Telephone surveys as an alternative for estimating prevalence of mental disorders and service utilization: a Montreal catchment area study

BACKGROUND: Large-scale mental health surveys have provided invaluable information regarding the prevalence of specific mental disorders and service use for mental health reasons. Unfortunately, because vast surveys conducted face to face are very costly, many countries and provinces do not embark upon this path of research, thus depriving themselves of a rich source of data useful for service planning. METHOD: As an alternative, the authors undertook a telephone survey with a sample of 893 residents from a Montreal catchment area. Mental disorders were assessed by the Composite International Diagnostic Interview Simplified (CIDIS), an instrument especially designed to be used in mail or telephone surveys. Service utilization was measured by an instrument similar to those used in recent large Canadian or American surveys. RESULTS: The prevalence rate for any mental disorder was lower in this study than in some large-scale epidemiological surveys reviewed. This could be explained by methodological differences, such as number of disorders covered and period of reference. With regard to specific mental disorders, results appeared very similar to those of other studies. Concerning service utilization, rates tended to be higher than in other studies, and this finding could reflect real differences between Quebec and other Canadian provinces or the United States. CONCLUSIONS: Aside from being lower in cost, telephone surveys can yield results comparable to those obtained in large-scale epidemiological surveys conducted by means of face-to-face interviews.     

Factors related to utilization of services for mental health reasons in Montreal, Canada

This study examines factors related to the utilization of services for mental health reasons by Montreal residents. Data were drawn from telephone interviews. A random sample of 893 respondents completed a questionnaire on service utilization and the Diagnostic Interview Schedule Self Administered to assess DSM-III-R psychiatric disorders. Results indicate that 12.8% of the population had used such services in the past year. Medical doctors and psychiatrists, whose services are free of charge under universal health coverage, were consulted, respectively, by 4.1% and 2.0% of respondents. Psychologists, whose services are not free, were seen by 3.4% of respondents. In all, 42.0% of respondents who presented a current diagnosis used services in the past year. The highest proportion of users (48.0%) was found among respondents who presented both current and lifetime diagnoses and among respondents with comorbidity. The choice of caregiver was related also to pattern of disorders: respondents with current and comorbid disorders tended to consult general practitioners, while respondents with lifetime disorders or with lifetime and current disorders favoured specialized care. In line with other studies, self-perception of mental health, gender and marital status were related to utilization; unlike other studies, attitudes and age were not. It is argued that particularities found in this study stem not only from methodological considerations, but also from the configuration of the mental health system in Quebec, where the greater availability of psychologists may facilitate service utilization.     

Chronic fatigue syndrome, chronic fatigue, and psychiatric disorders: Predictors of functional status in a national nursing sample.

Members of 2 nurses' associations (N?=?71) were assessed using 2 mail questionnaires, a telephone questionnaire, the Diagnostic Interview Schedule, and medical records. Physicians reviewed participants to determine whether they met current criteria for chronic fatigue syndrome (CFS). Stepwise multivariate regression analyses were conducted to identify predictors of functional status scores. Impairments in physical, role, and social functioning increased as fatigue severity increased. Bodily pain increased as fatigue severity increased, and ratings of overall health increased as severity of fatigue decreased. Nurses with a current psychiatric diagnosis reported more impairments in emotional functioning than nurses with a lifetime diagnosis or no psychiatric diagnosis. Quality of life decreased as fatigue severity increased. Nurses with fatigue not meeting CFS criteria reported better quality of life than those with CFS or medical exclusions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violence and psychiatric disorders: results from an epidemiological study of young adults in Israel

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.     

