Marijo B. Tamburrino

TELEPHONE-BASED TREATMENT FOR FAMILY PRACTICE PATIENTS WITH MILD DEPRESSION '

The need for treating milder forms of depression has recently been of increased interest. This was a randomized, controlled study to evaluate the effects of telephone-based problem-solving therapy for mild depression. Comparison groups were a treatment-as-usual group and another group receiving stress-management training by telephone. From 1,742 family practice patients screened for depression, 54 with mild depression entered the study. Treatment was provided by experienced family practice nurses, trained and supervised in the treatments. The Hamilton Rating Scale for Depression was administered before and after the intervention period, and the Beck Depression Inventory and Duke Health Profile were administered at the end of the intervention period. Of the 36 subjects assigned to the problem-solving and stress-management groups, half dropped out early in the study. Five from the treatment-as-usual group were lost to follow-up. In the remaining subjects, there was a significant decrease in depression scores. There were no significant differences in the amount of decrease between the groups on any scores. The small sample and high dropout rate limit the interpretation of the findings. However, since all subjects tended to improve, regardless of treatment received, mild levels of depression may generally remit even without focal intervention, and watchful waiting may be a reasonable alternative for management.

Eating attitudes in college males

Three hundred and forty male college students participated in a survey study of eating attitudes. Participants completed a survey including demographic data, a weight history, and the Eating Attitudes Test (EAT-26). Twelve subjects or 3.5% of the population had elevated scores of 20 or above on the EAT-26. Elevated scores correlated significantly with body building and with a past history of obesity. Fully 65% of the men reported weighing within 5 percentage points of their ideal weight. The authors suggest that males who are overinvested in their bodies and physical appearances are at higher risk for developing eating disorders.

Coherence between physician diagnosis and patient self reports of anxiety and depression in primary care.

Mood and anxiety disorders complicate the care of patients with physical illness and pose challenges for primary care physicians. This study explored the coherence between a screening tool (PRIME-MD), a standardized questionnaire (Eysenck Personality Inventory), and physician diagnoses of anxiety and depression. Of 165 patients, 29% had diagnoses of depression, 21% had anxiety, and 59% had no mental health diagnosis. Patients who were younger, female, divorced/widowed, or unemployed with minimal education had highest prevalence of anxiety or depression. Scores on the self-report inventories were significantly higher in patients with physician-diagnosed anxiety or depression compared with those without these diagnoses. Medical use and chronic illness were highest in patients with anxiety or depression diagnoses. Despite the statistical agreement between the self-report inventories and physician diagnosis, the coherence among these measures was less than optimal. Use of self report tools is recommended to complement physician understanding of patient symptom description and management of anxiety and depression in primary care.

Anniversary Reactions and Due Date Responses Following Abortion

Of 83 women who responded to surveys exploring postabortion coping, 30 women reported anniversary reactions associated with the abortion or due date. Women in the anniversary reaction group more often reported ambivalence about the decision to abort (p less than 0.007). This group also acknowledged fewer suicidal thoughts and attempts, but expressed more concern about verbally abusing their children (p less than 0.04). Strong trends toward dependency and somatoform disorders were present among anniversary group members (p less than 0.06). The authors recommend that physicians be alert to the possibility of hidden anniversary reactions of both physical and emotional nature during patient evaluation.

Teaching interviewing skills: the effect of instructors' academic department.

This study examines student evaluations of an interviewing and communications skills course taught in small groups by members of psychiatry and family medicine departments. Student course evaluations for two academic years were analyzed by means of t-tests and multiple regression analyses to explore if the group leaders academic department affected the students learning experience. Students taught by family medicine instructors rated significantly higher three aspects of the course: the usefulness of the role playing session, the credibility and realism of the videotaping session, and the recommendation that the course be continued. This study found the family medicine instructors to be valued teachers of interviewing and communication skills.

Rumination in adults: Two case histories

Rumination has been reported to be a relatively rare disorder of eating during infancy. Over the past decade, there appears to be a renewed interest in and recognition of adult rumination. Although some authors believe adult rumination is benign, others have begun to link it with both eating disorders and depressive symptoms. This paper presents two adult cases whose rumination was associated with anorexia and bulimia nervosa. More identification and study of adult rumination is needed to clarify its course and medical significance.

Evaluating empathy in interviewing: Comparing self‐report with actual behavior

The purpose of this study was to compare responses on the Medical Helping Relationship Inventory (MHRI), an instrument recently developed for evaluation of medical communications skills, with ratings of medical students’ videotaped interview behavior. Fifty videotapes of student interviews were evaluated by two trained raters, using the Carkhuff Empathic Understanding Scale, an adapted version of the Arizona Clinical Interview Rating scale, and additional items developed to measure specific interviewing behavior. Measures of empathy based on rated behavior were highly intercorrelated; however, expected positive relations between rated empathy and the MHRI Understanding subscale were not found. It would appear that preferences for Understanding responses on the MHRI multiple‐choice survey did not reflect the ratings of the students’ actual interview behavior.

Depressive symptoms: Associations with health perceptions and health behaviors

The association of depressive symptoms with health behaviors and perceptions was determined for 876 patients seeing family physicians. Correlational analyses revealed stress, pain, and overall health status were moderately related to depression for males and females. Smoking was positively related to depressive symptoms in women (r = .19, P < 0.01), and drinking was inversely related to depressive symptoms in men (r = -.16, P < .01). Multiple regression analyses indicated stress, poor health, smoking, and drinking were significant predictors of depressive symptoms in women; stress, poor health, and drinking were significant in men. Health perceptions appear to be better predictors of depressive symptoms than reported health behaviors.

Conflict With Physician Pregnancy Revisited

A 10-year follow-up survey found medical school physicians (N = 200) at one institution were more interested in and accepting of pregnancy among colleagues. A greater number of physicians in 1990 than in 1980 reported that pregnant colleagues maintained their work efficiency and interest in medicine. Fewer physicians in 1990 reported being inconvenienced during a colleague’s pregnancy, and fewer perceived hiring women of childbearing age to be a risk to the optimal functioning of their departments.

Rumination: the eating disorder of infancy.

Rumination is a relatively rare, potentially fatal syndrome in infants. This article reviews the historical and current treatment of rumination. Two cases are presented: a six-month-old who narrowly escaped surgery when the disorder was not recognized, and a complicated case from the neonatology intensive care unit. Environmental changes and enhanced mothering are described as being critical to correction of rumination and appropriate weight gain.