Biomedical subjects

W W Eaton

Publications and source records attributed to W W Eaton.

At least 37 records · Page 2Linked to original sources

PubMed2000

Psychopathology and the initiation of disability payments.

OBJECTIVE: Longitudinal prospective data from the multisite Epidemiologic Catchment Area (ECA) survey were examined to determine relationships between mental disorders, alcohol abuse or dependence, and transfer payments for disability. METHODS: ECA respondents who were not receiving disability benefits at baseline but who were receiving them at the one-year follow-up were identified. The effects of six psychiatric disorders on the risk of starting payments were examined. They were major depressive disorder, panic disorder, alcohol abuse or dependence, phobic disorder, obsessive-compulsive disorder, and schizophrenia. The odds of starting to receive payments were calculated for persons with these disorders, any mental or addictive disorder, or any two or more disorders, while the analysis controlled for sociodemographic characteristics. RESULTS: A total of 15,567 people were interviewed at baseline; 7 percent received disability payments. Among the 11, 981 people interviewed at one year, 261 had begun to receive payments that year, for a starting rate of 2.2 percent. Significant predictors of the initiation of payments were little education (odds ratio=3.7) and low household income (OR=2.6). Respondents with panic disorder were 5.2 times more likely to begin receiving benefits than those without this disorder; respondents with schizophrenia were 4.5 times more likely and those with two or more disorders were 2.8 times more likely to start benefits than those without these disorders. CONCLUSIONS: Differences in social class influenced the initiation of disability payments. However, having a mental or addictive disorder was a more significant predictor, strongly increasing the risk of receiving payments. Given the economic burden to society and potential loss of earnings and opportunity costs for persons with disability and their families, intervening to prevent or alleviate mental disorders should be considered as one alternative to reducing disability payments.

Adult↗

PubMed2000

Psychosocial work environment and depression: epidemiologic assessment of the demand-control model.

OBJECTIVES: This study examined the relation between occupational variables and 3 forms of depression (major depressive episode, depressive syndrome, and dysphoria). It was hypothesized that individuals working in occupations with high psychologic strain (high psychologic demands and low decision authority) would have a higher prevalence of depression relative to those working in occupations with the other 3 possible conditions. METHODS: The analysis was based on data for 905 respondents who were employed full-time in the year before the follow-up interview for the Epidemiologic Catchment Area Program in Baltimore, Md, between 1993 and 1996. Psychosocial work environment, sociodemographic variables, and psychopathology were assessed in a household interview that included the National Institute of Mental Health Diagnostic Interview Schedule. Subscales for the demand-control model for psychosocial work environment were modified slightly after factor analysis. RESULTS: High job strain was associated with greater prevalence of all 3 forms of depression, especially major depressive episode. The results were stronger for women; for men, being unmarried was the strongest prevalence correlate. CONCLUSIONS: Major depressive episode, depressive syndrome, and dysphoria are strongly associated with the psychosocial dimensions of the demand-control model.

Adult↗

PubMed1999

Psychopathology and attrition in the Baltimore ECA 15-year follow-up 1981-1996.

Predictors of non-response were investigated in a 15-year follow-up (1981-1996) of 3,481 individuals in a probability sample from the household population of East Baltimore. Demographics (age, sex, race, education, marital status, and unemployment), household factors (living arrangements, household income, household size, and number of children), cultural variables (ancestral ethnicity and foreign language), social variables (social support and networks, committing felony, carrying a weapon, using an alias, and wandering), health factors (physical illness, health insurance, medical assistance, Medicare, receiving disability benefits, social security, and welfare), interviewer's observation, and psychopathologic variables (mental disorders, suicide behavior, comorbidity, and drug use) were collected at baseline in 1981 and in 1982, then linked to follow-up data between 1993 and 1996. A tracing process involving mail, phone, criss-cross directories, motor vehicle administration records, a commercial credit bureau, the state criminal justice system, hospital records, the US National Death Index, and field tracing were used to locate the original sample. A total of 3,066 respondents of the original sample (88.1%) were traced. Non-response was categorized into Sample Mortality (that part of the original sample that died during follow-up), Sample Loss (that part of the original sample that survived but could not be found) and Refusal (that part of the original sample that survived and was found but refused to participate). Stratified analysis and adjusted multiple logistic regression modeling found sample mortality and sample loss were strongly influenced by individual and household variables and by psychopathology. Sample mortality was influenced by specific mental disorders or conditions as mania, drug abuse/dependency, antisocial personality, cognitive impairment, alcohol abuse/dependency, phobia, drug use (except PCP), and comorbidity. Household factors protective against mortality include higher household income, not living as extended members in a married couple family, and living with children in the household. Persons who were unemployed, widowed or single, without high school education, male, and 65 years of age or older were more likely to die. Sample loss was influenced by cognitive impairment, antisocial personality, and cocaine use. Household factors linked to sample loss include living in female-headed families, or non-family households, and living alone. Young nonwhite, divorced/separated, without high school education, and unemployed were also harder to find. Refusal was associated with being white, with incomplete elementary education, living as a spouse in traditional married couple families, or as a child in female-headed families. Psychopathology did not influence refusal.

