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Biomedical subjects

L N Robins

Publications and source records attributed to L N Robins.

At least 55 records · Page 3Linked to original sources

The role of parental disciplinary practices in the development of depression and alcoholism.

Awareness of child abuse has been growing over the past several decades as more cases have come to the attention of medical personnel and school and police authorities. Information-gathering systems have become more effective, and the long-term deleterious effects of abusive treatment have been brought into focus (American Humane Association 1981; Strauss et al. 1980). Cases which come to the attention of the authorities probably represent only the most blatant and severe instances of abuse. However, since Kempke and colleagues (1962) originally described the "battered child syndrome," descriptions of child abuse have been broadened to include maltreatment other than physical abuse resulting in injury (Martinez-Roig et al. 1983; Smith and Hanson 1974; Wolff 1981). Indeed, Strauss and colleagues contend that even mild forms of physical punishment should be considered abusive because they would be illegal if directed toward adults or strangers. The current paper examines retrospectively the relationship between disciplinary practices experienced in childhood, both mild and severe, and the experience of major depressive episodes and alcoholism in adulthood in a general population sample, in whom disorder tends to be untreated and mild.

Adolescent↗

Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey.

There have been numerous studies of post-traumatic stress disorder in trauma victims, war veterans, and residents of communities exposed to disaster. Epidemiologic studies of this syndrome in the general population are rare but add an important perspective to our understanding of it. We report findings on the epidemiology of post-traumatic stress disorder in 2493 participants examined as part of a nationwide general-population survey of psychiatric disorders. The prevalence of a history of post-traumatic stress disorder was 1 percent in the total population, about 3.5 percent in civilians exposed to physical attack and in Vietnam veterans who were not wounded, and 20 percent in veterans wounded in Vietnam. Post-traumatic stress disorder was associated with a variety of other adult psychiatric disorders. Behavioral problems before the age of 15 predicted adult exposure to physical attack and (among Vietnam veterans) to combat, as well as the development of post-traumatic stress disorder among those so exposed. Although some symptoms of post-traumatic stress disorder, such as hyperalertness and sleep disturbances, occurred commonly in the general population, the full syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition, was common only among veterans wounded in Vietnam.

Catchment Area, Health↗

Treatment-seeking for depression by black and white Americans.

This paper examines data from a psychiatric epidemiologic survey of 3004 households in St Louis to determine whether there are distinctions between black and white Americans in their propensities to seek treatment for episodes of depression and to discover those groups least likely to seek care. The process initiated by the experiencing of unusual or distressing signs or symptoms and completed by seeking treatment for those complaints is a complex one, involving several steps. Numerous factors may affect decisions regarding treatment-seeking including characteristics of the individuals themselves, characteristics of the symptoms, and attitudes and beliefs about the causes and proper treatment of psychiatric problems or mood. We, therefore, also examine the available epidemiologic data for some clues concerning those factors which may have contributed to the observed patterns of treatment-seeking. Significantly fewer blacks meeting psychiatric criteria for a diagnosis of depression had sought professional care. Moreover, severity of the problem was significantly related to treatment-seeking among blacks and it was among those with the least severe problems that the greatest differences were found. Whites did not significantly exceed blacks in seeking care when depressive episodes were long lasting, severe or frequent. Although there was some indication that blacks may be more tolerant of depressive symptoms, a considerable proportion of blacks who felt they had a troublesome problem had never sought professional care. There was little evidence to suggest that a fear of being stigmatized prevented blacks from seeking care. However, blacks were more likely to report that fear of treatment and of being hospitalized had prevented them from seeking care. A number of hypotheses generated by the epidemiologic data are presented. Once large-scale surveys such as this have delineated the patterns of health care utilization and identified those groups at high risk of not receiving care, anthropological concepts and problem-oriented field research may be extremely useful in testing hypotheses concerning those factors underlying the observed behavioral patterns.

Adult↗

Difficult-to-recruit respondents and their effect on prevalence estimates in an epidemiologic survey.

Generous contact efforts were used to recruit 3,004 respondents into the first wave of the St. Louis Epidemiologic Catchment Area (ECA) project, a psychiatric epidemiologic study of the general population, conducted from 1981-1982. These efforts were analyzed to establish which sociodemographic characteristics or current psychiatric disorders were determinants of difficulty in recruitment. Being young, male, black, a nonrural resident, educated, and full-time employed were the demographic characteristics associated with increased contact efforts. Persons currently meeting criteria for an alcohol disorder required almost 20% more contact attempts than those without the disorder; this difficulty lay both in their being less available for an initial contact and refusing at a higher rate once contacted. An optimal recruitment effort cutoff point is provided, and a method is suggested for detecting that optimal point in the course of ongoing studies.

Adult↗

The influence of childhood disciplinary experience on the development of alcoholism and depression.

In this case-control study, respondents from the general population with a lifetime diagnosis of major depressive disorder, alcohol abuse and/or dependence, or the absence of any psychiatric disorder ascertained by the St. Louis Epidemiological Catchment Area Study were reinterviewed about their early home environments during the period when they were 6 to 13 years of age. Two discipline scales were developed through factor analysis, and logistic regression was used to build a model using all the predictors. Unfair, inconsistent and harsh discipline by parents predicted both alcohol and depressive disorders independently of the influence of parental psychiatric history, the respondent's sex, and childhood behavior problems.

