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K G Meador

Publications and source records attributed to K G Meador.

30 records · Page 2Linked to original sources
PubMed1992

Religious affiliation and major depression.

Data from the Duke Epidemiologic Catchment Area survey were used to examine the relationship between religious affiliation and major depression among 2,850 adults in the community. Religious affiliations were categorized into six groups: mainline Protestant (27 percent), conservative Protestant (59 percent), Pentecostal (4.2 percent), Catholic (2.4 percent), other religions (2.6 percent), and no affiliation (4.4 percent). The six-month prevalence of major depression among Pentecostals was 5.4 percent, compared with 1.7 percent for the entire sample. Even after psychosocial factors such as gender, age, race, socioeconomic status, negative life events, and social support were controlled for, the likelihood of major depression among Pentecostals was three times greater than among persons with other affiliations. Carefully designed studies are needed to understand the complex interactions of religion and mental health.

Adolescent↗
PubMed1992

Self-rated depressive symptoms in medical inpatients: age and racial differences.

One thousand and eleven men under age forty (n = 161) or over age sixty-four (n = 850) admitted to medical and neurological services of an acute care hospital were screened for depressive symptoms as part of the Durham VA Mental Health Survey. Thirty-three percent of younger and 22 percent of older men scored 11 or higher on the Geriatric Depression Scale. Self-rated symptoms were most prevalent among younger whites (40%) and least common in older blacks (19%). Other exogenous factors such as being retired or unemployment and prior psychiatric history were also related to depressive symptoms, as were poor functional status, impaired cognitive status, and respiratory illness. Coping resources associated with fewer symptoms were social support and moderate alcohol use. In a subgroup of 443 patients, self-rated symptoms were compared with observer-rated symptoms. Agreement was highest among young Whites and lowest in older Blacks. Other correlates also varied depending on whether self-rated or observer-rated symptoms were considered. We conclude that self-rated symptoms are common among medical inpatients, are linked with and confounded by certain health and sociodemographic factors, and may be relatively insensitive as a measure of depression in elderly blacks.

Adult↗
PubMed1992

A brief depression scale for use in the medically ill.

OBJECTIVE: Using items from two existing depression scales, we have sought to develop a brief self-rated instrument for detecting major depressive disorder (M.D.D.) in medically ill, hospitalized patients. METHOD: Forty-two items from the Geriatric Depression Scale (G.D.S.) and Carroll Depression Scale were administered to 559 men under age 40 or over age 70 consecutively admitted to the hospital. Eighty-two M.D.D.'s were diagnosed in this group by structured psychiatric interview. After eliminating 12 items confounded by medical illness, 11 items were selected using regression analysis, correlation with the total score, and factor analysis. The 11-item scale includes an assessment of the five DSM-III-R criteria for M.D.D. which are least confounded by medical illness (mood, suicidal intent, guilt or worthlessness, concentration, and psychomotor agitation). The scale was then tested in 78 medical inpatients who were later assessed for M.D.D. using a structured psychiatric interview. RESULTS: Ten out of twelve M.D.D.'s were identified (83% sensitivity) and depression excluded in 51 of 66 non-depressed subjects (77% specificity) (compared with 82% sensitivity and 76% specificity for the 30-item G.D.S.). Scores on the 11-item scale were also correlated with the G.D.S. (.92), the Zung Depression Scale (.58), and the C.E.S.-D (.67). CONCLUSION: The 11-item scale is a practical tool for clinicians who screen patients for depression and for investigators who need a brief measure of depression in studies involving medical inpatients.

Adult↗
PubMed1992

Long-term follow-up of unsuccessful violent suicide attempts: risk factors for subsequent attempts.

