Richard Landerman

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.

Do older women use estrogen replacement? Data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE)

OBJECTIVES: The primary purpose of this study was to determine the prevalence of current and past estrogen use among older, community‐dwelling, postmenopausal women. The secondary purpose was to describe factors associated with estrogen use in this population.

Health and subjective well-being: a replicated secondary data analysis.

The purposes of this article are to use replicated secondary data analysis to summarize information about the relationship between health and subjective well-being and to assess the strengths and weaknesses of replicated secondary data analysis as a mode of research synthesis. The findings from thirty-seven replications in seven surveys suggest a moderate and robust relationship between self-rated health and subjective well-being. Physician-assessed health, in contrast, exhibits weaker and less robust associations with subjective well-being. Further, the relationship between health and subjective well-being is conditioned by age and is stronger for measures of negative than positive affect. The principal advantages of replicated secondary data analysis, vis-a-vis other modes of research synthesis, are cost-effectiveness, increased ability to apply multivariate statistical techniques, and greater control and flexibility for the investigator. We suggest, nonetheless, that different modes of research synthesis can best be used for different purposes.

Benzodiazepine anti-anxiety agents: prevalence and correlates of use in a southern community.

BACKGROUND Benzodiazepine anti-anxiety agents are the most widely prescribed psychotherapeutic drugs in the United States today. Recent evidence, however, suggests that their use may be decreasing. METHODS We examine the population prevalence and correlates of use of benzodiazepine anxiolytics at the Duke site of the NIMH-sponsored Epidemiologic Catchment Area project. RESULTS Bivariate analysis of use patterns for the drugs revealed demographic predictors similar to those reported in previous studies: increased likelihood of use by the elderly, Whites, women, the less educated, and the separated or divorced. Use is also associated with symptoms of psychic distress, negative life events, use of health care services, and diagnoses of affective disorder, agoraphobia with panic, and panic disorder. Age, sex, race, education, and marital status remain associated with non-hypnotic benzodiazepine use in a logistic regression analysis. CONCLUSIONS Multivariate analyses of these data indicate that when potential confounding factors are controlled, age, sex, race, education, and marital status are significantly related to benzodiazepine anxiolytic use but the effects of sex and education are mediated by intervening variables. Implications of these findings are discussed particularly in relation to high levels of use in the elderly.

Developing a screening index for community studies of somatization disorder

Despite the low prevalence of somatization disorder in the community, the section of the Diagnostic Interview Schedule used to make the diagnosis--as well as previous diagnostic interviews for the related diagnoses of hysteria, and Briquets syndrome--is quite lengthy. This study evaluates a somatization disorder screening index derived from completed interviews from the NIMH sponsored Epidemiologic Catchment Area program. A screening index comprised of 11 symptoms of somatization was derived at the Duke ECA site and replicated across the Johns Hopkins, Yale, and Washington University sites. Across ECA sites a screening threshold of five of 11 symptoms correctly identified 41 of 42 respondents with DIS/DSM-III somatization disorder (97.6%) while correctly classifying 14,600 of 14,750 (99.0%) without the disorder. The screening index offers promise as a screening device for clinical and community studies of somatization disorder.

Age as a Moderator of the Determinants of Life Satisfaction

Previous studies indicate that age differences in life satisfaction are minimal, especially when other variables are statistically controlled. This article examines the degree to which age moderates the impact of several predictors of life satisfaction. Interaction effects are investigated in context of a path model positing the structural determinants of life satisfaction. Results indicate that, although the total and direct effects of age are trivial, age is an important moderator of the effects of marital status, income, health, and social support upon lifesatisfaction.

Social outcomes related to age of onset among psychiatric disorders.

Analyses are presented that examine the impact of a diagnosis of affective disorder, anxiety disorder, and substance abuse before and after age 20 on multiple measures of education, socioeconomic and employment status, childbearing, marital status, and instability in a random sample (N = 3,000) of community respondents from the Piedmont Health Survey. Results indicate that all categories are associated with social outcomes regardless of age of onset, particularly for marital and family outcomes. For socioeconomic outcomes, the correlates of anxiety disorder are more pervasive, and the effects of a substance abuse diagnosis are stronger for early onset.

Adult Vulnerability for Psychiatric Disorders: Interactive Effects of Negative Childhood Experiences and Recent Stress

The effects of negative childhood experiences on adult psychiatric status remain unclear because of inconsistent findings in previous studies. In this study, we examine the extent to which parental separation/divorce before the age of 10, parental death before the age of 10, and self-reports of parental mental illness during early childhood interact with recent stressful life events to increase the probability of multiple psychiatric disorders and psychiatric symptoms during adulthood. Data are from a stratified random sample of 3801 adults residing in a five-county catchment area in North Carolina. The Diagnostic Interview Schedule was used to measure psychiatric disorders and symptoms during the 6 months prior to the interview. Regression analyses were used to determine whether negative childhood experiences interact with recent stressful life events to increase the probability of psychiatric disorders or symptoms, with other risk factors statistically controlled. Results suggest that: a) parental mental illness increases the likelihood that stressful life events will result in depression, although it is unclear whether this increased vulnerability is due to genetic or environmental factors; b) parental separation/divorce interacts with stressful life events to increase vulnerability to alcohol problems and psychiatric disorders more generally; and c) parental death does not interact with recent events to affect the likelihood of psychiatric problems.

Women's and Men's Retirement Income Status Early Family Role Effects

The effects of work history and early family roles on prospective economic (income) status at retirement are examined using the Earnings Records and Longitudinal Retirement History Study of the Social Security Administration. Regression analyses show that early family roles have greater direct and indirect effects on womens preretirement economic status than on mens. These effects present themselves as costs to women in retirement dollars. Sex differences are especially evident when observing the intervening effects of assets (net worth) and estimated retirement incomes from private and government pensions.

Concurrent Morbidity Between Physical and Mental Illness: An Epidemiologic Examination

Two broad research traditions have examined the relationship between physical and mental illness: epidemiologic surveys and clinical studies (Houpt, Orleans, George, et al., 1979; 1980). Epidemiologic surveys typically are based on community samples, obtain data about both physical and mental illness from respondents’ self-reports, and measure both physical and mental illness in terms of symptom counts or degree of functional impairment. Clinical studies typically are based on the patient population of a single health service setting, rely upon patient charts for information about physical and mental illness, and emphasize diagnosis rather than impairment.