Biomedical subjects

J Ormel

Publications and source records attributed to J Ormel.

At least 73 records · Page 4Linked to original sources

PubMed2000

The reliability of the structured interview for schizotypy-revised.

We investigated the reliability of the Structured Interview for Schizotypy-Revised (SIS-R). The original interview (SIS) was developed by Kendler. We revised the SIS, primarily by standardizing the rating procedures. Operational definitions and explicit criteria for rating were given. We introduced a four-point scale and provided clear criteria for rating severity of symptoms and signs (frequency, duration, and level of conviction) to operationalize schizotypal features. We divided schizotypal signs of global affect and global organization of speech into three separate signs of affect and five separate signs of thinking and speech. The main goal of this study was the assessment of test-retest reliability of the SIS-R. A robust test-retest design using different interviewers at both times, with a mean interval of 19 days, was used. The sample consisted of 42 psychiatric patients, almost all with personality disorders. The strong linear-weighted kappa statistic was used to evaluate reliability. The first conclusion is that most schizotypal symptoms can be reliably assessed with the SIS-R. The second conclusion is that most schizotypal signs do not reach sufficient levels of reliability. After unreliable items are excluded, the shortened SIS-R is a reliable research instrument for measuring schizotypal features (as far as it concerns our mixed samples). It covers all three dimensions of schizotypy.

Adult↗

PubMed2000

Predictors of time to remission from depression in primary care patients: do some people benefit more from positive life change than others?

The authors examined the role of personality, social support, and coping strategies and their interaction with positive life change (PLC) in influencing time to remission from depression in 86 depressed primary care patients (69% women, mean age = 36.6 years), who were followed for 3.5 years. Diagnostic information was obtained by the Present State Examination (J. K. Wing, J. Cooper, & N. Sartorius, 1974), and life change by the Life Events and Difficulties Schedule (G. W. Brown & T. O. Harris, 1978). The association of PLC and other predictors with the time to remission was studied by means of Cox regression. PLC reduced time to remission in women, but not in men. Other predictors that expedited remission were low severity of premorbid difficulties, high self-esteem, and a tension-reducing coping style. Neuroticism modified the effect of PLC in that the remission forward bringing effect of PLC was stronger for highly neurotic people. The results suggests that women and psychologically vulnerable persons benefit most from PLC.

Adult↗

PubMed1999

An international study of the relation between somatic symptoms and depression.

BACKGROUND AND METHODS: Patients with depression, particularly those seen by primary care physicians, may report somatic symptoms, such as headache, constipation, weakness, or back pain. Some previous studies have suggested that patients in non-Western countries are more likely to report somatic symptoms than are patients in Western countries. We used data from the World Health Organization's study of psychological problems in general health care to examine the relation between somatic symptoms and depression. The study, conducted in 1991 and 1992, screened 25,916 patients at 15 primary care centers in 14 countries on 5 continents. Of the patients in the original sample, 5447 underwent a structured assessment of depressive and somatoform disorders. RESULTS: A total of 1146 patients (weighted prevalence, 10.1 percent) met the criteria for major depression. The range of patients with depression who reported only somatic symptoms was 45 to 95 percent (overall prevalence, 69 percent; P=0.002 for the comparison among centers). A somatic presentation was more common at centers where patients lacked an ongoing relationship with a primary care physician than at centers where most patients had a personal physician (odds ratio, 1.8; 95 percent confidence interval, 1.2 to 2.7). Half the depressed patients reported multiple unexplained somatic symptoms, and 11 percent denied psychological symptoms of depression on direct questioning. Neither of these proportions varied significantly among the centers. Although the overall prevalence of depressive symptoms varied markedly among the centers, the frequencies of psychological and physical symptoms were similar. CONCLUSIONS: Somatic symptoms of depression are common in many countries, but their frequency varies depending on how somatization is defined. There is substantial variation in how frequently patients with depression present with strictly somatic symptoms. In part, this variation may reflect characteristics of physicians and health care systems, as well as cultural differences among patients.

Adult↗

PubMed1999

The relationship of functional limitations to disability and the moderating effects of psychological attributes in community-dwelling older persons.

