Felton Earls

Treatment-seeking for depression by black and white Americans

This paper examines data from a psychiatric epidemiologic survey of 3004 households in St Louis to determine whether there are distinctions between black and white Americans in their propensities to seek treatment for episodes of depression and to discover those groups least likely to seek care. The process initiated by the experiencing of unusual or distressing signs or symptoms and completed by seeking treatment for those complaints is a complex one, involving several steps. Numerous factors may affect decisions regarding treatment-seeking including characteristics of the individuals themselves, characteristics of the symptoms, and attitudes and beliefs about the causes and proper treatment of psychiatric problems or mood. We, therefore, also examine the available epidemiologic data for some clues concerning those factors which may have contributed to the observed patterns of treatment-seeking. Significantly fewer blacks meeting psychiatric criteria for a diagnosis of depression had sought professional care. Moreover, severity of the problem was significantly related to treatment-seeking among blacks and it was among those with the least severe problems that the greatest differences were found. Whites did not significantly exceed blacks in seeking care when depressive episodes were long lasting, severe or frequent. Although there was some indication that blacks may be more tolerant of depressive symptoms, a considerable proportion of blacks who felt they had a troublesome problem had never sought professional care. There was little evidence to suggest that a fear of being stigmatized prevented blacks from seeking care. However, blacks were more likely to report that fear of treatment and of being hospitalized had prevented them from seeking care. A number of hypotheses generated by the epidemiologic data are presented. Once large-scale surveys such as this have delineated the patterns of health care utilization and identified those groups at high risk of not receiving care, anthropological concepts and problem-oriented field research may be extremely useful in testing hypotheses concerning those factors underlying the observed behavioral patterns.

Assessing exposure to violence in urban youth.

This study reports on the development of a structured interview, My Exposure to Violence (My ETV), that was designed to assess child and youth exposure to violence. Eighty participants between the ages of 9 and 24 were assessed. Data from My ETV were fit to a Rasch model for rating scales, a technique that generates interval level measures and allows the characterization of both chronic and acute exposure. Results indicated that the fit statistics for six scales, covering both lifetime and past year victimization, witnessing of violence, and total exposure, were all good. These scales were found to have high internal consistency (r = .68 to .93) and test-retest reliability (r = .75 to .94). Evidence of construct validity was provided by the item analysis, which revealed a theoretically sensible ordering of item extremity, and also by analysis of bivariate associations. As expected, younger subjects generally reported less exposure to violence than did older subjects, males reported more exposure than did females, African-American subjects reported higher levels of exposure than did White subjects, violent offenders reported more exposure than did non-offenders, and those living in high crime areas reported more exposure than did those residing in low crime areas. Future areas of investigation and the potential contribution to studies of antisocial behavior and post-traumatic stress disorder are discussed.

The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: implications for public health

This paper explores the relationship between changes in HIV risk behaviors and physical and sexual abuse. A stratified random sampling procedure selected 602 youths from a sample of 2,787 patients seen consecutively at public health clinics in 10 cities. Face-to-face structured interviews conducted since 1984-85 provide a history of change in risk behavior from adolescence to young adulthood. Univariate and bivariate analyses assessed differences in demographic and number and type of risk behaviors between those experiencing single or multiple types of abuse and those with no abuse history at all. The results show that a history of physical abuse, sexual abuse, or rape is related to engaging in a variety of HIV risk behaviors and to a continuation or increase in the total number of these behaviors between adolescence and young adulthood. This information might help practitioners to both prevent initial involvement in HIV risk behaviors and to prevent continuation of behaviors as youths move into young adulthood.

Investigating psychopathological consequences of a disaster in children: a pilot study incorporating a structured diagnostic interview

ABSTRACT This paper reports on a pilot study examining the reactions of children to a disaster of severe flooding in a circumscribed area of rural Missouri. Both parents and children were interviewed separately approximately 1 year after the flood using parallel versions of a structured diagnostic interview designed to identify children with DSM-III diagnoses. The results document the importance of interviewing children directly. Children reported more anxiety symptoms than parents reported for their children. Although symptoms of posttraumatic stress were reported, none of the children met full criteria for the disorder. Children most likely to be adversely affected were those with a preexisting disorder and those with parents who also reported a high number of symptoms in themselves.

