Linda K. George

Post-traumatic stress disorder in the community: an epidemiological study

Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1.30 and 0.44% respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric comorbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.

Explaining the relationships between religious involvement and health

There is increasing research evidence that religious involvement is associated both cross-sectionally and prospectively with better physical health, better mental health, and longer survival. These relationships remain substantial in size and statistically significant with other risk and protective factors for morbidity and mortality statistically controlled. In this article, we review the social and psychological factors that have been hypothesized to explain the health-promoting effects of religious involvement. The four potential psychosocial mechanisms that have received empirical attention are health practices, social support, psychosocial resources such as self-esteem and self-efficacy, and belief structures such as sense of coherence. Evidence concerning these potential mediators is mixed and inconsistent, suggesting there is more to be learned about the pathways by which religion affects health. Other possible explanations for the salubrious effects of religious involvement on health and longevity are discussed.

Measuring multiple dimensions of religion and spirituality for health research: Conceptual background and findings from the 1998 general social survey

Progress in studying the relationship between religion and health has been hampered by the absence of an adequate measure of religiousness and spirituality. This article reports on the conceptual and empirical development of an instrument to measure religiousness and spirituality, intended explicitly for studies of health. It is multidimensional to allow investigation of multiple possible mechanisms of effect, brief enough to be included in clinical or epidemiological surveys, inclusive of both traditional religiousness and noninstitutionally based spirituality, and appropriate for diverse Judeo-Christian populations. The measure may be particularly useful for studies of health in elderly populations in which religious involvement is higher. The measure was tested in the nationally representative 1998 General Social Survey (N = 1,445). Nine dimensions have indices with moderate-to-good internal consistency, and there are three single-item domains. Analysis by age and sex shows that elderly respondents report higher levels of religiousness in virtually every domain of the measure.

One‐month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study

The associations between the one‐month prevalence rates of mental disorders and sociodemographic characteristics were investigated for 18571 people interviewed in the first‐wave community samples of all 5 sites in the US National Institute of Mental Health (NIMH) Epidemiologic Catchment Area program. Men were found to have a significantly higher rate of cognitive impairment than women after controlling for the effects of age, race or ethnicity, marital status and socioeconomic status. Marital status was one of the most powerful correlates of mental disorder risk: the odds of separated or divorced people having any NIMH Diagnostic Interview Schedule disorder were twice that of married people after controlling for age, gender, race or ethnicity and socioeconomic status. The odds of those in the lowest socioeconomic status group having any Diagnostic Interview Schedule disorder was about 2.5 times that of those in the highest socioeconomic status group, controlling for age, gender, race or ethnicity and marital status. For all disorders except cognitive impairment, race or ethnicity did not remain statistically significant after controlling for age, gender, marital status and socioeconomic status.

The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study

Social phobia was studied in a North Carolina community, using DSM-III criteria. Two kinds of comparison were made: social phobia v. non-social phobia, and comorbid social phobia v. non-comorbid social phobia. Six-month and lifetime prevalence rates were 2.7 and 3.8% respectively. Social phobia had an early onset, lasted a long time and rarely recovered. Predictors of good outcome recovery in a logistic regression analysis were onset of phobia after age 11, absence of psychiatric comorbidity and greater education. The disorder was often missed in medical consultation. Increased rates of psychiatric comorbidity existed, especially for other anxiety disorders and for schizophrenia/schizophreniform disorder. There was increased risk of neurological disorder. Social phobia was also associated with an increased rate of suicide attempts, antisocial behaviour and impaired school performance during adolescence, impaired medical health, increased health-seeking behaviour, poor employment performance, reduced social interaction and impaired social support. Comorbidity accounted for some, but not all observed differences.

Predictors of institutionalization among caregivers of patients with Alzheimer's disease.

The treatment aim of medical care for home‐based patients with Alzheimers disease is to maximize the functioning level of the patient without jeopardizing quality of life for the caregiver. Most demented elderly live in the community with their families who, until coping becomes ineffective, usually prefer to keep their relatives out of institutions for as long as possible. In the present study, the question of why some families continue to shoulder the burden of care, often beyond healthful limits, while others relinquish care to professionals is examined longitudinally in a sample of 209 caregivers. Using logistic regression techniques, caregiver characteristics and caregiver well‐being, rather than patient characteristics, emerge as important predictors of placement decisions. Results suggest that practitioners, in evaluating the familys need for institutionalization, must move beyond duration of illness and current cognitive functioning to aspects of the caregiver support system. J Am Geriatr Soc 34:493–498, 1986

Religion, Spirituality, and Health in Medically Ill Hospitalized Older Patients

Objectives: To examine the effect of religion and spirituality on social support, psychological functioning, and physical health in medically ill hospitalized older adults.

Abbreviating the Duke Social Support Index for Use in Chronically Ill Elderly Individuals

The 35-item Duke Social Support Index (DSSI) measures multiple dimensions of social support and has been used extensively in cross-sectional and longitudinal studies of aging. Epidemiological studies of chronically ill, frail elderly individuals often wish to include a measure of social support. However, most multidimensional measures (including the DSSI) are long and may exhaust the patient, especially when included in an often already congested interview schedule. The authors have developed two abbreviated versions of the DSSI (23-item and 11-item) that capture the essential components of social support related to mental health outcomes and use of health services in treating elderly individuals with nonpsychiatric medical illness.

Alternative models of the stress buffering hypothesis.

The interactive effects of life events and social support on a DSM-III diagnosis of major depressive episode and on number of depressive symptoms were examined. Data are from a stratified random sample of 3,732 community-dwelling adults. The paper focuses on differences between linear probability models and logistic regression models with regard to the definition, detection, and interpretation of interaction effects. Results indicate that conclusions about the interaction of life events and social support are model dependent. Using a linear probability model, significant event by support interactions were observed for both depressive symptoms and major depression. Using logistic regression, which estimates interactions in terms of odds ratios, no significant event by support interactions were observed. Discussion addresses the interpretive implications of modeling interaction in terms of probability differences versus odds ratios.

Modeling the Cross-Sectional Relationships Between Religion, Physical Health, Social Support, and Depressive Symptoms

The authors examined models of the relationships between religious activities, physical health, social support, and depressive symptoms in a sample of 4,000 persons age 65 and over. Religious activity was examined first as a single composite construct and then split into three component variables that were examined individually. Religious activity as a single construct was correlated with both social support and good physical health but was unrelated to depression. Split into the three components, model fit was significantly increased. Frequency of church attendance was positively related to physical health and negatively related to depression, but was surprisingly unrelated to social support. Frequent churchgoers were about half as likely to be depressed. Private prayer/Bible reading was negatively correlated with physical health and positively correlated with social support, but unrelated to depression. Religious TV/radio listening was unrelated to social support, negatively related to good physical health, and, unexpectedly, positively associated with depression.