STUDY POPULATION: Of 9046 consecutive trauma admissions, all suicide attempts (n = 156) were identified: 38 patients (24%) died in hospital; 118 (76%) were discharged and received long-term follow-up (mean = 2.8 years). Factors assessed included suicidal ideation and planning, reason for attempt; number of attempts, methods, dates of prior and subsequent attempts; psychiatric diagnoses, substance abuse history, treatment and medication compliance, hospitalizations, incidence of family depression and suicide; education level, job history, and living conditions. RESULTS: 104 (88%) patients were interviewed and 14 (12%) were lost to follow-up. Seventy-seven of the patients (74%) used guns in their attempt; their mean ISS was 14.2. Seven (6.7%) made repeat suicide attempts (all unsuccessful). Late mortality was 7% (one related to index suicide, five to chronic illness, one to motor vehicle crash). Most patients (96%) had psychiatric diagnoses at discharge, 77 of 93 (83%) had diagnosed depression. Sixty-six percent (69 of 104) had histories of alcohol abuse, 42% (42 of 101) histories of drug abuse. Thirty-five percent (34 of 96) were noncompliant with psychiatric follow-up and 70% (16 of 23) were noncompliant with alcohol abuse treatment. CONCLUSIONS: (1) Repeat attempts were rare (7%) after failed suicide attempts. (2) No late deaths resulted from repeat suicide attempts. (3) Risk factors associated with repeat attempts were younger age (p = 0.002), prior attempts (p = 0.02), family history of suicide (p = 0.03), schizophrenia (p = 0.005), and not living at home (p = 0.04). (4) Identifying patients with these risk factors, ensuring that they receive inpatient alcohol abuse treatment, along with sustained psychiatric treatment and help in maintaining home environments, may prevent repeat suicide attempts.

Adolescent↗
PubMed1991

Major depressive disorder in hospitalized medically ill patients: an examination of young and elderly male veterans.

OBJECTIVE: To study the epidemiology of depressive disorder in younger and older medical inpatients. DESIGN, PATIENTS, & SETTING: Depressive disorders were examined using the Diagnostic Interview Schedule in 116 young and 332 elderly medically ill men hospitalized in a VA medical center. RESULTS: Major depressive disorder was diagnosed in 22.4% of men under 40 and 13.3% of those age 70 or over; minor depression was found in 18.1% of young and 29.2% of older men. Besides age, other risk factors for major depression were impaired social support, severe medical illness or functional disability in older men, and history of psychiatric problems primarily in younger men; specific medical diagnosis was not a risk factor. Major depression was associated with more severe symptomatology in younger patients; in both age groups, however, symptoms were of prolonged duration and frequently included suicidal thoughts. CONCLUSIONS: Depressive disorder in hospitalized male veterans is common, varies with age, severity of medical illness, degree of social support, and history of psychiatric problems and is associated with considerable psychological morbidity.

Adult↗
PubMed1989

Major depression and the NIMH Diagnostic Interview Schedule: validation in medically ill hospitalized patients.

The authors validate the usefulness of the Diagnostic Interview Schedule (DIS) in prevalence studies of major depression (MD) in medically ill male veterans. The affective disorders portion of the DIS was administered by a trained interviewer to a representative sample of 408 medically-ill hospitalized patients (75% over age 70). Using a standardized handscoring method for the DIS, the patients were categorized as having or not having MD. Using a two-stage design, sixty-nine patients scoring above a cutoff score on a self-rated depression scale were referred for blind evaluation by a psychiatrist. The psychiatrist made a clinical diagnosis of MD using a standard checklist of DSM-III criteria. The DIS correctly diagnosed MD in 78 percent (14/18) of older and 69 percent (9/13) of younger patients, and correctly ruled out the disorder in 65 percent (15/23) of older and 67 percent (10/15) of younger patients; the kappa statistic of agreement was .40 in older and .36 in younger patients.

Adult↗
PubMed1988

Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness.

Until now, no self-rated depression scale had been validated as a screening measure for major depression in the older patient hospitalized with medical illness. The present report establishes the validity of two brief, easily administered depression screening tests, the Geriatric Depression Scale (GDS) and the Brief Carroll Depression Rating Scale (BCDRS), in this population. Structured psychiatric interviews were performed and self-rated depression measures administered to 128 men, aged 70 and over, consecutively admitted to medical and neurological services of a VA hospital. The GDS and BCDRS were both shown to have high sensitivity and specificity for detecting major depression in this setting. Optimal cut-off scores determined by the receiver operating curve characteristics of these tests were 11 for the GDS and 6 for the BCDRS. At a cutoff score of 11, the GDS had a sensitivity of 92%, a specificity of 89%, and a negative predictive value of 99%; lowering the break point to 8 did not increase sensitivity. At a cutoff score of 6, the BCDRS achieved a 100% sensitivity, 93% specificity, and 100% negative predictive value. Whether clinicians decide to implement either of these depression screens in their practice will depend to a large degree on the importance ascribed to the detection of these disorders and on attitudes toward the benefits of treatment.

