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Biomedical subjects

P Goering

Publications and source records attributed to P Goering.

At least 37 records · Page 2Linked to original sources
PubMed1997

Reversed neurovegetative symptoms of depression: a community study of Ontario.

OBJECTIVE: Most research on depression with reversed neurovegetative features (hypersomnia, hyperphagia, and weight gain) has been based on site-specific clinic-based samples. The goal of this study was to delineate the epidemiology of reversed symptoms in a large community sample and to use other symptom patterns for comparison. METHOD: Interviewers assessed 8,116 subjects across Ontario, aged 15-64 years, by using the World Health Organization Composite International Diagnostic Interview. Individuals who met the DSM-III-R criteria for major depression, current or lifetime, were classified into four groups on the basis of lifetime neurovegetative symptoms: episodes of typical symptoms only, episodes of reversed symptoms only, neither type, or both types (fluctuating-symptom group). The groups were compared on demographic characteristics, comorbidity, disability, and health care utilization. RESULTS: Of the 653 individuals with lifetime major depression, 11.3% had episodes of reversed symptoms only, and another 5.8% were classified as fluctuating. Most of the differences among the four groups were due to the unique characteristics of the groups with neither type of episode or a fluctuating pattern; individuals who had experienced only reversed symptoms were remarkably similar to those who had had only typical symptoms. The fluctuating-symptom group had high rates of comorbidity, substance abuse, and health care utilization. CONCLUSIONS: Several popular beliefs about depression with reversed features did not hold true for this community sample. Identifying individuals who fluctuate between reversed and typical episodes may be important in studies of major depression, in particular when reversed neurovegetative symptoms are a consideration.

Adolescent↗
PubMed1997

Family physicians and the mental health system. Report from the Mental Health Supplement to the Ontario Health Survey.

OBJECTIVE: To determine family physicians' role in the mental health care system. DESIGN: The Mental Health Supplement to the Ontario Health Survey is an epidemiologic, retrospective, home-interview survey. Results reported here are based on responses of a weighted sample of patients aged 15 to 64. SETTING: Ontario, 1990 to 1991. PARTICIPANTS: Random sample of 9953 household residents. MAIN OUTCOME MEASURES: Standardized assessment of mental disorders, associated risk factors and disability, and patterns of use of mental health services. RESULTS: More people seek mental health services from their family physicians (FPs) than from psychiatrists, social workers, or psychologists. Among patients who consulted for mental health purposes, more than 35.4% saw FPs only, 24.7% saw FPs and other mental health care providers (psychiatrists, psychologists, social workers, others), and 40% saw other mental health care providers only. There were few sociodemographic, diagnostic, or clinical severity differences between the FP-only group and the other two groups. Some evidence suggested FPs saw more recent onset cases, but they were also involved in joint care for more complex or disabled cases. More than 57% of those seeing FPs received medication; 43% received other forms of care. Those seeing FPs only made four visits per year; those who consulted other mental health professionals made 14 to 20. CONCLUSIONS: Our study confirms FPs' important role in the current mental health care system.

Adult↗
PubMed1996

Mood disorders: rural/urban differences in prevalence, health care utilization, and disability in Ontario.

This study examines whether rural Ontario differs from urban Ontario in mood disorder prevalence, health service use and concomitant disability. An epidemiologic community survey of 9953 individuals was conducted, with rural/urban status defined by population-density-related criteria. Overall, Ontario prevalence rates for depression, manic episode, and dysthymia were similar to previous studies, but rural rates were unexpectedly no different from urban ones. Nearly half of mood disorder subjects used no services, and one-third reported significant disability. Rural individuals with mood disorders were similar to their urban counterparts in service use and disability.

Adolescent↗
PubMed1996

Purging and nonpurging forms of bulimia nervosa in a community sample.

OBJECTIVE: Recent consensus on the subclassification of the eating disorder bulimia nervosa into purging and nonpurging forms is examined in the context of a large psychiatric epidemiological survey in Ontario, Canada. METHOD: Among a sample of 8,116 individuals, 62 met criteria for bulimia nervosa. Of these, the 17 who were of the purging subtype could be distinguished from the nonpurging group on a variety of parameters of comorbidity, family history, and childhood environment. RESULTS: The purging subtype was distinguishable on the basis of early age of onset, and high rates of affective disorders and anxiety and alcoholism, sexual abuse, and parental discord. DISCUSSION: The data support the taxonomy and point to the need for better understanding of the meaning of purging behavior.

Adolescent↗
PubMed1996

Mental health supplement to the Ontario Health Survey: methodology.

