Glen D. Mellinger

A cross-national comparison of anti-anxiety/sedative drug use

Findings are reported from a 1981 cross-national survey of the use of anti-anxiety/sedative medications by adults in the general population of the United States and 10 Western European countries. Representative national samples in the 11 countries were asked a standard set of questions about their use of these medications during the preceding 12 months. Data were obtained by personal interview in the course of a household visit. The number of persons interviewed ranged from 1486 to 2018. The data provide comparable estimates of past-year prevalence of use-the proportion of the population who took these medications one or more times, and duration of use-and the proportion of the population who took these medications daily for various lengths of time. Rates for past-year prevalence of use varied from 17.6% in Belgium to 7.4% in the Netherlands. The United States at 12.9% was in the middle of the distribution. There was wide variation among countries in the prevalence of long-term and short-term use, but regular daily use for 3 months or less was the predominant pattern in 10 of the 11 countries surveyed. Past-year prevalence rates were much higher for women than for men in every country surveyed. At the national level, the data show that simple past-year prevalence rates and durational parameters of use are relatively independent.

Risks and benefits of long-term benzodiazepine use.

Despite a sharp decline in the prescription of benzodiazepines during the past decade, reservations about their use have continued to escalate. This article presents converging data from three diverse sources: national survey data from consumers, laboratory data on the drug preferences of normal subjects, and a controlled clinical study of long-term diazepam treatment and withdrawal. These data suggest that (1) the risks of overuse, dependence, and addiction with benzodiazepines are low in relation to the massive exposure in our society; (2) benzodiazepine addiction can occur when doses within the clinical range are taken regularly over about 6 months; (3) many patients continue to derive benefit from long-term treatment with benzodiazepines; and (4) attitudes strongly against the use of these drugs may be depriving many anxious patients of appropriate treatment. (J Clin Psychopharmacol 1988;8:161–167)

Evaluating a household survey measure of psychic distress

This paper describes a study to assess the validity of a brief household survey measure of psychic distress (PSYDIS). The measure classifies persons according to their pattern of scores on four dimensions, including anxiety and depression. Study subjects were interviewed first as respondents from the general population in a cross-sectional household survey. Then, according to their ratings on PSYDIS, subsamples were selected for psychiatric evaluation in a clinic a few weeks later. The survey ratings of 287 persons were compared with evaluations of the same persons by experienced psychiatrists. Overall levels of concordance ranged from 76% to 80%, depending on the psychiatric criterion used. Concordance was very high for women; it was lower for men and for persons classified as High on PSYDIS. We than applied two analytic strategies for increasing agreement between the clinical judgements and the clinical ratings. Strategy number I augmented the symptom checklist data with additional survey data on the subjects history of episodes of distress. Strategy II revised procedures for constructing the PSYDIS typology by (1) using more rigorous cutting point scores on the component scales, and (2) using a non-typological method of classification. The first strategy improved agreement between the clinic and survey measures; the second did not. The paper also compares PSYDIS with other brief symptom checklist measures.

Anti-anxiety agents: duration of use and characteristics of users in the U.S.A.

A national survey of psychotherapeutic drug use was carried out in the U.S.A. in 1979. Data were obtained from a probability sample (n = 3161) of adults in the general population, using a clinically-oriented interview lasting an average of 90 minutes. The data provide estimates of the prevalence of using anxiolytic and other psychotherapeutic medications. Among users they also provide detailed descriptions of patterns of use and characteristics associated with various patterns of use. The study found that 11% of American adults used an anxiolytic during the 12 months prior to the survey. Benzodiazepines accounted for 84% of the anxiolytics mentioned. The analyses compared (i) users of anxiolytics with non-users and (ii) three groups of anxiolytic users classified according to pattern (frequency and regularity) of use. The results were generally consistent with an illness treatment model of psychotherapeutic drug use, and they raise interesting questions about short-term single-occasion use.

An exposure-coping model of accident liability among children.

Medical record data on number of injuries were used to select samples of children with varying degrees of accident liability. Interviews with mothers provided data about the behavioral characteristics of these children. The findings are discussed in terms of a conceptual model of accident liability among children which is based on two concepts: exposure to hazards and ability to cope with hazards. In general, the data support the model. However, modifications are suggested to account for personality maladjustment which, under certain conditions, also appears to be an important variable.

