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PubMed2004

The problem of diagnosing major depression in elderly primary care patients.

BACKGROUND: To clarify the problem of diagnosing major depression in elderly primary care patients, we studied the nuances of diagnostic classification by general practitioners (GPs) and the relationship between sociodemographic and clinical factors and an accurate diagnosis of depression. METHODS: As part of a national survey of general practice a standardised psychiatric interview (CIDI) was performed in 237 subjects > or =55 years screened for the presence of psychopathology. Fifty-five patients were found to suffer from a major depressive disorder in the last 12 months. In these patients, GPs registered during 1 year all contact diagnoses and prescriptions of medication. RESULTS: Nearly all depressed patients (96.4%) had one or more contacts with their GP during 1 year. GPs classified 20.8% of the patients as having a down/depressed feeling or depression, while 32.1% as having other psychological problems than depression. It was remarkable that an accurate diagnosis by GPs was significantly related to higher age in this age group. Regarding the clinical characteristics, there was a significantly higher number of prescriptions of antidepressants in the accurately diagnosed patients. We found no significant differences in respect to other clinical characteristics (e.g. severity and number of symptoms, comorbidity of anxiety and somatic disorders). CONCLUSIONS: GPs are aware of the psychological problems in half of the elderly patients with major depression, but do not explicitly distinguish depressive symptoms from other psychological problems or from social problems. Integrated programs may be more promising to improve the diagnostic rate than clinical education or guideline implementation alone.

Age Factors↗
PubMed1999

Attachment organizations in children with difficult life circumstances.

The purpose of this study was to use the Attachment Q-Set to create categories of attachment organization that were conceptually consistent with organizational categories derived from other attachment assessments, reliable, and valid. We were particularly interested in creating categories that would describe insecure attachment organizations in children from difficult life circumstances. Our sample of relationships included 3062 teacher-child relationships. Children ranged in age from toddlers to kindergartners and were diverse in ethnic background. Two percent of the children were diagnosed with severe social and emotional problems and enrolled in a therapeutic preschool. Sixteen percent were enrolled in intervention programs on the basis of family poverty and another 34% of the children attended subsidized child care programs for low-income children. All of the children's child-teacher relationships were assessed with the Attachment Q-Set (AQS). Independent observers observed or rated children's peer play. Teachers completed behavior problem questionnaires and Student Teacher Relationships Scales. Using the AQS we created five subscales and six attachment organizational categories. These subscales and organizational categories were associated in theoretically meaningful ways with measures of behavior problems, social competence with peers, and teacher perceptions of child-teacher relationship.

Avoidance Learning↗
PubMed2004

ODD and ADHD symptoms in Ukrainian children: external validators and comorbidity.

OBJECTIVE: To examine potential external validators for oppositional defiant disorder (ODD) and attention-deficient/hyperactive disorder (ADHD) symptoms in a Ukrainian community-based sample of 600 children age 10 to 12 years old and evaluate the nature of co-occurring ODD and ADHD symptoms using mother- and teacher-defined groups. METHOD: In 1997, parents, children, and teachers participated in extensive clinical assessments using standard Western measures. Four areas of functioning were assessed: child mental health, parent-child interactions, parental well-being, and school/cognitive performance. RESULTS: Mother-defined ODD versus ADHD symptom groups were differentiated by a history of overactivity and tantrums, behavior in school, and maternal anxiety and hostility. Teacher-defined groups were differentiated by conduct problems, internalizing symptoms, mother-child interactions, and paternal alcohol use. The effects of co-occurring ODD and ADHD symptoms were greater than would be expected based on their separate effects for conduct problems, internalizing symptoms, social problems, academic performance, parent-child relations, and marital discord. CONCLUSIONS: Children with ODD versus ADHD symptoms were not significantly different from each other for the majority of variables examined, and group differences were dependent on the rater used to define symptom groups.

Analysis of Variance↗
PubMed2006

Mental and physical symptoms associated with lower social support for patients with hepatitis C.

