RESUMO
OBJECTIVE: Early relational health (ERH) is a key developmental predictor and outcome in infancy and early childhood that reflects social-emotional well-being and promotes resilience throughout childhood. Currently, there is no gold-standard developmental screening tool for ERH in pediatric care settings. This study examined the psychometric properties of items assessing ERH that are part of a web-based, caregiver-report screening tool called PediaTrac TM . It was hypothesized that ERH could be reliably estimated and that second-order factors would be revealed within the latent construct ERH. METHOD: Participants included 571 caregivers of term (n = 331; ≥37 weeks) and preterm (n = 240; <37 weeks) infants recruited shortly after birth from several academic medical centers and a community health clinic. Caregivers completed PediaTrac modules at birth and 2, 4, 6, 9, 12, 15, and 18 months; data for this study are from the newborn through 12-month periods. RESULTS: Results from Item Response Theory Graded Response Modeling revealed excellent reliability for the PediaTrac ERH domain at all time points, ranging from 0.96 to 0.98. Exploratory factor analyses revealed 4 to 5 second-order factors, representing Parent-Child Relationship, Parent Distress, Parenting Stress, Parenting Efficacy, Sensitivity, and Perceptions of Child, depending on period. CONCLUSION: The caregiver-report developmental screening tool, PediaTrac, reliably measures ERH during the first year of life. The measure has promising clinical utility in pediatric clinic settings for tracking ERH over time to ensure early social-emotional well-being and to identify concerns as early as possible.
Assuntos
Psicometria , Humanos , Feminino , Lactente , Masculino , Psicometria/normas , Psicometria/instrumentação , Relações Pais-Filho , Cuidadores , Recém-Nascido , Adulto , Recém-Nascido Prematuro/fisiologia , Desenvolvimento Infantil/fisiologia , Reprodutibilidade dos TestesRESUMO
Individuals' reasons for marijuana use have been linked to their risk for continued use and development of disordered use. Although individuals tend to have multiple reasons for use, co-occurrence of reasons is not always accounted for in analytic approaches. Latent transition analysis (LTA) is ideal for modeling transitions in co-occurring reasons. Using longitudinal panel data from Monitoring the Future, LTA was used to identify profiles of self-reported reasons for marijuana use among young adults, examine transitions between profiles, and determine whether cohort, gender, race/ethnicity, parent education, grade of first marijuana use, and 4-year college attendance predicted transitions between profiles. Data included senior year cohorts from 1976-2009 and were collected at ages 19/20, 21/22, and 23/24 (weighted n = 7,294; 55.9% female; 79.3% White). Five latent classes were identified: Non-Users and individuals with Experimental, Typical, Get High + Relax, and Escape + Coping Reasons. Transitions among Non-Users, Experimental Reasons, and Typical Reasons were common; generally, those with earlier cohort membership, early initiation, college non-attending parents, and college attendance were more likely to make transitions to higher-risk classes. As the legalization of recreational marijuana use continues to expand, change over time in reasons for use should be considered carefully as interventions are developed and implemented.
Assuntos
Fumar Maconha , Uso da Maconha , Transtornos Relacionados ao Uso de Substâncias , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Fumar Maconha/epidemiologia , Uso da Maconha/epidemiologia , Autorrelato , Adulto JovemRESUMO
BACKGROUND: This study examines whether longitudinal patterns of persistent or experimental heavy substance use across young adulthood were associated with physical and mental health in midlife. METHODS: Data (N = 21,347) from Monitoring the Future from adolescence (age 18) to midlife (age 40) were used. Repeated measures latent class analysis modeled patterns of patterns of cigarettes, alcohol, marijuana, and other illicit drugs across young adulthood (ages 18-30). Latent classes were then used as predictors of physical health problems, cognitive problems, self-rated health, and psychological problems in midlife (age 40), while controlling for sociodemographic variables (i.e., gender, race/ethnicity, parental education). RESULTS: Identified classes were "Extreme Heavy Users" (3.9%), "Early Young Adult Users" (8.9%), "Cigarette Smokers" (9.2%), "All But Cigarette Smokers" (5.0%), "Frequent Alcohol Bingers" (10.4%), and "Not-Heavy Users" (62.6%). Extreme Heavy Users, Early Young Adult Users, and Cigarette Smokers had significantly poorer overall health based on a number of physical conditions and self-rated health. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers had more cognitive problems than other classes. Extreme Heavy Users, Early Young Adult Users, Cigarette Smokers, and All But Cigarette Smokers were more likely to see a health professional for a psychological problem. CONCLUSIONS: Patterns of heavy substance use were associated with health across decades. Regular cigarette smokers and heavy users across substances and ages had the worst health in midlife, although even those with time-limited use during young adulthood were at risk for later physical and cognitive health problems.
