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Biomedical subjects

K B Wells

Publications and source records attributed to K B Wells.

At least 91 records · Page 5Linked to original sources
PubMed1993

Alcohol use, depressive symptoms, and cultural characteristics in two Mexican-American samples.

We modeled associations of quantity and frequency of alcohol use with depressive symptoms (negative affect, lack of positive affect, somatic disturbance, interpersonal problems) in two household surveys of Mexican-Americans (Ns = 1,313 and 3,577). Multivariate analyses controlled cultural (immigration, acculturation) and demographic (age, income, household size, marital status, employment status) characteristics, and assessed interactions of these two classes of predictors. Alcohol use was inconsistently related to depression. In some analyses, cultural characteristics accounted for associations of alcohol use with depression. In others, associations of alcohol use with depression depended on cultural characteristics. Associations of drinking with depression tended not to be robust across samples.

Acculturation↗
PubMed1992

The course of depression in adult outpatients. Results from the Medical Outcomes Study.

OBJECTIVE: To compare the course of depression during a 2-year period in adult outpatients (n = 626) with current major depression, dysthymia, and either both current disorders ("double depression") or depressive symptoms with no current depressive disorder. METHODS: Depressed patients visiting 523 clinicians (mental health specialists and general medical providers) were identified using a two-stage screening procedure including the Diagnostic Interview Schedule. The course of depression was assessed in 2 follow-up years with a structured telephone interview based on the format of the Diagnostic Interview Schedule. RESULTS: Baseline severity of depressive symptoms was greatest in patients with double depression, but initial functional status was poor in those with dysthymia with or without concurrent major depression. Patients with dysthymia had the worst outcomes, those with current major depression alone had intermediate outcomes, and those with subthreshold depressive symptoms had the best outcomes. Even the latter group, however, had a high incidence (25%) of major depressive episode over 2 years. Initial depression severity and level of functional status accounted for more explained variance in outcomes than did type of depressive disorder. CONCLUSIONS: The findings emphasize the poor prognosis associated with dysthymia even in the absence of major depression; the prognostic significance of subthreshold depressive symptoms; and the clinical significance of assessing level of severity of symptoms as well as functional status and well-being, regardless of type of depressive disorder.

Adult↗
PubMed1992

First-year students' expectations of interacting with minority patients and colleagues.

In a 1988-89 pilot study, the authors surveyed the first-year medical students at the University of California, Los Angeles, School of Medicine in order to examine the students' expectations regarding future encounters with minority colleagues and patients, and how these expectations related to the students' own race or ethnicity and their perceived levels of experience with various racial-ethnic groups; 89 of 140 students responded (64%). There were significant positive associations between the students' levels of experience working or interacting socially with blacks or Hispanics (regardless of the students' own race or ethnicity) and their perceived likelihood of practicing with black or Hispanic partners, whereas there were significant negative associations between experience with blacks or Hispanics and the perceived likelihood of living in predominantly white communities. Further, the black and Hispanic students expected to have a higher percentage of their patients from black or Hispanic backgrounds than did other students. The authors suggest that these results underscore the importance of evaluating students' experience as well as race or ethnicity when attempting to increase representation of students with a commitment to serve minority populations.

Attitude of Health Personnel↗
PubMed1992

The effects of preferred provider options in fee-for-service plans on use of outpatient mental health services by three employee groups.

