Elliott M. Heiman

Pain and the marital relationship: Psychiatric distress

&NA; Psychologic assessment and treatment of the family of the chronic pain patient has been thought to be of benefit in the outcome of pain therapy. The present study was designed to determine the presence of psychologic symptoms in the spouses of pain patients and the relationship of distress levels between the marital pair. Forty‐four couples were studied. Demographic data was collected and each indicidual completed the SCL‐90, a widely used and validated measure of psychologic symptom severity. There was a significant correlation (P = < 0.001) on psychiatric distress scores between pain patients and their spouses particularly when pain patient distress scores were high. Distress levels tended to decrease with age and were highest among the unemployed and lowest in the retired. In addition spouses were significantly higher than nonpatient norms on most sympton suscales. These data underline the importance of conjoint assesement of the chronic pain patient and the spouse, and have implications for treatment.

Psychopathology, Treatment Outcome and Attitude Toward Mental Illness in Mexican American and European Patients

Lower socio-economic European American and Mexican American psychiatric in- patients were compared on degree of psychopathology, response to treatment and attitude toward mental illness and hospitalization. The Mexican American patients were proportionately under-represented, but did not differ from the European Americans in degree of psychopathology at admission nor in response to treatment — both groups showing a high degree of improvement by both MMPI and clinical judgement. However, the Mexican American patients did have a significantly more negative view of hospitalization and treatment, viewing it as controlling and restrictive which may account for their lower proportion in the patient population.

Psychiatric disability assessment: Clarification of problems

Abstract The cost of psychiatric disability is not only millions of dollars in benefits but, more important, an enormous amount of suffering and waste of life. In spite of the vastness of the problems, few psychiatrists have a sense of professional competence and most avoid this field. This avoidance is quite understandable considering the complexities, ambiguities, and downright frustration involved in psychiatric disability assessment, not to mention the problems of treatment. The object of this paper is not to tell the psychiatrist how to do a disability assessment, although a few suggestions are offered, but rather to clarify the nature of the anxiety-provoking questions asked of the psychiatrist. Once the psychiatrist understands the source of these anxieties his avoidance behavior may diminish and he may do more and better disability assessments. Once the quality of assessment improves, more rational and effective treatment plans will follow.

Mental Health Patients in a Barrio Health Center

U TILIZATION by Mexican Americans of Mental Facilities of a Barrio area neighborhood health center, and demographic and symptom characteristicts of this population were investigated. The findings suggest that contrary to other studies this program was able to reach a high risk Mexican American population frequently missed by mental health programs. The barrio location, the relationship to a neighborhood health clinic and a large proportion of Spanish speaking and local personnel, seemed to be factors in this result. The patients tended to be young adult women with marital problems, somatic complaints and depressive symptoms. Significant under-utilization of mental health facilities by Mexican Americans has been reported in several studies (12,7). Since Mexican Americans are predo minantly in the lower socio-economic groups which have a greater incidence of psychopathology than higher socio-econimic groups (5, 8, 17), the explanation would not seem to be that Mexican Americans have fewer emotional problems. Rather, it would appear that Mexican Americans do not utilize available services and have psychological problems that go untreated. While there may be several other explanations for this under-utilization, this study attempted to demonstrate that in an appropriate helping facility, such as a mental health program integrated into a Barrio neighborhood health center, this under-utilization would not occur. In addition, the study examined the demographic and symptom characteristics of the Mexican American mental health population of the center, and compared these dimensions with those of outpatient mental health clinics dealing with more general populations. While there was no compelling reason to consider that the Mexican American population would be significantly different from other groups of similar socio-economic status, this comparison has not been as yet adequately assessed. Data for comparison of the characteristics of our sample with persons receiving outpatient mental health services have been reported in several studies. Bahn, Chandler, and Eisenberg (1) have summarized characteristics for all outpatients in the State of Maryland; and, in a somewhat later paper, Rosen, Bahn and Kramer (14) presented the same data for the entire United States. Thus, national and state level characteristics of individuals receiving outpatient mental health services are available. In addition, characteristics of populations of certain local clinics have been compared with other geographically diverse clinics. In this connection, McKnight, Reznikoff, and Mulligan (10) compared demographic characteristics of patients in their outpatient clinic to that of the entire area of Hartford, Con necticut. Ginott and Lebow (4) have compared characteristics of a local northern region outpatient clinic with those of a local southern region clinic.

Factors associated with number of treatment interviews of patients from a barrio neighborhood mental health service: a cross-validation.

Demographic and treatment variables were, for a second time, found associated with number of treatment interviews completed by lower socioeconomic patients of a barrio area neighborhood mental health service. Of the eight variables that originally differentiated patients with respect to number of interviews, six remained significant on cross-validation. The longer staying patients were characterized by: young adult age range; disrupted marital status; self-referral; using psychotropic medication; major and secondary problems of anxiety and depression.

Factors Associated With Length of Treatment in a Barrio-Neighbourhood Mental Health Service

Factors which discriminae between lower socio-economic largely Mexican- Americans who continue in treatment for few interviews, from those who continue longer were investigated. Demographic and treatment data were obtained from 356 consecutive cases. The factors which significantly differentiate short from long treatment contact patients were : self-referral, age, marital instability, and complaints of anxiety, depression, social or family incompatibilities. Non-self referral and financial or situation problems characterise the short treatment patient. While there were few Anglos in the sample they were disproportionately high in the long treatment group.