Assuntos
Cognição/fisiologia , Análise de Classes Latentes , Saúde Mental/tendências , Aptidão Física/fisiologia , Aptidão Física/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Fumar Cigarros/epidemiologia , Fumar Cigarros/psicologia , Fumar Cigarros/tendências , Cognição/efeitos dos fármacos , Feminino , Humanos , Drogas Ilícitas/efeitos adversos , Estudos Longitudinais , Masculino , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto JovemRESUMO
Accidents are a leading cause of deaths in U.S. active duty personnel. Understanding accident deaths during wartime could facilitate future operational planning and inform risk prevention efforts. This study expands prior research, identifying health risk factors associated with U.S. Army accident deaths during the Afghanistan and Iraq war. Military records for 2004-2009 enlisted, active duty, Regular Army soldiers were analyzed using logistic regression modeling to identify mental health, injury, and polypharmacy (multiple narcotic and/or psychotropic medications) predictors of accident deaths for current, previously, and never deployed groups. Deployed soldiers with anxiety diagnoses showed higher risk for accident deaths. Over half had anxiety diagnoses prior to being deployed, suggesting anticipatory anxiety or symptom recurrence may contribute to high risk. For previously deployed soldiers, traumatic brain injury (TBI) indicated higher risk. Two-thirds of these soldiers had first TBI medical-encounter while non-deployed, but mild, combat-related TBIs may have been undetected during deployments. Post-Traumatic Stress Disorder (PTSD) predicted higher risk for never deployed soldiers, as did polypharmacy which may relate to reasons for deployment ineligibility. Health risk predictors for Army accident deaths are identified and potential practice and policy implications discussed. Further research could test for replicability and expand models to include unobserved factors or modifiable mechanisms related to high risk. PTSD predicted high risk among those never deployed, suggesting importance of identification, treatment, and prevention of non-combat traumatic events. Finally, risk predictors overlapped with those identified for suicides, suggesting effective intervention might reduce both types of deaths.
Assuntos
Acidentes de Trabalho/mortalidade , Transtornos Mentais/diagnóstico , Militares/estatística & dados numéricos , Polimedicação , Ferimentos e Lesões , Acidentes de Trabalho/prevenção & controle , Adulto , Feminino , Humanos , Masculino , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: This study examines reasons for marijuana use among young adults age 19/20 in the United States and the extent to which patterns of reasons are associated with marijuana use and problems 15 years later. METHOD: The national Monitoring the Future study provided data on marijuana users at age 19/20 who were also surveyed at age 35 (n = 2,288; 50% women; 83% White). Latent class analysis was used to identify distinct patterns of reasons for marijuana use, which were then used as predictors of later marijuana use and problems. RESULTS: Five latent classes described the following patterns of reasons for marijuana use at age 19/20: Experimental, Get High + Relax, Typical, Typical + Escape, and Coping + Drug Use. Highest risk for later marijuana use and problems was found for people with Coping + Drug Use and Get High + Relax reasons in young adulthood; those with Experimental reasons were at lowest risk for later use or problems. CONCLUSIONS: Coping and getting high emerged as strong predictors of later marijuana use and problems. Results support the predictive value of self-reported reasons for using marijuana among young adults.
Assuntos
Adaptação Psicológica , Fumar Maconha/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: Examine associations of chronic health conditions on workplace productivity and accidents among US Department of Energy employees. METHODS: The Health and Work Performance Questionnaire-Select was administered to a random sample of two Department of Energy national laboratory employees (46% response rate; N = 1854). RESULTS: The majority (87.4%) reported having one or more chronic health conditions, with 43.4% reporting four or more conditions. A population-attributable risk proportions analysis suggests improvements of 4.5% in absenteeism, 5.1% in presenteeism, 8.9% in productivity, and 77% of accidents by reducing the number of conditions by one level. Depression was the only health condition associated with all four outcomes. CONCLUSIONS: Results suggest that chronic conditions in this workforce are prevalent and costly. Efforts to prevent or reduce condition comorbidity among employees with multiple conditions can significantly reduce costs and workplace accident rates.
