A comparison of mail and telephone interview strategies for mental health surveys

The high cost of mental health surveys of the general population has sparked interest in less costly research methods. Two low-cost mental health survey strategies (mail and telephone) were compared in terms of cost, response rate and quality of data obtained. A total of 1,074 persons agreed to participate in the study as a sample, one-half by telephone and the other half by mail. They completed the Diagnostic Interview Schedule Self-Administered, a questionnaire designed to be self-administered, which was used to assess specific mental disorders and to evaluate risk factors. In addition, 239 respondents who were selected according to the presence or absence of specific diagnoses were reinterviewed face-to-face using the Diagnostic Interview Schedule as an external criterion. The telephone method yielded a better response rate (15% higher) and better control over answers (for example, less missing data). The mail strategy was less expensive and appeared to yield data of slightly better quality, particularly for respondents suffering from anxiety disorders.     

Comparability and representativeness of clinical homeless, community homeless, and domiciled clinic samples: Physical and mental health, substance use, and health services utilization.

Evaluating the representativeness of homeless samples is important for generalizing research findings on the homeless and designing interventions targeting their health needs. The present study contrasts homeless and domiciled free-clinic users (216 homeless [132 men, 84 women], 212 domiciled [102 men, 110 women]) and 531 community homeless persons (388 men, 143 women) on latent variables representing substance use, mental and physical health, appearance, life satisfaction, and health services utilization (HSU). Homeless clinic patients equalled the community sample in substance abuse and psychological problems but exceeded the sample in HSU and cleanliness. Homeless clinic users reported more substance abuse, poorer health, greater mental illness and mental HSU, less cleanliness, and lower life satisfaction than domiciled patients. Relationships among the variables are reported, and implications concerning health needs among the homeless are discussed (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing acute stress disorder: Psychometric properties of a structured clinical interview.

This study presents the development of a structured clinical interview to diagnose acute stress disorder (ASD). The Acute Stress Disorder Interview (ASDI) is a 19-item, dichotomously scored interview schedule that is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). It was validated against clinician-based diagnoses of ASD on 65 trauma survivors assessed between 1 and 3 weeks posttrauma. It possessed good internal consistency (r?=?.90), sensitivity (91%), and specificity (93%). Test-retest reliability was evaluated on 60 trauma survivors between 1 and 3 weeks posttrauma, with a readministration interval of 2 to 7 days. Test-retest reliability of ASDI severity scores was strong (r?=?.88), and diagnostic agreement for presence (88%) and absence (94%) of ASD diagnosis was high. The ASDI appears to be a useful tool to identify those individuals who suffer ASD and are at risk of long-term posttraumatic stress disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing the needs of homeless women with mental health problems

Vertical transmission of the Human Immunodeficiency Virus is the major cause of pediatric AIDS cases. It is known that zidovudine therapy will substantially reduce the incidence of perinatal vertical transmission. Some authorities have made recommendations for universal HIV screening based on these findings. However, in an area of low prevalence of HIV, such as South Dakota, the benefits of such testing are questionable. We undertook a survey of one thousand consecutive deliveries in which a sample of cord blood was tested for HIV in an anonymous fashion. In all cases, the ELISA test was negative. Based on this extremely low incidence of HIV in our population, it is reasonable at the present time to undertake a selective screening protocol for testing for HIV during the antepartum period, based on the presence of risk factors, rather than applying universal screening to our population.     

Children in homeless families: Risks to mental health and development.

Examined the psychological adjustment of 159 homeless children in comparison with a sample of 62 low-income children living at home. In each group, ages ranged from 8–17 yrs. As expected, homeless children were found to have greater recent stress exposure than housed poor children, as well as more disrupted schooling and friendships. Child behavior problems were above normative levels for homeless children, particularly for antisocial behavior. Across the 2 samples, however, behavior problems were more related to parental distress, cumulative risk status, and recent adversity than to housing status or income. Results suggest that homeless children share many of the risks and problems of other American children being reared in poverty. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PhD and MA clinical psychologists and MSWs in public mental health settings: A nationwide comparison.