Descriptions of how preferred provider organizations (PPOs), offered as options to employees enrolled in fee-for-service plans, affected use of outpatient mental health services are provided. Data are from the RAND Preferred Provider Organization Study, which has a sample of employees who enrolled in fee-for-service plans 1 year before and 2 years after a PPO option was offered by three employers in two U.S. sites. To study effects of the optional PPOs on access to mental health care, usage patterns among those who initially stated that they did or did not intend to use PPO providers were examined. By the end of the second post-PPO year, employees had a similar annual probability of having an outpatient mental health visit whether or not they initially intended to use PPO providers. However, during the first post-PPO year, there was a decrease in the probability of use for those initially intending to use PPO providers, relative to those who did not intend to do so, among employees who had no regular medical provider. To study effects of the PPO option on usage levels of mental health care services, users of mental health services who primarily visited PPO were compared with those who primarily visited non-PPO providers. Users who visited PPO providers had significantly lower levels of use, controlling for other factors, than those who primarily visited non-PPO providers. Therefore, despite lower cost sharing for services received from PPO providers, the PPO option appeared to lower outpatient mental health care costs while having no more than a transient effect on access. This study did not evaluate mental health outcomes.

Adult↗
PubMed1992

The effects of psychological distress and psychological well-being on use of medical services.

In this study, the authors determined whether mental health status affects the use of general medical services, with and without adjustment for the correlated effects of general health perceptions and physical health status on such use. Data were used from the RAND Health Insurance Experiment, which has information on up to 5 years of use of medical services by a nonelderly, civilian, general population. Health status and other covariates were assessed by self-administered questionnaires at enrollment. In the absence of statistical control for general and physical health status, worse mental health status-whether assessed by a global self-report measure or its two component parts, psychological well-being and psychological distress-significantly increased the use of both inpatient and outpatient general medical services. After controlling for general health perceptions, physical health status, demographic factors, and insurance plan coverage, the effects of mental health status on use are reduced, but not eliminated. Psychological distress and psychological well-being retained independent effects on total medical expenses.

Activities of Daily Living↗
PubMed1992

Clinical factors associated with better quality of life in a seriously mentally ill population.

Improving the quality of life of persons with chronic mental illness is becoming an important treatment goal. In this study, 101 former acute care psychiatric inpatients with serious mental illness who were living in Mississippi communities were interviewed using portions of Lehman's Quality of Life Interview. A particular focus was whether clinical characteristics, such as medication compliance and social skills, that could be changed by interventions were associated with patients' ratings of their quality of life. Self-reports of better quality of life were associated with fewer depressive symptoms, fewer medication side effects, and better family interactions. Results indicate that clinical interventions to improve quality of life in this population should include family psychoeducational programs and better detection, evaluation, and treatment of both depressive symptoms and side effects of medication.

Adolescent↗
PubMed1991

Mental health and selection of preferred providers. Experience in three employee groups.

While Preferred Provider Organizations (PPOs) are designed to contain the costs of health care, they may not be able to do so if sicker individuals opt not to use PPO providers. This study examined how level of mental health status and prior use of mental health services affected the decision to use or not use PPO providers for mental health care for employees enrolled in fee-for-service plans with a PPO option. Data were obtained from an employee survey and claims data on three large employee groups. It was not possible to examine effects of sickliness on the intent to select PPO providers for mental health care directly because about one half of employees could not identify who they would visit for mental health care or even how they would select a provider for such care. The intent to use PPO or non-PPO providers for general medical care, however, was not significantly associated with mental health status when other factors were controlled. Furthermore, among persons who used mental health services after implementation of the PPO option, those who had previously visited providers who were to become part of the PPO panel tended to stay with PPO providers, while those who previously visited providers who were not to enter the PPO panel subsequently selected away from PPO providers for mental health care. This pattern of results suggests that established individual patient-provider relationships, rather than sickliness, determined the selection of PPO versus non-PPO providers for mental health care for employees enrolled in these optional PPO fee-for-service plans.

Adult↗
PubMed1991

How do HMOs reduce outpatient mental health care costs?

