James W. Thompson

Gender differences in phobias: Results of the ECA community survey☆

Abstract Analyses of gender differences in phobias are presented based on Wave 1 of the five-site ECA community survey. A total of 18,572 respondents, aged 18 and over, were questioned about 15 phobic symptoms, yielding diagnoses based on DSM-III criteria for agoraphobia, social phobia, and simple phobia. Women had significantly higher prevalence rates of agoraphobia and simple phobia, but no gender differences were found for social phobia, the least prevalent of the phobic disorders. The most common phobias for both men and women involved “spiders, bugs, mice and snakes,” and “heights.” The largest differences between men and women were found on the agoraphobic symptoms of “going out of the house alone” and “being alone,” and on two simple phobia items, the fear of “any harmless or dangerous animal,” and “storms.” No sex differences were found in age of onset, reporting a fear on the phobic level, telling a doctor about symptoms, or recall of past symptomatology. Mean age of onset was significantly older for agoraphobia than for social or simple phobia, although all phobias evidenced onset at an early age.

Prescribing of Psychotropics in Elderly Nursing Home Patients

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one‐fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one‐fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

Phobia: prevalence and risk factors

SummaryThis article is the presentation of the main phobia data from the Epidemiologic Catchment Area (ECA) program, with a sample size ofn=18,571. Work on this article was initiated in 1981 at the beginning of the ECA study, but publication has been delayed a decade. Phobias are determined from information from the Diagnostic Interview Schedule (DIS), classified according to DSM III. Phobias are found to be the most common psychiatric disorder in the community, more common than major depression or alcohol abuse or dependence in the month prior to interview. The one month prevalence is between 4.0 and 11.1%, with the estimated prevalence in the United States being 6.2%. There were nine community surveys of the prevalence of phobia that pre-dated the ECA studies, which found a wide range of prevalence rates from 1.2% to 26.1%. By far the strongest risk factor associated with phobias is the presence of another psychiatric disorder. Prevalence rates of simple phobia and agoraphobia are found in the ECA studies to be significantly higher in women; social phobia, which is less prevalent, has no significant sex difference. The prevalence rates are higher in younger age groups, and in those with low socioeconomic status (SES). The onset of phobias occurs primarily in the childhood or teenage years, and they tend to be chronic conditions. Less than a quarter of phobics receive treatment.

Detection of substance use disorders among psychiatric inpatients

This study examines the utility of the Addiction Severity Index (ASI) for detecting psychoactive substance use disorders (PSUDs) among psychiatric inpatients. Four hundred thirty-five inpatients at two inner-city psychiatric hospitals completed the ASI and the Structured Clinical Interview for DSM-III-R (SCID). Receiver operating characteristic (ROC) analysis assessed the optimal threshold ASI alcohol and drug composite scores to detect DSM-III-R PSUDs. The correlations of both the ASI alcohol and drug composite scores with their corresponding DSM-III-R PSUD categories were significant (p <.0001). However, the ROC analysis revealed that the ASI misses approximately 20% of SCID-positive PSUD cases. Specificity of the ASI, on the other hand, is quite good (95% to 98%), and optimal ASI threshold scores to rule out a PSUD among these patients are identified. The results also support the sensitivity of these patients to the toxic effects of illicit substance use.

Implications of mental and substance use disorders. A comparison of single and dual diagnosis patients.

To understand better the implications of co-occurring mental and substance use disorders, we examined DSM-III-R diagnoses and life problems among a representative sample of 314 patients admitted to either a psychiatric hospital or a residential substance abuse treatment program from the same inner-city catchment area. Based upon the Structured Clinical Interview for DSM-III-R, the patients were divided into four groups. The first two groups had dual diagnoses, either: a) a primary axis I mental disorder (MD) and a comorbid psychoactive substance use disorder (PSUD); or b) a PSUD-related mental disorder and a PSUD, but no primary axis I MD. The third and fourth groups had a single diagnosis, either: c) a primary axis I MD, but no lifetime PSUD; or d) a PSUD, but no lifetime primary axis I MD. As expected, the two dual disorder groups had more cumulative problems than did cither of the single disorder groups. Dually disordered patients with PSUD-related MD most resembled singlediagnosis PSUD patients in terms of substance use profile and life problems. Dually disordered patients with primary MD more resembled single-diagnosis MD patients, but had more severe life problems. Presence of a PSUD was associated with male gender, antisocial personality disorder, and more severe legal problems. Presence of a primary mental disorder was associated with more extensive prior hospitalizations and greater psychiatric severity.

