Martha Livingston Bruce

Affective disorders in five United States communities

Results on the age/sex specific prevalence of DSM-III affective disorders from the NIMH Epidemiologic Catchment Area Study (ECA), a probability sample of over 18,000 adults from five United States communities, are presented. The cross-site means for bipolar disorder ranged from 0.7/100 (2 weeks) to 1.2/100 (lifetime), with a mean age of onset of 21 years and no sex difference in rates. The cross-site means for major depression ranged from 1.5/100 (2 weeks) to 4.4/100 (lifetime), with a mean age onset of 27 years and higher rates in women. The cross-site means for dysthymia, a chronic condition, was 3.1/100 with a higher rate in women. There was reasonable consistency in prevalence rates among sites. The implications of these findings for understanding psychopathology are discussed.

The impact of depressive symptomatology on physical disability: MacArthur Studies of Successful Aging.

OBJECTIVES The purpose of these analyses was to test the hypothesis that depressive symptomatology affects the risk of onset of physical disability in high-functioning elderly adults. METHODS The data come from the MacArthur Study of Successful Aging, a community-based cohort of high-functioning adults aged 70 through 79 years who were assessed twice at a 2.5-year interval. Physical and cognitive status was assessed by performance as well as by self-report measures. RESULTS In gender-stratified logistic regression models, high depressive symptoms as measured by the depression subscale of the Hopkins Symptom Checklist were associated with an increased risk of onset of disability in activities of daily living for both men and women, adjusting for baseline sociodemographic factors, physical health status, and cognitive functioning. CONCLUSIONS Joined with evidence that physical disability is a potential risk factor for depression, these findings suggest that both depressive symptoms and physical disability can initiate a spiralling decline in physical and psychological health. Given the important impact of activities-of-daily-living functioning on utilization of medical services and quality of life, prevention or reduction of depressive symptoms should be considered an important point of intervention.

Social and physical health risk factors for first-onset major depressive disorder in a community sample

Using prospective data on 3,170 respondents aged 18 years and over who were at risk for a first-onset major depression from the New Haven site of the Epidemiologic Catchment Area (ECA) study, these analyses assessed the effects of social status, physical health status, and social isolation on first-onset depression in a 1-year. period, controlling for demographic characteristics and baseline psychiatric factors. Among the assessed potential risk factors, poverty status [odds ratio (OR=2.034,P<0.05)] and confinement to a bed or chair (OR=4.015,P<0.05) were independently associated with an increased risk for a first-onset depressiveepisode when controlling for gender, age, past history of substance abuse, and subclinical depressive symptoms. The effects of poverly, and to a lesser degree homebound status, were substantially reduced when controlling for degree of isolation from friends and family, suggesting that social isolation mediates some of the relationships between social and physical statuses and major depression.

Gender differences in the use of mental health-related services: a re-examination

In this study we re-examine the issue of gender differences in the use of mental health services by asking (1) whether gender differences in use depend upon the specific services studied; and (2) whether statistical models which are aligned closely to help-seeking theory can explain such differences better than previously used approaches. Our analyses are drawn from two waves of data collected from a representative sample of 3,921 respondents of the Epidemiologic Catchment Area study at the Yale University site. Results indicate that although women are more likely than men to consult a physician in the general medical sector about mental health-related problems, there are no gender differences in use of the mental health specialty sector. The relationship between gender and use of the general medical sector for mental health problems also varies by psychiatric status and by attitudes toward mental health services. In the presence of a psychiatric disorder determined by the Diagnostic Interview Schedule, the likelihood of using services is highest for women with positive attitudes and for men with negative attitudes.

The differential effect of attitudes on the use of mental health services

SummaryThis study examines the relationship between attitudes and use of mental health related services using data collected from 4838 respondents in the first wave of the Yale Epidemiological Catchment Area (ECA) project. Respondents were asked about their propensity to use mental health services, their perceptions of barriers to using services, and the potential reactions of family members to their receiving mental health treatment. Each of these measures was related to use of mental health services — but only among women meeting DIS-DSM III criteria for a recent psychiatric disorder, our indicator of need for treatment. These findings suggest that increasing the availability and accessability of mental health treatment services will not promote superfluous utilization. On the other hand, such efforts may not be sufficient to reduce unmet need for mental health treatment among men with psychiatric disorders. These findings also contribute to our understanding of the disproportional use of mental health related services by women.