Assuntos
Acidentes de Trabalho , Doença Crônica , Eficiência , Pessoal de Laboratório , United States Government Agencies , Absenteísmo , Acidentes de Trabalho/estatística & dados numéricos , Adulto , Idoso , Doença Crônica/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Presenteísmo/estatística & dados numéricos , Prevalência , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
PURPOSE: A review of methods for the estimation of attributable fraction (AF) statistics from case-control, cross-sectional, or cohort data collected under a complex sample design. Provide guidance on practical methods of complex sample AF estimation and inference using contemporary software tools. METHODS: Statistical literature on AF estimation from complex samples for the period 1980 to 2014 is reviewed. A general approach based on weighted sum estimators of the AF and application of Jackknife repeated replication and Bootstrap resampling methods for estimating the variance of AF estimates is outlined and applied to an example analysis of risk factors for alcohol dependency. RESULTS: The literature lays the theoretical foundation to address the problem of AF estimation and inference from complex samples. To date, major statistical software packages do not provide a complete program but the approach is easily implemented using the modeling software and macro/function language capabilities available in major statistical analysis packages. In an example application, weighted sum estimation and inference for the population AF showed stable and consistent results under both Jackknife repeated replication and Bootstrap methods of variance estimation. CONCLUSIONS: Future work on AF estimation for complex samples should focus on simulation studies and empirical testing to investigate the properties of the resampling variance estimation methods across a range of complex study design features and populations.
Assuntos
Métodos Epidemiológicos , Inquéritos Epidemiológicos , Projetos de Pesquisa , Medição de Risco/métodos , Estudos de Casos e Controles , Estudos Transversais , Humanos , População , Fatores de RiscoRESUMO
BACKGROUND: Accidents are one of the leading causes of death among U.S. active-duty Army soldiers. Evidence-based approaches to injury prevention could be strengthened by adding person-level characteristics (e.g., demographics) to risk models tested on diverse soldier samples studied over time. PURPOSE: To identify person-level risk indicators of accident deaths in Regular Army soldiers during a time frame of intense military operations, and to discriminate risk of not-line-of-duty from line-of-duty accident deaths. METHODS: Administrative data acquired from multiple Army/Department of Defense sources for active duty Army soldiers during 2004-2009 were analyzed in 2013. Logistic regression modeling was used to identify person-level sociodemographic, service-related, occupational, and mental health predictors of accident deaths. RESULTS: Delayed rank progression or demotion and being male, unmarried, in a combat arms specialty, and of low rank/service length increased odds of accident death for enlisted soldiers. Unique to officers was high risk associated with aviation specialties. Accident death risk decreased over time for currently deployed, enlisted soldiers and increased for those never deployed. Mental health diagnosis was associated with risk only for previous and never-deployed, enlisted soldiers. Models did not discriminate not-line-of-duty from line-of-duty accident deaths. CONCLUSIONS: Adding more refined person-level and situational risk indicators to current models could enhance understanding of accident death risk specific to soldier rank and deployment status. Stable predictors could help identify high risk of accident deaths in future cohorts of Regular Army soldiers.
Assuntos
Acidentes de Trabalho , Causas de Morte , Militares/estatística & dados numéricos , Prevenção de Acidentes , Acidentes de Trabalho/mortalidade , Acidentes de Trabalho/prevenção & controle , Acidentes de Trabalho/estatística & dados numéricos , Adulto , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national BED data are presented here and compared with bulimia nervosa (BN) data in the World Health Organization (WHO) World Mental Health Surveys. METHODS: Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high-income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist. RESULTS: Country-specific lifetime prevalence estimates are consistently (median; interquartile range) higher for BED (1.4%; .8-1.9%) than BN (.8%; .4-1.0%). Median age of onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2-15.4) than BED (4.3 years; 1.0-11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid DSM-IV disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and to a somewhat lesser degree BED predicting subsequent onset of these conditions. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment. CONCLUSIONS: Binge eating disorder represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.