Adolescent↗

PubMed1999

The long-term outcomes of mental health treatment in a population-based study.

This study examined the long-term outcomes of mental health treatment, specifically individual therapy, group therapy, and pharmacotherapy, in a population-based study. Using a prospective cohort design, the effectiveness of mental health treatment was analyzed on the basis of data from an epidemiological catchment area follow-up study, which assessed health care use and mental health status at 2 times, 15 years apart, in a random sample of Baltimore residents. A cohort of 771 men and women with at least 1 diagnosable Diagnostic and Statistical Manual of Mental Disorders disorder was selected from the 1,920 individuals randomly sampled in 1980 who were followed in 1994-1996. The results are consistent with clinical trials on the efficacy of pharmacotherapy and psychotherapy. After controlling for baseline psychopathology, sociodemographic characteristics, and service providers, participants who received group and individual therapy had lower distress at follow-up than those who either received medication or did not seek or receive any treatment. No concomitant reductions in the number of disorders were found, except for a dose-response association between the number of therapy sessions and the number of disorders at follow-up, as well as distress at follow-up.

Adult↗

PubMed1999

Mental health service utilization by African Americans and Whites: the Baltimore Epidemiologic Catchment Area Follow-Up.

OBJECTIVE: To compare mental health service utilization and its associated factors between African Americans and whites in the 1980s and 1990s. DESIGN: Household-based longitudinal study with baseline interviews in 1981 and follow-up interviews from 1993 to 1996. SETTING: The Baltimore Epidemiologic Catchment Area (ECA) Follow-Up. SUBJECTS: Subjects included 1,662 adults (590 African Americans and 1,072 whites). MAIN OUTCOME VARIABLE: Use of mental health services, defined as talking to any health professional about emotional or nervous problems or alcohol or drug-related problems within the 6 months preceding each interview. RESULTS: In 1981, crude rates of mental health service use in general medical (GM) settings and specialty mental health settings were similar for African Americans and whites (11.7%). However, after adjustment for predisposing, need, and enabling factors, individuals receiving mental health services were less likely to be African American. Mental health service use increased by 6.5% over follow-up, and African Americans were no longer less likely to report receiving any mental health services in the 1990s. African Americans were more likely than whites to report discussing mental health problems in GM settings without having seen a mental health specialist. They were less likely than whites to report use of specialty mental health services, but this finding was not statistically significant, possibly because of low rates of specialty mental health use by both race groups. Psychiatric distress was the strongest predictor of mental health service use. Attitudes positively associated with use of mental health services were more prevalent among African Americans than whites. CONCLUSIONS: Mental health service use increased in the past decade, with the greatest increase among African Americans in GM settings. Although it is possible that the racial disparity in use of specialty mental health services remains, the GM setting may offer a safety net for some mental health concerns of African Americans.

Adult↗

PubMed1999

Incidence of DIS/DSM-IV social phobia in adults.

OBJECTIVE: The aim of the study was to estimate the incidence of social phobia in the general population. METHOD: The Baltimore cohort of 3481 subjects, sampled during the 1981 Epidemiologic Catchment Area study, was traced. A total of 1920 subjects were re-interviewed from 1993 to 1996 using the Diagnostic Interview Schedule (DIS). A subsample of 349 subjects was interviewed by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry. RESULTS: The estimated incidence of DIS/DSM-IV social phobia is 4-5/1000/year. New cases were found in all age groups, with the highest rates in subjects with baseline depressive and panic disorders. Psychiatric evaluations showed broad diagnostic concordance with DIS diagnoses in incident cases. However, validity indices were highly dependent on diagnostic thresholds. None of the psychiatrist-ascertained social phobics had received treatment for the disorder, although the majority were considered likely to benefit from treatment. CONCLUSION: New cases of social phobia occur in adults of all age groups, and are often secondary to other psychiatric conditions.

Adult↗

PubMed1999

The psychiatric profile of patients with chronic diseases who do not receive regular medical care.

