Search PubMed⌕ Search

Biomedical subjects

M M Weissman

Publications and source records attributed to M M Weissman.

At least 145 records · Page 8Linked to original sources
PubMed1990

Panic disorder, comorbidity, and suicide attempts.

In a previous report, we demonstrated a strong association between panic disorder and suicide attempts based on data from the Epidemiologic Catchment Area study (a probability sample of more than 18,000 adults living in five US communities). In these analyses, although we controlled statistically for comorbidity of panic disorder with other psychiatric disorders, we did not directly estimate the risk of suicide attempts in persons with uncomplicated panic disorder (ie, without any other Axis I disorders) compared with those with comorbid conditions. Persons with uncomplicated panic disorder represent fewer than a third of persons with panic disorder. However, the lifetime rates of suicide attempts in persons with uncomplicated panic disorder (7%) were consistently higher than for persons with no psychiatric disorder (1%). Similar findings on the rate of suicide attempts in persons with uncomplicated major depression (7.9%) emerged. We conclude that suicide attempts are associated with panic disorder in its uncomplicated or its comorbid form and that the risks are comparable with those of major depression, comorbid and uncomplicated. These epidemiologic findings are discussed within a clinical perspective to explain why these associations may not appear obvious in clinical practice.

Adolescent↗
PubMed1990

Two-year recall of lifetime diagnoses in offspring at high and low risk for major depression. The stability of offspring reports.

Stability of recall of DSM-III diagnoses was assessed at two interviews 2 years apart in a sample of 150 offspring, aged 6 to 23 years, at high and low risk for major depression. Stability of recall was good for major depression with the use of DSM-III criteria and fair for major depression with the use of "strict" criteria (based on 4 weeks' duration of illness and an impairment in a major social role). Stability of recall was good for substance abuse and conduct disorder. Stability of recall was generally poor for anxiety disorder, regardless of subtype. For all major disorders except anxiety disorder, the difference in reported age at onset between the two interviews was small (less than 1 year) and not statistically significant. The most important correlates of stability of reports of major depression were previous psychiatric treatment and dysthymia and poor social functioning at the initial interview. This is the first study to evaluate long-term recall of DSM-III lifetime diagnoses in a nonreferred sample of children, adolescents, and young adults.

Adolescent↗
PubMed1990

Panic and generalized anxiety: are they separate disorders?

Evidence that panic and generalized anxiety disorder are separate disorders is presented from a review of epidemiological, family, and twin studies. Generalized anxiety disorder and panic disorder have been shown to have different rates and risk factors in the community and different family aggregation, which is consistent with the separation of the disorders. The one small twin study using Diagnostic and Statistical Manual, Third Edition criteria also supports the separation between these disorders. The concordance for panic disorder is greater among monozygotic than among dizygotic twins. There undoubtedly are overlaps between these disorders, and some patients with generalized anxiety disorder may later develop panic disorder; however, the results thus far support the separation of these disorders.

Agoraphobia↗
PubMed1990

Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children.

The utility of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC), a modified version of the Center for Epidemiologic Studies Depression Scale, was explored in a sample of children, adolescents, and young adults at high or low risk for depression according to their parents' diagnosis. Proband parents were participants in the Yale Family Study of Major Depression who had children between the ages of 6 and 23 years. Diagnostic and self-report information on offspring was collected over two waves, spaced 2 years apart, from 1982 to 1986. Support was obtained for the reliability and validity of the CES-DC as a measure of depressive symptoms, especially for girls and for children and adolescents aged 12-18 years. Children with major depressive disorder or dysthymia, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), had elevated scores in comparison with all other respondents. The CES-DC lacked diagnostic specificity; children with a range of current DSM-III diagnoses had elevated scores on the measure. A cutoff point of 15 and above for screening children and adolescents for current major depressive disorder or dysthymia may be optimal. Depressed respondents scoring below this cutoff point (false negatives) showed better social adjustment than true positives; nondepressed respondents scoring above this cutoff point (false positives) showed worse adjustment than true negatives. Factor analysis was used to construct an abbreviated, four-item version of the scale. The abbreviated scale was shown to be useful as a screen.