This paper examines the moderating effects of three psychological attributes (neuroticism, self-efficacy expectancies and mastery) on the association between functional limitations (motor and cognitive limitation, vision and hearing loss) and disability ((instrumental) activities of daily living, role function and social function) in a sample of 624 community-dwelling older persons. In contrast to our hypothesis, we did not find any evidence for interaction effects. This means that low levels of psychological resources do not exacerbate the effect of functional limitation on disability in community-dwelling older persons. We found significant unique contributions of the psychological attributes to disability. Even when all three psychological attributes were taken into account, neuroticism and mastery had unique effects on social and role function, and self-efficacy expectancies had unique effects on (instrumental) activities of daily living. We conclude that the effects of functional limitation and psychological attributes on disability can be considered as additive. Older persons with less psychological resources are particularly at risk in developing disability.

Activities of Daily Living↗

PubMed1999

Morbidity and quality of life and the moderating effects of level of education in the elderly.

The moderating effect of level of education (as an indicator of socioeconomic status) on the associations between chronic medical morbidity and six domains of health-related quality of life (physical function, role function, social function, health perceptions, bodily pain and mental health) is studied in a large community-dwelling elderly sample (N = 5279). The results showed that health-related quality of life is substantially affected by chronic medical morbidity, and that level of education has weak, but significant unique contributions to physical function, social function, health perceptions, and mental health. We did not find substantial evidence for the differential vulnerability hypothesis. At best, low education might amplify the negative effects of the number of chronic medical conditions on mental health only, but this result was not confirmed in four specific disease groups.

Aged↗

PubMed1999

Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes?

BACKGROUND: We developed a comprehensive, 20-hour training programme for primary-care physicians, that sought to improve their ability to detect, diagnose and manage depression. We evaluated the effects of physician training on patient outcomes, using a pre-post design. METHODS: In the pre-training phase of the study, we sampled 1834 consecutive patients of 17 primary-care physicians and evaluated 518 of these patients for the presence of depression. We measured outcomes of all patients with depression at 3 months and 1 year. The outcome measures were: severity of psychopathology; duration of depressive episode; and level of daily functioning. After the 17 physicians completed the training, we drew a new sample from their practices (498 of 1785 consecutive patients were evaluated for depression) and measured outcomes for the depressed patients. RESULTS: We found an effect of the training on short-term outcome, particularly for patients with a recent-onset depression. At 3-month follow-up depressed patients whose physicians had received training had less severe psychopathology and patients with recent-onset depression also showed higher levels of daily functioning than patients of the same physicians prior to the training. The patients with a recent-onset depression that was recognized by trained physicians had shorter depressive episodes, but this was not statistically significant. At 1-year follow-up, all training effects had faded away. CONCLUSIONS: Training primary-care physicians to recognize, diagnose and manage depression can improve short-term patient outcomes, especially for patients with a recent onset of depression. Patients suffering from a recurrent or chronic depression may need more specific interventions, both for acute treatment and long-term management.

Adult↗

PubMed1999

Onset of disability in depressed and non-depressed primary care patients.

BACKGROUND: While cross-sectional and longitudinal studies have consistently found depressive illness and disability to be related, understanding whether depression leads to subsequent onset of disability is limited. METHODS: In the context of the multi-centre international WHO Collaborative Study on Psychological Problems in General Health Care, we followed prospectively consulting non-elderly primary care patients who were essentially disability free at baseline but who differed in baseline depression status, comprising 1051 patients free of physical disability at baseline including 14% depression; 914 free of social disability including 9% depression. Depression status was assessed with the CIDI; patient-reported physical disability with the MOS physical functioning scale and social disability with the BDQ role functioning and number of disability days measures; investigator-rated social disability with the Occupational section of Groningen Social Disability schedule; and the treating physicians rated the severity of physical illness. RESULTS: In patients essentially disability free at baseline, depressive illness resulted in a 1.5-fold (at 3 months) and a 1.8-fold (at 12 months) increase in risk of onset of physical disability, after controlling for physical disease severity. Depressive illness also resulted in a 2.2-fold (at 3 months) and a 23-fold (at 12 months) increase in risk of onset of social disability, after controlling for physical disease severity, physical disability and onset of physical disability. CONCLUSIONS: Among non-elderly primary care patients, depressive illness is associated with onset of physical disability and shows an even stronger association with onset of social disability.

Adolescent↗

PubMed1999

The impact of psychological attributes on changes in disability among low-functioning older persons.

