Stability of diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area study

OBJECTIVE: This study examined the 1-year temporal stability of a National Institute of Mental Health Diagnostic Interview Schedule (DIS) lifetime diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area (ECA) study. METHOD: In that study, 20,862 individuals, aged 18 years and over, at five sites were evaluated by lay interviewers using the DIS (wave 1). All of those who were available 12 months later were reinterviewed (wave 2). In the present study, the temporal stability of wave 1 obsessive-compulsive disorder diagnoses at wave 2 was examined, as well as relationships with comorbid diagnoses. The consistency of reports of "new-onset" illness was also examined. Factors contributing to these measures were evaluated. RESULTS: The temporal stability of the diagnosis of obsessive-compulsive disorder was very low. Subjects with a stable diagnosis of obsessive-compulsive disorder had a higher rate of both obsessions and compulsions, an earlier age at onset, and more comorbid anxiety, affective, and alcohol abuse/dependence disorders at initial assessment. The originally reported 1-year incidence estimates for obsessive-compulsive disorder primarily reflect data from subjects at wave 2 who reported the onset of symptoms as preceding the wave 1 interview. Older and less-educated subjects had significantly higher error rates in reporting onset. CONCLUSIONS: The DIS diagnosis of obsessive-compulsive disorder has poor validity, leaving the true incidence and prevalence of the disorder unknown. Older and less-educated subjects require special attention in the design of instruments for use with community samples.     

Race, ethnicity, and depression: A confirmatory analysis.

Investigated whether depressive-symptom scales are equally indicative of depression in different racial/ethnic groups and whether there are mean differences between the groups in the underlying depressive disorder assessed by these scales. Interviews were obtained from a large community survey of depression in Los Angeles County, California, (N?=?909). Four racial/ethnic groups were considered: Anglos, Blacks, English-speaking Hispanics, and Spanish-speaking Hispanics. Confirmatory factor analysis was used to test both 1- and 2-factor models of depression. An invariant factor pattern was demonstrated. No significant mean differences on a factor of Depression were found, but the groups differed on a Well-Being factor. Implications for survey research on psychiatric impairment among different racial/ethnic groups are discussed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual assault and mental disorders in a community population.

In a cross-sectional probability survey of 3,132 household adults representing two Los Angeles communities, lifetime diagnoses of nine major mental disorders were compared between those who reported that they had been sexually assaulted at some time in their lives and those who reported no sexual assault. Sexual assault predicted later onset of major depressive episodes, substance use disorders, and anxiety disorders. Those who were assaulted in childhood were more likely than those first assaulted in adulthood to report the subsequent development of a mental disorder. Demographic characteristics of gender, age, Hispanic ethnic background, and education, however, were generally unrelated to the probability of developing any specific disorder after being assaulted. Finally, major depression, drug abuse or dependence, antisocial personality, and phobia were all associated with a higher probability of subsequent sexual assault. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and substance use disorders: A prospective study.

The personality systems of Cloninger (as measured by the Tridimensional Personality Questionnaire [TPQ]) and Eysenck (as measured by the Eysenck Personality Questionnaire [EPQ]) both have been linked to substance use and abuse. The current study examined the predictive utility of both systems for substance use disorder (SUD) diagnoses, both cross-sectionally and prospectively. Participants (N?=?489 at baseline) completed the EPQ and TPQ and were assessed via structured diagnostic interview at baseline and 6 years later (N?=?457 at follow-up). Both the EPQ and TPQ scales demonstrated bivariate cross-sectional and prospective associations with SUDs. Within each system, those dimensions marking a broad impulsive sensation-seeking or behavioral disinhibition trait were the best predictors prospectively, although the 2 systems were differentially sensitive to specific diagnoses. These relations remained significant even with autoregressivity, other concurrent SUD diagnoses, and multiple personality dimensions statistically controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A structured interview version of the Hamilton Rating Scale for Depression: Reliability and validity.

