Brooke Fielding

Representativeness of clinical samples of youths with mental disorders: a preliminary population-based study.

In a household community sample of 1,285, 9-17 years-olds with mental disorders who had received outpatient specialty mental health services in the past year were compared with youths with mental disorders who had not received those services to determine if samples drawn from clinical settings are representative of youths with mental disorders in the general population. Those who had used services were more impaired, less competent, more likely to have comorbid disorders, more likely to belong to non-Hispanic White relative to other ethnic groups, and less likely to be prepubertal girls. Their parents were more educated, but less satisfied with family life, engaged in less monitoring of their children, and more likely to have used mental health services themselves. These findings suggest the hypothesis that samples of youths with mental disorders drawn from outpatient clinical settings are not representative of all youths with mental disorders. If confirmed, this would indicate the importance of population-based samples for the study of psychopathology in youths.

Employment Status and Ability to Work among Working-Age Chronic Dialysis Patients

283 patients, age 18-59 years on chronic dialysis were interviewed about their current work status and their ability to work if currently not employed. Only 11% of the total sample was currently employed. However, one third of the nonemployed patients said they were able to work, and most of these patients had made an effort to be employed. Age, race, educational level, health status, and physical ability to perform job tasks, recent work experience, and interest in working were related to the reported ability to work. Patients who said they were able to work were also likely to be rated able to work by the medical director of their dialysis facility. The data indicate the importance of helping work-interested patients maintain their jobs when they start chronic dialysis treatment.

Quality of life for elderly dialysis patients: effects of race and mode of dialysis

In the United States and many other countries, the number of elderly ESRD patients treated by dialysis continues to increase. Many of these receive treatment for a relatively short time before they die. Our own analysis of factors related to survival on dialysis of 1354 black and 965 white patients, who began treatment during 1982–1986 at age 60 or older, showed median survival times of only 2.7 years for black patients and 1.7 years for white patients [1]. Data reported by Neu and Kjellstrand [2] and by Eggers [3] indicate that elderly patients are significantly more likely to withdraw from dialysis than are younger patients, raising questions about the value that elderly persons attribute to life on dialysis. As Marai et al. have noted, “with the shorter life expectancy in the elderly, particularly in the group over 65 the ‘quality of life’ provided by dialysis is particularly relevant…” [4]. We investigated the quality of life of elderly dialysis patients, using responses from a large probability sample of older patients living in the southeastern United States, and will discuss the relation of demographic variables, health status, and dialysis treatment modality to patients’ quality of life responses.

Changes over time in older dialysis patients' self-assessed quality of life

Followup interviews were conducted after three years with 127 older dialysis patients whose treatment modality was unchanged. The mean age of black patients was 70; the mean age of white patients was 72. A significant race difference in reported change in quality of life (QOL) was found for only one variable; white patients, but not black patients, felt they were not taking care of their health as well at Time 2 as at Time 1. For the total sample of patients who were reinterviewed, significant change in QOL responses was found for 9 measures. Vascular access problems were reported significantly less often at Time 2 by hemodialysis patients. Physical complaints related to ESRD and dialysis, use of assist devices, functional impairment, exercise involvement, number of leisure activities, perceived control over future health, depressive symptoms, and mood state responses at Time 2 indicated decline in QOL self-assessments. For the majority of QOL measures that were investigated, including overall life satisfaction, no significant change was found. A clinical challenge is to identify interventions that effectively target areas in which older dialysis patients are at risk for declining QOL over time.