Adolescent↗
PubMed1990

Applying impairment criteria to children's psychiatric diagnosis.

This paper examines the effect of applying impairment criteria using the Children's Global Assessment Scale on rates, agreement between informants, and recall of diagnosis over 2 years in a sample of 220 offspring of depressed and nondepressed parents. The findings show that the offspring of depressed parents, compared with nondepressed parents, were more impaired overall. The rates of most psychiatric disorders in both groups of children were markedly reduced when impairment criteria were applied. The application of impairment criteria improved agreement between mother and child on many of the children's diagnoses and also improved stability of recall of child's diagnosis at 2-year follow-up. Long-term follow-up studies are needed to determine the clinical consequences for children who meet diagnostic criteria for psychiatric disorder but who have minimal functional impairment.

Adaptation, Psychological↗
PubMed1990

Parents' awareness of children's suicide attempts.

In independent psychiatric interviews with 175 children and their mothers, either the mother or the child reported that 13 (7%) of the children had made a suicide attempt. Eight of the 13 children reported attempts that were not reported by their mothers.

Adolescent↗
PubMed1990

Panic disorder and cardiovascular/cerebrovascular problems: results from a community survey.

Follow-up studies of psychiatric patients with panic disorder have shown an abnormally high mortality rate in men due to cardiovascular and cerebrovascular events. The authors report that in the New Haven portion of the Epidemiologic Catchment Area program the risk for stroke in persons with lifetime diagnoses of panic disorder was over twice that in persons with other psychiatric disorders or no psychiatric disorder. After adjustments for demographic differences between groups, the risk was even higher. While the results should be interpreted cautiously because of the small sample and absence of medical examinations, these findings are consistent with clinical studies showing an association between panic disorder and cardiovascular/cerebrovascular events.

Adolescent↗
PubMed1990

The hidden patient: unrecognized panic disorder.

The lifetime prevalence of panic disorder in the United States is 1.5%; nearly 3 times that many Americans experience recurrent panic attacks. Both conditions are associated with diminished well-being, increased alcohol and drug abuse, suicide attempts, and financial dependency, at rates often exceeding those for other psychiatric disorders, including major depression. In spite of these considerable social consequences, panic disorder and panic attacks often go unrecognized. Because their symptoms can present as other medical disorders, including myocardial infarction, temporal lobe epilepsy, Cushing's disease, anemia, hypoglycemia, and lupus, these patients are instead often seen in emergency departments and cardiac and other medical clinics. General practitioners, and especially physicians working in emergency departments, should be alert to the possibility of panic disorder, especially if the patient has a first-degree family member suffering from panic disorder.

Anxiety Disorders↗
PubMed1989

Suicidal ideation and suicide attempts in panic disorder and attacks.

Panic disorder, which is found in about 1.5 percent of the population at some time in their lives, includes recurrent episodes of sudden, unpredictable, intense fear accompanied by symptoms such as palpitations, chest pain, and faintness. Panic attacks, which do not meet these diagnostic criteria fully, are two to three times more prevalent. Since panic symptoms can mimic those of other medical disorders, patients with these symptoms use medical services frequently. To determine the risk of suicidal ideation and suicide attempts in panic disorder and attacks, we studied a random sample of 18,011 adults drawn from five U.S. communities. Subjects who had panic disorder, as compared with other psychiatric disorders, had more suicidal ideation and suicide attempts, with an adjusted odds ratio for suicide attempts of 2.62 (95 percent confidence interval, 1.83 to 3.74). The odds ratio was 17.99 (95 percent confidence interval, 12.18 to 26.58) when the group with panic disorder was compared with subjects who had no psychiatric disorder. Twenty percent of the subjects with panic disorder and 12 percent of those with panic attacks had made suicide attempts. These results could not be explained by the coexistence of major depression or of alcohol or drug abuse. We conclude that panic disorder and attacks are associated with an increased risk of suicidal ideation and suicide attempts. Physicians working in general medical settings and emergency departments should be alert to this problem.