Psychopathology in children of alcoholics

OBJECTIVE To assess psychopathology in 125 and 158 children who are offspring of alcoholic and control parents. METHOD Parents and children were interviewed by means of structured interviews. Parents were interviewed about themselves and about their children. Teacher reports were obtained. A total of 158 young people ages 6 to 18 years were in the study, although some of the analyses use only 125. RESULTS Children of alcoholic parents showed higher rates of oppositional and conduct disorders but not attention deficit disorder. Children of alcoholic parents did not have significantly higher rates of depression, but they may be at risk for anxiety. These children also showed increased incidence of alcohol and other substance use but not abuse or dependence as defined by DSM-III. Few differences were detected with respect to self-esteem and achievement tests among the groups. There were no differences in the rates of psychopathology between offspring of alcoholic versus antisocial parents. CONCLUSION These data indicate that children of alcoholics exhibit high rates of psychopathology and may be at risk specifically for oppositional and conduct disorders but not for depression. There are few differences between alcoholics and controls with respect to self-esteem and achievement tests.

A Multilevel Study of Neighborhoods and Parent-to-Child Physical Aggression: Results From the Project on Human Development in Chicago Neighborhoods

The majority of children in the United States experience parent-to-child physical aggression (PCPA), a disciplinary strategy out of favor with many experts. Several decades of research have documented a link between community characteristics and severe child maltreatment. None have taken a multilevel approach to study whether neighborhoods affect the amount of corporal punishment and/or physical abuse used by individual families. Data for this article come from the Project on Human Development in Chicago Neighborhoods and were analyzed using hierarchical linear modeling. An interval scale of PCPA was developed. Values obtained show that several neighborhood characteristics were associated with PCPA. Immigrant concentration remained significant after controlling for family composition. A cross-level interaction was found between neighborhood social networks and Hispanic race/ethnicity. The article’s conclusion is that neighborhood characteristics may influence the amount of PCPA used by families. Neighborhood intervention strategies hold promise.

Father involvement and cognitive/behavioral outcomes of preterm infants

OBJECTIVE To assess the independent effect of father involvement on intellectual and behavioral outcome of 985 low birth weight preterm infants followed longitudinally from birth to age 3 years as part of the Infant Health and Development Program. METHOD The sample for this study is drawn from eight urban sites, composed largely of ethnically diverse and relatively disadvantaged families. On the basis of a combined score for fathers stable presence in the home and amount of play with the infant, we defined extreme groups of high-involvement fathers (33%, n = 305) and low-involvement fathers (16%, n = 148), with the remainder as a middle group (51%). RESULTS Most fathers played a meaningful role as play partner with their high-risk infants. Approximately 75% of fathers were reported to play with the baby every day at 12 (peak), 24, and 36 months. Fathers who were black, younger, had teenage mothers as companions, or were from low-income families were less involved with their infants. For black fathers, low family income was significantly associated with low father involvement. Within the black ethnic subgroup only, higher father involvement was associated with improved cognitive outcome. Mean IQ for the high-involvement subgroup was 6.00 points higher than for the low-involvement group even after adjusting for family income, neonatal health, treatment group status, and paternal age. CONCLUSION Father involvement enhances cognitive outcome in black families and may have implications for intervention.

Temperament and Home Environment Characteristics as Causal Factors in the Early Development of Childhood Psychopathology

Abstract Results are reported of a 2-year prospective, longitudinal study of young children representing a general population sample. Temperament and home environment characteristics measured at age 2 and again at 3 are used to predict behavioral problems at age 3. The findings indicate that the temperament characteristics of poor adaptability and high intensity of emotional expression more powerfully predict behavior problems than do indices of the interpersonal and material home environment. Beyond the influence of temperament, marital discord operates rather selectively in boys to heighten the risk for a poor outcome.

The influence of mental health problems on AIDS-related risk behaviors in young adults.

This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r =.28]; conduct disorder [r =.27]; depression [r =.16]; suicide [r =.14]; anxiety [r =16]; and posttraumatic stress [r =.09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a highrisk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B =.10], alcohol/drug abuse or dependence [B =.34], depression [B =.20], suicidality [B =.35], anxiety [B =.13], and posttraumatic stress [B =.14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults.

Testosterone and Aggression in Children

OBJECTIVE A link between serum testosterone and aggressive behavior, which has been demonstrated in numerous animal studies and suggested in several studies of adult men, has never been investigated in children before the time of puberty. METHOD We measured serum testosterone, sex hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEAS) in 18 highly aggressive prepubertal boys, ages 4 to 10, hospitalized for violent or unmanageable behavior at a state childrens psychiatric facility in New York City (the Bronx). We compared them with a group of age and race matched controls from the same demographic area, screened negative for aggressive behavior problems. All the aggressive subjects met DSM-III-R criteria for conduct disorder and scored higher than the 98th percentile on the aggression subscale of the Child Behavior Checklist (mean T = 80 for the group). RESULTS There were no significant differences between aggressive and nonaggressive children for T, SHBG, DHEA, DHEAS, or ratios of combinations of these variables. CONCLUSIONS These findings raise questions about inferences from adult studies that testosterone may play a causal role in the development of human aggression. Testosterone does not appear to be a useful biological marker for aggressivity in early childhood.