Assuntos
Transtorno da Compulsão Alimentar/epidemiologia , Bulimia Nervosa/epidemiologia , Bulimia/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Comorbidade , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Organização Mundial da SaúdeRESUMO
CONTEXT: Insomnia is a common and seriously impairing condition that often goes unrecognized. OBJECTIVES: To examine associations of broadly defined insomnia (ie, meeting inclusion criteria for a diagnosis from International Statistical Classification of Diseases, 10th Revision, DSM-IV, or Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition) with costly workplace accidents and errors after excluding other chronic conditions among workers in the America Insomnia Survey (AIS). DESIGN/SETTING: A national cross-sectional telephone survey (65.0% cooperation rate) of commercially insured health plan members selected from the more than 34 million in the HealthCore Integrated Research Database. PARTICIPANTS: Four thousand nine hundred ninety-one employed AIS respondents. MAIN OUTCOME MEASURES: Costly workplace accidents or errors in the 12 months before the AIS interview were assessed with one question about workplace accidents "that either caused damage or work disruption with a value of $500 or more" and another about other mistakes "that cost your company $500 or more." RESULTS: Current insomnia with duration of at least 12 months was assessed with the Brief Insomnia Questionnaire, a validated (area under the receiver operating characteristic curve, 0.86 compared with diagnoses based on blinded clinical reappraisal interviews), fully structured diagnostic interview. Eighteen other chronic conditions were assessed with medical/pharmacy claims records and validated self-report scales. Insomnia had a significant odds ratio with workplace accidents and/or errors controlled for other chronic conditions (1.4). The odds ratio did not vary significantly with respondent age, sex, educational level, or comorbidity. The average costs of insomnia-related accidents and errors ($32 062) were significantly higher than those of other accidents and errors ($21 914). Simulations estimated that insomnia was associated with 7.2% of all costly workplace accidents and errors and 23.7% of all the costs of these incidents. These proportions are higher than for any other chronic condition, with annualized US population projections of 274 000 costly insomnia-related workplace accidents and errors having a combined value of US $31.1 billion. CONCLUSION: Effectiveness trials are needed to determine whether expanded screening, outreach, and treatment of workers with insomnia would yield a positive return on investment for employers.
Assuntos
Acidentes de Trabalho/economia , Distúrbios do Início e da Manutenção do Sono/economia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Acidentes de Trabalho/psicologia , Adulto , Idoso , Comorbidade , Estudos Transversais , Emprego/economia , Emprego/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Telefone , Estados Unidos/epidemiologia , Adulto JovemRESUMO
STUDY OBJECTIVES: To estimate associations of broadly defined insomnia (i.e., meeting inclusion criteria for International Classification of Diseases, Tenth Revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), or Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2) diagnosis) with workplace/nonworkplace injuries controlling for comorbid conditions among workers in the America Insomnia Survey (AIS). DESIGN/SETTING: Cross-sectional telephone survey. PARTICIPANTS: National sample of 4,991 employed health plan subscribers (age 18 yr and older). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Broadly defined insomnia with duration of at least 12 mo was assessed with the Brief Insomnia Questionnaire (BIQ). Injuries in the 12 mo before interview were assessed with a standard self-report measure of injuries causing role impairment or requiring medical attention. Eighteen comorbid condition clusters were assessed with medical/pharmacy claims records and self-reports. Insomnia had significant gross associations (odds ratios, ORs) with both workplace and nonworkplace injuries (OR 2.0 and 1.5, respectively) in logistic regression analyses before controlling for comorbid conditions. The significant population attributable risk proportions (PARPs) of total injuries with insomnia was 4.6% after controlling for comorbid conditions. Only 2 other conditions had PARPs exceeding those of insomnia. The associations of insomnia with injuries did not vary significantly with worker age, sex, or education, but did vary significantly with comorbid conditions. Specifically, insomnia was significantly associated with workplace and nonworkplace injuries (OR 1.8 and 1.5, respectively) among workers having no comorbid conditions, with workplace but not nonworkplace injuries (OR 1.8 and 1.2, respectively) among workers having 1 comorbid condition, and with neither workplace nor nonworkplace injuries (OR 0.9 and 1.0, respectively) among workers having 2 or more comorbid conditions. CONCLUSIONS: The associations of insomnia with injuries vary with comorbid conditions in ways that could have important implications for targeting workplace interventions.