Aged↗
PubMed1988

The couch and the cloth: the need for linkage.

Data from the Epidemiologic Catchment Area study were used to compare the demographic characteristics and psychiatric symptomatology of persons classified into four groups based on source of mental health services: clergy only, mental health specialists only, both clergy and mental health specialists, and neither source. Those receiving services from both clergy and mental health specialists were more likely to have major affective and panic disorders than those who sought services from clergy or mental health specialists only or who sought services from neither. Those in the care of mental health specialists were more likely to have substance abuse disorders. Those in the care of clergy only were as likely as those seeing mental health specialists only to have serious mental disorders. The data make clear the need for formal linkages between clergy and mental health professionals.

Adolescent↗
PubMed1988

Detection and treatment of major depression in older medically ill hospitalized patients.

While major depression is common among medically ill older inpatients, little is known about the frequency of detection or appropriate treatment in this population. In the present study, 171 consecutive men age seventy and over admitted to the medical and neurological services of a VA medical center were screened for major depression. The medical records of all patients identified with this disorder were reviewed for documentation of depression by housestaff 1) prior to our evaluation and 2) throughout the rest of the hospital stay. Relative and absolute contraindications to antidepressant therapy were also sought. Of patients identified with major depression, 20 percent (3/15) had depressive symptoms documented in their charts by housestaff prior to our evaluation. After housestaff were informed of the possibility of major depression, 27 percent (4/15) of these patients eventually received psychiatric consultations, and 13 percent (2/15) had antidepressants initiated. At the time of discharge only 13 percent (2/15) had followup plans documented in their medical record to provide ongoing therapy or any therapy for depression after discharge. While this low detection rate and less than adequate treatment may indicate a lack of sensitivity on the part of clinicians to depression in this population, the reluctance to use antidepressants may be partly explained by the observation that 87 percent (13/15) of depressed patients had relative or absolute contraindications to antidepressants.

Aged↗
PubMed1988

Depression in elderly hospitalized patients with medical illness.

Depressive symptoms and disorders were identified by structured psychiatric interview in 130 consecutively admitted male inpatients aged 70 years and over. Major depression was found in 11.5% and other depressive syndromes in 23%. While depressive symptoms and syndromes are common among the medically ill, this study demonstrated the need for careful diagnostic assessment of older patients with depressive symptoms before initiating treatment that may itself convey significant risk. Sociodemographic and health characteristics of older men at higher risk for depression were also identified. Patients more likely to be depressed were over age 75 years, had less formal education, experienced cognitive dysfunction, suffered from more severe medical illness (particularly recent myocardial infarction), and had a history of psychiatric illness. Depressive symptoms were also common among patients with renal or neurologic diseases, those having a family history of psychiatric illness, the unmarried, and the more severely disabled. Given the impact of depression on recovery from medical illness, compliance with medical therapy, and costs of extended hospital stays, detection and treatment of this disorder are imperative.

Aged↗
PubMedDate not supplied

Antidepressant use in elderly medical inpatients: lessons from an attempted clinical trial.

The authors conducted a clinical trial to examine the efficacy and safety of nortriptyline in the treatment of major depression in elderly medical inpatients. The diagnosis of major depression was made by a psychiatrist in 41 of 680 patients 65 years of age or older. The study was balted at the midpoint because of inadequate patient recruitment, primarily a consequence of medical illnesses that prevented more than 80% of eligible patients from participating in or completing the clinical trial. Major or minor medical contraindications to the use of antidepressants were present in over 90% of depressed patients. Short-term follow-up was conducted on untreated depressed patients, those receiving antidepressants at the time of assessment, and those in whom antidepressant treatment was initiated after assessment. Non-randomized exposure to antidepressants did not predict remission of depression at follow-up due to spontaneous remission in the untreated group. Given the prevalence of medical contraindications to antidepressant use among depressed elderly patients and the problems with side effects in treated patients, there were few depressed, elderly hospitalized patients who were candidates for antidepressant therapy.

Aged↗