Psychiatric disorder among American Indian adolescents: prevalence in Northern Plains youth

This article presents data on the prevalence of psychiatric disorders among American Indian adolescents, using DSM-III-R criteria. OBJECTIVE: To generate current prevalence data using a structured diagnostic instrument, the Diagnostic Interview Schedule for Children, Version 2.1C (DISC-2.1C). METHODS: Youths from a Northern Plains tribe who had participated in an earlier study comprised the sample. At reinterview, respondents were between 14 and 16 years of age, when Indian adolescents are thought to be at particularly high risk for manifesting emotional disorders. One hundred nine of the original sample of 251 were still in schools on the reservation. Trained indigenous lay interviewers administered the DISC-2.1C to respondents in a private setting within the school. RESULTS: The findings indicate that rates of some psychiatric problems (e.g., disruptive behavior disorders, substance-related disorders, and their comorbidity) are high among these high school students. CONCLUSIONS: These data, as well as national statistics, suggest that, compared with non-Indian populations, a greater percentage of Northern Plains adolescents manifest significant psychiatric symptoms which warrant treatment.     

Symptom scales of the Diagnostic Interview Schedule: Factor results in Hispanic and Anglo samples.

The Diagnostic Interview Schedule (DIS) was designed for use in large-sample surveys of mental health to produce categorical diagnoses according to criteria such as those found in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, based on structured information about lifetime symptoms provided to nonclinician interviewers. Using symptom data from a probability sample of community residents in Puerto Rico who ranged in age from 18 to 64 (N?=?1,513), we examined five clusters of items (those associated with diagnoses of affective disorders, schizophrenia, phobic disorder, somatization disorder, and alcoholism) and formed quantitative measures of psychopathology from each. We checked the factor structure of these five scales in two probability samples obtained in Los Angeles, one composed of Mexican-Americans (N?=?1,113) and one of Anglo-Americans (N?=?975). Both Los Angeles samples were restricted to persons aged 18 to 64 for these analyses. Evidence of the cross-cultural stability of the DIS Affective Symptoms and Alcoholism scales was obtained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental disorders and access to medical care in the United States

OBJECTIVE: The authors examined the barriers to receipt of medical services among people reporting mental disorders in a representative sample of U.S. adults. METHOD: The sample was drawn from adults who responded to the 1994 National Health Interview Survey (N=77,183). The authors studied the association between report of a mental disorder and 1) access to health insurance and a primary provider, and 2) actual receipt of medical care. Multivariate techniques were used to model problems with access as a function of mental disorders, controlling for demographic, insurance, and health variables. RESULTS: While people who reported mental disorders showed no difference from those without mental disorders in likelihood of being uninsured or of having a primary care provider, they were twice as likely to report having been denied insurance because of a preexisting condition or having stayed in their job for fear of losing their health benefits. Among respondents with insurance, those who reported mental illness were no less likely to have a primary care provider but were about two times more likely to report having delayed seeking needed medical care because of cost or having been unable to obtain needed medical care. CONCLUSIONS: People who reported mental disorders experienced significant barriers to receipt of medical care. Efforts to measure and improve access to health care for this population may need to go beyond simply providing insurance benefits or access to general medical providers.     

Social role functioning by adolescents with psychiatric disorders

OBJECTIVE: To identify aspects of social role functioning that are impaired in adolescents with specific psychiatric disorders in order to improve the psychiatric taxonomy and clinical knowledge base. METHOD: Adolescents in four urban public schools were screened for mental health problems. Structured psychiatric interviews (National Institute of Mental Health Diagnostic Interview Schedule for Children Version 2.2) with 288 adolescents and their mothers were used to identify youths with psychiatric disorders, and 10 aspects of social role functioning were assessed. Aspects of social role functioning that discriminated between youths with and without psychiatric disorders and between those with emotional disorders and those with disruptive disorders were identified for boys and for girls. RESULTS: Boys with any type of disorder and all youths with disruptive disorders had significant, consistent impairment in academic performance and several other areas of functioning. Youths with emotional disorders, especially girls, demonstrated impairment in social activity participation and peer acceptance, but girls with disorders were not as consistently different from those without as were the boys with emotional disorders. CONCLUSIONS: Role functioning differs in important ways between youths with and without psychiatric disorders and between girls and boys with disorders. The results underscore the importance of investigating observable aspects of role behavior in order to improve the timely detection and effective management of psychiatric disorders in youth.     