OBJECTIVE: To assess the relationship between psychiatric disorders and lack of regular medical care in individuals with chronic medical diseases. METHODS: Nine hundred sixty-three respondents to the household-based Baltimore Epidemiologic Catchment Area (ECA) Follow-Up Study were interviewed in 1981, 1982, and 1993-1996. The main outcome measures were: 1) not receiving regular care from a health professional for an active chronic medical condition in 1981, 2) persistent lack of regular medical care, and 3) leaving regular medical care. RESULTS: In cross-sectional analyses, having a psychiatric disorder (OR 1.70, 95% CI 1.17-2.48) was associated with not receiving regular medical care. This was mostly due to individuals with phobic disorder (OR 1.57, 95% CI 1.02-2.43). In prospective analyses, depression (RR 2.4, p < 0.04) and alcohol abuse (RR 2.9, p < 0.001) predicted leaving regular medical care one year later. Phobic disorder (RR 2.8, p < 0.001) predicted leaving care thirteen years later. CONCLUSIONS: Psychiatric disorders appear to place an individual at risk for irregular medical care. Studies of the quality and continuity of care for patients with chronic medical conditions should include measures of common psychiatric conditions.

Adolescent↗

PubMed1998

Psychopathology as a predictor of disability: a population-based follow-up study in Baltimore, Maryland.

To determine whether psychopathology is associated with disability as a result of underlying physical illness or whether such psychopathology antedates disability and is an independent determinant of disability, the authors conducted a nested case-control study within the Epidemiologic Catchment Area Follow-up Study in Baltimore, Maryland. From a 1981 random sample of 3,481 persons from Baltimore interviewed for psychopathology, disability, and other comorbidity, 1,920 who were alive in 1993 were traced and were reinterviewed with a similar instrument. Within the study population, 168 new cases of disability were identified as occurring between 1981 and 1993, as measured by the inability to perform activities of daily living. These cases were compared with 1,715 controls who reported no disability. The sociodemographic factors that were significantly related to incident disability in this analysis were age, female gender, and less than a high school education. These comparisons revealed associations of incident disability in activities of daily living with almost all antecedent chronic physical illnesses. Significant age- and gender-adjusted associations were observed between incident disability in activities of daily living and antecedent (in 1981) alcohol abuse and dependence (odds ratio (OR)=2.5, 95% confidence interval (CI) 1.5-4.2), major depressive disorder (OR=4.2, 95% CI 2.2-8.3), and phobia (OR=1.9, 95% CI 1.3-2.8). The adjusted odds ratio for the joint effect of antecedent depression and chronic physical illness on incident disability in activities of daily living was 17.0 (95% CI 6.9-41.7). There was a significant independent effect of antecedent major depression on activities of daily living disability. The effect of psychopathology on incident disability is nonspecific as to type of baseline chronic physical illness. Such a finding has important implications for defining strategies to prevent disability.

Adolescent↗

PubMed1998

Social class, assets, organizational control and the prevalence of common groups of psychiatric disorders.

This study provides an update on the association between social class and common types of psychiatric disorder in the US. In addition to usual measures of social class, we provide hypotheses for the expectation that assets and organizational control are associated with specific varieties of psychiatric disorders (mood, anxiety, alcohol and drug use disorders). We analyzed two surveys. The National Comorbidity Survey conducted in 1990-1992 yielded 12-month prevalence rates in a probability sample of 8098 respondents in the 48 contiguous states. The Epidemiologic Catchment Area Follow-up conducted in 1993-1996 provided similar rates among 1920 East Baltimore residents. Analyses of the National Comorbidity Survey showed an inverse association between financial and physical assets and mood, anxiety, alcohol, and drug disorders. The Epidemiologic Catchment Area Followup provided additional evidence for the inverse association between financial and physical assets and anxiety, alcohol and drug disorders. Also in the Epidemiologic Catchment Area, lower level supervisors presented higher rates of depression and anxiety disorders than higher level managers. Inequalities in assets and organizational control, as well as typical measures of social class, are associated with specific psychiatric disorders. These constructs can provide additional explanations for why social inequalities in psychiatric disorders occur.

Adolescent↗

PubMed1998

The epidemiology of blood-injection-injury phobia.