Reliability and validity data are provided for pre- and posttreatment administrations of a structured interview version of the Hamilton Rating Scale for Depression (HRSD) integrated with the National Institute of Mental Health Diagnostic Interview Schedule (DIS). Ss were 70 adult patients requesting therapy for depression. Results indicate excellent agreement between DIS–HRSD ratings made by graduate students and psychiatrist-administered HRSD ratings. The DIS–HRSD exhibited a pattern of correlation with other scales of depression similar to that of the HRSD, thus supporting the validity of the new scale. Intraclass correlations and concurrent validity estimates obtained from analyzing data separately for pre- and posttest administrations were consistently lower than those obtained from the whole sample, suggesting that methodological shortcomings in prior psychometric studies of the HRSD may have spuriously inflated the obtained results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of community attitudes towards suicide in Windsor and Los Angeles.

Administered a Suicide Opinion Questionnaire (SOQ; G. Domino et al, 1980) to 103 community adults in Windsor, Canada, and 103 in Los Angeles, California. Samples were matched as to gender, age, and occupational status. Significant differences were obtained on 5 of the 8 SOQ scales, with Windsor Ss showing greater endorsement of agreement on the Mental Illness, Cry for Help, and Right to Die scales and lesser endorsement of agreement on the Religion and Moral Evil scales than Los Angeles Ss. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression as measured by the DSM-III and the Beck Depression Inventory in an unselected adult population.

The National Institute of Mental Health Diagnostic Interview Schedule (DIS) and Beck Depression Inventory (BDI) were administered to 298 volunteers (average age 37.9 yrs) to determine the relation between DSM-III diagnosis of depression derived from the DIS and BDI scores of Ss. Results show that DSM-III diagnoses of depression were not associated with specific ranges of scores on the BDI, due to the heterogeneous nature of the category of dysthymic disorder. Using a cutting point of 9/10, sensitivity was 100%, specificity 86%, the proportion of false negatives 0%, and of false positives 13.7%, respectively. Upward adjustment of the cutting point on the BDI to 21/22 for research purposes reduced false positives to 1.4% but increased false negatives correspondingly to 52.4%. Upward adjustment of the cutting point on the BDI to 18/19 for epidemiologic purposes yielded an unbiased estimate of the prevalence of depression diagnosed by the DSM-III. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of clinical and structured interview diagnoses in a homeless mental health clinic

OBJECTIVE: This study compared psychiatric diagnoses ascertained by independent clinicians with structured research interviews of homeless psychiatric patients assessed in a mental health clinic and in the community. Problems of both overdiagnosis and underdiagnosis in structured research interviews compared to clinician assessment were predicted. METHOD: Over a period of a year, 97 patients referred to a mental health clinic for homeless people were assessed with the Diagnostic Interview Schedule (DIS) administered by a clinical social worker who then completed a full clinical psychiatric social work assessment. These same patients received a thorough and systematic clinical psychiatric evaluation by a psychiatrist or psychologist, both experienced with this population. These clinicians gathered data from multiple sources, often with extended observation over time. The DIS and clinician diagnoses were made blind to one another and then compared; the clinician was often made aware of some of the symptoms that the social worker had elicited, but not whether the elicited material was from the DIS or from the clinical assessment. Diagnoses of 33 clinic patients previously assessed by trained nonclinician DIS interviews in an epidemiologic study of the homeless population in the community were also compared to clinician diagnoses, and no information from these patients' survey DIS interviews was made available to the clinicians. RESULTS: Compared to clinician assessment, structured interviews underdiagnosed antisocial personality disorder (ASPD) and overdiagnosed major depression. Alcohol use disorder and schizophrenia showed only small discrepancies by assessment method. Drug use disorder revealed no bias according to method of ascertainment, but showed very discrepant kappa levels comparing DIS to clinician assessment in the two different comparison contexts. CONCLUSIONS: If structured research methods assessing the homeless population actually overestimate depression, underestimate ASPD, and misclassify drug abuse, then policies stemming from structured interview research recommendations may call for levels and types of services not optimally suited to the reality of this population's needs. Because mental illness and substance abuse are thought to be critical factors in the generation and perpetuation of homelessness, the issue of accurate diagnosis is tantamount to understanding and providing workable solutions to the problem of homelessness. Further research is needed to untangle potential confounders of the homeless situation to psychiatric diagnosis.     

Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample.

