Biomedical subjects

M A Burnam

Publications and source records attributed to M A Burnam.

At least 37 records · Page 2Linked to original sources

PubMed1993

Risk factors for secondary depression among Mexican Americans and non-Hispanic whites. Alcohol use, alcohol dependence, and reasons for drinking.

We evaluated demographic (age, gender, income), cultural (ethnicity, acculturation), clinical (alcohol use, alcohol dependence), and motivational (subjective reasons for drinking) potential risk factors for secondary depression in 372 persons with lifetime alcohol abuse or dependence (from a randomly selected community sample of 2393). Lifetime alcohol abuse or dependence increased the risk of major depression by a factor of approximately 2 to 7. Recent secondary depression was present in 2% to 18% of persons meeting criteria for alcohol use disorders. Low income, female gender, and among Mexican Americans, low acculturation were associated with increased risk of secondary depression. Persons with lifetime alcohol diagnoses who currently drank, but did not name relaxation as a reason for drinking, were also at higher risk for secondary depression. Drinking to forget was associated with increased risk of secondary depression among Mexican American alcoholics, but not among non-Hispanic white alcoholics. Current abstinence was associated with greater risk among lifetime alcoholics born in Mexico, but not among those born in the United States.

Adult↗

PubMed1993

Development of screeners for depressive disorders and substance disorder history.

If screeners are going to be widely incorporated in clinical care to increase the detection of common psychiatric disorders, they need to be brief, easy to score, and sensitive across diverse patient populations. Few screeners exist that meet these criteria. This problem is addressed in this study by identifying a subset of questions from the Diagnostic Interview Schedule (DIS), which predicted simultaneously obtained DIS diagnoses. A two-item screener to detect depression or dysthymia within the last year and three-item screeners for lifetime drug disorders and alcohol disorders were tested in community residents, medical, and mental health patients. The sensitivity of the depression screener ranged between 83% and 94%. The sensitivity of the drug screener ranged between 91% and 94%, excluding one site with an extremely low prevalence of drug problems. The sensitivity of the alcohol screener ranged between 87% and 92%. Specificity for all three screeners exceeded 90% in community and medical samples, while being somewhat lower among mental health patients. These findings indicate that these brief screeners may be useful in a variety of epidemiologic studies to provide estimates of common psychiatric disorders when complete diagnostic interviews are not feasible. If further validation studies support these sensitivity and specificity estimates, these new instruments may also be valuable as initial brief screeners in a two-stage screening process to improve clinicians' recognition of common mental health problems that complicate case management and impair patient functioning.

Adult↗

PubMed1993

Course of depression in patients with hypertension, myocardial infarction, or insulin-dependent diabetes.

OBJECTIVE: The authors examined the course of depression over 2 years for outpatients with and without a history of hypertension, a history of myocardial infarction, or current insulin-dependent diabetes. METHOD: Among outpatient visitors to the practices of 523 general medical clinicians and mental health specialists, 626 depressed patients were followed for 1 or 2 years with a telephone-administered interview based on the format of the National Institute of Mental Health Diagnostic Interview Schedule. RESULTS: Depressed patients with and without medical illness had high rates of persistent depressive symptoms and spells over 2 years. Patients with a lifetime history of myocardial infarction had significantly more spells of depression over the first follow-up year, more total symptoms of depression in the second follow-up year, and more depressive symptoms at the end of each follow-up year than depressed patients without myocardial infarction. The course of depression did not differ significantly for depressed patients with and without a lifetime history of hypertension or current insulin-dependent diabetes. CONCLUSIONS: Among depressed adult outpatients, a history of myocardial infarction is associated with a particularly poor clinical prognosis. A relatively high percentage of all depressed patients in this study had persistent depression regardless of the extent of medical comorbidity.

Adolescent↗

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

Measuring the outcomes of care for mental health problems. The case of depressive disorders.

To conduct effectiveness research in mental health, many nontrivial problems need to be addressed. A multidisciplinary expert panel designed an outcomes module for major depression and dysthymia to measure disease-specific outcomes, treatments routinely provided, and patient characteristics that influence treatment or its outcomes. The outcomes module was pilot-tested to evaluate its ability to identify a diagnostically homogeneous group of patients, to establish its reliability and validity, and to assess the feasibility of administering the module in a mental health setting. In a cohort of 40 patients, the module identified all 31 patients who had a research diagnosis of major depression or dysthymia (100% sensitivity), and 2 of 9 patients who did not have this diagnosis (77.8% specificity). The outcomes module measured key constructs accurately enough to discriminate between groups of depressed patients expected to differ, indicating positive construct validity. High rates of instrument completion supported the feasibility of using the module in specialty settings. Extensive efforts locating patients for follow-up will be needed to draw valid conclusions about treatment effectiveness.

Adult↗

PubMed1992

Mental health status among Puerto Ricans, Mexican Americans, and non-Hispanic whites.