We studied the impact of four psychological attributes (neuroticism, extraversion, mastery or perceived control, and general self-efficacy expectancies) on changes in disability in a community-based sample of 575 low-functioning elderly persons between 1993 and 1995. Unlike elderly persons with low or medium levels of mastery and general self-efficacy expectancies, older persons with high levels of such attributes showed no significant increase of disability between 1993 and 1995. However, multivariate analyses showed only unique contributions of mastery to changes in disability. Neuroticism and extraversion were found to be not related to changes in disability, supporting previous research outcomes. Findings highlight that, particularly, feelings of perceived control are crucial for maintaining functional ability in later life.

Activities of Daily Living↗

PubMed1999

Performance-based and self-reported physical functioning in low-functioning older persons: congruence of change and the impact of depressive symptoms.

This prospective cohort study examines the impact of depressive symptoms on changes in self-reported physical functioning in 574 low-functioning older persons. The data were collected in two waves in 1993 and 1995. Initial levels of depressive symptoms were not predictive for subsequent change in self-reported physical functioning. Changes in self-reported physical functioning were only moderately associated with changes in performance-based physical functioning. The strongest congruence of measured change between self-reported and performance-based physical functioning was found in older persons with increased depressive symptoms. The results suggest that preventing an increase in depressive symptoms may help prevent further deterioration in physical functioning in poorly functioning older persons.

Aged↗

PubMed1998

[Improved recognition and treatment of depression with occasional faster recovery through postgraduate training of family practitioners].

OBJECTIVE: To examine to what extent postgraduate training of general practitioners (GPs) with the Intervention Study Primary Care (INSTEL) programme improved detection, diagnosis, and treatment of depression, and whether the course of depression was influenced favourably. DESIGN: Prospective, comparative. SETTING: Academic Hospital Groningen, discipline group Psychiatry and General Practice, Groningen, the Netherlands. METHOD: General practitioners active in ten practices in Groningen and surrounds were trained in recognition and treatment of depression. The first group consisted of ten GPs who had not participated in psychiatrically oriented research before, the second group of seven GPs who had participated in such research. Both before and after the training, a group of patients aged 18-65 years visiting these GPs' office hours were examined by the investigators for presence of depression with the aid of questionnaires. The GPs recorded of each patient whether or not they found him/her depressed, and they mentioned the treatment. The researchers assessed the outcomes of depressed patients shortly after the index consultation and at 3 and 12-month follow-up. RESULTS: Before the training a questionnaire was completed by 1778 patients, of whom 179 were depressed; after the training a questionnaire was completed by 1724 patients, of whom 155 were depressed. Detection and diagnosis of depression improved in the first group of GPs, but not in the second group. Treatment improved for patients in both groups. In terms of symptoms, illness duration, daily functioning, and absence from work patients recovered slightly faster from their depression after the training, although the effects were weak, not always statistically significant (p < 0.05), and mostly limited to the subgroup of recognized depressions with a recent onset. At the 12-month follow-up the pre-post differences were not statistically significant. CONCLUSION: The postgraduate training with the INSTEL programme appears to be an effective intervention that improves treatment and somewhat speeds up recovery in recent onset cases.

Adolescent↗

PubMed1998

The impact of physical performance and cognitive status on subsequent ADL disability in low-functioning older adults.

OBJECTIVES: The purpose of this study was to examine the independent contributions of physical performance and cognitive status to subsequent levels of ADL disability in low-functioning non-institutionalized older adults. METHODS: A prospective cohort study included 416 women and 141 men 57 years or older who were living in the community and who reported substantial physical limitation. Physical performance and cognitive status were assessed at baseline in 1993. ADL disability was assessed at baseline and in two follow-ups in 1994 and 1995. Data were analysed with correlation analyses and linear multiple regressions. RESULTS: Both physical performance and ADL disability at baseline were highly predictive of subsequent ADL disability. Although cognitive status was slightly related to (subsequent) ADL disability, we found no independent contributions of cognitive status to subsequent ADL disability. CONCLUSIONS: Measures of both physical performance and ADL disability may identify older low-functioning adults who may benefit from interventions to prevent them from further disablement.

Activities of Daily Living↗

PubMed1998

Depression in survivor of stroke: a community-based study of prevalence, risk factors and consequences.

