Gary L. Tischler

Affective disorders in five United States communities

Results on the age/sex specific prevalence of DSM-III affective disorders from the NIMH Epidemiologic Catchment Area Study (ECA), a probability sample of over 18,000 adults from five United States communities, are presented. The cross-site means for bipolar disorder ranged from 0.7/100 (2 weeks) to 1.2/100 (lifetime), with a mean age of onset of 21 years and no sex difference in rates. The cross-site means for major depression ranged from 1.5/100 (2 weeks) to 4.4/100 (lifetime), with a mean age onset of 27 years and higher rates in women. The cross-site means for dysthymia, a chronic condition, was 3.1/100 with a higher rate in women. There was reasonable consistency in prevalence rates among sites. The implications of these findings for understanding psychopathology are discussed.

The epidemiology of depression: An update on sex differences in rates

Data from the New Haven, CT, Standard Metropolitan Statistical Area, site of the NIMH Epidemiologic Catchment Area (ECA) study, a multi-site collaborative community survey of psychiatric disorders is presented. The 6-month prevalence rates based on the Diagnostic Interview Schedule (DIS) interview and the DSM-III found that major depression was more frequent in women than men (2.4:1). The sex ratios for bipolar disorder were about equal. The sex ratios for major depression were fairly consistent at different time periods retrospectively assessed. There appeared to be a birth cohort effect with cohorts born after 1936 having an earlier age of onset and higher rates of major depression but not a change in sex ratios. These findings must be considered in light of the methodologic limitations of retrospective recall.

Factors affecting the utilization of specialty and general medical mental health services.

This study compares the extent to which need, predisposing, and enabling factors affect the use of mental health services in the specialty and general medical health sectors during a 6-month period. Data are drawn from the first wave of interviews of the Epidemiological Catchment Area (ECA) project at the Yale University site. The results indicate that 1) in the general population, factors affecting use of the two sectors differ; 2) among those using any mental health services, factors affecting use of the two sectors differ; 3) indicators of need have the strongest relationships with utilization; and 4) the effects of predisposing and enabling factors are contingent upon the presence of need.

Contact with health professionals for the treatment of psychiatric and emotional problems

This study focuses on predisposing, enabling, and need factors affecting contact with health professionals for the treatment of psychiatric and emotional problems during a 6-month period. Data are from the first wave of the Yale Epidemiologic Catchment Area (ECA) Project. The study confirms the important relationship of psychopathology to both the likelihood of using mental health related services and the quantity of service contacts. Sex, age, race, education, marital status, usual source of medical care, and attitudes toward mental health services were found to exert independent effects on the likelihood of contact with a health professional after controlling for clinical status. Factors affecting the quality of service contacts among utilizers were psychiatric status, usual source of care, and attitudes.

The relationship between demographic factors and attitudes toward mental health services

Considerable effort has been exerted in recent years toward educating the public concerning mental illness and the efficacy of various treatment modalities. Most previous studies of attitudes have focused solely on attitudes toward the mentally ill. In this study we investigated attitudes toward mental health services and found that most people are positively disposed toward the use of these services. Attitudes toward the use of mental health services were affected by the age, sex, race, education, and income of the subjects. In general, differences of attitude lie in the direction that would tend to inhibit utilization among those most at risk.

Psychiatric diagnoses of medical service users: evidence from the Epidemiologic Catchment Area Program.

Based on data from the five sites of the National Institute of Mental Health-sponsored Epidemiologic Catchment Area (ECA) Program, this paper examines the prevalence of psychiatric disorder among recent medical service users versus nonusers, with a particular focus on affective disorders, substance abuse/dependence, and phobias. The rate of current Diagnostic Interview Schedule (DIS) disorders among medical users in all five ECA sites is 21.7 per cent (slightly higher than general population rates) versus 16.7 per cent among nonusers; there is generally no difference between users and nonusers with past DIS diagnoses. Affective disorders were among the most common mental disorders of medical service users, especially among females, with little variation between sites: females: users: 6.9 per cent to 9.3 per cent, nonusers: 3.4 per cent to 6.4 per cent, and males: users: 3.3 per cent to 6.5 per cent, nonusers: 1.2 per cent to 4.1 per cent. Rates of phobias among persons using medical services are also higher than among nonusers. Substance abuse disorders are at least as common among persons who use medical services (8 per cent to 14 per cent of male users) as among those who do not (9 per cent to 11 per cent of male nonusers). The high rates of affective disorders among women and of substance abuse among male medical service users underscore the need to increase the ability of general medical practitioners to recognize and manage or refer these conditions.

The differential effect of attitudes on the use of mental health services

SummaryThis study examines the relationship between attitudes and use of mental health related services using data collected from 4838 respondents in the first wave of the Yale Epidemiological Catchment Area (ECA) project. Respondents were asked about their propensity to use mental health services, their perceptions of barriers to using services, and the potential reactions of family members to their receiving mental health treatment. Each of these measures was related to use of mental health services — but only among women meeting DIS-DSM III criteria for a recent psychiatric disorder, our indicator of need for treatment. These findings suggest that increasing the availability and accessability of mental health treatment services will not promote superfluous utilization. On the other hand, such efforts may not be sufficient to reduce unmet need for mental health treatment among men with psychiatric disorders. These findings also contribute to our understanding of the disproportional use of mental health related services by women.

Social factors related to psychiatric disorder: the Yale Epidemiologic Catchment Area Study

SummaryResults are reported from the first wave of the Yale Epidemiologic Catchment (ECA) Project, a large community survey conducted in South-central Connecticut, USA. The NIMH-Diagnostic Interview Schedule (DIS) was employed in the study to generate DSM III diagnoses. The 6-month prevalence rate from the unweighted data are reported. Factors associated with having had a recent DSM III diagnosis are examined. The need to take the age and sex of respondents into account when interpreting these relationships is emphasized.

The Affective Disorders: Results from the Epidemiologic Catchment Area Study (ECA)

This paper describes the historical roots of psychiatric epidemiology in the United States and summarizes recent data on prevalence rates and correlates of affective disorders (based on DSM-III) obtained from a large multi-site epidemiologic survey, the Epidemiologie Catchment Area Study (ECA), recently completed in the United States.

Social Risk Factors for Psychiatric Disorders: Being Young, Poor and Lonely

Study of the relationship between social factors, such as social class or social stress, and mental illness through epidemiologic surveys has a long tradition at Yale University. The tradition began in the 1950s with Hollingshead and Redlich’s classic study on social class and mental illness which showed that social class determined treatment for mental illness.1 The tradition was carried on by Myers and Bean,2 students of Hollingshead who began a longitudinal community survey in the 1960s and demonstrated the relationship between social stress and mental impairment independent of specific psychiatric diagnosis.3