OBJECTIVE: To describe the methodology of a province-wide, cross-sectional, epidemiologic study of psychiatric disorder among those aged 15 years and over living in household dwellings in Ontario. METHOD: Respondents for the survey were drawn from households (N = 13002) participating in a province-wide health survey. One person per household was selected, and 9953 (76.5%) participated. RESULTS: Participants and nonparticipants were similar to each other. An extensive array of data, including measures of psychiatric disorder classified using a revised version of the Composite International Diagnostic Interview (CIDI), are available for all respondents. CONCLUSIONS: The Ontario Health Supplement is contained in a public-use data file at the Ontario Ministry of Health and is available to investigators for study. A strong survey design, careful measurement, and acceptable levels of response provide the rationale for our inviting researchers to access and use the Ontario Health Supplement data base.

Adolescent↗
PubMed1996

One-year prevalence of psychiatric disorder in Ontarians 15 to 64 years of age.

OBJECTIVE: To present the one-year prevalence of 14 psychiatric disorders in a community sample of Ontarians aged 15 to 64 years. METHOD: Data on psychiatric disorders were collected on 9953 respondents using the University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI). DSM-III-R criteria were used to define the psychiatric disorders. RESULTS: Almost 1 in 5 Ontarians (18.6%) had one or more of the disorders measured in the survey. Among 15-to 24-year-olds, 1 in 4 was affected. The distribution of individual disorders varied by sex and age. CONCLUSION: Because of the immense burden of suffering associated with psychiatric disorders, clinical and research efforts in this area should receive high priority within the health budget.

Adolescent↗
PubMed1996

The use of mental health services in Ontario: epidemiologic findings.

OBJECTIVE: To describe the distribution and predictors of mental health service use for a survey of Ontario household residents aged 15 to 64 years. METHOD: Service use was defined as any past-year contact with formal or informal health care providers for mental health reasons. Data from the Mental Health Supplement (the Supplement) to the Ontario Mental Health Survey were used to compare the sociodemographic, geographic, and diagnostic status characteristics of service users with these characteristics among nonusers. RESULTS: Mental health services were used by 7.8% of respondents in the past year. The majority (57.8%) had a past-year University of Michigan Composite International Diagnostic Interview (UM-CIDI) diagnosis, although 27.1% had never met diagnostic criteria. Other significant predictors were marital status, household public assistance, gender, age, and urban/rural residence. CONCLUSION: Although diagnosis is the strongest predictor of use, the fit between "need" and "care" in Ontario is not perfect. Help seeking differs within specific sociodemographic and geographic groups. Furthermore, the association of marital disruption and economic disadvantage with utilization indicates that prevention and intervention should address needs beyond the medical or psychological.

Adolescent↗
PubMed1996

Should amenorrhoea be necessary for the diagnosis of anorexia nervosa? Evidence from a Canadian community sample.

BACKGROUND: This study compares the characteristics of women with anorexia nervosa with those of women who have all the diagnostic features of that disorder except amenorrhoea. METHOD: The study uses data from a large community epidemiological survey of the mental health status of household residents in Ontario, Canada. A multi-stage stratified sampling design generated a sample of 4285 females aged 15-64. DSM-III-R diagnoses were made using the Composite International Diagnostic interview. RESULTS: Eighty-four out of 4285 female respondents met full or partial-syndrome criteria for anorexia nervosa. Comparison of these two groups revealed few statistically significant differences in terms of demographics, psychiatric comorbidity, family history or early experiences. CONCLUSIONS: Amenorrhoea did not discriminate between women with anorexia nervosa and women with all the features except amenorrhoea across a number of relevant variables. The authors question the utility of amenorrhoea as a diagnostic criterion.

Adolescent↗
PubMed1996

Psychiatric disability in Ontario.

OBJECTIVE: To describe the disability associated with psychiatric disorder in a community sample in order to refine estimates of service need and identify subgroups with greater priority for intervention. METHOD: Disability is conceptualized broadly as performance difficulties, troubled relationships, and dissatisfaction in various life domains. Data from the Mental Health Supplement are used to compare disability between those with and without disorder and among various subtypes of disorder. RESULTS: Although the majority of those with disorder do not report disability, their difficulties with functioning are far greater than for the rest of the population. Those with comorbid or affective disorders typically have more disability than those with anxiety or substance abuse disorders. CONCLUSIONS: Society needs to recognize the high human and economic costs associated with the prevalence of psychiatric disorder. Assessments of service need and decisions about priorities should take both disorder and disability into consideration.

Adolescent↗
PubMed1995

Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups.