AIM: To systematically examine the impact of the hepatitis C virus (HCV) diagnosis on patients' level of social support in a large-scale study. METHODS: Patients evaluated and treated for HCV in a tertiary referral center were enrolled in a cross-sectional study. Demographic data, functional and emotional status as measured by the Hospital Anxiety and Depression Scale (HAD) and the Sickness Impact Profile (SIP), severity of liver disease, mode of acquisition, and physical and psychiatric comorbidities were collected from patients or abstracted from the medical record. All participants completed a semi-structured interview, addressing questions of social support. RESULTS: A total of 342 patients (mean age 45.2 years; 37% women) were enrolled. Ninety-two (27%) patients described lower levels of support by family and friends. Nearly half of the participants (45%) noted the loss of at least one relationship due to the disease. Fears related to transmitting the disease (25%) were common and often associated with ignorance or even discrimination by others (19%). Nearly one fifth of the patients did not share information about their disease with others to avoid being stigmatized. Lower levels of social support were significantly associated with living alone, being unemployed, being excluded from antiviral therapy, having psychiatric comorbidities, contracting HCV through intravenous drug use, having high levels of anxiety and depression as measured by the HAD and negative mood state as measured by the SIP. Patients reporting lower levels of social support also noted more physical symptoms as measured by the SIP. CONCLUSION: Patients with hepatitis C often face significant social problems, ranging from social isolation to familial stress. The most common concerns reflect a limited insight of patients and their relatives and friends about the disease, the risk factors for its spread, and about potential consequences. Our data suggest that educational interventions targeting support persons and the stressors identified in our findings may lessen or alleviate the social strains patients with hepatitis C experience.

Adult↗
PubMed1995

Amputation history and rehabilitation of black men living in the greater Durban area who have had traumatic amputations of the lower limb.

A survey was undertaken amongst twenty five black men living in the greater Durban area who had had amputations of the lower limbs. The type of amputation care the rehabilitation programme they underwent post-operatively is described. The sample included men from 24 to 50 years of age, of whom the majority were from rural areas. The amputation care intra and post-operatively was marked by the lack of emotional preparation pre-operatively, and lack of rehabilitation information and teaching afterwards. Most respondents had to find information for themselves. This lack of information and teaching seemed to impede physical rehabilitation, with stump sores and limited use of prostheses being the main problems. Vocational rehabilitation was almost totally absent. In contrast to the twenty two respondents who worked before their amputations, only four worked afterwards. The majority had to support their families alone; sixteen of them were totally reliant on a Disability Grant. These problems lead to social isolation, depression, loneliness and other psycho-social problems.

Adult↗
PubMed1979

[Young women of today and model of yesterday.].

The author describes the difficulties encountered by two groups of female students at the Cegep level (16 to 20 years old, and 25 to 35 years old) in discussing with their psychologist on family problems, social loneliness and problems with their boyfriend. They express desires for traditional marriage, security, fulfilling life ; they show not too well defined identity ; and they complain about the rigidity of the Cegep system. The group of 25 to 35 years old feel that they failed to achieve the idealistic roles with which they were inculcated and suffer from strong guilt feelings. They experience additional tensions due to their lack of sexual relations. The author also notes that the Cegep is a diversified environment with regards to the roles it proposes but is very traditional in its hierarchical structure. Finally, the author, describing her own uneasiness, stresses the need to change the image of the therapist.

English Abstract↗
PubMed1991

[Pregnancy in adolescence. A review of 840 clinical cases].

Pregnancy during adolescence is a medical problem and a social phenomenon of increasing importance. Opportune medical care may resolve pregnancy risk, but the lacks of this stage of life, and the lack of resources of certain communities, may frustrate the mother's desires, in such a way, that pregnancy in adolescence, will mean more a social problem than a medical one.

Adolescent↗
PubMed1985

Behavior problems and social competence in girls with true precocious puberty.

