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J Ormel

Publications and source records attributed to J Ormel.

At least 109 records · Page 6Linked to original sources
PubMed1995

Health care costs associated with depressive and anxiety disorders in primary care.

OBJECTIVE: The authors examined the overall health care costs associated with depression and anxiety among primary care patients. METHOD: Of 2,110 consecutive primary care patients in a health maintenance organization, 1,962 were screened with the 12-item General Health Questionnaire. A stratified random sample of 615 patients were selected for further diagnostic assessment; 373 of these patients completed the Composite International Diagnostic Interview at baseline and 328 were reassessed 12 months later. Computerized cost records were used to calculate total health care costs for the 6-month period surrounding the baseline assessment and a similar period surrounding the follow-up assessment. Cost accounting data were available for 327 patients at baseline and for 206 patients at both assessments. RESULTS: Primary care patients with DSM-III-R anxiety or depressive disorders at baseline had markedly higher baseline costs ($2,390) than patients with subthreshold disorders ($1,098) and those with no anxiety or depressive disorder ($1,397). Large cost differences persisted after adjustment for medical morbidity. Cost differences reflected higher utilization of general medical services rather than higher mental health treatment costs. Although most patients with baseline anxiety or depressive disorders showed significant improvement, longitudinal analyses did not show any clear relationship between change in psychiatric diagnosis and change in health care cost. CONCLUSIONS: Among primary care patients, anxiety and depressive disorders are associated with markedly higher health care costs even after adjustment for medical comorbidity. In this small sample, improvement in depression over 1 year was not clearly associated with decreases in cost.

Adolescent↗
PubMed1995

Positive life change and recovery from depression and anxiety. A three-stage longitudinal study of primary care attenders.

BACKGROUND: The objective was to examine the relationship between positive life change (PLC) and recovery from depression and anxiety. Following Brown et al (1988, 1992), we hypothesised: (a) that an excess of PLC would be found in the 3-month period before recovery compared with base rates ('excess hypothesis') and (b) that fresh-start and anchoring subtypes of PLC would trigger recovery from depression and anxiety respectively ('specificity hypothesis'). METHOD: One hundred and seventy primary care patients with a depressive and/or anxiety disorder, selected from 1994 consecutive attenders, were assessed at baseline and at 1-year and 3.5-year follow-ups on life change (LEDS) and psychopathology (PSE and Course Interview). RESULTS: Our results appeared to confirm the excess hypothesis regarding depression and anxiety (twofold excess was found prior to recovery), but not regarding mixed anxiety/depression. They did not support the specificity hypothesis. CONCLUSIONS: PLC facilitates recovery but is neither a necessary nor sufficient condition for remission. Difficulty reduction is the most important recovery-enhancing factor.

Adaptation, Psychological↗
PubMed1995

[The Mini Mental Status Examination. Normative data and a comparison of a 12-item and 20-item version in a sample survey of community-based elderly].

The results of a study on the comparison of the original 20-item Mini-Mental State Examination with a shortened 12-item version as a brief screening test for cognitive impairments in a community based older sample are presented. The scores on the MMSE decrease with higher ages and lower levels of education. The results show that a threshold value of 24 on the MMSE-20 (Cohen's kappa .70), which supports previous Norwegian findings. In case of the identification of older people with severe cognitive impairments -threshold value 17 or 18 on the MMSE-20-, we found a corresponding threshold on the MMSE-12 of 7 (Cohen's kappa .87 and .91, respectively). Although the Norwegian researchers made no direct comparison between the MMSE-20 and MMSE-12 for these lower thresholds, a threshold 7 on the MMSE-12 resulted in a lower level of misclassifications of cognitively impaired patients by a psychogeriatrician compared to a threshold of 18 on the MMSE-20. It may be concluded that the MMSE-12, which is simpler to use and takes less time, has the same diagnostic properties as a screening tool for mild and severe cognitive impairments.

Aged↗
PubMed1994

Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care.

OBJECTIVE: To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. DESIGN: A cross-sectional sample selected by two-stage sampling. SETTING: Primary health care facilities in 14 countries covering most major cultures and languages. PATIENTS: A total of 25,916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). MAIN OUTCOME MEASURES: Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. RESULTS: After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. CONCLUSIONS: The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.

Adolescent↗
PubMed1993

Outcome of depression and anxiety in primary care. A three-wave 3 1/2-year study of psychopathology and disability.