Presents results of a nationwide survey of 402 public mental health facility directors that solicited information and opinions comparing the employment opportunities, salaries, duties, and job skills of doctoral and subdoctoral clinical psychologists and MSWs. Results indicate that although all groups are in demand in the marketplace, receive competitive salaries, and are evaluated as competent service providers, subdoctoral clinicians consistently fall behind MSWs on all dimensions, and both, in turn, fall behind doctoral-level clinical psychologists. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond the mental health clinic: New settings and activities for clinical psychology internships.

Is the current internship system sufficiently diverse to prepare psychologists for the many professional roles they will take on in the post-managed care future? Creating internships in new settings may help clinical psychology become a stronger presence in diverse areas of intervention and expand work with populations less commonly reached in the clinical psychotherapy model. The author presents initial suggestions for creating training programs in which interns could develop and apply their knowledge in prevention, public policy, and community action. The potential benefits and challenges of such innovative internships are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

19 Years later: a mental hygiene clinic revisited--a comparison of three methods to describe a clinic caseload

This is a replication of a 1956 study that compared three ways to describe the case load of a mental hygiene clinic. The methods used were to follow-up of a cohort group, cases closed, and a survey of all active cases. In 1975, as compared to 1956, it was found that patients are more likely to be psychotic, to be receiving psychotropic drugs, and to stay in treatment much longer. Rate of improvement declined slightly. The number of patients increased by 166% and the annual number of patient visits increased by 84%, with about the same size staff. Some hypotheses for these changes are discussed.     

A comparison of the demography, clinical profile and treatment of adopted and non adopted children at a children's mental health centre

A retrospective analysis of adopted and non adopted children attending a children's mental health centre between 1959 and 1973 indicated a higher than expected number of males and a significantly higher number of professional fathers than expected in the adopted group. A sub-group of adopted children identified as having learning problems by reports of the parents and teachers had a different pattern of test scores on the Wechsler Intelligence Scale for Children from a non adopted group, who were also selected for learning difficulties. On the parent's and clinician's ratings, the adopted group had more parent-identified hyperactivity symptoms and clinicians' diagnoses of hyperactivity. Treatment data indicated that they used more stimulant medication; this was particularly significant for the early adoptees. The early adoptees were considered to be more hyperactive by their parents than the late adoptees. The late adoptees were more impaired on psychometric testing than those placed early, before six months of age. These findings are discussed in relation to possible explanations for the higher than expected prevalence of adoptees seen in clinical populations.     

Depression and anxiety in children: A comparison of self-report questionnaires to clinical interview.

The validity of the Children's Depression Inventory (CDI), the Revised Children's Manifest Anxiety Scale (RCMAS), and the Trait Scale of the State–Trait Anxiety Inventory for Children (STAIC) were examined. Scores on these measures were compared to diagnoses and symptom scores derived from the Child Assessment Schedule. Ss were 70 psychiatric inpatient children, with a mean age of 10 yrs. Evidence was found for the convergent and discriminant validity of both the CDI and the STAIC. Scores for both depressed and anxious children were elevated on the RCMAS. The sensitivity for all 3 measures was too low for diagnostic purposes. Generally, these results support the use of these self-report questionnaires as screening measures and symptom inventories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of suicidal and nonsuicidal elders referred to a community mental health center program

Sociodemographics, clinical characteristics, and life stressors of community-dwelling suicidal risk and nonsuicidal risk elders referred to a community aging and mental health provider were compared in this study. Information was collected through case manager surveys and agency records on 683 older adults referred to the Elder Services Program of Spokane Mental Health in 1994 and the first 6 months of 1995. This sample included 109 individuals who were clinically judged to be at suicide risk by case managers at the time of initial assessment. Comparisons between suicidal risk and nonsuicidal risk elders indicated that suicidal elders were younger, more likely to be separated or divorced, and more likely to report a previous history of suicidal behavior. Results of a logistic regression analysis indicated that living alone, depression or anxiety disorder, and higher levels of emotional disturbance predicted suicide risk status. In addition, medical problems, family conflict, and relationship loss predicted suicide risk status in this particular sample. Individuals at suicide risk were also more likely to have a family physician than others. Implications of findings for identification and treatment of suicidal elders are discussed.     