We report a controlled standardized behavioral assessment of 33 girls with true precocious puberty using the Child Behavior Checklist. Although a majority of the girls were reported not to have behavior problems, many were reported to have a dysphoric adjustment to their condition. Twenty-seven percent of the girls with true precocious puberty scored greater than 2 SD above the mean on the Total Behavior Problem scale 10 times the expected prevalence rate. They also scored significantly higher (P less than 0.01) than matched controls on both the internalizing or "overcontrolled symptom" and externalizing or "undercontrolled symptom" scales. Forty-eight percent scored greater than 2 SD above the mean on the Social Withdrawal scale. The high prevalence of reported problem behaviors in this sample may be related directly or indirectly to the precocious maturation mediated by biologic, psychologic, social, and environmental variables. Although elevated levels of sex steroids may directly contribute to increased aggressive and hyperactive behaviors, they may also be modified by social and environmental factors.

Adaptation, Psychological↗
PubMed2005

Sheway's services for substance using pregnant and parenting women: evaluating the outcomes for infants.

Sheway is a single-access comprehensive street-front service to pregnant and parenting women with a history of alcohol and/or drug abuse that is located in one of Canada's poorest neighbourhoods, the Downtown Eastside of Vancouver. This investigation assesses the concurrent health and social problems clients report upon entry into the program, service utilization, and the impact of services on neonate and infant well-being. Data were collected through the review of files from the 9 1/2 years of the agency's service. Findings suggest that the clients' concurrent health and social problems have increased over the years of operation while indicators of infant health have either improved or maintained steady rates.

Alcoholism↗
PubMed1995

[How much time does the physician dedicate to his patients? A study of contents of office visits and their length].

OBJECTIVE: To describe the content and length of General Medicine interviews at a health centre, analysing the problems dealt with and activities undertaken, in function of the time taken. DESIGN: A crossover study. SETTING: An urban health centre at Alcobendas (Madrid). PATIENTS AND OTHER PARTICIPANTS: The problems, activities and length of all the interviews (926) were recorded over a period of 10 days. MEASUREMENTS AND MAIN RESULTS: The average length of the interviews was 6.7 minutes (standard error SE = 0.13). More problems were dealt with, and more activities carried out, in the longer interviews. Problems of a psycho-social character and preventive activities were discussed in the long interviews. Significant differences were found in the length of interviews in function of the patient's age and between different professionals. CONCLUSION: To achieve integrated care which includes both preventive medicine and psycho-social problems, doctors must have more interview time, as these questions are not tackled in short interviews.

Adolescent↗
PubMed1996

[Negative effect of perceived transportation problems on social activities of elderly people living in a small town far from the nearest train station].

Social activities such as visiting friends or participating in community groups have been shown to correlate positively with active health promotion, more frequent physical exercise, and maintenance of activities of daily living in older people. Social inactivity may result from personal factors such as physical condition and from environmental factors such as limited means of transportation. To study the latter factors, we focused on perceived transportation difficulties and on the influence of those perceptions on the daily activities of elderly people. We sought to test the hypothesis that perceived transportation problems restrict health promotion or social activities and accelerate the decline in activities of daily living, and also to determine how transportation can be improved. A questionnaire was sent to 238 people (a fifth of the population) aged 60 years or older who were living in a small town in Kanagawa prefecture. Buses are the principal mode of public transportation from their residences to the nearest train station and the trip takes about 50 minutes. Responses were received from 190 persons (83.3%, excluding those who had died, moved, or were in the hospital). Of the respondents, 166 (74 men and 92 women) went out by themselves and their responses were subjected to logistic regression analysis. The results revealed the following points. (1) For both men and women, riding buses to the hospital was associated with a greater perception of problems with respect to convenience, physical exertion, or anxiety when crossing the road. (2) Among women, greater perceived inconvenience of transportation correlated with a lower frequency of going out for daily shopping; a higher frequency of visiting friends correlated with greater perception of physical exertion. (3) Among women, the main desire was to visit friends. Men indicated that they wanted to be more active in hobbies. The women indicated that the main reason they do not fulfill their desires was that transportation is inconvenient. These findings indicate that perceived transportation problems can prevent elderly people, especially women, from going out for health promotion and social activities. This indicates that to support social activities of elderly people, the means of transportation should be made more convenient and more physically accessible, and local circumstances should be taken into consideration.

Activities of Daily Living↗