BACKGROUND: We evaluated the long-term outcome of depression and anxiety and associated disability among primary-care attenders with common psychiatric disorders and symptoms (n = 201) using binary and multicategorical, interview-based outcome measures of psychiatric illness and disability. METHODS: A two-stage design was used. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Questionnaire and by their physicians. A stratified random sample (n = 292) with differing probabilities was selected for second-stage interview (Present State Examination and Groningen Disability Schedule). Patients with psychiatric symptoms (n = 201) were reassessed 1 (n = 182) and 3 1/2 (n = 154) years later. RESULTS: At 1- and 3 1/2-year follow-ups, many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped. However, partial remission, not full recovery, was the rule, and was associated with residual disability. Depression had better outcomes than anxiety and mixed anxiety-depression. CONCLUSIONS: We concluded that a multicategorical, rather than a binary, outcome measure better reflects patient outcomes, since it highlights partial remission, mild symptoms, and residual disability, and as such, stresses the need to supplement short-term treatment. A multicategorical caseness model may be advantageous for research and clinical practice. We suggest a dynamic-equilibrium model to account for residual symptoms and disability. This study is a follow-up to two earlier reports on the recognition, treatment, and 1-year course of common psychiatric illnesses in general practice.

Adaptation, Psychological↗
PubMed1993

An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on 'Psychological Problems in General Health Care'.

This article describes a large longitudinal multicenter collaborative study that investigated the form, frequency, course, and outcome of psychological problems that were seen in primary health care settings in 15 different sites around the world. The research employed a two-stage sampling design in which the 12-item General Health Questionnaire was administered to 26,422 persons aged 18 to 65 years who were consulting health care services. Of these persons, 5604 were selected for detailed examinations using standardized instruments and were followed up at 3 months and 1 year to provide information on course and outcome. All assessment instruments have been translated into 13 different languages. The project has produced a database that allows for the exploration of the nature of psychological disorders experienced by patients in general medical care and their association with physical illness, illness behavior, and disability over time.

Adolescent↗
PubMed1993

The relationship between social dysfunctioning and psychopathology among primary care attenders.

The extent of social dysfunctioning and its relationship to psychological disorders among Dutch primary care patients was examined. Social dysfunctioning in these patients was rather limited, but was more pronounced in patients with a psychological disorder than in those without. Disabilities were largely restricted to the occupational and social roles, with family role functioning and self-care relatively intact. Social dysfunctioning was moderately related to psychopathology, with higher levels of dysfunctioning in more severe and depressed cases. The extent of social dysfunctioning among patients with both anxiety and depression was similar to that of patients with a single diagnosis of depression. Depressed patients had a similar level of dysfunctioning to non-psychotic psychiatric out-patients. Analyses regarding the effects of diagnosis and severity on social dysfunctioning revealed considerable overlap between these two aspects of psychopathology. This study supports the need for a simultaneous but separate assessment of psychopathology and social dysfunctioning. However, future research should incorporate additional predictors of social dysfunctioning (e.g. personality, life events, long-term difficulties, physical disorders), and prospective studies should be conducted to clarify the temporal sequences of symptom severity, diagnosis, and comorbidity on the one hand, and social dysfunctioning on the other.

Activities of Daily Living↗
PubMed1993

Depression, anxiety, and social disability show synchrony of change in primary care patients.

OBJECTIVES: The purposes of this study were to (1) characterize the social disability associated with the common psychiatric illnesses of primary care patients in terms of role dysfunction (self-care, family role, social role, occupational role) and (2) establish whether severity of psychiatric illness and disability level show synchrony of change. METHODS: A two-stage sample design was employed. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness by their physicians and with the General Health Questionnaire. A stratified random sample (n = 285) with differing probabilities was selected for a second-stage interview. Patients with psychiatric symptoms were reinterviewed 1 and 3.5 years later (n = 143). RESULTS: (1) Disability level among patients was increased (moderately for depression, mildly for anxiety) and was associated with severity of psychiatric illness. (2) Most disability was found in occupational and social roles. (3) Change in severity of psychiatric illness was concordant with change in level of disability and was largely invariant across diagnosis (depression, anxiety, mixed anxiety/depression). At follow-up, disability among improved patients had returned to normal levels. CONCLUSIONS: Psychiatric illness in primary care patients is associated with mild to moderate disability, and severity of psychiatric illness and disability show synchrony of change.

Activities of Daily Living↗
PubMed1992

Disability and depression among high utilizers of health care. A longitudinal analysis.