Compared mental health characteristics of island Puerto Ricans to three groups from the Los Angeles Epidemiologic Catchment Area Study: Mexican American immigrants, U.S.-born Mexican Americans, and Non-Hispanic whites. The Diagnostic Interview Schedule was used to obtain both diagnostic and symptom scale information about affective disorders, alcohol abuse/dependence, somatization, phobic disorder, and psychotic disorder. Mexican American immigrants had the fewest mental health problems of all groups. Puerto Ricans had more somatization disorder, but less affective and alcohol disorders than U.S.-born Mexican Americans or non-Hispanic whites. Results are considered in the light of selection factors, relative disadvantage of groups and methodological problems.

Adolescent↗

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

Immigration, stress, and depressive symptoms in a Mexican-American community.

This study assessed levels of depressive symptomatology in a household probability sample of Mexico-born (N = 706) and U.S.-born (N = 538) Mexican Americans. We hypothesized that immigration status differences in acculturation, strain, social resources, and social conflict, as well as differences in the associations of these variables with depression, would account for differences in depression between U.S.-born and Mexico-born respondents. U.S.-born Mexican Americans had higher depression scores than those born in Mexico. When cultural and social psychological variables were controlled in a multiple regression analysis, the immigrant status difference persisted. Tests of interaction terms suggested greater vulnerability to the effects of low acculturation and low educational attainment among the U.S.-born relative to those born in Mexico; however, the immigrant status difference persisted after controlling for these interactions. Unmeasured variables such as selective migration of persons with better coping skills, selective return of depressed immigrants, or generational differences in social comparison processes may account for the immigration status difference.

Acculturation↗

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↗

PubMed1989

Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study.

We estimated clinicians' awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care.

Adult↗

PubMed1989

The functioning and well-being of depressed patients. Results from the Medical Outcomes Study.

We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.

Adult↗

PubMed1989

Affective, substance use, and anxiety disorders in persons with arthritis, diabetes, heart disease, high blood pressure, or chronic lung conditions.

The authors estimated the sex- and age-adjusted prevalence of affective, substance use, and anxiety disorders in persons in a general population sample who identified themselves as having arthritis, diabetes, heart disease, high blood pressure, chronic lung disease, or no chronic medical conditions. Persons who reported ever having arthritis, heart disease, chronic lung disease, or high blood pressure had a significantly increased adjusted prevalence of each of the three groups of lifetime psychiatric disorders, relative to a no-chronic conditions comparison group (each p less than 0.05). Persons who ever had diabetes had an increased adjusted prevalence of lifetime affective and anxiety but not substance use disorder. Persons with current (i.e., active) arthritis, heart disease, or high blood pressure had a significantly increased adjusted prevalence of recent (6-month) anxiety disorder, whereas those with current chronic lung disease had an increased adjusted prevalence of recent affective and substance use but not anxiety disorder.

Adult↗

PubMed1989

Anxiety disorders among Mexican Americans and non-Hispanic whites in Los Angeles.

This report from the Los Angeles site of the NIMH Epidemiologic Catchment Area study reveals significant ethnic and national origin differences in lifetime prevalence rates for three out of six specific, DSM-III-defined anxiety disorders. In the case of simple phobia, United States-born Mexican Americans report higher rates than native non-Hispanic whites or immigrant Mexican Americans, the latter two groups having similar rates. Mexican Americans born in the United States had higher rates of agoraphobia than immigrant Mexican Americans, and non-Hispanic whites reported higher lifetime rates of generalized anxiety disorder compared with both immigrant and native Mexican Americans. Neither ethnic nor national origin differences in lifetime prevalence rates were found for panic disorder, social phobia, and obsessive-compulsive disorder. Selective migration is postulated as a potential factor influencing prevalence differences between native and immigrant Mexican Americans.

Anxiety Disorders↗

PubMed1989

Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders.

The authors studied the prevalence of eight chronic medical conditions in an adult population sample (N = 2,554) with and without psychiatric disorders. Adjusted for age and sex, the prevalence of any lifetime chronic medical condition for persons with any lifetime affective, anxiety, or substance use disorder was 61.4%, 57.1%, and 57.7%, respectively. Each of these percentages was significantly higher than that for persons with no lifetime psychiatric disorder (53.4%). Both lifetime affective and anxiety disorders were uniquely associated with a greater prevalence of any lifetime chronic medical condition, but the only psychiatric disorders uniquely associated with current (i.e., active) chronic medical conditions were anxiety disorders, suggesting that the association between anxiety disorders and chronic medical conditions develops more quickly than associations between medical conditions and other psychiatric disorders.

Adult↗

PubMed1989

Resistance to sexual assault: who resists and what happens?

To determine who resists sexual assault and what happens, data were examined from a probability sample of 3,132 adult community residents of Los Angeles, California. Seventy-five per cent of the respondents reporting an assault (n = 365) indicated that they had attempted to resist their most recent assault; talking was the most frequently used resistance strategy. The strongest predictor to emerge in the multivariate analyses of resistance was timing of assault: respondents assaulted only in childhood were less likely to resist than either respondents assaulted only in adulthood, or respondents assaulted in both phases. Univariate analyses indicated that resistance reduced the probability of sexual contact, however multivariate analyses suggested that assailant use of force was the most important determinant of assault outcome.

Adolescent↗