Depression in survivors of stroke is both common and clinically relevant. It is associated with excess suffering, handicap, suicidal ideation and mortality and it hampers rehabilitation. Most of the data currently available are derived from clinical studies. The objective of the present study was to study the prevalence, risk factors and consequences of depression in survivors of stroke, in a large (n = 3050) community-based study of older (55-85 years) people in three regions of the Netherlands. Depression was measured using the CES-D scale; histories of stroke were obtained using self-reports and data from general practitioners. The study was designed as a case-control study, using both bivariate and multivariate analyses. The prevalence of depression in stroke survivors was 27%, which was significantly higher than the base rate (OR 2.28, 95% CI 1.61-3.24). Both stroke-related disease characteristics and psychosocial characteristics of the respondents were predictors of depression. The consequences of depression were most evident in the realm of disability and impairment of well-being. The patterns of service utilization showed that depressed survivors of stroke are relatively high users of a wide range of health services.

Aged↗

PubMed1998

Spousal caregivers' activity restriction and depression: a model for changes over time.

In this paper we examine the effects of increasing as well as decreasing caregiving demands on depressive symptomatology. In addition, we focus on spousal caregivers' activity restriction as an explanatory mechanism for changes in depressive symptomatology in the caregiving context. Two databases are used to answer our research questions. An increase of caregiving demands is assessed in study 1, which includes prospective data on 127 spousal caregivers of stroke, hip fracture, congestive heart failure and myocardial infarction patients. A decrease of caregiving demands is examined in study 2, which includes prospective data on 110 spousal caregivers of bypass operation patients. The results generally support the hypothesis that an increase in caregiving demands results in increased depressive symptomatology, while a decrease in caregiving demands reduces depressive symptomatology. The results also support the notion of activity restriction as a critical mediator of changes in depressive symptoms. Cross-sectionally it mediates the association between caregiving and depressive symptomatology, and longitudinally it contributes to changes in depressive symptomatology in both samples.

Activities of Daily Living↗

PubMed1998

Relationship of domain-specific measures of health to perceived overall health among older subjects.

The associations between nine domain-specific measures of health (e.g., depressive symptoms, psychological distress, mental health, physical functioning, role functioning, social functioning, bodily pain, somatic symptoms, and chronic medical morbidity) and a single-item measure for perceived overall health were studied in an extensive community-based sample of elderly persons (n = 5279). The results showed that: (1) the discriminative power of perceived overall health compared to domain-specific measures of health was moderate to large only at the fair/poor end of the perceived overall health spectrum; (2) a single-item measure of perceived overall health did not cover domain-specific measurements of health since only 41.8% of the variance in perceived overall health was explained by all domain-specific measures; and (3) the affective domains of functioning (psychological distress, mental health) were weakly related to perceived overall health. Bodily pain, chronic medical morbidity and, to a lesser extent, physical functioning were more strongly related to perceived overall health. These results were fairly consistent for men and women and for three age groups. We conclude that a global, single-item measure of perceived health and domain-specific health measures are not exchangeable in evaluation, survey, or epidemiological research.

Activities of Daily Living↗

PubMed1998

Why GHQ threshold varies from one place to another.

BACKGROUND: No convincing explanation has been forthcoming for the variation in best threshold to adopt for the GHQ in different settings. METHODS: Data dealing with the GHQ and the CIDI in 15 cities from a recent WHO study was subjected to further analysis. RESULTS: The mean number of CIDI symptoms for those with single diagnoses, or those with multiple diagnoses, does not vary between cities. However, the best threshold is found to be related to the prevalence both of single and of multiple diagnoses in a centre. Variations in the diagnoses to be included in the 'gold standard' did not account for the variation observed. There was a strong relationship between area under the ROC curve (as a measure of the discriminatory power of the GHQ) and the best threshold, with higher thresholds being associated with superior performance of the GHQ. The items on the GHQ-12 that provided most discrimination between cases and non-cases varied from one centre to another. CONCLUSIONS: The GHQ threshold is partly determined by the prevalence of multiple diagnoses, with higher thresholds being associated by higher rates of both single and multiple diagnosis. The mean GHQ score for the whole population of respondents provides a rough guide to the best threshold. In those centres where the discriminatory power of the GHQ is lowest, it is necessary to use a low threshold as a way of ensuring that sensitivity is protected, but the positive predictive value of the GHQ is then lower. Some of the variation between centres is due to variation in the discriminatory power of different items.

