diagnostic interview protocols, centralized training of interview supervisors, standard instructions to interviewers, and reinterview of a subsample by clinicians. In the area of completion, the methods include a 75% to 80% respondent completion rate, a 95% or greater completion rate for individual questions, use of informant interviews where necessary, and statistical adjustments to correct for low completion rates in some subgroups. Analytic methods include use of a computerized diagnostic algorithm, common estimation formulas on identically formatted data files, and estimation of exact variances that take account of the multistage sample design.
Six-month prevalence of psychiatric disorders in three communities 1980 to 1982.
Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis. As part of the Epidemiologic Catchment Area program, data were gathered on more than 9,000 adults, employing the Diagnostic Interview Schedule to collect information to make a diagnosis. The most common disorders found were phobias, alcohol abuse and/or dependence, dysthymia, and major depression. The most common diagnoses for women were phobias and major depression, whereas for men, the most predominant disorder was alcohol abuse and/or dependence. Rates of psychiatric disorders dropped sharply after age 45 years.
Exclusion criteria of DSM-III. A study of co-occurrence of hierarchy-free syndromes.
The diagnostic criteria of the third edition of the DSM-III often state that one diagnosis cannot be made if it is "due to" another disorder. Using data from the National Institute of Mental Health Diagnostic Interview Schedule, with a sample of 11,519 subjects from a community population, we found that if two disorders were related to each other according to the DSM-III exclusion criteria, then the presence of a dominant disorder greatly increased the odds of having the excluded disorder. We also found that disorders, which DSM-III says are related to each other, were more strongly associated than disorders, which DSM-III says are unrelated. However, we also found there was a general tendency toward co-occurrence, so that the presence of any disorder increased the odds of having almost any other disorder, even if DSM-III does not list it as a related disorder. We concluded that empirical studies are needed to study the assumptions underlying the use of a diagnostic hierarchy.
The increasing rate of suicide by firearms.
The rate of suicide has risen over the past 25 years, particularly among persons under the age of 40 years. An examination of types of suicide shows that only the rate of suicide by means of firearms has risen continuously over this period. From 1953 to 1978, the age-adjusted rate of suicide by means of firearms increased from 4.9 to 7.1 per 100,000 population per year, whereas the age-adjusted rate of suicide by all other means remained the same: 5.9 in 1953 and 5.4 in 1978. I have examined and rejected the hypothesis that this striking increase in suicide by firearms could have been due to an increase in self-inflicted firearm accidents that were misdiagnosed as suicide. It is conceivable that the rise in the suicide rate might be controlled by restricting the sale of handguns, since another study has shown that handguns account for 83 per cent of all suicides by firearms.
Different definitions of alcoholism, I: Impact of seven definitions on prevalence rates in a community survey.
The authors applied seven different sets of diagnostic criteria for alcoholism to data obtained by using the Schedule of Affective Disorders and Schizophrenia (SADS) in a community sample. They found that the different diagnostic schemes for alcoholism are hierarchical in the sense that some definitions identify smaller groups of subjects as alcoholic than do other definitions. This study illustrates a potentially useful empirical approach to comparing diagnostic criteria for psychiatric disorders in epidemiologic or clinical studies.