Depression and medical illness in late life: Report of a symposium.

Clinically significant depression in older people is an important public health problem. Medical illness is the most consistently identified factor associated with the presence of late‐life depression and is the most powerful predictor of poor depressive outcome. Closer examination of these associations holds promise for revealing insights into depressive pathogenesis at biological, psychological, and social levels of organization.

Single parent women: a community study

SummaryWhile there has been considerable interest in the problems of single parent families, no study has yet determined if the problems are due to increased risk of specific psychiatric disorders in single parents as compared to their married counterparts. Data collected as part of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) Project are presented to compare the psychiatric as well as economic and social functioning of single vs. married parent women ages 18–44, based on a probability sample of members of the greater New Haven community. The major finding between groups is their relative similarity in psychiatric as well as social functioning. The major difference is economic. Single parents, both Black and White, more frequently are less educated and poorer. While many are on welfare, single compared to married female parents are more likely to be working and to report insufficient income to meet their needs. There are no appreciable differences in social contacts, use of health services or six-month prevalence rates of psychiatric disorders including major depression, alcohol or drug abuse. The data suggest that the problems faced by single parent women and their children may be a reflection of poverty and stress in families and not of psychiatric disorders or poor social relations in mothers.

Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic catchment area study ☆

Social functioning was compared among 4913 community participants with current depression, past depression, other psychiatric disorders and no psychiatric history, from the New Haven Epidemiologic Catchment Area Wave I survey. Respondents with current major depressive disorder (1.5%) (based on the Diagnostic Interview Schedule) reported significantly poorer intimate relationships and less satisfying social interactions than respondents with past depression or other current disorders. Respondents with no psychiatric history (77%) reported significantly more active and satisfying social interactions than persons with any psychiatric disorder. These social functioning and depression associations were similar among males and females, and corroborated results from patient samples.

Cognitive impairment and depression in the oldest old in a German and in U.S. communities

Data on cognitive impairment in the oldest old is reported comparing two different samples, one in Munich, Germany, and the other in the United States (Epidemiologic Catchment Area [ECA] study). In both studies the Mini Mental State Examination (MMSE) was used for assessing cognitive impairment. The Munich sample consisted of 402 and the ECA sample of 827 very old people aged 85 years and above. The results indicate that approximately 40% of each sample scored below 24 points in the MMSE indicating at least mild cognitive impairment. Severe cognitive impairment was found in 13.4% of the Munich and in 14.6% of the American sample. The prevalence of major depression was 1.4% in Munich and 2.0% in the ECA study, and dysthymia was found in 5.1% in the Munich and in 2.0% in the ECA sample aged 85 years and above. Persons living in institutions in both studies more frequently showed signs of cognitive impairment than those living in private households. The ECA sample, but not the Munich sample, showed a significantly higher prevalence of cognitive impairment for females and for the oldest age cohort above 90 years of age. Major depression was more frequent in Munich in persons living in institutions and in the ECA study among the oldest age cohort above 90 years of age. Dysthymia in both studies did not show any association with sociodemographic factors. Most of the excess comorbidity (cognitive impairment and depression) was observed among subjects with mild (and not with severe) cognitive impairment. Very similar prevalence rates were generally found not only for MMSE-based cognitive impairment, but contrary to our expectations, also for major depressive disorder. Out data partially confirm a further increase in the prevalence of cognitive impairment in very old age.

Birth-cohort changes in the rates of mania

Secular changes in the rates of mania have been reported in the relatives of affectively ill patients, and the present study is an independent replication of these findings in a large probability sample of a community. Data from the five U.S. sites of the National Institute of Mental Healths Epidemiologic Catchment Area study (ECA), a community survey of adults, are presented. A total of 17,827 respondents were divided into eight birth cohorts, each spanning a 10-year interval. Actuarial life-table analyses showed a greater cumulative risk of mania for white men and women from the three most recently born cohorts (i.e., those born after 1935). The Wilcoxon test for homogeneity indicated an overall significant difference by birth cohort. These findings in a community sample are consistent with those previously reported in relatives of affectively ill patients. The results support the hypothesis that birth cohort changes have occurred in the risk of mania and that the risk was greatest in the post-1935 cohorts.