Global Health↗

PubMed1998

The impact of multiple impairments on disability in community-dwelling older people.

INTRODUCTION: we have tested the hypothesis that the co-occurrence of common impairments (motor and cognitive impairments, vision and hearing loss, depressive symptoms) of later life have exacerbating effects on disability [activities and instrumental activities of daily living, social and role function, (in)activity]. METHOD: data were drawn from a community-based sample of 624 people aged 57 and older. RESULTS: motor impairments and depressive symptoms were associated with all disability measures, even when the effects of other impairments, age and gender were controlled. This indicates independent, predominant effects of motor impairments and depressive symptoms. Although several significant first-order interaction effects (indicating exacerbation) of impairments on disability were found, they were not very strong, but vision and hearing losses exacerbate the impact of the other impairments on disability. CONCLUSIONS: impairments, particularly motor impairments and depressive symptoms, largely act 'solo', by main effects on disability. Only a few combinations including vision or hearing loss further exacerbate the effects of other impairments on disability.

Activities of Daily Living↗

PubMed1998

Physical fitness related to age and physical activity in older persons.

OBJECTIVE: This study investigated physical fitness as a function of age and leisure time physical activity (LTPA) in a community-based sample of 624 persons aged 57 yr and older. METHODS: LTPA during the last 12 months was assessed through personal interviews. A wide range of physical fitness components was measured using performance-based tests. RESULTS: Physical fitness was associated with the interaction age by LTPA in only a few components, in a gender-specific way, with generally larger differences in fitness between active and less active persons with increasing age. All LTPA, including low intensity LTPA, is positively and age-independent associated with most physical fitness components. CONCLUSION: The importance of LTPA typically participated in by the general population lies not so much in the delaying of the motor aging process but rather in a general, age-independent, positive effect.

Age Factors↗

PubMed1998

Functioning, well-being, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions.

OBJECTIVES: To expand the landmark Medical Outcomes Study (MOS) and World Health Organization (WHO) findings on the unique association of symptoms of depression with multiple domains of functioning, health perception, and well-being in consulting populations to the late middle-aged and older community-dwelling population and to contrast this unique association to that of specific chronic medical conditions and sensory and cognitive impairment (collectively denoted as medical conditions (MCs)). DESIGN: Population-based, cross-sectional health survey. SETTING AND PARTICIPANTS: A total of 5279 noninstitutionalized late middle-aged and older persons living independently or in residential homes for older people housing in the northern part of The Netherlands. MEASUREMENTS: Behavioral: physical functioning, (Independent) Activities of Daily Living ((1)ADL), and role functioning. Subjective: health perception, life satisfaction and well-being. Mixed: discretionary activities and activity level. Two aspects of the association were examined: the unique risk (adjusted difference in mean outcome between those with the condition and those without, expressed in SD units) and the unique contribution (adjusted proportion of variance in outcome accounted for by the condition). The latter takes the prevalence of the condition into account. RESULTS: Among both individuals with MCs and those without, persons with symptoms of depression did worse on all outcomes than those without. Depressive symptoms were more consequential for subjective and mixed outcomes compared with behavioral outcomes. For all outcomes, none of the unique contributions of MCs exceeded that of depressive symptoms, whereas the unique contribution of depressive symptoms typically outranked those of the MCs. For behavioral outcomes, the unique risks associated with neurological conditions, persistent back problem, arthritis, and stroke exceeded that of depressive symptoms, but risk associated with depressive symptoms exceeded that of nine of 18 MCs, on average. For the mixed and subjective outcomes, none of the unique risks associated with MCs exceeded that of depressive symptoms, but risks of depressive symptoms exceeded those of 16 of the 18 MCs, on average. The effects of depressive symptoms and medical conditions were largely additive although depressive symptoms amplified the effect of some medical conditions on (I)ADL. The pattern of unique risks and contributions was similar across all ages (57-64, 65-74, 75+). CONCLUSION: The unique contribution of depressive symptoms in dysfunction, poor health perception, and well-being typically exceeds that of medical conditions because depressive symptoms combine a moderately large unique risk with a rather high prevalence. Results expand the MOS and WHO findings to the community-dwelling late middle-aged and older population and to additional outcomes as well. Results underscore the importance of detection and management of (comorbid) symptoms of depression in older people.

Activities of Daily Living↗