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Biomedical subjects

J J Gallo

Publications and source records attributed to J J Gallo.

At least 37 records · Page 2Linked to original sources
PubMed1999

Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades.

It is anticipated that the number of people older than 65 years with psychiatric disorders in the United States will increase from about 4 million in 1970 to15 million in 2030. The current health care system serves mentally ill older adults poorly and is unprepared to meet the upcoming crisis in geriatric mental health. We recommend the formulation of a 15- to 25-year plan for research on mental disorders in elderly persons. It should include studies of prevention, translation of findings from bench to bedside, large-scale intervention trials with meaningful outcome measures, and health services research. Innovative strategies are needed to formulate new conceptualizations of psychiatric disorders, especially those given scant attention in the past. New methods of clinical and research training involving specialists, primary care clinicians, and the lay public are warranted.

Age Distribution↗
PubMed1999

Sadness in older persons: 13-year follow-up of a community sample in Baltimore, Maryland.

BACKGROUND: Our prior psychometric work suggested that older adults interviewed in 1981 in a community survey were less likely than younger adults to report dysphoria. We hypothesized that this would also be true of older adults interviewed 13 years later. METHODS: This study is a population-based 13-year follow-up survey of community-dwelling adults living in East Baltimore in 1981. Subjects were the continuing participants of the Baltimore Epidemiologic Catchment Area Program. After excluding 269 adults who were 65 years of age and older at initial interview in 1981, 1651 adults remained (347 aged 65 years and older and 1304 who were 30-64 years-old at follow-up). We applied structural equations with a measurement model for dichotomous data (the MIMIC -- multiple indicators, multiple causes -- model) to compare symptoms between adults who were 65 years and older at follow-up with younger adults, in relation to the nine symptom groups comprising the diagnostic criteria for major depression, adjusting for several potentially influential characteristics (namely, gender, self-reported ethnicity, educational attainment, cognitive impairment, marital status and employment). RESULTS: Older adults were less likely to endorse sadness as evidenced by a direct effect coefficient of -0.335 (95% Confidence Interval -0.643, -0.027). After adjusting for several potentially influential characteristics, the direct effect of age was substantially unchanged (-0.298 (95% CI -0.602, 0.006)). CONCLUSIONS: Older adults in 1994, like older adults in 1981, were less likely to endorse sadness than younger persons. This finding suggests, but does not prove, that the observed age difference in reporting depression does not reflect a cohort effect.

Adult↗
PubMed1999

Mental health service utilization by African Americans and Whites: the Baltimore Epidemiologic Catchment Area Follow-Up.

OBJECTIVE: To compare mental health service utilization and its associated factors between African Americans and whites in the 1980s and 1990s. DESIGN: Household-based longitudinal study with baseline interviews in 1981 and follow-up interviews from 1993 to 1996. SETTING: The Baltimore Epidemiologic Catchment Area (ECA) Follow-Up. SUBJECTS: Subjects included 1,662 adults (590 African Americans and 1,072 whites). MAIN OUTCOME VARIABLE: Use of mental health services, defined as talking to any health professional about emotional or nervous problems or alcohol or drug-related problems within the 6 months preceding each interview. RESULTS: In 1981, crude rates of mental health service use in general medical (GM) settings and specialty mental health settings were similar for African Americans and whites (11.7%). However, after adjustment for predisposing, need, and enabling factors, individuals receiving mental health services were less likely to be African American. Mental health service use increased by 6.5% over follow-up, and African Americans were no longer less likely to report receiving any mental health services in the 1990s. African Americans were more likely than whites to report discussing mental health problems in GM settings without having seen a mental health specialist. They were less likely than whites to report use of specialty mental health services, but this finding was not statistically significant, possibly because of low rates of specialty mental health use by both race groups. Psychiatric distress was the strongest predictor of mental health service use. Attitudes positively associated with use of mental health services were more prevalent among African Americans than whites. CONCLUSIONS: Mental health service use increased in the past decade, with the greatest increase among African Americans in GM settings. Although it is possible that the racial disparity in use of specialty mental health services remains, the GM setting may offer a safety net for some mental health concerns of African Americans.

