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L N Robins

Publications and source records attributed to L N Robins.

At least 37 records · Page 2Linked to original sources
PubMed1991

Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiologic Catchment Area project.

Children with conduct disorder have long been known to be at high risk for developing externalizing disorders, alcohol and drug abuse, and antisocial personality. Relationships of conduct disorder to other adult psychiatric disorders, on the other hand, have not been definitively shown. Taking advantage of the large community sample (N = 19,482) interviewed in the NIMH Epidemiologic Catchment Area Program, the authors examined the effects of childhood conduct problems on ten DSM-III psychiatric disorders: somatization, phobia, panic, obsessive-compulsive, depression, mania, alcohol use disorder, drug use disorder, schizophrenia and antisocial personality. Each of the ten adult disorders showed an increase in prevalence with an increasing number of conduct problems, although effects were stronger for externalizing disorders. The predictive power of conduct problems was similar for males and females. The effect of conduct problems on nonexternalizing disorders was found to be largely mediated through externalizing disorders, particularly for men but direct effects also occurred for both sexes. These findings raise questions about the conventional view of psychiatric disorders as divisible into externalizing and internalizing disorders. They also suggest that the increasing rates of conduct problems in younger cohorts may be responsible in part for the rising rates of other disorders. Thus, prevention of and early intervention with conduct disorder may hold promise for reducing rates of a broad range of disorders.

Adolescent↗
PubMed1991

Conduct disorder.

Explore the source record for details and available documents.

Antisocial Personality Disorder↗
PubMed1991

Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD-10 and DSM-III-R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.

Cross-Cultural Comparison↗
PubMed1991

The CIDI-core substance abuse and dependence questions: cross-cultural and nosological issues. The WHO/ADAMHA Field Trial.

The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM-III-R and proposed ICD-10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the questions, there was found to be high acceptance and excellent reliability for the substance use questions, problems with the lengthy alcohol section, and difficulties translating relevant substance use concepts into different languages. There is therefore room for further improvement in the substance-related questions. There proved to be differences between ICD-10 and DSM-III-R regarding substance abuse and dependence disorders.

Alcoholism↗
PubMed1990

Cognitive impairment and length of hospital stay in older persons.

We looked at performance on the Folstein Mini-Mental State Exam (MMSE) as a predictor of hospitalization and length of stay in the coming year in community-dwelling older persons from the National Institute of Mental Health Epidemiologic Catchment Area program. They had been assessed with the MMSE at the outset and were re-evaluated with the MMSE and a Health Services Questionnaire 1 year later. Subjects were more likely to be hospitalized in the subsequent year if they were older than 75 years or if they scored poorly on the MMSE. Severe cognitive impairment increased the risk more than mild impairment. Multivariate analyses that controlled for demographic variables demonstrate that MMSE performance is a significant predictor of any subsequent hospitalization (medical or psychiatric) among whites and among those at both high and low educational levels. This effect was not explained solely by the increased rate of psychiatric hospitalizations. We also determined that a decline in MMSE score over 1 year was associated with an increased risk of hospitalization, more hospital days, longer average length of stay, and a prolonged (greater than 20 days) hospital stay. We conclude that both initial poor performance on the MMSE and deterioration increase the risk of hospital use and lead to more extended hospital stays. However, even with poor MMSE performance, most older persons remain out of the hospital and most of those hospitalized do not have prolonged stays; thus, MMSE score alone is insufficient as a predictor of impending hospitalization. Further studies are needed to add other measures of risk for hospitalization and prolonged hospital stays.

Age Factors↗
PubMed1989

Diagnostic grammar and assessment: translating criteria into questions.

There has been concern about whether standardized psychiatric interviews make valid diagnoses. Agreements between the Diagnostic Interview Schedule (DIS), as an example of a standardized interview, with independent assessments by a clinician are reasonably high in most studies, but the clinical assessment is itself of uncertain validity. Using predictive ability is an alternative way of judging validity. Data are presented to show that the DIS is almost as good at prediction as a clinician's assessment, but here too there are problems. Because prediction is probabilistic (i.e. the same disorder can have multiple outcomes, and different disorders can share outcomes), it is not possible to say how good prediction has to be to demonstrate perfect validity. Across varied methods of validity assessment, some disorders are regularly found more validly diagnosed than others, suggesting that part of the source of invalidity lies in the diagnostic grammar of the systems whose criteria standardized interviews evaluate. Sources of invalidity inherent in the content and structure of a variety of diagnoses in DSM-III and its heir, DSM-III-R, are reviewed and illustrated, in part with results from the Epidemiological Catchment Area study. The relationship between diagnostic criteria and standardized interviews is symbiotic. While attempts to adhere closely to existing diagnostic criteria contribute to the diagnostic accuracy of standardized interviews, the exercise of translating official diagnostic criteria into standardized questions highlights problems in the system's diagnostic grammar, enabling standardized interviews to contribute to improvements in diagnostic nosology.

