Gary B. Cox

Ethnic populations: community mental health services ten years later.

In a replication of a series of studies conducted by Sue and colleagues in the mid-1970s, demographic and service data were retrieved for the Seattle-King County area from the Washington Mental Health Information System. Caucasian clients were compared against Asian, black, Hispanic, and Native American client groups, and, where possible, against the findings reported earlier by Sue. These clients were compared in terms of basic demographic characteristics, characteristics of staff providing the services, dropout rates, and average number of services received. The most notable findings are (a) that failure-to-return rates are dramatically lower for the current sample than for Sues and not greatly different for minorities than for Caucasians, (b) that variability in failure-to-return rates is most strongly related to level of functioning and not related to minority status, and (c) that although Asian Americans still average fewer services than Caucasians (other minorities do not differ significantly), the mean number of services had increased substantially for all groups but more for minorities than for Caucasians.

Bright light treatment of winter depression: morning versus evening light

In a randomized crossover design, 7 patients with winter depression were treated with 7 d of bright morning light (0600 to 0800) and 7 d of evening light (2000 to 2200). Bright lights in the morning significantly reduced the Hamilton Rating Scale for Depression (HRSD) score (18.4 to 5.0); the bright light in the evening moderately decreased the HRSD score (19.4 to 15.1). The improvement in the HRSD score was significantly greater with morning light than with evening light.

Anxiety, pain, and depression surrounding elective surgery: a multivariate comparison of abdominal surgery patients with kidney donors and recipients.

Abstract Anxiety, depression, and pain were psychometrically assessed in 67 abdominal surgery patients on the day before surgery, on the first postoperative day, and on the third postoperative day. Patients were divided into kidney donor, kidney recipient, and general surgery groups, and a multi-variate analysis of variance was performed in order to compare the trends of response over days across groups. There were significant group differences in the pattern of scores over the three days. Trait anxiety was related to post-surgical pain, anxiety, and depression in general surgery and renal recipient patients, but not in kidney donors. Results suggest that the meaning attached to the stress of surgery significantly affects the subjective state changes surrounding the operation.

Social support as a multifaceted concept: Examination of important dimensions for adjustment

Four commonly used operationalizations of the social support concept: network contact frequency, satisfaction with support (including nine dimensions), perceived availability of support, and use of support, were related to two measures of psychological adjustment (Beck Depression Inventory and Symptom Checklist-90) and to one measure of physical adjustment (Cornell Medical Index). Subjects were 68 45- to 85-year-old, highly stressed care-givers to spouses with Alzheimers disease. Results indicate that of the four operationalizations, Satisfaction with Support was the only significant predictor of depression and general psychopathology. The set of four support variables showed the strongest relationship to depression level, next strongest to general psychopathology, and least to physical health. The satisfaction with nine social support dimensions related differentially to the types of adjustment. Results suggest the importance of specificity (sample, support operationalization, dimensions, adjustment measures) in social support research.

Morning or evening bright light treatment of winter depression ? : the significance of hypersomnia

In a randomized crossover design 19 patients with winter depression were treated with 7 days of bright morning light (6:00 to 8:00 AM) and 7 days of evening light (7:00 to 9:00 PM). Bright light in the morning reduced the Hamilton Depression Rating Scale score from 22.3 to 5.5; bright light in the evening decreased the Hamilton score from 21.0 to 12.2. Improvement in the depression as measured by the Hamilton Depression Rating scores was greater with morning light compared with evening lights. Hypersomnia was associated (p less than 0.05) with a superior response to morning light.

The MMPI and chronic pain: the diagnosis of psychogenic pain.

This study investigates the capacity of the MMPI to discriminate among groups of patients with different types of pain. When multivariate analysis of variance is used, the standard set of MMPI scales discriminates between acute pain and chronic pain but not between chronic pain of two different etiologies (surgicaliatrogenic vs. unknown). The three scales that discriminate acute from chronic pain patients are those in the “neurotic triad,” Hs, D, and Hy. The possibility that the unknown pain etiology group could be broken down into psychogenic pain and undetected somatogenic pathology subgroups was explored using cluster analysis. This procedure did not yield any group of patients who could be identified as having chronic pain of psychogenic origin. These results suggest that the MMPI is not a reliable tool for the differential diagnosis of chronic pain. It appears, however, that patterns of findings are partly contingent on population characteristics. Researchers should be cautious about generalizing to populations other than those from which samples are drawn.

Managerial Style: Implications for the Utilization of Program Evaluation Information.

One of the central problems with program evaluation is the general perception that results are not utilized as fully as possible in decision making processes. A variety of explanations for this sho...One of the central problems with program evaluation is the general perception that results are not utilized as fully as possible in decision making processes. A variety of explanations for this shortcoming have been offered, but there has been little research and very little theorizing on the matter. The fact that a similar problem exists in a wide range of information exchange situations suggests that the source of the problem is not primarily methodological. This article draws on other research in order to characterize managerial behavior generally, and then draws some inferences as to how utilization would proceed and how it might be increased.

Racial differences in the utilization of public mental health services in Washington State

This study analyzed racial differences in the use of public outpatient mental health services in four regions of Washington State. Patients in this study were enrolled in the states mental health management information system, which contains detailed information about patient characteristics and service utilization. There were distinct racial differences with respect to baseline characteristics, and even after adjusting for these characteristics and region of the state as well, racial differences in the type and amount of services used persisted. In particular, African-Americans were more likely to use crisis services and were less likely to use individual or group treatment. This previously reported finding requires further exploration.

Demographic and clinical features predictive of recovery in acute mania.

Discrepancies exist in previous reports regarding clinical and demographic features associated with recovery in acute mania. The authors studied 44 hospitalized patients with bipolar affective disorder, manic type. They report a significant association between more depressive symptomatology and perhaps younger age of illness onset, and poor immediate treatment response. They also found the total amount of psychopathology at admission, as measured by the Brief Psychiatric Rating Scale and Manic State Rating Scale, and the degree of psychosis to be unrelated to immediate outcome. The authors suggest that the not recovered manic subgroup has a distinct illness or a variant of bipolar disorder with poor prognosis that warrants further and separate investigation.

Substance use and five-year survival in Washington State mental hospitals.

This report combines five-year survival and cause of death in individuals discharged from Washington State mental hospitals with (1) mental illness only, (2) co-occurring mental illness and substance use disorder, or (3) substance use disorder only. Five-year survival was similar in the three groups, although after adjusting for age, individuals with co-occurring disorders or substance use disorder were almost 50% more likely to die than those with mental illness only. Persons with these conditions need treatment to prevent premature death and medical conditions directly related to substance use disorder.