Ben Z. Locke

One‐month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study

The associations between the one‐month prevalence rates of mental disorders and sociodemographic characteristics were investigated for 18571 people interviewed in the first‐wave community samples of all 5 sites in the US National Institute of Mental Health (NIMH) Epidemiologic Catchment Area program. Men were found to have a significantly higher rate of cognitive impairment than women after controlling for the effects of age, race or ethnicity, marital status and socioeconomic status. Marital status was one of the most powerful correlates of mental disorder risk: the odds of separated or divorced people having any NIMH Diagnostic Interview Schedule disorder were twice that of married people after controlling for age, gender, race or ethnicity and socioeconomic status. The odds of those in the lowest socioeconomic status group having any Diagnostic Interview Schedule disorder was about 2.5 times that of those in the highest socioeconomic status group, controlling for age, gender, race or ethnicity and marital status. For all disorders except cognitive impairment, race or ethnicity did not remain statistically significant after controlling for age, gender, marital status and socioeconomic status.

Gender differences in phobias: Results of the ECA community survey☆

Abstract Analyses of gender differences in phobias are presented based on Wave 1 of the five-site ECA community survey. A total of 18,572 respondents, aged 18 and over, were questioned about 15 phobic symptoms, yielding diagnoses based on DSM-III criteria for agoraphobia, social phobia, and simple phobia. Women had significantly higher prevalence rates of agoraphobia and simple phobia, but no gender differences were found for social phobia, the least prevalent of the phobic disorders. The most common phobias for both men and women involved “spiders, bugs, mice and snakes,” and “heights.” The largest differences between men and women were found on the agoraphobic symptoms of “going out of the house alone” and “being alone,” and on two simple phobia items, the fear of “any harmless or dangerous animal,” and “storms.” No sex differences were found in age of onset, reporting a fear on the phobic level, telling a doctor about symptoms, or recall of past symptomatology. Mean age of onset was significantly older for agoraphobia than for social or simple phobia, although all phobias evidenced onset at an early age.

Phobia: prevalence and risk factors

SummaryThis article is the presentation of the main phobia data from the Epidemiologic Catchment Area (ECA) program, with a sample size ofn=18,571. Work on this article was initiated in 1981 at the beginning of the ECA study, but publication has been delayed a decade. Phobias are determined from information from the Diagnostic Interview Schedule (DIS), classified according to DSM III. Phobias are found to be the most common psychiatric disorder in the community, more common than major depression or alcohol abuse or dependence in the month prior to interview. The one month prevalence is between 4.0 and 11.1%, with the estimated prevalence in the United States being 6.2%. There were nine community surveys of the prevalence of phobia that pre-dated the ECA studies, which found a wide range of prevalence rates from 1.2% to 26.1%. By far the strongest risk factor associated with phobias is the presence of another psychiatric disorder. Prevalence rates of simple phobia and agoraphobia are found in the ECA studies to be significantly higher in women; social phobia, which is less prevalent, has no significant sex difference. The prevalence rates are higher in younger age groups, and in those with low socioeconomic status (SES). The onset of phobias occurs primarily in the childhood or teenage years, and they tend to be chronic conditions. Less than a quarter of phobics receive treatment.

Concordance between two measures of depression in the Hispanic Health and Nutrition Examination Survey

SummaryA concordance analysis between the Center for Epidemiologic Studies Depression Scale (CES-D) and the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) for current major depression was conducted using data from Cuban Americans and Puerto Rican respondents to the Hispanic Health and Nutrition Examination Survey (HHANES). Overall agreement between the two depression measures was relatively high, which suggested that the CES-D might be appropriate as a first-stage screening instrument for community-based surveys of clinical depression. Female gender and indicators of social class (education, income, poverty index, and employment) were related to low specificity and low agreement. The estimated cutoff points of the CES-D that best predicted DIS current major depression were different between the two ethnic groups; 17 for Cuban Americans, and 20 for Puerto Ricans. A receiver operating characteristics (ROC) curve analysis revealed that the traditional method of defining CES-D cases by summing the scores for each item was superior to counting only the persistent symptoms, that is, those present nearly everyday.

The persistence of depressive symptomatology among prepaid group practice enrollees: an exploratory study.

This exploratory study examines the persistence of depressive symptomatology as measured by the Center for Epidemiological Studies Depressive Scale (CES-D). Over as 12-month period, half of the group of 309 prepaid group practice enrollees reporting depressive symptoms at the beginning of the interval also had high scores on the CES-D at the end of the interval. Sociodemographic characteristics did not predict persistence of depression. Persistence of depression was positively associated with initially reporting cognitive and affective types of depressive symptoms, the presence of physical illness, the seeking of psychiatric treatment, and the receipt of psychotropic drug prescriptions.