Adolescent↗
PubMed1989

Increasing rates of depression.

Several recent, large epidemiologic and family studies suggest important temporal changes in the rates of major depression: an increase in the rates in the cohorts born after World War II; a decrease in the age of onset with an increase in the late teenaged and early adult years; an increase between 1960 and 1975 in the rates of depression for all ages; a persistent gender effect, with the risk of depression consistently two to three times higher among women than men across all adult ages; a persistent family effect, with the risk about two to three times higher in first-degree relatives as compared with controls; and the suggestion of a narrowing of the differential risk to men and women due to a greater increase in risk of depression among young men. These trends, drawn from studies using comparable methods and modern diagnostic criteria, are evident in the United States, Sweden, Germany, Canada, and New Zealand, but not in comparable studies conducted in Korea and Puerto Rico and of Mexican-Americans living in the United States. These cohort changes cannot be fully attributed to artifacts of reporting, recall, mortality, or labeling and have implications for understanding the etiology of depression and for clinical practice.

Adolescent↗
PubMed1989

Quality of life in panic disorder.

Data from the Epidemiologic Catchment Area study showed that a lifetime Diagnostic Interview Schedule/DSM-III diagnosis of panic disorder was associated with pervasive social and health consequences similar to or greater than those associated with major depression. These consequences included subjective feelings of poor physical and emotional health, alcohol and other drug abuse, increased likelihood of suicide attempts, impaired social and marital functioning, financial dependency, and increased use of psychoactive medications, health services, and the hospital emergency department for emotional problems. Comorbidity of panic disorder with major depression, agoraphobia, and alcohol or other drug abuse did not explain these findings. The social and health consequences of panic disorder (quality of life) should be considered, as risks and benefits of currently available acute and maintenance treatments are evaluated. Clinical trials of panic disorder, whether of drugs or behavioral treatment, should include quality of life assessments as outcome measures. Long-term prospective studies based on clinical samples of patients with panic disorder are indicated to relate the illness more precisely to social morbidity.

Adolescent↗
PubMed1989

Reliability of self-reported age at onset of major depression.

Reliability of self-reported age at onset of major depressive disorder was studied in a sample of 335 subjects who were ascertained from a large epidemiologic survey conducted in several U.S. communities and who were interviewed blindly at two different times. Reliability was generally good for these subjects who met DSM-III criteria for depression at two interviews. A large proportion of the variability in the difference of test-retest values can be accounted for by recency of last episode of depression and interactions of age with duration of illness, having been treated for a mental health problem, and comorbidity of other mental disorders. Interactions between duration and comorbidity and between geographic region and treatment were also significant. Contrary to previous studies which do not consider the interval between current age and age at onset and which suggest that reliability diminishes with age, our findings show that older respondents tend to systematically decrease and not increase age at onset across the two interviews. These findings do not support the hypothesis that recently reported secular changes in major depression, including a decreased age at onset and higher rates in younger as compared to older cohorts, can be explained by a differential reporting effect. Furthermore, the findings suggest that factors which contribute to variability in an individual's age at onset should be incorporated in genetic and clinical studies of major depression.

Age Factors↗
PubMed1989

Age, period and cohort effects on the risk of major depression: results from five United States communities.