Mixed-mode survey of female veterinarians yields high response rate

In a recent study of female veterinarians, a subgroup of health professionals growing rapidly in number, the authors employed a mixed-mode survey design in targeting the cohort of women graduating from all US veterinary colleges during the 11-year period 1970-80 (n = 2,997). The questionnaire elicited information on a variety of health and occupational factors and required 35 minutes on average to complete. In the first stage, a modified version of Dillman's Total Design Method for mailed, self-administered questionnaires was employed, yielding a response rate of 82.9%. In the second stage, a telephone interview of all mail non-respondents was attempted, yielding a response rate here of only 30.1%, but increasing the overall response rate among those contacted to 90.2%. Non-respondents differed little from mail (early) or telephone (late) respondents with respect to year of graduation and geographic region of veterinary college attendance. Gentle probing of telephone non-respondents suggested the personal nature of some questions and the amount of time required to answer all questions were the main reasons they chose not to participate. It therefore appears that conventional survey techniques may be successfully employed in health studies of health professionals, particularly if issues of great concern to the target population are addressed.     

Perceived social support and community adaptation in schizophrenia

Prompted by the continuing transition to community care, mental health nurses are considering the role of social support in community adaptation. This article demonstrates the importance of distinguishing between kinds of social support and presents findings from the first round data of a longitudinal study of community adaptation in 156 people with schizophrenia conducted in Brisbane, Australia. All clients were interviewed using the relevant subscales of the Diagnostic Interview Schedule to confirm a primary diagnosis of schizophrenia. The study set out to investigate the relationship between community adaptation and social support. Community adaptation was measured with the Brief Psychiatric Rating Scale (BPRS), the Life Skills Profile (LSP) and measures of dissatisfaction with life and problems in daily living developed by the authors. Social support was measured with the Arizona Social Support Interview Schedule (ASSIS). The BPRS and ASSIS were incorporated into a client interview conducted by trained interviewers. The LSP was completed on each client by an informal carer (parent, relative or friend) or a professional carer (case manager or other health professional) nominated by the client. Hierarchical regression analysis was used to examine the relationship between community adaptation and four sets of social support variables. Given the order in which variables were entered in regression equations, a set of perceived social support variables was found to account for the largest unique variance of four measures of community adaptation in 96 people with schizophrenia for whom complete data are available from the first round of the three-wave longitudinal study. A set of the subjective experiences of the clients accounted for the largest unique variance in measures of symptomatology, life skills, dissatisfaction with life, and problems in daily living. Sets of community support, household support and functional variables accounted for less variance. Implications for mental health nursing practice are considered.     

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does psychiatric disorder predict violent crime among released jail detainees? A six-year longitudinal study.

Examined whether jail detainees with schizophrenia, major affective disorders, alcohol or drug use disorders, or psychotic symptoms (hallucinations and delusions) are arrested more often for violent crimes 6 yrs after release than are detainees with no disorders. Trained interviewers assessed 728 randomly selected male jail detainees using the National Institute of Mental Health Diagnostic Interview Schedule and then obtained follow-up arrest data for 6 yrs. Neither severe mental disorder nor substance abuse or dependence predicted the probability of arrest or the number of arrests for violent crime. Ss with symptoms of both hallucinations and delusions had a slightly higher number of arrests for violent crime, but not significantly so. These findings held even after controlling for prior violence and age. The findings do not support the stereotype that mentally ill criminals invariably commit violent crimes after they are released. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric morbidity among adults in The Netherlands: the NEMESIS-Study. I. Objectives, design and methods. Netherlands Mental Health Survey and Incidence Study

OBJECTIVE: To determine prevalence, incidence and course of psychiatric disorders in non-institutionalised Dutch adults. DESIGN: Prospective and cross-sectional. SETTING: Trimbos Institute, Utrecht, the Netherlands. METHOD: A multistage, stratified random sampling procedure was used to obtain a sample of 7076 adults (18-64 years). Respondents were interviewed throughout 1996 in their homes. The main diagnostic instrument was the 'Composite international diagnostic interview' (CIDI), designed to assess lifetime prevalence of mental disorders according to Diagnostic and statistical manual of mental disorders, 3rd revised edition (DSM-III-R). The diagnostic categories were: affective disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, and substance use disorders (dependence and abuse). The sample was weighted towards national census data on sex, age, marital status and urbanicity. RESULTS: The results of the first measurement (1996) will be described in the next article (1997:2353-60). The response rate was 64.2%. There were no indications that the psychiatric morbidity of non-respondents differed from respondents. The same respondents will be interviewed again after 12 (1997) and after 36 months (1999).     