Prevalence of Mental Illness in Germany and the United States: Comparison of the Upper Bavarian Study and the Epidemiologic Catchment Area Program

The objective of the present study was to compare data on the prevalence of mental illness in Germany and the United States. For this purpose, data from the Upper Bavarian Study (UBS) and the Epidemiologic Catchment Area (ECA) are presented and compared. In both studies, personal interviews were administered to a sample of community residents. The UBS sample consisted of 1,847 persons aged > or = 18 years, and the ECA study consisted of 24,371 household members aged > or = 18 years in five sites; 1,876 persons from the ECA sample lived in rural sites, and they were used for comparison with the (rural) UBS sample. The diagnostic classification (according to DSM-III) obtained by clinical interviewers in the UBS and by lay interviewers in the ECA was used. The total 6-month prevalence for any axis I Diagnostic Interview Schedule mental disorder (corrected for sample stratifications and adjusted for age) was 18.5% in the (rural) UBS, 18.0% in the total ECA sample (five sites), and 13.4% in the rural sites of the ECA. High morbidity rates for substance use disorders (UBS, 5.8%; ECA rural sites, 3.4%) and affective disorders (UBS, 6.8%; ECA rural sites, 4.1%) were observed in both studies. The 6-month prevalence rates for alcohol use disorders (3.1% considered marked or severe) were 5.1% in the UBS and 2.9% in the ECA rural sites. Concerning anxiety disorders (UBS, 1.6%; ECA rural sites, 6.7%) there was a substantial difference between the studies, which mainly resulted from a higher prevalence of phobia in the ECA program. There were higher rates of dysthymia (3.8% considered marked or severe) in the UBS (5.4%) than in the ECA rural sites (2.6%), whereas the rate of major depression was somewhat lower in UBS (1.4%) as compared with the ECA rural sites (2.4%). Alcohol use disorder was the most frequent category of mental disorder for men in both studies; for women, affective disorder and phobia (in the ECA) were the most frequent categories. Despite differences in methodology concerning sampling, instruments, and case identification the similarities between the results of the two studies were considerable.

Depression among Cuban Americans. The Hispanic Health and Nutrition Examination Survey.

SummaryThis paper presents the findings on depressive symptomatology and major depressive disorder in Cuban American respondents to the Hispanic Health and Nutrition Examination Survey (HHANES). The HHANES represents the first population-based assessment of the mental health status of Cuban Americans. High levels of depression, as measured by a CES-D score of 16 or more, were found in ten percent of the sample. Female gender was independently associated with CES-D caseness. The lifetime, six-month, and one-month prevalence rates of major depressive disorder, as measured by the National Institute of Mental Health Diagnostic Interview Schedule (DIS), were 3.15%, 2.12%, and 1.505, respectively. An income level of less than ten thousand dollars was independently associated with a lifetime diagnosis of major depression.

Immigration and insanity

I NFOR1AMATTION on mental illness among the foreign-born is sparse and vefry little is, current. Indeed, in a recently publisihed booik the data in the section on nativity pertained to the period 1917-34 (1). Also, aside from gross na,tional data derived from the decennial ceins.us of institutions, most of the detailed available information on this subject concerns admissions to mental hospitals in but three States,: Minnesota (2), Massachusetts (3), and New York (4-6). This paper reviews these early data and presents the rateis at whiclh native and foreignborn were admitted to Ohio, public mental hiospitals during tihe period 1948 to June 30, 1952.

Utilization of medical services after short-term psychiatric therapy in a prepaid health plan setting

Utilization of medical services in Group Health Association of Washington, D.C., was analyzed for patients referred in 1970 for short-term psychiatric therapy under benefits but who had no therapy or referral for at least the 12 preceding months. A matched comparison group and family members were also studied. Medical visits were analyzed in three time periods: the 12 months preceding referral, the next 4 months when therapy was likely to be received, and a final 12 months. Compared with controls, the Index Cases did not show a significant reduction of “offset” in utilization of outpatient medical services after referral, but they did decrease days of medical hospitalization significantly. When Index Cases were divided into low and high users of psychiatric therapy, the former showed a decline, the latter an increase in medical visits, and the difference between them was significant. The before-after change in utilization among other family members was similar to that for index and control subjects. The findings suggest the need to identify the types of patient and the clinical settings which are most likely to maximize the offset effect of brief psychotherapy. Medical care programs should be tailored to meet the different psychiatric needs of these and other patients in an effective and efficient manner.

Mental Diseases of the Senium at Mid-Century: First Admissions to Ohio State Public Mental Hospitals

THE DISPROPORTIONATELY large number of first admissions to public mental hospitals arising from the population 65 years of age and over is a matter of much concern to public health, mental hospital, and welfare officials throughout the nation. The reasons for this concern are several. First, the population in the age group 65 and over has been increasing rapidly; and it is anticipated that by 1980 the population in this age group will be 50 per cent more than it is now.1 Therefore, even if admission rates stay at current levels, there will be a considerable increase in the number of persons in this age group admitted to mental hospitals. Second, patients in this age group constitute a special problem for hospital staffs, since they require a great deal of physical and medical care and account to a large extent for the high mortality rate in the mental hospitals. To assist in the solution of this problem considerably more knowledge is needed on the aging process; the etiology of mental illness in the older population; the social, economic, and cultural factors that lead to various patterns of care for those who become ill; and, in particular, the factors that lead to the admissions of these people to the mental hospital as opposed to other community facilities. Although data are available to show the trend of first admission rates for the nation and for the various states,2 there is a paucity of current data on the variations of these rates by such factors as race, marital status, education, urbanrural residence, occupation, etc. The most extensive studies of these rates by such factors were those done by Dayton for first admissions to mental hospitals in the years 1917-1933 in the State of Massachusetts3 and by Malzberg for first admissions to the New York State Civil Hospital for the years 1929-1931 and 1939.1941.4,5,6 Recently, an extensive analysis has been carried out, on first admissions to the state public mental hospitals in Ohio, which yielded certain data on the variations and the rates of admissions to these hospitals for patients with mental