We evaluated, among depressed medical patients who are high utilizers of health care, whether improved vs unimproved depression is associated with differences in the course of functional disability. At baseline, 6 months, and 12 months, depression and disability were assessed among a sample of enrollees in health maintenance organizations (N = 145) in the top decile of users of ambulatory health care who exceeded the 70th percentile of health maintenance organization population norms for depression. Improved depression was defined as a reduction of at least one third in depressive symptoms averaged across the two follow-up times. At the 12-month follow-up, persons with severe-improved depression experienced a 36% reduction in disability days (79 days per year to 51 days per year) and a 45% reduction in disability score. Persons with moderate-improved depression experienced a 72% reduction in disability days (62 days per year to 18 days per year) and a 40% reduction in disability score. In contrast, persons with severe-unimproved depression reported 134 disability days per year at baseline, while persons with moderate-unimproved depression reported 77 disability days per year at baseline. Neither group with unimproved depression showed improvement in either disability days or disability score during the 1-year follow-up period. High utilizers of health care with severe-unimproved depression were more likely to have current major depression and to be unemployed. Improved (relative to unimproved) depression was associated with borderline differences in the severity of physical disease and in the percent married. We conclude that depression and disability showed synchrony in change over time. However, depression and disability may show synchrony in change with disability because both depression and disability are controlled by some other factor that influences the chronicity of depression (eg, chronic disease or personality disorder). The finding of synchronous change of depression and disability provides a rationale for randomized controlled trials of depression treatments among depressed and disabled medical patients to determine whether psychiatric intervention might improve functional status in such patients. Such research is needed to determine whether there is a causal relationship between depression offset and reductions in functional disability.

Activities of Daily Living↗
PubMed1992

Adequacy and duration of antidepressant treatment in primary care.

Among a sample of 119 distressed high-utilizers of primary care, 45% of patients evaluated by a psychiatrist as needing antidepressant treatment had been treated in the year before the examination. However, only 11% of the patients needing antidepressants had received adequate dosage and duration of pharmacotherapy. In the year following the intervention, study patients whose physicians were advised regarding treatment during a psychiatric consultation were more likely to receive antidepressant medications (52.7%) relative to a randomized control group (36.1%). However, the intervention did not significantly increase the provision of adequate antidepressant therapy (37.1% vs 27.9%). Among study patients using antidepressants, patient characteristics did not differentiate patients who received adequate dosage and duration of antidepressant medications from those who did not. Analysis of data on the duration of antidepressant therapy for all health maintenance organization enrollees initiating use of antidepressants showed that only 20% of patients who had been given prescriptions for first-generation antidepressants (amitriptyline, imipramine, or doxepin) filled four or more prescriptions in the following six months, compared to 34% of patients who had prescriptions for newer antidepressants (nortriptyline, desipramine, trazodone and fluoxetine). Experimental research evaluating whether these newer medications (with more favorable side effect profiles) improve adherence, and thereby patient outcome, is needed.

Adult↗
PubMed1992

[Measuring psychological well-being in the elderly].

The results of a comparison of measures assessing psychological well-being in a random sample of 354 elderly people in the city of Groningen are presented: Positive Affect and Negative Affect of the Affect Balance Scale, Positive Well-being (comprising three subscales: General Positive Affect, Emotional Ties and Life Satisfaction), and the Seven Point Satisfaction Rating. None of the studied instruments is based on a clear conceptual model of well-being. The results show reasonable psychometric properties of most measures (internal reliability, skewness, test-retest reliability). Exceptions are the low internal reliability of Positive Affect and the low test-retest reliability of the (I item) Seven Point Satisfaction Rating; the same results were previously reported. Furthermore, the test-retest reliability of the short scales is lower. As expected, the correlation between Positive Well-being and Positive Affect is strong; the same holds for the correlation between Positive Well-being and General Positive Affect. The last one is suggested as alternative for the subscale of the Affect Balance Scale. The results of multiple regression analysis showed that indicators of physical and social well-being explained most variance in General Positive Affect.

Aged↗
PubMed1991

Recognition, management, and course of anxiety and depression in general practice.

This article addresses the issues of recognition of psychiatric disorders by general physicians (GPs) and the effects of recognition on management and course. Among 1994 patients who were screened with the General Health Questionnaire and who were rated by their GP, 1450 (72.7%) had not been identified by the GP as having a psychiatric disorder in the year before the index visit. Among these "new" patients, 557 (38.4%) had positive General Health Questionnaire scores. Only 47% of the new patients who met Bedford College diagnostic criteria for anxiety, depression, or ill-defined disorder had their psychiatric disorder recognized by their GP. Among patients who met Bedford College criteria, mean episode durations were longer for anxiety disorders (20 to 22 months) than for depressive disorders (9 to 10 months). Among the new patients, those with psychiatric disorders recognized by the GP were more likely to receive mental health interventions. Recognition was associated with shorter episode duration among patients with an anxiety disorder, but not among patients with depressive or ill-defined disorders.