The Use of Ambulatory Services by Persons With and Without Phobia

The delivery of ambulatory mental health and general health services to persons with phobias (unweighted n=1,689) and without phobias during a 6-month period are examined. The phobics were part of a larger study of 18,572 subjects, drawn as a representative sample of the population in five locations, as part of the Epidemiologic Catchment Area Program (ECA). Among phobic conditions, agoraphobia most often leads to use of services related to emotional problems, especially in the specialty mental health sector. There were no significant differences between male and female subjects in their use of the various sectors for a mental health reason. The highest age group of agoraphobics that used health services most often was 25-44 years old, and the group that used them least often was 65 years and older. Agoraphobics with four or more symptoms of panic use services in higher proportions than agoraphobics with zero to three panic symptoms. The authors observe that a very large proportion of phobics report seeking no help from any source.

Psychotropic Medication Prescription in U.S. Ambulatory Medical Care

Because of the pharmacologic power of psychotropic medications, the potential for adverse effects, and the changing popularity of particular psychotropic drugs, it is vital for pharmacoepidemiologists to monitor the prescribing patterns of these medications. Using data from the 1985 National Ambulatory Medical Care Survey (NAMCS), this article assesses psychotropic medication prescribing by U.S. ambulatory care physicians. Psychotropic medications are classified into three categories: Minor tranquilizers (i.e., anxiolytics and sedative-hypnotics), antidepressants, and antipsychotics. The prescribing patterns of psychiatrists, primary care clinicians, and all other physicians are compared. Differences in psychotropic prescribing patterns by psychiatric diagnosis are examined as well. The excessive use of minor tranquilizers, the continuing use of first-generation psychotropic medications (particularly minor tranquilizers), and the lack of concordance between diagnoses and prescribed psychotropic medications are discussed.

Who talks to physicians about mental health and substance abuse problems

This is an analysis of data from the NIMH-sponsored Epidemiologic Catchment Area community-based study, investigating who reported discussing mental health or substance abuse problems with nonpsychiatric physicians. Data were from 7,092 respondents in four sites, all of whom had received care only in the nonpsychiatric sector in the previous six months. A multiple logistic model found that those individuals who had psychiatric disorders, and female, middle-aged, and Hispanic respondents, were more likely to have discussed emotional or mental health problems with their physicians. Respondents with alcohol abuse and substance abuse disorders did not report any more discussion of mental health problems than did respondents without alcohol or substance abuse disorders. Only 36% of the respondents who said they had discussed mental health problems were found to have psychiatric disorders by the Diagnostic Interview Survey (DIS), but many of those without disorders reported more anxiety symptoms. An analysis was done to predict which respondents with DIS-defined psychiatric disorders did not report discussing mental health problems with their nonpsychiatric physicians. Those less than 35 years of age, those older than 65 years of age, males, and those with only one recent visit to a provider were statistically at high risk for not discussing their psychiatric problems.This is an analysis of data from the NIMH-sponsored Epidemiologic Catchment Area community-based study, investigating who reported discussing mental health or substance abuse problems with nonpsychiatric physicians. Data were from 7,092 respondents in four sites, all of whom had received care only in the nonpsychiatric sector in the previous six months. A multiple logistic model found that those individuals who had psychiatric disorders, and female, middle-aged, and Hispanic respondents, were more likely to have discussed emotional or mental health problems with their physicians. Respondents with alcohol abuse and substance abuse disorders did not report any more discussion of mental health problems than did respondents without alcohol or substance abuse disorders. Only 36% of the respondents who said they had discussed mental health problems were found to have psychiatric disorders by the Diagnostic Interview Survey (DIS), but many of those without disorders reported more anxiety symptoms. An analysis was done to predict which respondents with DIS-defined psychiatric disorders did not report discussing mental health problems with their nonpsychiatric physicians. Those less than 35 years of age, those older than 65 years of age, males, and those with only one recent visit to a provider were statistically at high risk for not discussing their psychiatric problems.

The severely mentally Ill in General Hospital psychiatric units

Analysis of data from the NIMH Survey of Discharges from Non-Federal General Hospitals found that severely mentally ill patients (those with schizophrenia, other psychoses, paranoia, and major affective disorders) became an increasingly larger proportion of general hospital discharges between 1970 and 1980, with more change observed between 1975 and 1980. This seems to confirm that general hospital care is replacing at least some of the care previously provided in State mental hospitals. There has been an increase in beds in nongovernment-owned general hospitals and a decrease in beds in state hospitals. In addition, while discharge referrals from government general hospitals for severe patients were made predominantly to state hospitals in 1970, in 1980 this was rarely the case.

Initial treatment decisions by level of care for youth in the CHAMPUS Tidewater Demonstration

Over a three-year span, the level of care initially provided to children and adolescents receiving mental health services under a CHAMPUS Demonstration in the Tidewater area of Virginia shifted dramatically to less restrictive and less expensive settings, consistent with national policy. Issues about the quality of care under this cost containment model (which includes fiscal incentives for the contractor) are explored; criteria for placement decisions require further attention.