Adult↗
PubMed1999

The driving habits of adults aged 60 years and older.

OBJECTIVES: We describe the driving habits of adults aged 60 years and older who were interviewed in the context of a community survey focused on mental disturbances. Our goal was to identify clinical cues that might signal driving difficulty in older adults who might present to the primary care physician for health care. DESIGN: A population-based survey. SETTING: Continuing participants in a follow-up study of community-dwelling adults who were living in East Baltimore in 1981. PARTICIPANTS: Subjects were 1920 continuing participants of the Baltimore sample of the Epidemiologic Catchment Area Program; 589 were aged 60 years and older and provided information on driving habits. MEASUREMENTS: Respondents were asked about their driving status: had they made adaptations to driving and had they experienced any adverse driving events in the 2 years before the interview. Driving behaviors were assessed in relation to chronic disease, sensory impairment, functional status, and mental status. RESULTS: Former drivers were more likely to be older, female, and nonwhite. Diabetes, vision impairment, functional impairment, and making an error on the copy design task of the Mini-Mental State Examination (MMSE) were associated with no longer driving. Women were more likely to report having made adaptations to driving, as were persons with heart disease, arthritis, vision impairment, and those who made an error on the copy design task of the MMSE. Heart disease and hearing impairment were associated with report of an adverse driving event. In multivariate models that included terms for potentially influential characteristics such as age, gender, and miles driven, only the copy design task was associated with driving status, and only heart disease was associated with driving adaptation and adverse driving events. CONCLUSION: Simple tests that tap visuospatial ability, such as the copy design task of the MMSE, may warrant additional study for use in driving assessment of older adults in primary care. The results underscore the importance of making an inquiry about driving as a separate and independent component of functional assessment.

Accidents, Traffic↗
PubMed1999

The epidemiology of common late-life mental disorders in the community: themes for the new century.

OBJECTIVE: The prevalence and incidence of the major mental disorders of late life that are common in the community and in primary health care are reviewed. METHODS: Community-based studies in English that included older adults were identified through MEDLINE searches and were reviewed. RESULTS: As the population ages, dementia, depression, and other mental conditions of the aged will demand more attention from clinicians and investigators to minimize their effects on disability, the use of health care services, and the quality of life for older adults and caregivers. Up to 15 to 20 percent of older adults have significant depressive symptoms, and it is estimated that as many as 45 percent of persons age 85 years and older have significant cognitive impairment and dementia. Other mental-health-related conditions, such as anxiety disorders, alcohol abuse, and prescription medicine misuse, are also important considerations but have not been as well studied as depression and dementia. Because an increasing proportion of older adults are members of minority groups, clinicians need to increase their awareness of how cultural factors relate to risk for mental disorders in late life. CONCLUSIONS: Attention to three themes may help clinicians and investigators meet the challenge of treating the common mental disorders of later life: the effect of these disorders on functioning, prevention of the consequences of mental disorders, and integration of mental health care and primary health care services.

Adult↗
PubMed1998

Depressive symptoms of whites and African Americans aged 60 years and older.

Consistent with prior work, our hypothesis was that older African Americans are less likely to report dysphoria than are older Whites. Study subjects were 968 participants aged 60 years and older in Baltimore, Maryland, and 1,486 participants aged 60 years and older in the Durham-Piedmont region of North Carolina who identified themselves as African American or White and who had complete data on symptoms of depression active in the one month prior to interview, as well as several covariates thought to be related to depression. The effect of self-reported race on the endorsement of symptoms from the section on Major Depression in the Diagnostic Interview Schedule was estimated employing structural equations with a measurement model. Older African Americans were less likely to report dysphoria than older Whites, although this only achieved statistical significance by conventional standards at the Durham-Piedmont site. Older African Americans at both sites were significantly more likely to report thoughts of death.