Anxiety Disorders↗
PubMed1991

Mental health intervention programs in primary care: their scientific basis.

This study examines the scientific basis for mental health intervention programs in primary care. The validity of five underlying assumptions is evaluated, using the results of a naturalistic study covering a representative sample of 25 Dutch family practices and data from the literature. Our findings corroborate the validity of the assumptions. Firstly, our study indicates that mental disorders are indeed very prevalent in primary care settings. Secondly, we find that a substantial proportion of mental disorders is not recognized by the general practitioner (GP). Thirdly, our data show that mental disorders in primary care are not transient or self-limiting. Fourthly, it is shown that only half of the GP attenders with a mental disorder receive some form of mental health treatment in the 14 months after their index consultation. Finally, our data suggest that mental disorders, when identified, can be treated effectively in primary care. These findings are in general agreement with the literature. In the discussion we underscore the need for public health intervention programs targeted at primary care providers. Training programs for general physicians must be directed at improving recognition and diagnosis and at enhancing the availability and quality of mental health interventions. The effectiveness of these programs has to be tested in randomized trials.

Adolescent↗
PubMed1991

Stability and change in psychological distress and their relationship with self-esteem and locus of control: a dynamic equilibrium model.

The proposed model assumes (a) that each person has a stable and characteristic symptom level, (b) that external events act to deflect symptom levels from this stable level, and (c) that adaptive mechanisms tend to normalize these deviations. The model is used to examine (a) the dynamics of psychological distress (PD), (b) the role of personality traits (i.e., self-esteem and locus of control), and (c) the contamination of these traits by the current level of PD. The analyses show that the structural model adequately fits data of 2 longitudinal community studies. Two thirds of the variance in distress could be attributed to differences in stable symptom levels, leaving 1/3 for environmental change agents. Both personality traits were substantially contaminated by PD levels. Finally, high symptom levels were strongly related to low self-esteem and external control. The applications of the model and the origins of stability and change in PD are discussed.

Adaptation, Psychological↗
PubMed1991

How neuroticism, long-term difficulties, and life situation change influence psychological distress: a longitudinal model.

The causal relationships between neuroticism (N), long-term difficulties (LTDs), life situation change (LSC), and psychological distress (PD) were examined using self-report and interview data from a 7-year, 3-wave study in a general population sample (N = 296). LTDs were classified as either endogenous (dependent) or exogenous (independent). We found that earlier neuroticism had a strong direct and a moderate indirect effect (through endogenous LTDs) on PD. The direct effect was strikingly stronger than those of LTDs and LSC. In addition, much correlation between endogenous LTDs, LSC, and PD could be attributed to the confounding effects of earlier neuroticism. High neuroticism tended to strengthen the effect of LSC on PD. These findings suggest that temperamental dispositions are more powerful than environmental factors in predicting PD.

Adaptation, Psychological↗
PubMed1990

Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study.

This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and the association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS). Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 'new' patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrollment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders. Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

Anxiety Disorders↗
PubMed1990

A model of stability and change in minor psychiatric symptoms: results from three longitudinal studies.

A statistical model designed to estimate the contributions of stable and changing symptomatology to levels of minor psychiatric symptoms is developed. This model is fitted to data obtained from three longitudinal studies. These studies involved subjects from Canberra (Australia), Christchurch (New Zealand) and Groningen (Holland). Data from all three data sets were shown to fit the proposed model adequately. However, there were systematic differences in the findings of the study. The findings from the Canberra and Groningen studies suggested that a large amount (50-75%) of the variance in symptom levels could be attributed to between subject difference in stable levels of symptomatology. In contrast the Christchurch study suggested a smaller contribution of stable symptomatology. These differences may be explained by the nature of the samples studied. All three studies showed evidence of strong correlations (0.79-0.94) between stable levels of symptomatology and the measure of trait neuroticism. It is concluded on the basis of this evidence that the neuroticism may be little more than a way of measuring the subject's characteristic level of minor psychiatric symptoms. The model also made it possible to secure estimates of the extent to which measures of neuroticism were contaminated by short-term mental state. Estimates of contamination effects varied between studies. For the Canberra data contamination was negligible, for the Groningen data mild contamination effects were present but for the Christchurch data contamination was larger. These differences may be explained by differences in the nature of the samples studied.

Adaptation, Psychological↗