Biomedical subjects
P D Gerber
Publications and source records attributed to P D Gerber.
Natural history of male psychological health, XIII: Who develops high blood pressure and who responds to treatment.
OBJECTIVE: This study was an effort to clarify both the psychological contributions to and the long-term consequences of uncomplicated essential hypertension. METHOD: The subjects were 193 healthy college students selected as sophomores and prospectively followed for over 50 years. Independent assessments of physical and mental health were made. RESULTS: Although objective indices of psychopathology predicted both physical morbidity and mortality, they did not predict hypertension. When pyknic somatotype, college diastolic blood pressure, and well-integrated personality in college were controlled, no other preadult variable predicted hypertension. As expected, heart disease, obesity, and alcohol abuse were each correlated with hypertension. After roughly 20 years, 14 of the 41 men with treated hypertension were in stable remission, and 13 men had developed cardiac complications. No differences between these groups could be discerned. CONCLUSIONS: Over time, hypertension appeared to be more a product of biological than of psychosomatic variables. Good psychological health did not diminish the risk of hypertension.
Generalist physicians and the new health care system.
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The prevalence of psychiatric disorders in a primary care practice.
Using a two-stage case identification process, patients from a rural primary care practice were assessed for psychiatric disorders (Research Diagnostic Criteria [RDC] categories) over a 15-month period. The prevalence of all psychiatric disorders was 26.5%; 10.0% were specific RDC depressive disorders, and 5.3% were disorders without depression, usually anxiety related. Another 11.2% of patients were thought to have a disorder with significant depressive symptomatology that could not be classified into a specific depressive disorder category, a finding that suggests restricted usefulness of specialty-based categories for the range of clinical presentations in primary care. The relationship of demographic variables to specific disorders was examined; there were age, sex, and marital status differences in the rates for certain disorders, although these findings need replication using large patient samples. The prevalence findings emphasize the need for research on outcome and treatment response for depression presentations in primary care.
Recognition of depression by internists in primary care: a comparison of internist and "gold standard" psychiatric assessments.
In an effort to elucidate the process of internists' recognition of depression in primary care settings, a comparison of internist and "gold standard" psychiatric assessments of patients was undertaken in a rural primary care practice over a 15-month period. Clinical characteristics and diagnoses, global assessments of psychosocial stress, and two aspects of chief-complaint presentation style, clarity and somatization, were recorded by the internists for each patient, who was independently assessed by a psychiatrist for the presence of any specific depressive disorder by structured interview. Internists correctly labeled 57% of the interview-assessed depressives as depressed; 13% of patients with "no psychiatric disorder" were assessed as depressed by internists. Clinical and demographic characteristics of the "false-negative" and "false-positive" internists' diagnoses were examined to clarify how internists think of "depression" in the primary care context.
A prospective study of the effects of cigarette smoking and alcohol abuse on mortality.
OBJECTIVE: To compare the relative risks of alcohol abuse and cigarette smoking. DESIGN: Cohort studies utilizing a 12-to-16-year follow-up of 47-to-52-year old men. PARTICIPANTS AND SETTING: 237 Caucasian college sophomores (COLLEGE sample) and 366 socially disadvantaged junior high school students (CORE-CITY sample) selected in 1940-43 for relative mental health and for interdisciplinary study. MAIN RESULTS: The presence of many risk factors for death, including alcohol abuse and smoking, had been assessed prior to age 47 (CORE-CITY sample) and age 52 (COLLEGE sample). Over the next 12 years (CORE-CITY sample) and the next 16 years (COLLEGE sample), the men's mortality was monitored. Heavy use of cigarettes and alcohol abuse were highly correlated. When the effect of alcohol abuse was controlled, heavy smoking was associated with elevated mortality risks in both samples, although this was not statistically significant in the CORE-CITY sample. When smoking was controlled, the odds ratios for mortality from alcohol abuse were substantial in both samples. CONCLUSIONS: These results and a literature review suggest that insufficient alcohol abuse histories may lead clinicians to underestimate the mortality risk of alcohol abuse.
The relationship of presenting physical complaints to depressive symptoms in primary care patients.
OBJECTIVE: To assess the relationship of specific patient chief physical complaints to underlying depressive symptoms in primary care practice. DESIGN: A cross-sectional study that was part of a larger prevalence study of depression in primary care. SETTING: A general medical primary care practice in a teaching medical center in rural New England. PATIENTS: 1,042 consecutive outpatients screened for depression with the Hopkins Symptom Checklist 49-item depression scale and for whom physicians filled out a form recording both specific chief complaints and two aspects of complaint presentation style, clarity and amplification. INTERVENTIONS: None. RESULTS: Complaints that discriminated between depressed and non-depressed patients (at the p = 0.05 level) were sleep disturbance (PPV 61%), fatigue (PPV 60%), multiple (3+) complaints (PPV 56%), nonspecific musculoskeletal complaints (PPV 43%), back pain (PPV 39%), shortness of breath (PPV 39%), amplified complaints (PPV 39%), and vaguely stated complaints (PPV 37%). CONCLUSIONS: Depressed patients are common in primary care practice and important to recognize. Certain specific complaints and complaint presentation styles are associated with underlying depressive symptoms.