BACKGROUND: We report the prevalence, clinical characteristics, frequency of mental health treatment, demographic correlates, frequency of co-morbid psychiatric conditions, and general health ramifications of DSM-IV blood-injection-injury phobia in the general population. METHOD: The Diagnostic Interview Schedule (version III-R), which included questions on blood-injection-injury phobia, was administered to 1920 subjects in the Baltimore ECA Follow-up Study. RESULTS: The estimated unweighted lifetime prevalence of blood-injection-injury phobia was 3.5%. The median age of onset was 5.5 years; 78% had had symptoms within the last 6 months. Subjects with blood-injection-injury phobia (cases) had higher lifetime histories of fainting and seizures than those without (non-cases). None reported seeking mental health treatment specifically for phobia. Prevalences were lower in the elderly and higher in females and persons with less education. Cases had significantly higher than expected lifetime prevalences of other psychiatric conditions, including marijuana abuse/dependence, major depression, obsessive-compulsive disorder, panic disorder, agoraphobia, social phobia and other simple phobia. Cases and non-cases did not differ with regard to usual health-care settings, regular care for specific medical conditions, numbers of out-patient visits or hospitalizations, or previous general anaesthesia or live births. However, diabetics with blood-injection-injury phobia had higher than expected rates of macrovascular complications. CONCLUSION: Blood-injection-injury phobia is common, especially in females and those with less education, and it is associated with several co-morbid psychiatric conditions. No strong, broad general health ramifications of this phobia are apparent. However, diabetics with this phobia appear at particular risk for complications; this deserves further study.

Adult↗

PubMed1998

Absence of social networks, social support and health services utilization.

BACKGROUND: This study examines the effects of distress and three types of social relationships (family, friends, and confidantes) on the use of out-patient health services in an adult sample from a community survey of 3481 persons in Baltimore, Maryland. METHODS: Independent effects of predisposing (age, education, marital status, race and sex), enabling (employment, income and insurance) and need (physical health) factors are adjusted for in estimating the odds of using health care services. RESULTS: Illness, being female, and having insurance were positively related to use of services, while being aged was inversely related. After adjustment for the above factors, social support interacted with psychological distress to effect the use of medical care: the combination of high distress and low social support by a confidante results in a fourfold increase of medical utilization. CONCLUSIONS: Our findings support the inclusion of psychological distress and social network variables in addition to physical health status in models attempting to explain the use of health services. Despite an inability to analyse change over time, our data suggest an understanding of the interrelationship between psychosocial factors, distress and health care use would benefit health providers and their patients.

Adolescent↗

PubMed1998

Characterizing generalized anxiety: temporal and symptomatic thresholds.

We compared demographic and comorbidity profiles of subjects with varying levels of anxiety pathology to test if the clinical characteristics of generalized anxiety disorder (GAD) subjects differed from those of other subjects with generalized anxiety. Using Diagnostic Interview Schedule data from the 1993 follow-up study of the Baltimore cohort of the Epidemiologic Catchment Area Program, we divided subjects into the following five mutually exclusive symptom categories: a) DSM-III-R GAD; b) 6 months of worry or anxiety with six associated symptoms; c) 1 month of anxiety with or d) without six symptoms; and e) no anxiety. The first three groups were homogeneous with regard to demographic and comorbidity profiles, but their profiles differed from those of subjects with no anxiety or fewer than six symptoms. Thus, requiring six symptoms produced a group with a particular epidemiologic profile. Neither the nature of the subjects' worries nor the duration of symptoms influenced this profile. These results are discussed in terms of GAD's construct validity.

Adult↗

PubMed1998

Remission and relapse in schizophrenia: the Madras Longitudinal Study.

This paper uses monthly symptom data on 90 first-onset schizophrenics in Madras, India, to characterize, in a continuous manner, the course of remission and relapse. Remission from the first episode occurs in about 6 months and in about 3 months for later episodes. Syndromes from the Present State Exam, assessed at the first episode, predict differentially to early and later parts of the course. Hypomania and simple depression predict early remission from the first episode; flat affect and grandiose delusions predict longer episodes and shorter remissions later in the course.

Adult↗

PubMed1998

Incidence of obsessive-compulsive disorder in adults.

This study addressed the incidence of obsessive-compulsive disorder (OCD) in adults in the general population. The Baltimore cohort of 3481 subjects, originally sampled during the 1981 multisite Epidemiologic Catchment Area Study, was traced. From 1993 to 1996, 1920 people were reinterviewed using the Diagnostic Interview Schedule. The incidence of DSM-III-R obsessive-compulsive disorder in adults was estimated at .55 per 1000 person-years. There was a relatively high rate of new cases in elderly women. It appeared that there were two peaks of onset of OCD over the life span, both of which occur later in female subjects. Subjects with adult incidence OCD often presented for psychiatric treatment, though they did not specify obsessive-compulsive symptoms as the reason. The difference in diagnostic criteria between DSM-III and DSM-III-R substantially influenced the threshold for new case identification.

Adolescent↗

PubMed1998

Onset and recovery from panic disorder in the Baltimore Epidemiologic Catchment Area follow-up.

