Irving D. Goldberg

Estimated Prevalence of RDC Mental Disorder in Primary Medical Care

The prevalence of mental disorder in primary -care practice has been estimated to be between 15% and 50% (Anderson, Francis, Lion, & Daughety, 1977; Finn & Huston, 1966; Gardner, 1970; Goldberg, Kay, & Thompson, 1976; Locke & Gardner, 1969; Patrick, Eagle, & Coleman, 1978; Shepherd, Cooper, Brown, & К alt on, 1966). These estimates have been based on general practitioners T diagnoses (Finn & Huston, 1966; Goldberg, Kay, & Thompson, 1976; Locke & Gardner, 1969) or on levels of self -reported mental or emotional symptoms (Anderson et al., 1977; Goldberg, Kay, & Thompson, 1976; Shepherd et al., 1966). Studies of patients receiving services from specialized medical settings such as hospital-based general medical clinics and emergency rooms have reported significantly higher rates of mental disorder among their patients than those reported for office-based practices (Nigro, 1970: Rosen, Locke, Goldberg, & Babigian, 1972). Anderson and co-workers (1977)

A proposed index for measuring agreement in test-retest studies

This paper is concerned with measuring agreement in test-retest studies of reliability. Discussion is confined principally to the 2 × 2 case. The commonly used index of agreement is calculated as the number of subjects identically classified by both test and retest divided by the total number of individuals classified. The inadequacies of this index (referred to as the index of ‘crude agreement’ and denoted by A) are discussed. In light of the deficiencies of A, an index of ‘adjusted agreement’ denoted by A1 is proposed: A1 = 14(aa + b + aa + c + dc + d + db + d), where a and d are the cells of agreement; b and c the cells of disagreement. By the nature of its construction, A1 yields the very useful result that expected agreement (based on observed marginals) is always 12 or 50 per cent. The two indexes A and A1 are compared by utilizing numerical examples and by application to published studies. The limitations of A1 are discussed. A test of significance for the 2 × 2 case, and the extension of A1 to the n × n case are considered.

Survivorship and causes of death among the blind

Abstract A follow-up study of 11,732 persons first registered as legally blind in Massachusetts during the 20-year period 1940–1959, was conducted in order to determine survival rates, sight-restored rates and probabilities of dying from major causes of death for the blind. Blind persons experienced poorer survivorship than expected at all ages up to 75, with little if any difference apparent at ages 75 and over. Marked differences were noted for asges 25–64. Survival rates for persons with diabetes as the cause of blindness were extremely low in comparison with the general population. Diabetes and heart disease were the two causes of death among the blind that especially showed large excesses in mortality over the expected rates. Sight-restored rates were in general rather low. Throughout, findings were similar for males and females. Data were also compared with material in two previous studies. Limitations in the present study were discussed and further research suggested.

A longitudinal study of offset in the use of nonpsychiatric services following specialized mental health care

This study examines the use of nonpsychiatric services hy mentally ill persons following the receipt of specialized mental health care, frequently referred to as the “offset effect.” A total of 9,761 persons enrolled during 1975 in the Columbia Medical Plan, a prepaid group practice in Columbia, Maryland, were studied over a 5–year period. Enrollees were classified into three groups: Treated—mental disorder diagnosis in 1975 and specialized mental health care in 1975; Untreated—mental disorder diagnosis in 1975 but no specialized mental health care in that year; and Comparison—neither mental disorder diagnosis nor specialized mental health care in 1975. The nonpsychiatric utilization for these groups was compared for 1973–1977. Specialized mental health care appears to have a short–term effect on nonpsychiatric utilization by attenuating the peak in use. Mentally ill persons without specialized mental health care in 1975 also reduced their use of nonpsychiatric services in 1976–1977. The utilization changes were more likely to occur in primary care departments, rather than nonpsychiatric specialty care departments. A diagnosis of mental disorder in either 1973 or 1974 was associated with a larger offset effect.

Utilization of medical services after short-term psychiatric therapy in a prepaid health plan setting

Utilization of medical services in Group Health Association of Washington, D.C., was analyzed for patients referred in 1970 for short-term psychiatric therapy under benefits but who had no therapy or referral for at least the 12 preceding months. A matched comparison group and family members were also studied. Medical visits were analyzed in three time periods: the 12 months preceding referral, the next 4 months when therapy was likely to be received, and a final 12 months. Compared with controls, the Index Cases did not show a significant reduction of “offset” in utilization of outpatient medical services after referral, but they did decrease days of medical hospitalization significantly. When Index Cases were divided into low and high users of psychiatric therapy, the former showed a decline, the latter an increase in medical visits, and the difference between them was significant. The before-after change in utilization among other family members was similar to that for index and control subjects. The findings suggest the need to identify the types of patient and the clinical settings which are most likely to maximize the offset effect of brief psychotherapy. Medical care programs should be tailored to meet the different psychiatric needs of these and other patients in an effective and efficient manner.

Future Directions in Primary Care/Mental Health Research

a major policy emphasis on increasing the availability of providers of primary health care while limiting the supply of medical specialists (P.L. 94-484). The development of a comprehensive public mental health delivery system has failed to occur as rapidly as anticipated, as reflected in a slightly less than 50% accomplishment of the 1963 goal of establishing 1,500 community mental health centers by 1983. Further, a holistic approach within medicine has been emphasized recently (Eisenberg, 1979; Lazerson, 1978). Related to these concerns, the Presidents Commission on Mental Health (1978) recommended that greater attention be paid to the relationship between health and mental health. Limited new initiatives have been undertaken to increase the mental health training of primarycare practitioners (PCPs) and to coordinate health and mental health services through linking government-funded primary health care projects with community mental health centers. Nonetheless, there are major gaps in knowledge with respect to mental health needs