OBJECTIVE: Because previous studies of differences in utilization of mental health care services have had important limitations, it is not clear if their findings that health maintenance organization (HMO) outpatient mental health care costs less than fee-for-service care are due to less access, less intensive care per user, or selective enrollment of healthier people by HMOs. Therefore, the authors used data from the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study to examine differences in the prevalence of psychiatric disorder and differences in the use of outpatient mental health services for adults enrolled in HMO or fee-for-service health insurance plans. METHOD: The subjects were an ECA community sample obtained from East Los Angeles and West Los Angeles. This sample included a large number of Hispanic subjects. The subjects were categorized according to their responses to a 5-item battery on insurance as Medicare enrolles, members of private fee-for-service plans, Medicaid enrollees, members of an HMO, and uninsured. The presence or absence of psychiatric disorders was determined by using the NIMH Diagnostic Interview Schedule. Both users and nonusers of mental health services were studied. RESULTS: The HMO and fee-for-service plans had similar prevalence of psychiatric disorder and similar access to specialty mental health care. However, HMO enrollees had significantly fewer visits per user to providers of specialty care. CONCLUSIONS: The most likely explanation for lower mental health care costs in HMOs is a less intensive style of care for a comparably sick population.

Adult↗
PubMed1991

How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study.

OBJECTIVE: Although depression is one of the most common problems of medical and psychiatric outpatients, it has not been clear whether the extent of medical comorbidity among depressed patients varies across major types of clinical settings in which depressed patients receive care--especially by type of treating clinician (general medical versus mental health specialty) or type of payment for services (prepaid versus fee-for-service). METHODS: The authors examined these issues using data on 1,152 adult outpatients with current depressive symptoms and a lifetime history of unipolar depressive disorder who received care in one of three health care delivery systems in three U.S. sites. RESULTS: Depressed patients had a similarly high prevalence (64.9%-71.0%) of any of eight common chronic medical conditions whether they were seen in the general medical or specialty mental health sector; however, those visiting medical clinicians had a significantly higher prevalence of the two most common chronic medical conditions, hypertension and arthritis. Among depressed patients with hypertension, those visiting the general medical sector were more likely to be taking antihypertensive medication than were those visiting the mental health specialty sector. Type of payment (prepaid versus fee-for-service) was unrelated to either prevalence or severity of comorbid medical conditions, suggesting that the typical depressed patient in all types of practices studied had medical comorbidity. CONCLUSIONS: These data suggest that clinicians in all health care settings must be prepared to encounter chronic medical conditions and complaints in the depressed patients who visit them.

Adult↗
PubMed1991

Caring for depression in America: lessons learned from early findings of the medical outcomes study.

Research has documented that depressive disorders are a highly prevalent condition among adults in general population and patient samples and that these disorders are strongly associated with functional limitations. But data have not been available to compare the societal importance of depression to other major health conditions. In addition, although about one-half of persons with psychiatric disorders are believed to have their only contact with health care providers in the primary care sector, research findings suggest that depression often remains undetected and untreated in this secto; and there have been few data on how appropriateness of care for depression differs for patients in different health care delivery systems, or whose care is financed by prepayment or fee-for-service arrangements. As a result, it is not clear which health care systems should be promoted as providing appropriate care for this important psychiatric disorder. Data from the Medical Outcomes Study corroborate and strengthen the conclusion that depression is of considerable clinical and social importance in both outpatient medical and mental health specialty care sectors. Specifically, we have learned that depression is associated with as much limitation in multiple aspects of daily functioning and well-being as are most common chronic medical conditions. In addition, we have found that rates of detection of depressive disorder in the primary care sector are low and influenced by nonclinical factors such as type of payment for services. These findings increase the urgency of improving care for depression in the primary care sector, and of carefully evaluating how changes in the financing and organization of health care delivery systems affect the clinical care of psychiatric disorders.

Adult↗
PubMed1990

A structured interview version of the Hamilton Depression Rating Scale: evidence of reliability and versatility of administration.

A structured interview version of the Hamilton Depression Rating Scale (SI-HDRS) is described. Data are presented in support of its inter-rater and internal consistency reliability. SI-HDRS scores were reproducible by trained interviewers who lacked psychiatric backgrounds. Test-retest scores of a subset of patients who were interviewed twice (once in person and once by telephone) were highly correlated. Scores on the SI-HDRS did not differ between face-to-face and telephone administration groups, controlling for demographic factors, depression-specific indicators, and social and physical functioning. Since the SI-HDRS does not require a face-to-face interview by an experienced clinician, this instrument can be used economically in large-scale, community-based research projects.