The factor structure, reliability, and validity of the Depression Anxiety Stress Scales (DASS; S. H. Lovibond & P. F. Lovibond, 1995) and the 21-item short form of these measures (DASS–21 ) were examined in nonclinical volunteers (n?=?49) and patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses of panic disorder (n?=? 67), obsessive-compulsive disorder (n?=?54), social phobia (n?=?74), specific phobia (n?=?17), and major depressive disorder (n?=?46). This study replicates previous findings indicating that the DASS distinguishes well between features of depression, physical arousal, and psychological tension and agitation and extends these observations to the DASS–21. In addition, the internal consistency and concurrent validity of the DASS and DASS–21 were in the acceptable to excellent ranges. Mean scores for the various groups were similar to those in previous research, and in the expected direction. The implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Further validation of the IDAS: Evidence of convergent, discriminant, criterion, and incremental validity.

The authors explicated the validity of the Inventory of Depression and Anxiety Symptoms (IDAS; D. Watson et al., 2007) in 2 samples (306 college students and 605 psychiatric patients). The IDAS scales showed strong convergent validity in relation to parallel interview-based scores on the Clinician Rating version of the IDAS; the mean convergent correlations were .51 and .62 in the student and patient samples, respectively. With the exception of the Well-Being Scale, the scales also consistently demonstrated significant discriminant validity. Furthermore, the scales displayed substantial criterion validity in relation to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) mood and anxiety disorder diagnoses in the patient sample. The authors identified particularly clear and strong associations between (a) major depression and the IDAS General Depression, Dysphoria and Well-Being scales, (b) panic disorder and IDAS Panic, (c) posttraumatic stress disorder and IDAS Traumatic Intrusions, and (d) social phobia and IDAS Social Anxiety. Finally, in logistic regression analyses, the IDAS scales showed significant incremental validity in predicting several DSM-IV diagnoses when compared against the Beck Depression Inventory-II (A. T. Beck, R. A. Steer, & G. K. Brown, 1996) and the Beck Anxiety Inventory (A. T. Beck & R. A. Steer, 1990). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescents and children injured or killed in drive-by shootings in Los Angeles

BACKGROUND: Drive-by shootings by violent street gangs contribute to early morbidity and mortality among adolescents and children in Los Angeles. This study attempted to determine the frequency of this problem and the population at greatest risk. We also studied the most frequently injured areas of the body, the seasons in which the most shootings occurred, the most common sites for drive-by shootings, and the types of firearms used. METHODS: We retrospectively reviewed the files of the Gang Information Section of the Los Angeles Police Department to identify all drive-by shootings in Los Angeles in 1991 in which a child or adolescent under the age of 18 was shot at, injured, or killed. RESULTS: A total of 677 adolescents and children were shot at, among whom 429 (63 percent) had gunshot wounds and 36 (5.3 percent) died from their injuries. Three hundred three of those with gunshot wounds (71 percent) were gang members. Arms and legs were the areas of the body most commonly injured. Handguns were the most frequently used type of firearm. All the homicide victims were African American or Hispanic, and 97 percent were boys. African American and Hispanic children and adolescents, especially male gang members, had a significantly higher risk than their Asian and white counterparts of injury and death from drive-by shootings in Los Angeles (P < 0.001). CONCLUSIONS: Drive-by shootings involving adolescents and children are frequent in Los Angeles. Although Los Angeles may be an atypical case, understanding why violent street gangs form, preventing causes of violence, and limiting access to firearms are essential steps in preventing this serious problem.     

Long-distance ESP: A controlled study.

Using a group of 22 transmitters (Ts) in Los Angeles, and 3 groups of receivers (Rs) in Los Angeles (N = 28), New York (N = 15), and Sussex, England (N = 14), a long-distance ESP study was conducted in which a series of 3 emotional episodes and 3 control episodes were shown Ts in Los Angeles. After each episode, Ts wrote their reactions, while at the same (local) time, Rs wrote their free associations. After writing these impressions, Rs were shown a pair of slides and chose the 1 slide which best matched their impressions. Results show that the 57 Rs scored significantly beyond chance expectations (p     

Computerized offender assessment: Validation study.

Evaluated the validity of a computer-based test interpretation (CBTI) system for mental health screening in correctional settings. First, 100 adult male felons were administered a brief mental status interview and a series of psychological tests, including the Minnesota Multiphasic Personality Inventory (MMPI), the revised Beta IQ Examination, and the Buss-Durkee Hostility Inventory. Psychiatric diagnoses and CBTI ratings of victimization, violence, suicide, and substance abuse potentials were compared with clinicians' evaluations. Second, CBTI diagnoses of 109 inmates were compared with Diagnostic Interview Schedule (DIS) diagnoses. Last, CBTI risk ratings were compared with institutional infraction records of 1,718 inmates. Agreement with CBTI and clinicians' risk ratings was fair. CBTI agreement with clinicians' and DIS diagnoses ranged from 60–93%. Ways of improving CBTI algorithms and the value of this approach in correctional screening are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's action-control beliefs about school performance: How do American children compare with German and Russian children?