Assuntos
Distúrbios do Início e da Manutenção do Sono/epidemiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Comorbidade , Estudos Transversais , Escolaridade , Emprego , Feminino , Humanos , Cobertura do Seguro , Seguro Saúde , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto JovemRESUMO
STUDY OBJECTIVES: To estimate the prevalence and associations of broadly defined (i.e., meeting full ICD-10, DSM-IV, or RDC/ICSD-2 inclusion criteria) insomnia with work performance net of comorbid conditions in the America Insomnia Survey (AIS). DESIGN/SETTING: Cross-sectional telephone survey. PARTICIPANTS: National sample of 7,428 employed health plan subscribers (ages 18+). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Broadly defined insomnia was assessed with the Brief Insomnia Questionnaire (BIQ). Work absenteeism and presenteeism (low on-the-job work performance defined in the metric of lost workday equivalents) were assessed with the WHO Health and Work Performance Questionnaire (HPQ). Regression analysis examined associations between insomnia and HPQ scores controlling 26 comorbid conditions based on self-report and medical/pharmacy claims records. The estimated prevalence of insomnia was 23.2%. Insomnia was significantly associated with lost work performance due to presenteeism (χ² (1) = 39.5, P < 0.001) but not absenteeism (χ² (1) = 3.2, P = 0.07), with an annualized individual-level association of insomnia with presenteeism equivalent to 11.3 days of lost work performance. This estimate decreased to 7.8 days when controls were introduced for comorbid conditions. The individual-level human capital value of this net estimate was $2,280. If we provisionally assume these estimates generalize to the total US workforce, they are equivalent to annualized population-level estimates of 252.7 days and $63.2 billion. CONCLUSIONS: Insomnia is associated with substantial workplace costs. Although experimental studies suggest some of these costs could be recovered with insomnia disease management programs, effectiveness trials are needed to obtain precise estimates of return-on-investment of such interventions from the employer perspective.
Assuntos
Absenteísmo , Efeitos Psicossociais da Doença , Emprego , Distúrbios do Início e da Manutenção do Sono/complicações , Adulto , Estudos Transversais , Avaliação de Desempenho Profissional , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
CONTEXT: Although significant associations of childhood adversities (CAs) with adult mental disorders have been documented consistently in epidemiological surveys, these studies generally have examined only 1 CA per study. Because CAs are highly clustered, this approach results in overestimating the importance of individual CAs. Multivariate CA studies have been based on insufficiently complex models. OBJECTIVE: To examine the joint associations of 12 retrospectively reported CAs with the first onset of DSM-IV disorders in the National Comorbidity Survey Replication using substantively complex multivariate models. DESIGN: Cross-sectional community survey with retrospective reports of CAs and lifetime DSM-IV disorders. SETTING: Household population in the United States. PARTICIPANTS: Nationally representative sample of 9282 adults. MAIN OUTCOME MEASURES: Lifetime prevalences of 20 DSM-IV anxiety, mood, disruptive behavior, and substance use disorders assessed using the Composite International Diagnostic Interview. RESULTS: The CAs studied were highly prevalent and intercorrelated. The CAs in a maladaptive family functioning (MFF) cluster (parental mental illness, substance abuse disorder, and criminality; family violence; physical abuse; sexual abuse; and neglect) were the strongest correlates of disorder onset. The best-fitting model included terms for each type of CA, number of MFF CAs, and number of other CAs. Multiple MFF CAs had significant subadditive associations with disorder onset. Little specificity was found for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of previous lifetime disorders but increased with length of recall. Simulations suggest that CAs are associated with 44.6% of all childhood-onset disorders and with 25.9% to 32.0% of later-onset disorders. CONCLUSIONS: The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates. Even considering this, the results suggest that CAs have powerful and often subadditive associations with the onset of many types of largely primary mental disorders throughout the life course.
Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Acontecimentos que Mudam a Vida , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Idade de Início , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Família/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Prevalência , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Controversy exists about the role of mental disorders in the consistently documented association between smoking and suicidal behavior. This controversy is addressed here with data from the nationally representative National Comorbidity Survey-Replication (NCS-R). Assessments were made of 12-month smoking, suicidal behaviors (ideation, plans, attempts), and DSM-IV disorders (anxiety, mood, impulse-control, and substance use disorders). Statistically significant odds ratios (2.9-3.1) were found between 12-month smoking and 12-month suicidal behaviors. However, the associations of smoking with the outcomes became insignificant with controls for DSM-IV mental disorders. Although clear adjudication among contending hypotheses about causal mechanisms cannot be made from the cross-sectional NCS-R data, the results make it clear that future research on smoking and suicidal behaviors should focus more centrally than previous research on mental disorders either as common causes, markers, or mediators.
Assuntos
Transtornos Mentais/epidemiologia , Fumar/epidemiologia , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Comorbidade , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Modelos Estatísticos , Razão de Chances , Prevalência , Escalas de Graduação Psiquiátrica , Fumar/psicologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To examine nationally representative patterns and predictors of delays in contacting a professional after first onset of a mental disorder. DATA SOURCES: The National Comorbidity Survey, a nationally representative survey of 8,098 respondents aged 15-54. STUDY DESIGN: Cross-sectional survey. DATA COLLECTION: Assessed lifetime DSM-III-R mental disorders using a modified version of the Composite International Diagnostic Interview (CIDI). Obtained reports on age at onset of disorders and age of first treatment contact with each of six types of professionals (general medical doctors, psychiatrists, other mental health specialists, religious professionals, human services professionals, and alternative treatment professionals). Used Kaplan-Meier (KM) curves to estimate cumulative lifetime probabilities of treatment contact after first onset of a mental disorder. Used survival analysis to study the predictors of delays in making treatment contact. PRINCIPAL FINDINGS: The vast majority (80.1 percent) of people with a lifetime DSM-III-R disorder eventually make treatment contact, although delays average more than a decade. The duration of delay is related to less serious disorders, younger age at onset, and older age at interview. There is no evidence that delay in initial contact with a health care professional is increased by earlier contact with other non-health-care professionals. CONCLUSIONS: Within the limits of recalling lifetime events, it appears that delays in initial treatment contact are an important component of the larger problem of unmet need for mental health care. Interventions are needed to decrease these delays.
Assuntos
Transtornos Mentais/terapia , Adolescente , Adulto , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Necessidades e Demandas de Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Transtornos Mentais/classificação , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Fatores de Tempo , Estados UnidosRESUMO
OBJECTIVE: To present nationally representative data on the part played by clergy in providing treatment to people with mental disorders in the United States. DATA SOURCES: The National Comorbidity Survey (NCS), a nationally representative general population survey of 8,098 respondents ages 15-54. STUDY DESIGN: Cross-sectional survey. DATA COLLECTION: A modified version of the Composite International Diagnostic Interview was used to assess DSM-III-R mental disorders. Reports were obtained on age of onset of disorders, age of first seeking treatment, and treatment in the 12 months before interview with each of six types of professionals (clergy, general medical physicians, psychiatrists, other mental health specialists, human services providers, and alternative treatment providers). PRINCIPAL FINDINGS: One-quarter of those who ever sought treatment for mental disorders did so from a clergy member. Although there has been a decline in this proportion between the 1950s (31.3 percent) and the early 1990s (23.5 percent), the clergy continue to be contacted by higher proportions than psychiatrists (16.7 percent) or general medical doctors (16.7 percent). Nearly one-quarter of those seeking help from clergy in a given year have the most seriously impairing mental disorders. The majority of these people are seen exclusively by the clergy, and not by a physician or mental health professional. CONCLUSIONS: The clergy continue to play a crucial role in the U.S. mental health care delivery system. However, interventions appear to be needed to ensure that clergy members recognize the presence and severity of disorders, deliver therapies of sufficient intensity and quality, and collaborate appropriately with health care professionals.