A life review interview guide: a structured systems approach to information gathering

To study the efficacy of eye movement desensitization and reprocessing (EMDR) with traumatized young women, 60 women between the ages of 16 and 25 were randomly assigned to two sessions of either EMDR or an active listening (AL) control. Factorial ANOVA interaction effects and simple main effects for outcome measure (Beck Depression Inventory, State-Trait Anxiety Inventory, Penn Inventory for Posttraumatic Stress Disorder, Impact of Event Scale, Tennessee Self-Concept Scale) indicated significant improvement for both groups and significantly greater pre-post change for EMDR-treated participants. Pre-post effect sizes for the EMDR group averaged 1.56 compared to 0.65 for the AL group. Despite treatment brevity, the posttreatment outcome variable means of EMDR-treated participants compared favorably with nonpatient or successfully treated norm groups on all measures.     

A comparison of defectors and continuers in a child guidance clinic.

Matched 30 defector families (families that completed the entire diagnostic evaluation and were offered, but declined, clinic treatment) with 30 continuer families (families that completed the entire diagnostic process and had at least 1 family member receive no less than 6 treatment sessions). There were no significant differences between mothers of defectors and continuers and fathers of defectors and continuers when compared on the MMPI validity and clinical scales, the number of T scores greater than or equal to 70, and the high-point code types. However, continuers more frequently had longer symptom durations. Results provide support for the position that the defector group is similar to the continuer group and may be used as an appropriate control group for child psychotherapy. (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost effectiveness of clinical training in a community mental health center.

The future of professional psychology may well rest on psychology training programs successfully defending their existence in purely monetary terms. This article examines the effectiveness of the training program of an urban mental health center that includes an American Psychological Association-accredited psychology internship. The training program was found to produce net revenues for the facility and to meet the training needs of its participants. Variables related to producing a cost effective psychology training program are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of hospital- and community-based mental health nurses: perceptions of their work environment and psychological health

This study compares hospital- (n = 67) and community-based (n = 55) mental health nurses in relation to their perceptions of the work environment and also their psychological health. Measures include: the General Health Questionnaire, the Maslach Burnout Inventory and the Work Environment Scale. The data, obtained from self-returned questionnaires, show that community nurses rated their work environments higher for the dimensions of Involvement, Supervisor Support, Autonomy, Innovation and Work Pressure. Hospital nurses saw their environments as being higher in (managerial) Control. There were no differences between the groups for the dimensions of Peer Cohesion, Task Orientation, Clarity or (physical) Comfort. Furthermore, there were no overall differences between the two groups in relation to psychological health, although the pattern of factors associated with emotional well-being differed. Finally, analyses of the community data revealed that those nurses with 'flexitime' arrangements evaluated their work environments less positively and showed higher levels of psychological strain than did those working 'fixed-time' schedules. The findings suggest that the hospital and community environments make different demands on nursing staff, and that this should be considered when organizing nursing services if stress is to be avoided.     

A comparison of for-profit and not-for-profit hospitals on the cost of mental health admissions