Black or African American↗
PubMed1997

Symptom profiles of depression among general medical service users compared with specialty mental health service users.

BACKGROUND: Since depressive disorders are now eminently treatable and early detection and treatment could bring substantial benefits, it is critical to address alternative presentations of depression in the general medical setting. Concern regarding under-diagnosis of depression in general medical settings has given rise to the question of whether the clinical disorder of depression differs qualitatively or only quantitatively across care settings. METHODS: Symptom profiles of depression were compared across care sectors to investigate how the presentation of depression among general medical service users might differ qualitatively from specialty mental health service users. Data on depression symptoms within 6 months of interview gathered in three community surveys that were part of the NIMH Epidemiologic Catchment Area Program were analysed using methods developed to assess item bias. The subjects were 4931 and 363 persons who reported a visit to the general medical sector or to specialty mental health respectively, within 6 months of interview. RESULTS: Compared with specialty mental health service users, general medical service users were less likely to present dysphoria (adjusted Odds Ratio, aOR = 0.57; 95% Confidence Interval, CI = 0.38-0.84) and feeling worthless, sinful, or guilty (aOR = 0.63; 95% CI = 0.40-0.98), but were more likely to present fatigue (aOR = 1.71; 95% CI = 1.09-2.69), even after holding constant other characteristics that might influence reporting of symptoms as well as level of depression. CONCLUSIONS: These results suggest that there are qualitative differences in depression presenting in general medical care compared with specialty mental health care and call for a re-conceptualization of depression in the general medical setting.

Adolescent↗
PubMed1997

Clinical diagnosis: a marker for disease?

In the science of psychiatry, a careful logic has linked items of phenomenology to diagnoses and hypothesized disease constructs. However, the resultant improved reliability of diagnostic assessment does not directly ensure the specificity and validity of diagnosis, and diagnoses are often thought of as identical to diseases. Although specificity is enhanced by the use of patterns of items of phenomenology operationalized into diagnoses to classify psychiatric disease, evidence suggests that diagnostic heterogeneity remains significant, limiting specificity. Furthermore, diagnostic concepts may bias assessments of phenomenology. Theoretically, psychiatric diseases are pathological states of neurobiological, social, and psychological processes and interactions. Although advances in social and psychological science continue, neurobiological science is advancing rapidly and is expected to contribute substantially to validity. But the relative psychometric distance and sources of measurement error between these underlying aspects of diseases and manifest phenomenology suggest that the use of clinical diagnoses, derived from phenomenology, may not be optimal as a standard from which to test neurobiological hypotheses, limiting validity. The authors submit that an approach utilizing measurement theory to combine standardized assessment of symptom items with neurobiological observations for classification will assist in efforts to understand the complexities of psychiatric disorders. Incorporation of neurobiological (and other) measures into the diagnostic logic has potential to extend and refine definitions of psychiatric diseases. A subtle shift of paradigm is suggested, in which clinical diagnosis is thought of not as the definition of disease, but as a marker for disease.

Biomarkers↗
PubMed1997

Depression without sadness: functional outcomes of nondysphoric depression in later life.