Rates of major depression are presented from the recently completed Epidemiologic Catchment Area (ECA) Study based on probability samples of over 18,000 adults, 18 years of age and older, living in five U.S. communities. These rates were analyzed to describe simultaneously the changes affecting successive birth cohorts and the changes associated with the period in which the onset of the disorder occurred, using age-period-cohort (APC) models. The non-identifiability problem inherent in all APC models was resolved by assuming that the linear period effect and linear cohort effect were non-negative. This assumption is consistent with our a priori substantive knowledge of the disease. Under this assumption, as the linear period effect varies from its minimum to its maximum values, a family of curves representing the possible effects of a factor was generated for each of the time factors--age, period and cohort. The results of the analysis showed a sharp increase in rates of major depression among both men and women in the birth cohort born during the years 1935-1945. The rates among females, however, seemed to have stabilized in the generations born since 1945, while the rates in males continued to rise sharply among the cohorts born in the following decade, after which, in 1955, they also levelled off. In contrast, the rates associated with period of onset of major depression continued to increase between the years 1960-1980 among both men and women of all ages studied. These findings are considered in light of the persistent concentration of depression in women and in biologically related members of families of affected individuals.

Adolescent↗
PubMed1989

The prevalence of major depression in black and white adults in five United States communities.

There have been inconsistent findings on race differences in the rates and nature of depression, which are probably due to methodological differences between studies. Data are presented on the prevalence of major depression in white and black adults from the Epidemiologic Catchment Area Study, which examined a large community sample of five United States sites using diagnostic criteria based on the American Psychiatric Association Diagnostic and Statistical Manual, Third Edition. A total of 16,436 adults living in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), the Piedmont area of North Carolina, and Los Angeles (California) were surveyed in 1980-1983. In the five sites, age-adjusted analyses by site and sex did not show any consistent black excess in lifetime prevalence or six-month prevalence; white men as compared with black men in particular tended to have slightly higher prevalence of major depression. At all sites, in the 18-24 years age group, black women as compared with white women showed a trend for higher six-month prevalence. White men in the 18-24 years age group showed a trend for higher six-month prevalence than black men. In New Haven, Baltimore, and the Piedmont area of North Carolina, logistic regression analyses of lifetime prevalence (by site and sex) showed no significant or consistent interaction of race with household income or age. Controlling for age and household income, whites tended to have higher lifetime prevalence than black at each of these three sites, regardless of sex.

Adult↗
PubMed1988

Physicians' recognition of psychiatric disorders in children and adolescents.

We examined the ability of physicians to recognize psychiatric and behavioral problems in the children and adolescents under their care. The report by 35 physicians of psychopathology in their patients was compared with the reports of parents and of children which were derived from direct and independent assessments of the children and of parents about their children. Physicians' reports of psychological problems were also compared with reports by a child psychiatrist who used all available data on the children and made a best estimate diagnosis. Agreement between the physicians and any of the three other sources of information--parents, children, or child psychiatrist--was poor, with kappa ranging from -15 to .11. Physicians tended to underreport both minor and serious psychiatric problems in children. These results are discussed in the context of the recent American Medical Association initiative to improve the health of children and adolescents.

Adolescent↗
PubMed1988

Family and genetic studies of affective disorders.

This article summarizes discussion, conclusions, and recommendations of participants in a National Institute of Mental Health-sponsored workshop dealing with major issues in family and genetic studies of affective disorders. Key up-to-date findings in the field are reviewed with emphasis on areas of agreement. Remaining controversies and problems are identified, and a set of overall conclusions and recommendations for future research activities in the field is presented.

Adult↗
PubMed1988

The epidemiology of anxiety disorders: rates, risks and familial patterns.

This paper reviews what we know about the epidemiology and familial patterns of anxiety disorders. Focus is on the current studies based on specified diagnostic criteria. Data are presented, when available, on the subclassifications of the anxiety disorders. Data from epidemiologic and family studies support the notion that anxiety disorders have a relatively high prevalence and are familial, that they are heterogeneous, and that some are related to depression. It suggests that there is an increased probability that a person with one anxiety disorder will have another or will have a major depression during his or her lifetime. Data also suggest that panic disorder has the most severe consequence in terms of morbid risk to first-degree relatives, particularly risk to children, and that there may be a relationship between adult and childhood anxiety disorders. Potential research areas are given.

Adolescent↗