BACKGROUND: The objective is to estimate parameters of the natural history of panic disorder, including its prodrome, incidence, recovery and recurrence. METHOD: In 1981 the Baltimore Epidemiologic Catchment Area Study interviewed 3481 individuals probabilistically selected from the household population. During 1993-1996, 1920 of these individuals (73% of survivors) were interviewed again. Baseline and follow-up interviews included the National Institute of Mental Health Diagnostic Interview Schedule. During the follow-up, a subsample was assessed by psychiatrists using the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry (SCAN). RESULTS: There were 35 new cases of panic disorder in 24,475 person years of exposure, yielding an annual incidence of 1.43 per 1000 per year. Data from the SCAN assessments suggest the incidence estimate is conservative. Incidence is greater in females and declines with age. About one-third of the new cases arise without agoraphobia, but about half have anxiety of some sort present for many years prior to meeting criteria for diagnosis. People with agoraphobia have less intense onsets but slower recoveries than those without agoraphobia. CONCLUSIONS: Panic is heterogeneous in its pattern of onset and recovery. Some of the heterogeneity is associated with the presence of other anxiety over a long period of the life.

Adolescent↗

PubMed1998

Specific fears and phobias. Epidemiology and classification.

BACKGROUND: Data on eight specific fears representing DSM-III-R simple phobia were analysed to evaluate: (a) their prevalence and (b) the validity of subtypes of specific phobia defined by DSM-IV. METHOD: A modified version of the Composite International Diagnostic Interview was administered to a probability sample of 8098 community respondents. Correlates of responses to questions concerning these fears were analysed. RESULTS: The most prevalent specific fears were of animals among women, and of heights among men. Slight evidence was found for specific phobia subtypes. Number of fears, independent of type, powerfully predicted impairment, comorbidity, illness course, demographic features, and family psychopathology. CONCLUSION: Number of specific fears may mark a general predisposition to psychopathology. More detailed information is needed to resolve the question of specific phobia subtypes.

Adolescent↗

PubMed1997

Natural history of Diagnostic Interview Schedule/DSM-IV major depression. The Baltimore Epidemiologic Catchment Area follow-up.

BACKGROUND: Natural history can be characterized by incidence, recurrence, and duration of episodes. Research on the incidence of major depression is rare; studies of recurrence and duration are limited to clinical samples. METHODS: The Baltimore, Md, site of the Epidemiologic Catchment Area Program followed up its 1981 baseline cohort of 3481 respondents with an additional assessment in 1993 to 1996. Interviews were obtained from 1920 respondents (73% of the survivors). The Diagnostic Interview Schedule and the same survey procedures as in 1981 were used, augmented with a Life Chart Interview for dating the onset and duration of syndromes. RESULTS: There were 71 new cases of Diagnostic interview Schedule/DSM-IV major depression and 23,698 person-years of exposure, generating an estimated incidence of 3.0 per 1000 per year. Incidence peaked while subjects were in their 30s, with a smaller peak when they were in their 50s. Prodromal symptoms often occurred many years before the full criteria for diagnosis were met. Women were at higher risk for becoming new cases but had neither higher risk for recurrence nor longer episodes than men. Episodes of depression lasted for 12 weeks. The duration of an episode, and time to an episode-free year, was longer in the first episode than in recurrent episodes. CONCLUSIONS: The incidence estimated in this study is consistent with that found in the few other similar studies performed. The bimodality of onset suggests the value of further exploring the heterogeneity of depression via its natural history. Reported differences in prevalence between men and women seem to be due to differences in incidence, not chronicity.

Adolescent↗

PubMed1997

Psychopathology and the development of disability.

The objective was to determine the effect of preexisting psychopathology on days missed from work or usual activities ("disability days") in a large community sample (N = 3481). Logistic regression analyses were performed with the presence or absence of disability days (wave 2) as the dependent variable. The effects of sociodemographic variables, six psychiatric disorders, a high distress score, and chronic physical conditions (wave 1) were studied. Separate analyses were conducted for the total sample and four subgroups (labor force participants, homemakers, men, and women). The adjusted odds ratios and 95% confidence intervals (95% CI) for subjects with onset of panic disorder were 7.3 (95% CI = 1.8, 28.7); for those with chronic major depressive disorder, 7.2 (95% CI = 0.3, 160.6); and for those with chronic high distress, 5.0 (95% CI = 2.6, 9.9). The relative odds for developing a disability were greater for those with either type of psychiatric disorder or high distress than for those with any prior physical illness or those with a prior disability day. Disability days experienced by persons with psychopathology result in diminished quality of life, economic losses, and increased need for health services. Improved health services and educational and work adjustments for emotionally disabled persons are recommended.

Absenteeism↗