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Biomedical subjects

J Ormel

Publications and source records attributed to J Ormel.

122 records · Page 7Linked to original sources
PubMed1989

Psychiatric diagnosis in an outpatient population. A comparative study of PSE-Catego and DSM-III.

Two diagnostic systems are compared in a psychiatric outpatient population of 175 patients. The Present State Examination (PSE)-Catego system identified 121 patients (69%) as "cases," whereas DSM-III identified 152 patients (87%) as cases. The two systems converged in 115 patients, yielding a kappa coefficient of only .32. Approximately one third of the DSM-III cases that were not detected by the PSE-Catego system was due to the restricted coverage of the latter system; the remaining two thirds could be attributed to differences in threshold and time framing. Compared with DSM-III, the PSE-Catego system showed a strong bias toward depression, and the system was extremely insensitive to the detection of social phobias and obsessive-compulsive disorders. Only 58% of cases of depression and 46% of cases of anxiety were diagnosed by both systems. The results are compared with other studies, and some consequences are discussed.

Adult↗
PubMed1989

Measuring change with the General Health Questionnaire (GHQ). The problem of retest effects.

The available evidence suggests that the GHQ is a valid case-finding and screening instrument and a reasonable measure of severity of functional non-psychotic psychopathology. However, recently Henderson et al. (1981) have demonstrated a substantial retest effect for the GHQ, which may affect its usefulness in longitudinal population and outcome studies. In a three-wave longitudinal study among 175 new psychiatric outpatients, we examined whether retest effects can also be found in treatment settings and what its likely causes might be. A substantial retest effect was found, and the social desirability and legitimation hypotheses appeared to offer the most likely explanations. The implications of the findings for longitudinal and treatment evaluation studies are discussed.

Anxiety Disorders↗
PubMed1989

Personality as modifier of the life change-distress relationship. A longitudinal modelling approach.

We present a structural equation model of the way in which personality factors may modify the response to changes in life situation, based on two-wave panel data from a random sample of 296 Dutch adults. Three definitions of vulnerability were studied: high neuroticism (N), low self-esteem (SE), and an external locus of control (LC). The multigroup LISREL analysis led to the following conclusions: First, previous symptom level was strongly related to current symptom level. The strength of this relationship was independent of SE and LC but modified by N. Secondly, the impact of life situation changes on distress level was moderately strong and similar to what others have reported. Thirdly, a marked modifier effect was found for neuroticism; responsiveness significantly increased with N level. For SE and LC we observed reduced responsiveness among low vulnerability subjects, but the differences did not reach statistical significance. The implications of the findings are discussed.

Adult↗
PubMed1989

General practitioners' characteristics and the assessment of psychiatric illness.

We put forward the hypothesis that general practitioners (GPs) with a family medicine orientation are more sensitive to the presence of mental health problems than GPs with a clinical orientation. To test it, GPs were divided into three subgroups on the basis of an attitude questionnaire. The General Health Questionnaire (GHQ) and the Present State Examination (PSE) were used as criteria. No differences in sensitivity to psychiatric illness were observed using either scale. Results of factor analysis with the subscales of the GP attitude questionnaire and the indices 'bias' and 'accuracy' were similar to those reported by GOLDBERG and associates. 'New' patients were defined as patients in whom the GP had not identified a mental health problem (MHP) in the past year. 'Old' patients were defined as 'not new'. GPs tended to under-identify MHPs in 'new' and over-identify them in 'old' patients. Recognition of psychiatric illness was better in 'old' than in 'new' patients. In 'new' patients, recognition depended on psychiatric diagnosis. Among 'old' patients, older people and people (especially women) with low education predominated. In their assessments GPs used information not contained in the GHQ.

Adult↗
PubMed1989

Concurrent validity of GHQ-28 and PSE as measures of change.

Substantial cross-sectional correlations have been reported between the GHQ and PSE (and CIS) total scores. Although necessary, this is not a sufficient condition for assuming good validity of the GHQ as a severity measure in longitudinal and health care evaluation studies. For this purpose the GHQ should also accurately reflect changes in severity over time. To examine their concurrent validity, GHQ and PSE scores were compared, in a three-wave longitudinal study, among 175 new psychiatric out-patients. Using a longitudinal structural equation model that takes measurement error into account, the strength of both the cross-sectional and longitudinal relationship between GHQ and PSE were estimated. The GHQ performed remarkably well; changes in severity as defined by PSE-ID and PSE total score were clearly reflected by changes in GHQ scores. The revised scoring method of the GHQ proposed by Goodchild and Duncan-Jones did not yield superior results.

Adult↗
PubMed1989

Chronic psychiatric complaints and the General Health Questionnaire.

The sensitivity of the GHQ and a revised scoring procedure (CGHQ) for chronic psychiatric complaints was investigated on 175 out-patients. The mean level of severity of symptoms of the groups with and without chronic complaints was not significantly different. However, patients with chronic complaints showed a significantly lower mean GHQ score than patients without chronic complaints. The mean CGHQ scores of the two groups did not differ, suggesting that the CGHQ is a better indicator of the severity of the chronic psychiatric state than the GHQ. The revised scoring procedure resulted in a decrease in the number of false negatives. The strongest reduction in false negatives, however, was induced by a combination of the original and the revised scoring procedures. This reduction was achieved at the expense of only a small increase in the number of false positives. Altogether, the revised scoring procedure proved to be only marginally better.

Adult↗
PubMed1988

The Groningen Social Disabilities Schedule: development, relationship with I.C.I.D.H., and psychometric properties.