Using the revised Control, Agency, and Means–ends Interview (T. D. Little, G. Oettingen, & P. B. Baltes, 1995), we compared American children's (Grades 2–6) action–control beliefs about school performance with those of German and Russian children (Los Angeles, n?=?657; East Berlin, n?=?313; West Berlin, n?=?517; Moscow, n?=?541). Although we found pronounced cross-setting similarities in the children's everyday causality beliefs about what factors produce school performance, we obtained consistent cross-setting differences in (1) the mean levels of the children's personal agency and control expectancy and (2) the correlational magnitudes between these beliefs and actual school performance. Notably, the American children were at the extremes of the cross-national distributions: (1) they had the highest mean levels of personal agency and control expectancy but (2) the lowest beliefs–performance correlations. Such outcomes indicate that the low beliefs–performance correlations that are frequently obtained in American research appear to be specific to American settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder.

This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N?=?367) and suggested that the diagnoses from this scale possessed temporal reliability (mean κ?=?.80) and criterion validity (with interview diagnoses; mean κ?=?.83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test–retest reliability (r?=?.87), internal consistency (mean α?=?.89), and convergent validity with extant eating-pathology scales. Results implied that this scale was reliable and valid in this investigation and that it may be useful for clinical and research applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factorial structure of traits delineating personality disorders in clinical and general population samples.

Categorical and dimensional models for classifying personality disorders were evaluated by comparing the structure of personality pathology in a clinical sample (n?=?158) with the structure in a general population sample (n?=?274). Ss completed 100 personality scales. Separate factor analyses revealed similar structures in the 2 samples. An underlying structure in a combined sample showed limited agreement with the concepts of the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). 15 factors were retained: Generalized Distress, Rejection, Restricted Expression, Compulsivity, Stimulus Seeking, Insecure Attachment, Diffidence, Intimacy Problems, Oppositionality, Interpersonal Disesteem, Conduct Problems, Cognitive Dysfunction, Affective Reactivity, Narcissism, and Social Apprehensiveness. The results are consistent with a dimensional representation of personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smooth-pursuit eye tracking in first-episode psychotic patients and their relatives.

In order to determine the specificity of smooth-pursuit eye tracking dysfunction to schizophrenia (SC) and the prevalences of dysfunction among functionally psychotic and normal individuals, the authors investigated pursuit tracking in a large sample of psychotic patients, normal Ss, and 1st-degree relatives (N?=?482). Ss were recruited as part of an epidemiological study of 1st-episode psychosis that used a broadly based referral network to identify all cases in a major metropolitan area over a 2.5-yr period. Ss received diagnoses of SC, schizophreniform disorder, psychotic mood disorder, and paranoid or other psychotic disorder based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). The distribution of tracking performance was bimodal for the SC Ss and their relatives, perhaps reflecting major gene action. Moreover, poor tracking ran in families. Pursuit tracking dysfunction was relatively specific to SC Ss and their relatives and occurred infrequently in other psychotic Ss and normal Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for major depressive disorder in the community: A comparison of measures.

Self-administered questionnaires are frequently used as case-finding instruments in community studies of depression. The Center for Epidemiological Studies Depression Scale (CESD) is one of the most commonly used questionnaires, though several studies have found poor concordance between CESD- and interview-based diagnoses. The authors made the CESD more closely correspond to the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) criteria for major depression by adding 11 items to the original 20, and this enabled them to apply the DSM-III diagnostic algorithm to the CESD items to identify cases of depression. As part of a family study, they interviewed relatives of psychiatric patients and normal controls with the Diagnostic Interview Schedule (DIS) and gave them the CESD and Inventory to Diagnose Depression (IDD) to complete on their own. Concordance with a DIS diagnosis of major depression was greater with the IDD than with the modified or original version of the CESD. The modification of the CESD did not increase its concordance with the DIS diagnosis of MDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)