Adult↗
PubMed1990

Alcohol use and limitations in physical functioning in a sample of the Los Angeles general population.

The authors examined the relationships between drinking and perceived current health and physical functioning for a general household sample of Mexican Americans and non-Hispanic whites. These relationships differed by sex and by the presence or absence of medical and psychiatric comorbidity, but not by ethnicity. Among men with a chronic medical illness, current abstinence was uniquely associated with poor current health and physical functioning, especially when current abstinence was combined with a past history of alcohol disorder. Among men without a chronic medical illness, a history of alcohol disorder (irrespective of current drinking) was uniquely associated with poorer functioning. For women, among the medically or psychiatrically ill, drinking was not strongly associated with physical functioning; while among women without chronic medical or psychiatric illness, a history of drinking was uniquely associated with poor physical functioning. The authors interpret the findings in terms of adverse effects of drinking and chronic medical conditions on functioning and the tendency of physically limited and chronically medically ill persons to stop drinking.

Activities of Daily Living↗
PubMed1990

The effects of a prepaid group practice on mental health outcomes.

Does a prepaid group practice relative to comparable fee-for-service plans lead to different mental health outcomes for its beneficiaries? To answer this question, we used data from the RAND Health Insurance Experiment. We observed no statistically significant or clinically meaningful differences in mental health outcomes for families randomly assigned to Group Health Cooperative of Puget Sound or to comparable fee-for-service insurance plans in the Seattle area. We found the same null result for overall mental health status as well as for psychological distress (e.g., anxiety and depression) and psychological well-being, and for the full population as well as the initially sick and poor, although our precision was low for the latter comparisons. Thus, the less intensive style of treatment in the prepaid group practice was not associated with noticeably worse mental health outcomes.

Adult↗
PubMed1990

Alcohol use and depressive symptoms among Mexican Americans and non-Hispanic Whites.

Alcohol use is associated with depressive symptoms in several studies. Using data from a community survey, this study examined whether this relationship (a) can be accounted for by ethnic or sociodemographic differences among persons who engage in various levels of alcohol use; and (b) differs for Mexican Americans (N = 1244) and non-Hispanic Whites (N = 1149). Using large quantities of alcohol, and, among men, daily drinking, were associated with depressed mood. These associations were similar for Mexican Americans and non-Hispanic Whites, and associations of quantity and frequency with depression were independent of each other. Among women, the cultural and demographic characteristics of high-quantity drinkers and abstainers (both of whom tended to be Mexican Americans) accounted for the association of alcohol use with depression. Among men, there was some suggestion that unemployment and unmarried status mediated the association of alcohol quantity with depression. People who drank greater quantities of alcohol per occasion reported more somatic depressive symptoms, and more frequent male drinkers reported more of most types of depressive symptoms.

Adult↗
PubMed1990

Patterns of outpatient mental health care over time: some implications for estimates of demand and for benefit design.

The article examines patterns of starting and continuing outpatient mental health care as a function of time, and the implications of these patterns for estimates of the response of demand to generosity of fee-for-service insurance coverage. The data are from the RAND Health Insurance Experiment (HIE), which acquired a random sample of the nonelderly general population in six U.S. sites. People rarely had more than one episode of use of outpatient mental health services in a year. Persons who used in the prior year had high rates of continuing in treatment, while those without prior use entered treatment at a low, steady rate. Similar patterns of use by former users and nonusers were observed across insurance plans that varied widely in generosity, but the absolute probabilities of use were significantly lower in less generous plans. The probability of use of mental health services expanded significantly over time in the HIE; thus, estimates of demand in a steady state would be higher than those based on the HIE study years.

Community Mental Health Services↗