Most of the existing instruments for the assessment of social dysfunctioning of psychiatric patients are merely lists of precoded items, leaving little or no room for posing supplementary questions. In this article a new, semi-structured questionnaire--the Groningen Social Disabilities Schedule (GSDS)--is described, in which this shortcoming is met. The development of the GSDS is based on social role theory and on the existence of a hierarchy in social disabilities, demonstrated in an earlier World Health Organization study. Compatibility was sought with the International Classification of Impairments, Disabilities and Handicaps (ICIDH), a trial-classification of the World Health Organization, to be used in research on the consequences of illness. It is concluded that the inter-rater reliability of the GSDS is good. To a large extent the hierarchy proved to hold true for this instrument. Some implications for future research and for the ICIDH are discussed.

Disability Evaluation↗
PubMed1983

Neuroticism and well-being inventories: measuring traits or states?

Inventories designed to measure neuroticism are similar in form and content to inventories used to measure symptoms or subjective well-being. In addition, it is not clear to what extent traits as well as a person's present state explain the variance of such measures. Three inventories--the Neuroticism Scale from Wilde's Amsterdamse Biografische Vragenlijst, Bradburn's Affect Balance Scale and a Symptom Measure--were administered three times in order to study their reliability, stability and relation with psychosocial stress and life events. Major differences between inventories were not found. The results favoured the trait position.

Affective Symptoms↗
PubMed1978

Mental illness, neuroticism and life events in a Dutch village sample: a follow-up.

In a 5-year follow-up of 32 patients identified during a survey of a Dutch village in 1969, approximately two-thirds were found to have recovered. This result was reflected in the scores on a self-reporting questionnaire. A control group showed little change over those years. The persistence of psychiatric problems was related to life experience, as measured by a life-event interview.

Adaptation, Psychological↗
PubMedDate not supplied

The effectiveness of lithium prophylaxis in bipolar and unipolar depressions and schizo-affective disorders.

The effectiveness of lithium prophylaxis in bipolar affective disorders is generally supported in the literature. The effects in this group, as well as in unipolar depressions and schizo-affective disorders were studied, using an individual retrospective control method, and the Life Table method. Lithium prophylaxis resulted in a substantial decrease in the number of episodes and hospital admissions in bipolar and schizo-affective disorders. In addition, these two groups showed frequent relapses after termination of the prophylaxis. The number of episodes preceding the prophylaxis and the absence of unipolar depression are found to be predictors of effectiveness. The consequences of patient selection and of inconclusive diagnostic criteria are pointed out.

Adult↗
PubMedDate not supplied

Training primary care physicians improves the management of depression.

The purpose of this pretest-posttest study was to evaluate effects of a training program designed to improve primary care physicians' (PCPs) ability to recognize mental health problems (MHP) and to diagnose and manage depression according to clinical guidelines. The primary care settings were in the northern part of The Netherlands. There were eight intensive, hands-on training sessions of 2.5 hours, each of which three were targeting depression (7.5 hours). In the pretraining phase we screened 1778 consecutive patients of 17 PCPs with the 12-item General Health Questionnaire (GHQ-12) and interviewed a stratified sample of 518 patients about presence of current depression with the Primary Health Care version of the Composite International Diagnostic Interview (CIDI-PHC). PCPs registered patient's mental health (status, severity, diagnosis) and treatment prescribed. Then we trained the PCPs. In the posttraining phase, we screened a new group of 1724 consecutive patients of the same PCPs and a new stratified sample of 498 patients went through the same interview and rating procedures as patients in the pretraining phase. Knowledge about depression was assessed pre- and posttraining. PCPs' knowledge of depression improved significantly. Recognition of MHP and accuracy of depression diagnosis improved, but was not statistically significant. The proportion of patients receiving treatment according to the clinical guidelines increased significantly. It was observed that training PCPs improves the management of depression.

Cohort Studies↗
PubMedDate not supplied

The distribution of psychiatric and somatic III health: associations with personality and socioeconomic status.

OBJECTIVE: Psychiatric and somatic disorders frequently co-occur in the same individuals. We examined whether this happens because these types of morbidity share risk factors or because they are risk factors for each other. METHODS: Negative binomial regression was used to examine, in a random sample of Dutch adults (N = 7076), cross-sectional associations of sociodemographic and personality variables like income and neuroticism with the presence, over 1 year, of 30 somatic and 13 psychiatric disorders, with the latter diagnosed by structured interview. We examined to what extent the links of these variables with these two morbidity types were independent of each other. RESULTS: This population experienced 5050 somatic and 2438 psychiatric disorders during the preceding year. Subjects reporting more somatic disorders had more psychiatric disorders. Neuroticism, followed closely by low educational attainment, was the strongest correlate of both morbidity types. After adjustment for all other covariates including somatic morbidity, the number of psychiatric diagnoses rose 1.84-fold (95% confidence interval = 1.74-1.94) per standard deviation increase in neuroticism. Likewise, adjusted for all other covariates including psychiatric diagnoses, 1.42 (95% confidence interval = 1.35-1.50) times more somatic disorders were reported per standard deviation increase in neuroticism. CONCLUSIONS: Personal features like neuroticism and low educational attainment are linked with psychiatric and with somatic morbidity. These links are largely independent. Although this study was cross-sectional, the results suggest that these different types of morbidity may have overlapping etiologies. Key words: Comorbidity, multimorbidity coefficient, negative binomial regression, epidemiology, neuroticism, social class.

Adult↗