Richard C. Evenson

Suicide rates among public mental health patients

Age‐specific suicide rates are presented, based on 207 white patients of the Missouri Department of Mental Health who were identified as having committed suicide during 1972–74. Results, divided by age, sex, diagnosis and patient status, are compared with other studies. Male inpatients are about five times more likely to commit suicide compared to the general population, while female inpatients are about 10 times more likely to do so. In both sexes, the rate is greatest for the diagnosis of major affective disorder. A history of psychiatric treatment increases the suicide risk more for women than for men, although male patients are still about twice as likely to commit suicide than are female patients. A quantitative model is presented which describes the relative influence of age, sex and diagnosis on suicide rates.

Factor Analysis of the Symptom Checklist-90:

A 90-item version of the Hopkins Symptom Checklist was completed by 327 unselected outpatients during one year at an urban state hospital clinic, and the results factor analyzed. Ten descriptive factors were found: agitated depression, somatic concerns, phobic fear, hostility, compulsions and mental blocks, feelings of guilt and inferiority, suspicion and mistrust, psychotic thinking, sleep disturbance, and fainting. The last three factors were based on only two or three items each. Anxiety did not emerge as a separate factor and only two of the proposed psychotic items formed a factor. Hypothesized new factors of phobic fears and hostility did, in fact, appear. Factors of guilt/inferiority and suspicion/mistrust were similar to expected factors of interpersonal sensitivity and paranoid ideation.

Disturbing behavior: a study of incident reports

Over 5,000 incident reports from a large state hospital were factor-analyzed, and actuarial risk-rates were calculated for the resulting nine factors. Incident risk-rates are presented for sex, race, marital status, and diagnosis. Findings include: (1) young, single males with deferred diagnosis are high incident risk; and (2) schizophrenic incident rates, when corrected for length of stay, are relatively low.

Antecedents of Self-Induced Water Intoxication: A Preliminary Report

Although more and more case reports of self-induced water intoxication are published each year, we do not know yet what induces certain psychiatric patients to drink water in excess, and why only some of them develop water intoxication. This report, based on 13 patients who had 21 episodes of self-induced water intoxication, is an attempt to explore the characteristics of the patient population at risk for this malady. The role of psychosis, psychotropic drugs, electroconvulsive therapy, and the possible predilection of Caucasians, should be tested in a larger patient population before any firm conclusions can be drawn.

Prevalence of Polydipsia among Public Psychiatric Patients

Among 2201 public psychiatric patients evaluated for polydipsia (excessive ingestion of nonalcoholic beverages) there was a prevalence rate of 6.2%. Their mean age was 50.9 yr., being substantially younger than the comparable population of state patients, but predominantly chronic. Diagnoses were 73% schizophrenia, but mental retardation and alcoholism were also over-represented. Patients were predominantly white and almost 60% women. Almost one-quarter of the polydipsic patients met the diagnostic criteria for one or more instances of water intoxication.

An Outcome Study of Missouri’s CSTAR Alcohol and Drug Abuse Programs

The Comprehensive Substance Abuse Treatment and Rehabilitation (CSTAR) program is described, and a study of its services is presented. The CSTAR program is a community program with wrap-around services and intensive case management. Eleven domains typically affected by substance abuse were measured, plus satisfaction with treatment services. A retrospective study of 280 clients at 10 facilities was done, and results analyzed separately by General Programs. Women with Children programs, and Adolescent programs. A small sample of clients who were early in their treatment was re-interviewed 90 days later. Data were also examined according to length of stay in the program. Results were consistently positive, and increased with length of time in the program.

Using a quality of life measure to investigate outcome in outpatient treatment of severely impaired psychiatric clients

Subjective quality of life (SQL) reports in mental health settings are used with increasing frequency despite some theoretical and psychometric concerns. The authors report on 1,291 SQL reports from two assessment/casework centers serving indigent mental health outpatients in the St. Louis Metropolitan area, and a subsample of 156 clients who reported their SQL at admission and 1 year later. Standardization data for these clients are presented, as well as information on SQL domains and the internal consistency of the scale. It was found that symptom and adjustment scales comprise close to 40% of the SQL scale variance. In the 1-year follow-up subsample, the overall scale and six domains showed small but significant differences between admission and 1-year follow-up results.

Admission decisions in the psychiatric emergency room

Abstract Psychiatric admissions through an Emergency Room at a metropolitan state hospital were studied for a 3-month period. Only those with the presence of some degree of danger to self or others were included in the sample, and 74 out of 99 were admitted. Fifteen items were identified that discriminated between those admitted and those who were not. They included suicide attempts, assaultive threats, court referrals, duration of illness, previous hospitalization, use of LSD, previous arrests, inability to care for self, and lack of place to stay.

Patients of a Public State Mental Health System Who Commit Suicide

Twelve per cent of suicides in Missouri during a 3-year period were identified as having been patients of the state mental health care system by computer matching of death certificate tapes and a statewide case registry file. The percentage of Missouri suicides who had been patients varied markedly among age groups. Compared to nonpatient suicides, the patient suicides had a more equal male/female ratio and were younger. Diagnostically, schizophrenia, alcoholism (among males), and affective disorder (among females) were prominent. Nonwhites had a low incidence of suicide. The significance of the patient status at the time of death is discussed.

Prediction of readmission in a cohort of alcoholics: A 2-year follow-up

A cohort of 1,192 first admissions to metropolitan public alcohol treatment programs was examined after 2 years. With the sample sub-divided by number of readmissions, discriminant analysis based on demographic data, social history, and current drinking behavior provided only modest prediction of group membership (k = .46), but may be sufficient to provide an alerting function for recidivism.