Our aim was to test the effect of hypotonicity and extracellular Ca2+ (Cao) on cell volume and membrane potential (VM) in barnacle muscle cells. Under isotonic conditions the resting VM of isolated cells mounted in the experimental chamber exposed to either Ca(2+)-free or Ca(2+)-containing (11 mM) solutions was -46.3 +/- 1.0 mV (n = 24) and -56.2 +/- 0.9 mV (n = 38), respectively. In the absence of Cao, the cells depolarized at a rate of 2.3 +/- 0.47 mV/hr; the presence of Cao reduced this rate of depolarization by 2.9-fold. Both in the absence or presence of Cao, the cells swelled in response to hypotonicity but underwent regulatory volume decrease (RVD) when Cao was present. Addition of the Ca2+ channel blocker, verapamil (0.1 mM), inhibited the Cao-dependent RVD. The percentage of cells responding with RVD increased with larger hypotonic challenges. There was a Cao-independent direct relationship between cell swelling and membrane depolarization which can be explained by dilution of the concentration of intracellular K+ ([K+]i). RVD was accompanied by a small hyperpolarization (3.0 +/- 0.38 mV/2 hr) which may represent increases in [K+]i during cell shrinking and activation of a conductive pathway. The results indicate the following: (1) the presence of Cao stabilizes VM; (2) cell swelling produces a depolarization which can be explained by dilution of [K+]i; (3) cell swelling activates a verapamil-sensitive Ca2+ influx responsible for promoting RVD; and (4) RVD is accompanied by a hyperpolarization which may result from activation of a conductive pathway.     

Comparative responses of Mexican Americans and Anglo-Americans to early goal setting in a public mental health clinic.

I compared Mexican-American and Anglo-American clients at a community mental health center to determine possible differences in response to a program of early goal setting in counseling. Differences in response were measured by assessing the number of kept, cancelled, and broken appointments. I hypothesized that (a) Mexican Americans would have a stronger negative response than Anglo-Americans, (b) shorter time frames for goal setting would result in greater negative response among all clients, and (c) sex differences in terms of response would exist among Mexican-American clients. None of these hypotheses was fully supported by the data. Overall, the research suggested that both ethnic groups respond similarly and positively to goal setting even when problems must be discussed and goals must be set very early in the counseling process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of the Alcohol Dependence Scale and diagnostic interview schedule in homeless women

The Alcohol Dependence Scale (ADS) is a 25 item self-report instrument designed to evaluate the degree of severity of alcohol dependence. Although previous studies have reported on the validity of the ADS, no studies using the ADS have been done on the homeless population, a special and rapidly growing population. To assess the utility of the ADS in a population of homeless, substance-abusing women, the ADS questionnaire was compared with the DSM-III-R alcohol use disorder diagnosis as measured by the Diagnostic Interview Schedule (DIS). Both the ADS and the DIS were administered to 149 homeless, substance-abusing women by trained, lay interviewers. There was good agreement between the ADS and the past-year DIS diagnosis of alcohol use disorder. The level of agreement between the ADS and DIS, as well as sensitivity and specificity, for various ADS cutoff scores are reported to facilitate selection of cutoff scores by clinicians and future researchers.     

Sex-role stereotypes and clinical judgments of mental health.

Gave a sex-role stereotype questionnaire consisting of 122 bipolar items to 79 actively functioning clinicians with 1 of 3 sets of instructions: to describe a healthy, mature, socially competent (a) adult, sex unspecified, (b) a man, or (c) a woman. It was hypothesized that clinical judgments about the characteristics of healthy individuals would differ as a function of sex of person judged, and that these differences would parallel sterotypic sex-role differences. A 2nd hypothesis predicted that behaviors and characteristics judged healthy for an adult, sex unspecified, which are presumed to reflect an ideal standard of health, will resemble behaviors judged healthy for men, but not for women. Both hypotheses were confirmed. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The homeless and the health system: profile of the homeless patient

The homeless population is mobile and does not use ambulatory health care services. Thus the major contact between the homeless and the medical establishment occurs primarily when they are treated for acute symptoms in hospital. We describe the clinical and sociodemographic profile of the homeless who require hospital services. The research population included 50 homeless treated in the emergency room and various departments of our medical center between October 1994 and August 1995. Social workers used a questionnaire relating to clinical, sociodemographic and social factors. Most patients were men, 76% under the age of 50. The most common diagnosis was alcoholism; other diagnoses included back, limb and joint injuries, infections, skin diseases, and general exhaustion. There were subgroups with differing needs within this homeless population for which appropriate rehabilitation programs are proposed.