OBJECTIVE: Previous epidemiological studies of bulimia nervosa have generated differing estimates of the incidence and prevalence of the disorder. These differences are attributable, in part, to varying definitions of the illness and a range of methodologies. The authors sought to define the prevalence of bulimia nervosa in a nonclinical community sample, examine the clinical significance of DSM-III-R threshold criteria, and examine comorbidity. METHOD: Subjects across Ontario (N = 8,116) were assessed with a structured interview, the World Health Organization Composite International Diagnostic Interview, with specific questions added for bulimia nervosa. Subjects who met DSM-III-R criteria for bulimia nervosa were compared with those who were missing only the frequency criterion (two or more binge-eating episodes per week for 3 months). RESULTS: In this sample, the lifetime prevalence of bulimia nervosa was 1.1% for female subjects and 0.1% for male subjects. The subjects with full- and partial-syndrome bulimia nervosa showed significant vulnerability for mood and anxiety disorders. Lifetime rates of alcohol dependence were high in the full-syndrome group. Rates of parental psychopathologies were high in both bulimic groups but tended to be higher in the subjects with full-syndrome bulimia nervosa. Both bulimic groups were significantly more likely to experience childhood sexual abuse than a normal female comparison group. CONCLUSIONS: This study confirms other prevalence estimates of bulimia nervosa and its comorbid diagnoses from studies that were based on sound methodologies. It also points to the arbitrary aspects of the frequency of binge eating as a diagnostic threshold criterion for the disorder.

Adolescent↗
PubMed1994

Planning mental health services: background and key issues.

Deinstitutionalization in Canada produced a shift in locus of care from provincial psychiatric hospitals to general hospital psychiatric units. As a result of this approach, a number of key planning issues have emerged that most provinces are attempting to address.

Canada↗
PubMed1994

Gender differences in the use of outpatient mental health services.

Current economic constraints necessitate careful planning and evaluation of mental health services. Gender differences in need and use of outpatient mental health services are synthesized based on current epidemiological research. Although overall prevalence rates of mental disorder are similar, women use more outpatient mental health services than do men. This disparity exists largely within the primary care sector. The study of social roles and behavior may help explain these gender differences. Implications for planning and organizing outpatient mental health services are discussed.

Canada↗
PubMed1993

Psychiatric nursing and the context of care.

Our ability to provide nursing care for persons with severe mental illness is contingent on awareness of contextual factors and our ability to adapt and influence them. Briefer inpatient stays and more partial hospitalization programs must lead to changes in our theoretical orientation and types of intervention. Awareness of the shift to community mental health and the threat of the remedicalization of psychiatry should encourage nurses to broaden their roles and add new skills. Case management and political and systems advocacy are particularly crucial responses to the needs of the severely mentally ill and their families. We must never lose sight of individual patients and their pain. The alleviation or prevention of this pain is our ultimate goal.

Female↗
PubMed1993

Development of an animal model for testing human breast implantation materials.

Although breast implant materials have been tested in laboratory species since the early 1950s, a standardized evaluation system does not currently exist in which human-made polymers are exposed directly to the mammary milieu of female animals. The present study evaluated such a model as the basis for future experiments on long-term tissue effects. Polyesterurethane disks, 6 mm in diameter x 3 mm thick, were inserted bilaterally beneath the axillobrachial and inguinal mammary/fat pads of 50 9-wk-old female B6D2F1 mice (4 implants each). Implant sites were examined histologically at time points 24 hr to 47 wk after surgery. An acute inflammatory reaction at the implant edges began within 24 hr, and macrophages were found lining the smooth polyurethane fiber surfaces at the periphery by day 2. Multinucleated foreign body giant cells formed by day 4, and by week 4 giant cells contained polyurethane fragments within the cytoplasm, implying degradation of the material. Implant sites showed declining subacute inflammatory responses and increasing fibrosis by week 5. By 13 wk, the polyurethane disks appeared to be integrated into the growing adipose and mammary tissues. Although not apparent on gross inspection, microscopic examination showed that polyurethane fibers moved progressively into adjacent tissues and were always associated with chronic granulomatous inflammation. Histologic findings in the present study are strikingly similar to the human response to polyurethane-coated breast implants. These results suggest the applicability of this model to appropriately test mammaplasty materials in mammary tissues.

Animals↗
PubMed1992

Social networks of residents in supportive housing.

One goal of supportive housing is to enlarge and improve the functioning of the social support networks of residents. The networks of a convenience sample of 42 residents were assessed using scales developed by Barrera. The size of the networks (11.5) was no larger than that reported for similar clients living in other types of community settings but the composition differed. Staff and co-residents appear to partially replace rather than add to family and friends. This is of concern because friends are uniquely important determinants of satisfaction. An association between perceived need for support and network size was also found. These findings suggest some positive influences but also raise questions about unintended negative consequences of living in artificially constructed social environments.

Adult↗
PubMed1992

Clinical issues in social network therapy for clients with schizophrenia.

Social networks are viable foci for therapeutic interventions. A social network therapy program for clients with schizophrenia was developed by a community-based mental health agency. This paper presents four of the most common clinical issues encountered and illustrates each with a case example.

Adult↗