Humans↗
PubMed1989

The reliability of the CIDI-SAM: a comprehensive substance abuse interview.

The CIDI-SAM is a fully-structured interview that ascertains DSM-III, DSM-III-R, Feighner, RDC and ICD-10 diagnoses for alcohol, tobacco and nine classes of psychoactive drugs. It was designed at the request of the WHO/ADAMHA Task Force on Psychiatric Assessment instruments to expand the substance abuse sections of the CIDI. Using a test-retest design, the diagnostic and item reliabilities of this instrument were tested in a sample of 39 patients in substance abuse treatment at three St. Louis treatment facilities. Kappa values and their 95% confidence intervals, and Yule's Y values are reported. The average kappa for DSM-III substance disorders was 0.84, for DSM-III-R it was 0.82. We report, on the average, excellent kappa values for individual alcohol and drug symptoms. We also ascertained from the respondent's themselves the reasons why answers to specific questions might have been discordant. The findings from this unique 'discrepancy interview' are reported.

Adult↗
PubMed1989

History-taking in the elderly with and without cognitive impairment. How useful is it?

To assess the usefulness of interviewing older adults with cognitive impairment, we analyzed data from the NIMH Epidemiologic Catchment Area Study. People aged 65 and older with cognitive impairment were twice as likely as age-matched unimpaired elders to report sufficient symptoms of psychiatric disorders to qualify for a current diagnosis (16% vs 7%), and were also more likely to qualify for a lifetime diagnosis (25% vs 15%). We considered whether this excess could be due to random responses by the impaired, but found the rank order of their symptoms very similar to that of the unimpaired. Although dementia is thought to affect recent more than remote memory, the impaired were no less likely than the unimpaired to report disorders of recent onset. We also compared the cognitively impaired and unimpaired with respect to their reliability as assessed by reinterview one year later and found no significant difference. We conclude that there is no reason to believe that the excess of disorders in the mildly impaired is an artifact caused by their poorer performance as respondents. Interviewing the elderly person with cognitive impairment is a useful way of discovering concurrent disorders that may be treatable.

Aged↗
PubMed1989

Comprehensive health care for high-risk adolescents: an evaluation study.

This study was designed to evaluate the effectiveness of a large scale program to improve health care for high-risk adolescents. Seven clinics, funded to provide comprehensive primary care to adolescents, were compared to three non-funded clinics. The majority of the 2,788 adolescent patients sampled in these clinics were female (78 percent) and Black (71 percent). Each patient was initially interviewed at the time of a clinic visit and reinterviewed 12 months later; their medical records were systematically reviewed. As expected, the funded clinics detected and treated a wider range of medical and behavioral problems than the comparison clinics, a finding that was based on the self-reports of patients and confirmed by documentation in the medical records. However, improvements in life-style and in specific medical outcomes were not observed. To build on the limited success of this program, efforts are needed to encourage more males to receive care and to develop more specific interventions for patients in this age group.

Adolescent↗
PubMed1988

One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites.

One-month prevalence results were determined from 18,571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemiologic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (less than age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.

Adolescent↗
PubMed1988

The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures.

The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version. The field test is being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and the general populace in different cultures and to provide data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases, ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will allow investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.

Cross-Cultural Comparison↗
PubMed1988

Agreement between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule.

To increase the feasibility of identifying persons with depressive disorders in a large-scale health policy study, we tested the concordance between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule (DIS). This section was administered over the telephone to 230 English-speaking participants of the Los Angeles site of the NIMH Epidemiologic Catchment Area Program (ECA) after their completion of a face-to-face interview (Wave II) with the full DIS. Time lag between interviews was 3 months, on the average. Persons with depressive symptoms were oversampled. Using the face-to-face version as the criterion measure, the sensitivity, specificity, and positive predictive value of the telephone version for identifying the presence or absence of any lifetime unipolar depressive disorder were 71, 89, and 63 percent, respectively; the kappa statistic was 0.57, and agreement was unbiased. The comparable figures for concordance between two face-to-face interviews administered one year apart to the same subjects were 54, 89, and 60 percent and 0.45 (kappa), respectively. Thus, disagreement was due primarily to test-retest unreliability of the DIS rather than the method of administration.

Adolescent↗
PubMed1988

Problems and help seeking in high-risk adolescent patients of health clinics.

In this study, 2787 adolescents between the ages of 13 and 18 years living in inner-city communities were interviewed about their mental and physical health and their clinic use. The patients used consolidated mental and physical health clinics located in neighborhoods, hospitals, or schools; or traditional neighborhood or hospital health clinics. Analyses of selected patient problems reveal that less than one third of adolescent patients with suicide ideation, conduct disorder, and substance abuse or dependency sought or received care for those problems. Only half of the adolescents with major depression sought or received care for depression, and only two thirds of the sexually active females sought or received help with birth control. A special effort needs to be made to attract troubled youth to clinics and to identify and treat their problems, particularly when those problems involve mental health concerns.

Adolescent↗