Assessing match and mismatch between practitioner-generated and standardized interview-generated diagnoses for clinic-referred children and adolescents.

Although the Diagnostic and Statistical Manual of Mental Disorders (DSM) is widely used in both clinical and research settings, little is known about agreement between clinician and standardized research diagnoses. Diagnoses generated by the Diagnostic Interview Schedule for Children (DISC-P--2.3) were compared with clinician-generated diagnoses for 245 referred youths. Agreement was poor for all individual disorders and broader diagnostic clusters. Agreement was higher for externalizing categories than for internalizing, but no association was found between agreement and child, family, or clinician characteristics. Clinicians were more likely than the DISC to assign 1 diagnosis and less likely to assign 0 diagnoses, suggesting that clinic policies may play a role. Implications for the use of the DSM across different settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Corticobasal degeneration: clinical features

BACKGROUND: There are little epidemiologic data on psychiatric disorders of women in jails. Accurate data on female jail detainees are critical because of their increasing numbers and their unique treatment needs. METHODS: Using the Diagnostic Interview Schedule, independent interviewers assessed a randomly selected, stratified sample of 1272 female jail detainees awaiting trial in Chicago, Ill. We tabulated lifetime and 6-month prevalence rates of disorders by race or ethnicity (African American, non-Hispanic white, Hispanic), age, and education and compared the jail rates with general population rates for women in the Epidemiologic Catchment Area program. We also examined whether or not psychiatric disorder was associated with the severity of the detainee's current arrest charges. RESULTS: Over 80% of the sample met criteria for one or more lifetime psychiatric disorders; 70% were symptomatic within 6 months of the interview. The most common disorders were drug abuse or dependence, alcohol abuse or dependence, and post-traumatic stress disorder. Major depressive episode was the most prevalent major mental disorder. Rates were generally highest among non-Hispanic whites and among older detainees. Rates for all disorders were significantly higher than general population rates, except for schizophrenia. Most detainees with psychiatric disorders were arrested for nonviolent crimes. CONCLUSION: These results suggest substantial psychiatric morbidity among female jail detainees.     

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.     

Screening for principal versus comorbid conditions in psychiatric outpatients with the Psychiatric Diagnostic Screening Questionnaire.

In examining the performance of screening scales, a distinction should be made between principal and additional diagnoses. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong self-report scale designed to screen for the most common Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders encountered in outpatient mental health settings. In the present report, the authors compared the performance of the PDSQ in identifying principal and comorbid disorders. Seven hundred ninety-nine psychiatric outpatients completed the PDSQ and were interviewed with the Structured Clinical Interview for DSM-IV. The sensitivity and negative predictive values of the PDSQ subscales were similar for principal and additional diagnoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On bracket slot height: a methodologic study

The present study examined the prevalence of comorbid anxiety symptoms in 44 children with pervasive developmental disorders. Parents of the children were interviewed using the Anxiety Disorders section of the Diagnostic Interview Schedule for Children. Results indicated that severe anxiety symptoms are highly prevalent in children with pervasive developmental disorders: 84.1% of the children met the full criteria for at least one anxiety disorder. Furthermore, 72.7% of the children displayed ritualistic behaviors. Implications of the findings are discussed.     

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)     

Strategic planning in the community pharmacy

The extent and quality of strategic planning by community pharmacy owners and/or managers was assessed. Also examined were factors that may explain respondents use of the strategic planning process. A mail questionnaire on strategic planning yielded a total of 562 usable surveys (37.4% response rate). An unexpectedly small proportion (less than 31%) of respondents reported using strategic planning. Respondents who conducted strategic planning rated significantly higher the time available for their knowledge of, and the importance of strategic planning than those respondents who did not conducts strategic planning.