Philip J. Leaf

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 epidemiology of depression: An update on sex differences in rates

Data from the New Haven, CT, Standard Metropolitan Statistical Area, site of the NIMH Epidemiologic Catchment Area (ECA) study, a multi-site collaborative community survey of psychiatric disorders is presented. The 6-month prevalence rates based on the Diagnostic Interview Schedule (DIS) interview and the DSM-III found that major depression was more frequent in women than men (2.4:1). The sex ratios for bipolar disorder were about equal. The sex ratios for major depression were fairly consistent at different time periods retrospectively assessed. There appeared to be a birth cohort effect with cohorts born after 1936 having an earlier age of onset and higher rates of major depression but not a change in sex ratios. These findings must be considered in light of the methodologic limitations of retrospective recall.

Factors affecting the utilization of specialty and general medical mental health services.

This study compares the extent to which need, predisposing, and enabling factors affect the use of mental health services in the specialty and general medical health sectors during a 6-month period. Data are drawn from the first wave of interviews of the Epidemiological Catchment Area (ECA) project at the Yale University site. The results indicate that 1) in the general population, factors affecting use of the two sectors differ; 2) among those using any mental health services, factors affecting use of the two sectors differ; 3) indicators of need have the strongest relationships with utilization; and 4) the effects of predisposing and enabling factors are contingent upon the presence of need.

Contact with health professionals for the treatment of psychiatric and emotional problems

This study focuses on predisposing, enabling, and need factors affecting contact with health professionals for the treatment of psychiatric and emotional problems during a 6-month period. Data are from the first wave of the Yale Epidemiologic Catchment Area (ECA) Project. The study confirms the important relationship of psychopathology to both the likelihood of using mental health related services and the quantity of service contacts. Sex, age, race, education, marital status, usual source of medical care, and attitudes toward mental health services were found to exert independent effects on the likelihood of contact with a health professional after controlling for clinical status. Factors affecting the quality of service contacts among utilizers were psychiatric status, usual source of care, and attitudes.

The relationship between demographic factors and attitudes toward mental health services

Considerable effort has been exerted in recent years toward educating the public concerning mental illness and the efficacy of various treatment modalities. Most previous studies of attitudes have focused solely on attitudes toward the mentally ill. In this study we investigated attitudes toward mental health services and found that most people are positively disposed toward the use of these services. Attitudes toward the use of mental health services were affected by the age, sex, race, education, and income of the subjects. In general, differences of attitude lie in the direction that would tend to inhibit utilization among those most at risk.

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.

Age, period and cohort effects on the risk of major depression: results from five United States communities

Rates of major depression are presented from the recently completed Epidemiologic Catchment Area (ECA) Study based on probability samples of over 18,000 adults, 18 years of age and older, living in five U.S. communities. These rates were analyzed to describe simultaneously the changes affecting successive birth cohorts and the changes associated with the period in which the onset of the disorder occurred, using age-period-cohort (APC) models. The non-identifiability problem inherent in all APC models was resolved by assuming that the linear period effect and linear cohort effect were non-negative. This assumption is consistent with our a priori substantive knowledge of the disease. Under this assumption, as the linear period effect varies from its minimum to its maximum values, a family of curves representing the possible effects of a factor was generated for each of the time factors--age, period and cohort. The results of the analysis showed a sharp increase in rates of major depression among both men and women in the birth cohort born during the years 1935-1945. The rates among females, however, seemed to have stabilized in the generations born since 1945, while the rates in males continued to rise sharply among the cohorts born in the following decade, after which, in 1955, they also levelled off. In contrast, the rates associated with period of onset of major depression continued to increase between the years 1960-1980 among both men and women of all ages studied. These findings are considered in light of the persistent concentration of depression in women and in biologically related members of families of affected individuals.

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.

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.