A Mathematical Model with Applications to a Study of Accident Repeatedness among Children

Abstract A Bates-Neyman model is applied to four sets of accident data obtained in a study of childhood accidents. In each case, the model fits the data well. The inference is therefore tenable that the assumptions on which the model is based describe the processes underlying the observed accident distribution. For our purpose, the crucial assumptions are, first, that there are differences in accident liability within each of the groups of children studied and, second, that these differences persist over time. The model is then used to estimate the extent to which a measure of accident liability based on observed number of accidents would be contaminated by chance factors. We find as expected, that some children are likely to be classified incorrectly with respect to liability. However, the estimated proportion of incorrect classifications is low enough (especially in the extreme groups) to warrant using number of accidents as a criterion of accident liability. It is also demonstrated that keeping contami...

Assessing Comprehension in a Survey of Public Reactions to Complex Issues

This paper reports results of research to develop household interview procedures for obtaining reasonably informed public judgements about ethical issues in biomedical research. We describe (1) an interviewing strategy designed to enhance comprehension among survey respondents, and (2) a composite comprehension index based on three types of information from the interview. Using data from a cross-section sample, we identify subgroups that differ significantly with respect to scores on the comprehension index, and we then describe the observed levels of comprehension in terms of the operations defining the index. The results demonstrate both the feasibility and limits of obtaining informed rather than naive judgements about complex issues from lay respondents.

Personality characteristics of the child accident repeater

From 8874 boys and girls aged 4 to 18 in Berkeley-Oakland, California, 684 were selected to represent high-, intermediateor low-accident-liability children, based on records of medically attended injuries. Using data from intensive interviews with mothers supplemented with school records, we found a statistically significant relation between accident liability and indexes of extraversion, daring, roughhousing, and other traits tending to expose children to hazards. Similar relations held for traits such as poor discipline, aggressiveness toward peers, and, for girls, attention-seeking, which compete with the childs ability to cope with hazards. Other traits that may impair ability to cope with hazards were also found to be related to accident liability (impulsivity, carelessness, and unreliability) as were several indexes denoting maladjustment.

Clinical variables in pharmacoepidemiology

Pharmacoepidemiology traditionally concerns itself with the rates at which drugs are prescribed and used in the general population. Interpretations of these data frequently assume that the rates--for psychotropic drugs--reflect primarily the reinforcing properties of the drugs. This paper, in contrast, focuses on the influence of certain clinical characteristics of consumers on patterns of psychotherapeutic drug use. The data are from a nationwide (US) probability sample of 3,161 persons aged 18-79 years surveyed in 1979. One-year prevalence rates of use and the longest period of regular daily use serve as indices of drug consumption. Scores on a 43-item checklist of psychological symptoms were used to compute two clinical descriptors of the respondents--a quantitative index of the level of psychic distress and a qualitative syndromal classification including depression, agoraphobia/panic, other phobias, and generalized anxiety. The data showed that, although anxiolytics and antidepressants have characteristic patterns of prevalence and duration of use, the clinical characteristics of users (severity and pattern of symptoms) strongly influence these patterns. Prevalence and duration of drug use alone do not suffice to illuminate the social functions and significance of psychotherapeutic agents, to provide a basis for value judgments about the use of such compounds, and to guide medical decision-making. Since clinical variables play such a major role in the consumption of these agents, it is crucial to include information about these variables in the analysis and interpretation of patterns of psychotherapeutic drug use.

Survey method for post-marketing drug surveillance: a demonstration.

Distinguishing characteristics of a community survey method for post-marketing drug monitoring are described, as are results of a pilot study of the method. Representative samples of outpatients treated with tricyclic antidepressants or benzodiazepine anxiolytics were identified in a clinic or pharmacy and interviewed at baseline and specified intervals thereafter in the home or by telephone. Data were collected by lay interviewers trained to use a detailed interview schedule designed with input from experts in pharmacology, relevant clinical disciplines, and survey research. The critical validity question was the degree to which predicted outcomes for the two well-studied drug classes matched observed outcomes. The analytic design involved two contrast groups, three measurement periods, and six key symptom measures. The latter were specific to the disorder (anxiety and depression), to the medications, or to neither the disorders nor the medication (neutral symptoms). Predictions took account of degree and direction of change, as well as differences in profile levels over time. Results conformed precisely to expectations. As one component of a comprehensive system, the method provides an opportunity to examine efficacy as well as safety under conditions that are typically absent or excluded in clinical trials. Data on patterns of prescribing by physicians and use by patients are valuable byproducts that are immediately relevant for professional education and product liability. Advantages and limitations of the method are discussed. (J Clin Psychopharmacol 1988;8:168–176)