OBJECTIVES: We hypothesized that depressive symptoms not meeting full standard criteria for Major Depression would be associated with significant functional impairment among older adults over the course of a 13-year follow-up interval. Specifically, we developed criteria for a form of depression whose core symptoms did not include sadness or dysphoria. DESIGN: Population-based 13-year follow-up survey. SETTING: Community-dwelling adults living in East Baltimore in 1981. PARTICIPANTS: Subjects were the 1612 participants of the Baltimore sample of the Epidemiologic Catchment Area Program aged 50 years and older at the initial interview in 1981. MEASUREMENTS: The subjects were sorted into four categories based on their responses at baseline: (1) persons meeting standard criteria for Major Depression; (2) persons meeting alternative criteria for depression with dysphoria or (3) without dysphoria; and (4) a comparison category of persons not meeting any criteria for depression ("noncases"). The mortality and functional status of each group were compared after a 13-year follow-up interval. RESULTS: Compared with non-cases, participants aged 50 years and older who reported depressive symptoms but who denied sadness or dysphoria (nondysphoric depression) were at increased risk for death (relative risk (RR) = 1.70; 95% confidence interval (CI) (1.09, 2.67)), impairment in activities of daily living (RR = 3.76; 95% CI (1.73, 8.14)), impairment in instrumental activities of daily living (RR = 5.07; 95% CI (2.24, 11.44)), psychologic distress (RR = 3.68; 95% CI (1.47, 9.21)), and cognitive impairment (RR = 3.00; 95% CI (1.31, 6.89)) after a 13-year follow-up interval. The findings were not wholly explained by potentially influential baseline characteristics such as age, education, selected comorbid medical conditions, and functional status. CONCLUSION: Among adults aged 50 years and older, nondysphoric depression may be as important as Major Depression in relation to the development of functional disability and other long-term outcomes.

Activities of Daily Living↗
PubMed1997

The 'research magnificent' in late life: psychiatric epidemiology and the primary health care of older adults.

OBJECTIVE: Primary care occupies a strategic positive in the evaluation, treatment, and prevention of the mental disturbances of later life. This article highlights four themes that are crucial to understanding mental disturbances among older adults: 1) subsyndromal depression, 2) coexisting depression and anxiety, 3) comorbidity of depression and chronic medical conditions, and 4) risk factors for cognitive impairment. METHOD: The literature was selectively reviewed for each theme to ask the central question, "What can primary care physicians learn about mental disturbances of their older patients from epidemiologic and community studies?" RESULTS: The primary care setting itself is an important venue for an examination of aging issues and mental health. Workers in the "middle ground of psychiatric epidemiology"--primary health care--have not yet reached a full appreciation for the value of research in the primary care setting for enhancing our understanding of the mental disturbances of late life, and how these intersect with other salient factors. CONCLUSIONS: Primary care physicians and others who work in primary care should advocate for further mental health integration and research in primary care. Research is needed that will lead to new ways of maximizing the health and quality of life of older adults and their families.

Adult↗
PubMed1996

Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up.

BACKGROUND: There is suggestive evidence that depression increases risk of myocardial infarction (MI), but there are no prospective studies in which the measure of depression corresponds to clinical criteria. This study examines prospectively whether a major depressive episode increases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship. METHODS AND RESULTS: The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catchment Area Study, a survey of psychiatric disorders in the general population. A history of major depressive episode, dysphoria (2 weeks of sadness), and psychotropic medication use were assessed in 1981, and self-reported MI was assessed in 1994. Sixty-four MIs were reported among 1551 respondents free of heart trouble in 1981. Compared with respondents with no history of dysphoria, the odds ratio for MI associated with a history of dysphoria was 2.07 (95% CI, 1.16 to 3.71), and the odds ratio associated with a history of major depressive episode was 4.54 (95% CI, 1.65 to 12.44), independent of coronary risk factors. In multivariate models, use of barbiturates, meprobamates, phenothiazines, and lithium was associated with an increased risk of MI, whereas use of tricyclic antidepressants and benzodiazepines was not. Among individuals with no history of dysphoria, only lithium use was significantly associated with MI. CONCLUSIONS: These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI. The association between psychotropic medication use and MI is probably a reflection of the primary relationship between depression and MI.

Adolescent↗
PubMed1995

Filters on the pathway to mental health care, I. Incident mental disorders.

This study investigates health and mental health services use by adults with and without newly incident mental disorders and uses prospectively gathered data from the Epidemiologic Catchment Area Program, a multi-site interview survey of adult household residents in the United States. Study subjects were 13,400 participants who completed interviews in the initial survey and also in a follow-up 1 year later, and who reported no contact with mental health services in either the specialized mental health sector or in the general medical sector in the 6 months prior to the initial survey. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. 'Hierarchical' and 'filter' models of mental health services provide frameworks useful in understanding the possible effects of specific categories of psychiatric disturbances on use of health services. Only a minority of individuals with newly incident psychiatric disorder report discussion of mental health issues in a health care setting. Persons who developed a mental disorder during the follow-up interval were just as likely to consult a non-psychiatrist physician for their mental health problems as to consult a specialist in mental health, even accounting for other factors known to be associated with differential use of health care services. This large community study of incident psychiatric disorders strengthens prior evidence on the importance of the general medical sector in the care of individuals with psychiatric disturbances.

