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L G Kessler

Publications and source records attributed to L G Kessler.

64 records · Page 4Linked to original sources
PubMed1983

A longitudinal study of offset in the use of nonpsychiatric services following specialized mental health care.

This study examines the use of nonpsychiatric services by mentally ill persons following the receipt of specialized mental health care, frequently referred to as the "offset effect." A total of 9,761 persons enrolled during 1975 in the Columbia Medical Plan, a prepaid group practice in Columbia, Maryland, were studied over a 5-year period. Enrollees were classified into three groups: Treated--mental disorder diagnosis in 1975 and specialized mental health care in 1975; Untreated--mental disorder diagnosis in 1975 but no specialized mental health care in that year; and Comparison--neither mental disorder diagnosis nor specialized mental health care in 1975. The nonpsychiatric utilization for these groups was compared for 1973-1977. Specialized mental health care appears to have a short-term effect on nonpsychiatric utilization by attenuating the peak in use. Mentally ill persons without specialized mental health care in 1975 also reduced their use of nonpsychiatric services in 1976-1977. The utilization changes were more likely to occur in primary care departments, rather than nonpsychiatric specialty care departments. A diagnosis of mental disorder in either 1973 or 1974 was associated with a larger offset effect.

Adolescent↗
PubMed1983

Co-occurrence of psychiatric and medical morbidity in primary care.

This study examines the co-occurrence of psychiatric and medical morbidity in primary care patients utilizing a health care clinic in Marshfield, Wisconsin. Previous research has shown that individuals with psychiatric disorders have higher rates of medical illness than people without psychiatric illness, but most prior studies have tended to confound the measures of psychiatric and medical morbidity. In addition, appropriate controls for bias resulting from different medical utilization patterns have sometimes been absent. The present study reports the medical diagnoses of persons who had been assessed for psychiatric disorder with a standardized psychiatric interview using research diagnostic criteria independent of their medical assessment. Psychiatric diagnoses are analyzed in relation to medical diagnoses at the time of the interview and for a one-year period--six months before and six months after that date. The results indicate that persons with mental disorder diagnoses have significantly more morbidity for the one-year study period. Although considerable congruence exists in the physical diagnoses recorded for both groups, those with mental disorders are more likely to have diagnoses of the digestive and genitourinary systems. Some sex differences are also explored.

Digestive System Diseases↗
PubMed1982

Screening for mental disorder among primary care patients. Usefulness of the General Health Questionnaire.

The General Health Questionnaire (GHQ) and a structured psychiatric interview (lifetime version of the Schedule for Affective Disorders and Schizophrenia) were administered to a sample of primary care patients in the United States. Responses to the GHQ tended to form factors that have substantive interpretations, such as depression, anxiety, sleep problems, and social functioning. However, there seems to be little gain in using subscale scores to help identify persons with different types of psychiatric disorders.

Adult↗
PubMed1982

Episodes of psychiatric care and medical utilization.

This study examines the reduction in medical care utilization after mental health treatment, also known as the offset effect. With data from a computerized ambulatory care information system, an episode-of-care method is used to characterize the mental health care received by patients in a prepaid group practice. The characteristics of the psychiatric episodes, such as duration, type of therapy, and number of visits, are examined in relation to the degree of offset effects among psychiatric patients. The results indicate that offset effects are most pronounced for a variety of characteristics related to the psychiatric episode of care including brief, high-intensity therapy, treatment for transient rather than chronic mental illness, and individual rather than group therapies. Finally, this study replicates two major findings in the offset literature: the characteristic peaking of medical use before mental health care and the short-term nature of the offset effect.

Adult↗
PubMed1981

Rates of symptoms of depression in a national sample.

This paper is an analysis of data on symptoms of depression in a nationwide sample of adults, collected during the National Center for Health Statistics' first Health and Nutrition Examination Survey. The data are analyzed by a statistical adjustment procedure which assesses the impact of the major sociodemographic variables simultaneously, instead of one by one, which avoids a former major source of confusion. The measure of depression is the Center for Epidemiologic Studies Depression (CES-D) Scale. With the exception of race, the study replicates earlier findings. The adjustment procedure facilitates generalization of the results to other populations which are not demographically comparable, such as to smaller locales in the United States, or to populations defined by some criterion variable. Comparison of results is made with earlier work that used the identical measure of depression in two separate locales.

Adult↗
PubMed1980

Episodes of psychiatric utilization.