Assuntos
Clero/estatística & dados numéricos , Transtornos Mentais/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Distribuição de Qui-Quadrado , Comorbidade , Estudos Transversais , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/classificação , Pessoa de Meia-Idade , Papel (figurativo) , Índice de Gravidade de Doença , Estados UnidosRESUMO
BACKGROUND: The economic burden of depression was estimated to be 43.7 billion dollars in 1990. A subsequent study reported a cost burden of 52.9 billion dollars using revised prevalence data and a refined workplace cost estimation approach. The objective of the current report is to provide a 10-year update of these estimates using the same methodological framework. METHOD: Using a human capital approach, we developed prevalence-based estimates of 3 major cost categories: (1) direct costs, (2) mortality costs arising from depression-related suicides, and (3) costs associated with depression in the workplace. Cost-of-illness estimates from 1990 were updated to reflect the experience in 2000 using current epidemiologic data and publicly available population, wage, and cost information. RESULTS: Whereas the treatment rate of depression increased by over 50%, its economic burden rose by only 7%, going from 77.4 billion dollars in 1990 (inflation-adjusted dollars) to 83.1 billion dollars in 2000. Of the 2000 total, 26.1 billion dollars (31%) were direct medical costs, 5.4 billion dollars (7%) were suicide-related mortality costs, and 51.5 billion dollars (62%) were workplace costs. CONCLUSION: The economic burden of depression remained relatively stable between 1990 and 2000, despite a dramatic increase in the proportion of depression sufferers who received treatment. Future research will incorporate additional costs associated with depression sufferers, including the excess costs of their coexisting psychiatric and medical conditions and attention to the role of painful conditions as a driver of these costs.
Assuntos
Efeitos Psicossociais da Doença , Transtorno Depressivo/economia , Custos e Análise de Custo/tendências , Estudos Transversais , Transtorno Depressivo/epidemiologia , Previsões , Gastos em Saúde/tendências , Humanos , Suicídio/economia , Suicídio/tendências , Estados Unidos , Local de Trabalho/economiaRESUMO
Estimation of comparative disease burden in epidemiological surveys is complicated by the fact that high comorbidities exist among many chronic conditions. The easiest way to take comorbidity into consideration is to distinguish between pure and comorbid conditions and to evaluate the incremental effects of comorbid conditions in prediction equations. This approach is illustrated here in an analysis of the effects of pure and comorbid major depression (MD) and generalized anxiety disorder (GAD) on a number of different measures of role impairment in the US National Comorbidity Survey (NCS) and the Mental Health Supplement to the Ontario (Canada) Health Survey (the Supplement). Pure MD and pure GAD were found to have roughly equal independent associations with role impairments. The incremental effects of having comorbid MD and GAD were found to vary depending on the outcome under investigation. The paper closes with a discussion of the methodological complexities associated with generalizing to comorbidities that involve rare conditions or more than two disorders.
Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Adolescente , Adulto , Transtornos de Ansiedade/epidemiologia , Comorbidade , Efeitos Psicossociais da Doença , Transtorno Depressivo Maior/epidemiologia , Humanos , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Escalas de Graduação Psiquiátrica , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: The authors interviewed individuals treated for self-described mental health problems in the preceding year to examine patterns and predictors associated with dropping out of treatment. METHOD: Subjects were drawn from respondents to community epidemiological surveys carried out in representative samples of the United States and Ontario populations. Dropouts were those who had left mental health treatment during the prior year for reasons other than symptom improvement. The surveys also assessed potential dropout correlates: sociodemographic characteristics, attitudes about mental health care, disorder type, provider type, and treatment received. RESULTS: The proportion of dropouts did not significantly differ between the United States (19.2%) and Ontario (16.9%), nor did the effects of the predictors differ significantly between the two samples. Sociodemographic characteristics associated with treatment dropout included low income, young age, and, in the United States, lacking insurance coverage for mental health treatment. Patient attitudes associated with dropout included viewing mental health treatment as relatively ineffective and embarrassment about seeing a mental health provider. Respondents who received both medication and talk therapy were less likely to drop out than those who received single-modality treatments. CONCLUSIONS: Mental health treatment dropout is a serious problem, especially among patients who have low income, are young, lack insurance, are offered only single-modality treatments, and have negative attitudes about mental health care. Cost-effective interventions targeting these groups are needed to increase the proportion of patients who complete an adequate course of treatment.