Adolescent↗

Moderate drinking in ex-alcoholics: recent studies.

The literature on the occurrence of moderate drinking in ex-alcoholics that has been published since the Rand report in 1976 is reviewed. Although differences in diagnosis, definitions of moderate drinking and length of follow-up make strict comparisons of the studies difficult, the majority of studies seem to indicate that the earlier reports of the frequency of such moderate drinking may be overly optimistic. Depending on the definition of moderate drinking that is used, the longer the interval required for alcoholics to sustain moderate, problem-free drinking, the less likely is such an outcome. Among treated alcoholics, the percentage probably ranges from about 2 to 12%; the percentage may be higher among alcoholics identified in community population samples. Thus far, the only factor common to alcoholics who are able to achieve moderate drinking is their being mild cases (i.e., having fewer lifetime alcohol-related problems than other alcoholics). Factors pertinent in assessing discrepancies between the various studies are discussed.

Alcohol Drinking↗

The extent of long-term moderate drinking among alcoholics discharged from medical and psychiatric treatment facilities.

To assess the frequency of an evolution to stable moderate drinking among alcoholics coming to medical or psychiatric treatment facilities, we examined the five- to seven-year outcome for 1289 diagnosed alcoholics treated in our facilities during a two-year period (between 1973 and 1975). We obtained data from personal interviews, records, or both for 83 per cent of the sample. Only 1.6 per cent of the subjects met our definition of stable moderate drinking at follow-up, 15 per cent had become totally abstinent, and 4.6 per cent were mostly abstinent with occasional drinking. The only predictors of moderate drinking that we found were female sex and less severe alcoholism. The evolution to stable moderate drinking appears to be a rare outcome among alcoholics treated at medical or psychiatric facilities.

Adult↗

A comparison of clinical and diagnostic interview schedule diagnoses. Physician reexamination of lay-interviewed cases in the general population.

We examined the level of agreement between diagnoses derived from data gathered by lay interviewers using the Diagnostic Interview Schedule (DIS) in a general population survey (the Epidemiologic Catchment Area project) and both DIS and clinical diagnoses made by psychiatrists. Overall percent agreement between the lay DIS and the psychiatrists clinical impression ranged from 79% to 96%. The chance-corrected concordance was .60 or better for eight of the 11 diagnoses. Specificities were all 90% or better. Sensitivities were lower, but lay results showed a bias for only two diagnoses: major depression was significantly underdiagnosed and obsessive illness was overdiagnosed. We compared the present results with those of previous studies from clinical settings. We explored possible reasons for disagreement and discussed the implications of the findings for psychiatric epidemiologic research.

Adult↗

Epidemiology: reflections on testing the validity of psychiatric interviews.

Laboratory tests that validate psychiatric disorder are unavailable. Accordingly, the validity of structured diagnostic interviews such as the Diagnostic Interview Schedule have been assessed through a double-blind test-retest design. This approach compares the Diagnostic Interview Schedule to a clinician's assessment and evaluates its results by three statistics: sensitivity and specificity, for which the clinician's interview serves as the standard, and K, which measures concordance between the two interviews. This design is found wanting on several counts: the reinterview may be answered differently because of clinical change or because of its meaning to the respondent; the clinician's interview may be an erratic standard; and the statistics are affected by both prevalence and severity of disorder. Furthermore, the statistics may not predict the accuracy of prevalence estimates made by the interview or its ability to detect correlates of disorder. Some alternative approaches are suggested.

Clinical Trials as Topic↗

Occupational prestige and mortality in black and white alcoholics.

Mortality was studied in 1289 Black and White alcoholics. The overall proportion of mortality over 5-9 years was 22.0%. No overall differences were found between Black and White mortality rates by crude death proportions or standardized mortality ratios. Blacks were significantly younger at death than were Whites and were also significantly younger than Whites at admission to treatment. Occupational prestige was examined in the 374 Whites and 270 Blacks for whom an occupation was known, prestige being divided into high, medium and low categories. Blacks suffered significantly higher mortality in the high prestige group and Whites suffered significantly higher mortality in the middle prestige group. Alcoholics in the high prestige group suffered slightly greater mortality than alcoholics in the middle and lower groups. The results seem to indicate that although occupational prestige is an important variable in mortality among alcoholics, other variables that were not controlled in these analyses may also be important.

Adult↗

The NIMH Epidemiologic Catchment Area program. Historical context, major objectives, and study population characteristics.

The National Institute of Mental Health multisite Epidemiologic Catchment Area (ECA) program is described in the context of four previous psychiatric epidemiologic surveys that included a combined total of 4,000 subjects from Stirling County, the Baltimore Morbidity Study, Midtown Manhattan, and the New Haven third-wave survey. The ECA program is distinguished by its sample size of at least 3,500 subjects per site (about 20,000 total); the focus on Diagnostic Interview Schedule--defined DSM-III mental disorders; the one-year reinterview-based longitudinal design to obtain incidence and service use data; the linkage of epidemiologic and health service use data; and the replication of design and method in multiple sites. Demographic characteristics of community and sample populations are provided for New Haven, Conn, Baltimore, and St Louis.

Adolescent↗

Lifetime prevalence of specific psychiatric disorders in three sites.

Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.

Adolescent↗