The continued growth of outpatient psychiatric care has been accompanied by a large number of research studies concerning the determinants of psychiatric utilization. One of the major limitations of these efforts has been the inability to go beyond distributional data on the use of services. This article describes a methodology for generating episodes of psychiatric care given a data set with a small amount of routinely collected data present in many medical information systems. Both demographic and medical characteristics are significantly associated with health services resource use as defined by the number of visits in an episode. A model predicting recurrent episodes of care is also described. The general utility of this approach and the substantive implications of the specific results are discussed.

Adolescent↗
PubMedDate not supplied

Americans' knowledge of cancer risk and survival.

BACKGROUND: There are more than 500,000 deaths from cancer each year in the United States. This study examines Americans' knowledge of risk factors for breast, cervical, colon, and prostate cancers, which account for over 130,000 of these deaths, and their knowledge of the prospects of surviving these cancers following early detection. METHODS: Data were obtained from 12,035 subjects who completed the 1992 National Health Interview Survey Cancer Control Supplement which includes questions about cancer risk factors and survival. RESULTS: The majority of respondents were unable to identify major cancer risk factors when prompted with a list. Approximately two-thirds did not recognize that age increased the risk for breast and colon cancer, that diet increased the risk for colon cancer, or that multiple sex partners increased the risk for cervical cancer. Knowledge about survival was also poor. Only about half thought they had a good chance of survival following early detection of colon and cervical cancers, for which 5-year relative survival exceeds 90%. CONCLUSIONS: Americans lack knowledge about major risk factors for common cancers and about the prospects of survival following early detection. Knowledge about risk factors and about survival from cervical and colon cancers was poor at all ages, among all races, at all income levels, and at all educational levels. It was poorest among blacks and Hispanics and among those with the lowest income and least education. Americans need education about cancer risk factors and survival.

Adult↗
PubMedDate not supplied

A model for making project funding decisions at the National Cancer Institute.

This paper describes the development of a model for making project funding decisions at The National Cancer Institute (NCI). The American Stop Smoking Intervention Study (ASSIST) is a multiple-year, multiple-site demonstration project, aimed at reducing smoking prevalence. The initial request for ASSIST proposals was answered by about twice as many states as could be funded. Scientific peer review of the proposals was the primary criterion used for funding decisions. However, a modified Delphi process made explicit several criteria of secondary importance. A structured questionnaire identified the relative importance of these secondary criteria, some of which we incorporated into a composite preference function. We modeled the proposal funding decision as a zero-one program, and adjusted the preference function and available budget parametrically to generate many suitable outcomes. The actual funding decision, identified by our model, offers significant advantages over manually generated solutions found by experts at NCI.

Competitive Bidding↗
PubMedDate not supplied

Epidemiology and health service resource allocation policy for alcohol, drug abuse, and mental disorders.

Data from the NIMH Epidemiologic Catchment Area (ECA) Study in Baltimore, Md., are used to illustrate the association between alcohol, drug abuse, and mental disorder diagnoses with health service use. A probability sample of 3,481 adult (age 18 and over) residents of a geographically defined Baltimore City population of 175,000 was found to have a 23.4 per 100 population, 6-month prevalence of 13 specific alcohol, drug, and mental disorders. Of this population, 7.1 percent sought outpatient mental health treatment from both general medical physicians and mental health specialists in a 6-month period. The presence of a mental disorder diagnosis increased the average number of visits to all health providers from 1.91 to 4.06 during the same 6-month period. Although the presence of a mental disorder diagnosis clearly increased the probability of using both general medical and mental health services, only 15.6 percent of the persons with a mental disorder sought any mental health treatment during this 6-month timeframe--leaving 84 percent of those with mental disorders not seeking any outpatient treatment during the same period. The addition of a measure of high symptomatology (a score of 4 or more on the General Health Questionnaire) increased the percentage of persons with mental disorder using services to 30.5 percent. When a measure of disability was added to the diagnosis and the high symptom level score, 54.7 percent of the population could be predicted to use some mental health service. These data demonstrate the necessity of having additional patient assessment measures with a diagnosis to predict probable service use. However, even in the most comprehensive multidimensional model, more research is required to explore the phenomena of presumed unmet need--the 45 percent of those with a diagnosis, disability, and high symptoms who do not use services. Hence, epidemiologists who wish to participate in setting policy for resource allocation must join with their colleagues in economics, sociology, and health services research to identify all factors in addition to disease states that either predispose population groups to use services or represent additional resource allocation needs.

Adult↗