Adolescent↗
PubMed1995

Filters on the pathway to mental health care, II. Sociodemographic factors.

This study uses the prospectively gathered data of the Epidemiologic Catchment Area Program, a multi-site interview survey of mental disturbances among adult household residents in the United States, to compare health services use by individuals with different sociodemographic characteristics, accounting for the first-time occurrence of psychiatric disorder, over the course of a 1-year follow-up interval. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. In the present investigation, 13,400 continuing participants in the household sample who reported no contact with mental health services in the 6 months prior to the initial interview were studied with regard to health services use and sociodemographic characteristics. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. African-Americans were significantly less likely than whites to have consulted with a specialist in mental health (estimated relative odds, 0.22, 95% confidence interval 0.10 to 0.52), even accounting for coincident psychiatric disorder, gender, and other covariates known to be associated with differential use of health care services. Hispanics and other minorities were also less likely to have consulted a specialist in mental health (estimated relative odds, 0.37 and 0.26, respectively). This large community study extends previous work on mental health services and ethnicity.

Adult↗
PubMed1995

Alzheimer's disease in the NAS-NRC Registry of aging twin veterans, IV. Performance characteristics of a two-stage telephone screening procedure for Alzheimer's dementia.

In the course of a large twin study of Alzheimer's disease we used a two-stage telephone screening procedure. The modified Telephone Interview for Cognitive Status (TICS-m) served as an initial screen for dementia in 12709 individuals. The telephone Dementia Questionnaire (DQ) was then asked of collateral informants for subjects with TICS-m scores below 28, as well as for samples of persons with higher TICS-m scores. Based upon DQ responses, individuals with cognitive impairment not attributable to focal causes underwent assessment for the clinical diagnosis of Alzheimer's disease ('Alzheimer's dementia'), as did their twins. Well-defined Alzheimer's dementia was apparent in 39 subjects. Employing a cut-off of 27 or lower as indicative of cognitive impairment, the sensitivity of the TICS-m in the detection of Alzheimer's dementia was estimated at > 99% and specificity at 86%. Inclusion of the DQ increased the specificity at the 27/28 cut-point to 99%. The TICS-m score was associated with an area under the receiver operating characteristic (ROC) curve of 0.88 (95% confidence interval 0.81 to 0.94). The maximum number of cases of Alzheimer's dementia remaining undetected in the sample was estimated to be 34.

Aged↗
PubMed1995

Epidemiology of mental disorders in middle age and late life: conceptual issues.

One of the "uses of epidemiology" described by Morris (1) is to complete the clinical picture in describing the natural history of disease. This arena for epidemiologic inquiry is especially important in relation to psychiatric disturbances. Most adults with psychiatric complaints and symptoms, especially older adults, do not receive care in the mental health sector (2-4). Distorted views of the nature of these disturbances can result when studies sample only from those individuals who are treated by psychiatrists or other specialists (5, 6). This has led to greater interest in previously neglected venues such as nursing homes, home care, and the primary health care services (7-12). Improved detection and treatment of mental disturbances in primary health care may be an essential key to enhance the effectiveness of community treatment (13). Completing the clinical picture is a critical task indeed. The purpose of this review is to introduce several conceptual issues important to completion of the clinical picture in epidemiologic research on risk and protective factors for mental disorders across the life course, with a focus on adulthood and late life. These issues are 1) the measurement of psychiatric disturbances in populations, 2) methodological considerations in surveys of older adults, and 3) the life course perspective on risk factors for psychiatric disturbances.

Adult↗