Does somatization disorder occur in men? Clinical characteristics of women and men with multiple unexplained somatic symptoms.

Somatization disorder is thought to be rare or nonexistent in men. We examined this hypothesis by assessing gender differences in DSM-III-R diagnostic status, demographic and clinical characteristics, functional limitations, self-reported health status, and psychiatric comorbidity in 30 men and 117 women who were referred for multiple unexplained somatic complaints. Twelve men and 68 women met DSM-III-R criteria for somatization disorder. Among those meeting criteria, there were few differences on any of the dimensions that were assessed. Different referral sources for women and men suggested differences in physicians' perceptions of somatic symptoms in men and women. We concluded that somatization disorder exists in men, and that women and men with somatization disorder show similar clinical characteristics.

The epidemiology of obsessive-compulsive disorder in five US communities.

The prevalence of obsessive-compulsive disorder was measured in five US communities among more than 18,500 persons in residential settings as part of the National Institute of Mental Health (Bethesda, Md)--sponsored Epidemiologic Catchment Area program. Lifetime prevalence rates ranged from 1.9% to 3.3% across the five Epidemiologic Catchment Area sites for obsessive-compulsive disorder diagnosed without DSM-III exclusions and 1.2% to 2.4% with such exclusions. These rates are about 25 to 60 times greater than had been estimated on the basis of previous studies of clinical populations.

Somatization in the community.

We examined the prevalence of somatization disorder symptoms elicited with the Diagnostic Interview Schedule in 3132 community respondents interviewed in Los Angeles by the Epidemiologic Catchment Area program. The variables age, gender, ethnic background, and the presence of a psychiatric diagnosis significantly influenced the number of somatization symptoms reported. An introductory review on conceptual and nosological aspects of somatization phenomena led to the formulation of a less-restrictive operational definition of the somatizer. We found that 4.4% of the respondents met criteria for this abridged cutoff score of somatization, whereas only 0.03% of the respondents met criteria for the full DSM-III somatization disorder diagnosis. This abridged cutoff score was associated with sociodemographic factors and psychiatric diagnosis in the direction predicted.

Symptoms of major depression among Mexican-Americans and non-Hispanic whites.

The lifetime prevalence of symptoms of a major depressive episode was estimated in two large samples of randomly selected community residents that included many Mexican-Americans. Approximately 5% to 40% of the subjects reported each symptom cluster. The rates for Mexican-Americans born in the United States resembled those for non-Hispanic whites born in the United States; however, the rates for Mexican-Americans born in Mexico were lower in eight of nine symptoms clusters. Language differences did not account for this pattern. Cultural similarity to non-Hispanic whites born in the United States was associated with a higher rate of depressive symptoms.

Vulnerability of Jews to affective disorders.

OBJECTIVE: Psychiatric literature over the past 100 years suggests that Jews are at higher risk for affective disorders than numbers of other religious groups. To examine these claims, the authors analyzed data from the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study. In addition, the relationships among gender, alcoholism, and major depression were investigated. METHOD: The period prevalence and lifetime rates of DSM-III major depression among Jews, Catholics, Protestants, individuals in other religious groups, and individuals with no religious affiliation were examined in the Los Angeles and New Haven, Conn., ECA data. Logistic regression with covariates for site, gender, marital status, and socioeconomic status was used to estimate odds ratios and 95% confidence intervals. The calculated rates, based on the combined data from ECA study waves 1 and 2 for the white population, were weighted according to the 1980 U.S. population census. Female-to-male rate ratios and rates of alcohol abuse/dependence were also obtained. RESULTS: While no differences were found among females, Jewish males had significantly higher rates of major depression than Catholics, Protestants, and all non-Jews combined. Jews had a 1:1 female-to-male ratio for major depression, in contrast to the other religious groups, which approached the universal 2:1 ratio. Rates of alcohol abuse/dependence were inversely related to rates of major depression. CONCLUSIONS: The results support only in part the earlier reports that Jews have higher rates of depression. The equal gender distribution of major depression among Jews may be associated with the lower rate of alcoholism among Jewish males.

Psychiatric disorder in a sample of the general population with and without chronic medical conditions.

The authors studied data on psychiatric disorders and eight chronic medical conditions in a community sample of 2,554 persons. The sex- and age-adjusted prevalence of any psychiatric disorder in the preceding 6 months was 24.7% and of lifetime psychiatric disorder was 42.2% among persons with one or more medical conditions, compared to 17.5% and 33.0%, respectively, for persons with no medical condition. Persons with chronic medical conditions were more likely to have lifetime substance use disorders and recent affective and anxiety disorders. Arthritis, cancer, lung disease, neurological disorder, heart disease, and physical handicap were strongly associated with psychiatric disorders, but hypertension and diabetes were not.

Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders.

The authors studied the prevalence of eight chronic medical conditions in an adult population sample (N = 2,554) with and without psychiatric disorders. Adjusted for age and sex, the prevalence of any lifetime chronic medical condition for persons with any lifetime affective, anxiety, or substance use disorder was 61.4%, 57.1%, and 57.7%, respectively. Each of these percentages was significantly higher than that for persons with no lifetime psychiatric disorder (53.4%). Both lifetime affective and anxiety disorders were uniquely associated with a greater prevalence of any lifetime chronic medical condition, but the only psychiatric disorders uniquely associated with current (i.e., active) chronic medical conditions were anxiety disorders, suggesting that the association between anxiety disorders and chronic medical conditions develops more quickly than associations between medical conditions and other psychiatric disorders.

Psychiatric disorder and limitations in physical functioning in a sample of the Los Angeles general population.

The authors examined relationships between psychiatric disorder and perceived general health and physical functioning from data obtained from interviews with 2,554 non-Hispanic whites and Mexican-Americans in Los Angeles. Persons with recent psychiatric disorders perceived their general health as poorer and had more limitations in physical functioning than persons without such disorders, even when the analyses controlled for chronic medical conditions and demographic factors. Affective and anxiety disorders were independently associated with both acute and chronic limitations in physical functioning. The associations of recent psychiatric disorder and of chronic medical condition with acute activity restrictions were similar in magnitude.

Which Mexican-Americans underutilize health services?

Data collected from the Los Angeles site of the National Institute of Mental Health Epidemiologic Catchment Area Program were used to examine the utilization of health services in a community population. Mexican-Americans, especially the less acculturated, had significantly lower rates of use of outpatient, but not inpatient, care than non-Hispanic whites. Differences were greater for mental than physical health care. Less acculturated Mexican-Americans made very little use of either mental health specialists or the human services sector (e.g., religious leaders). Among those with a recent psychiatric disorder, non-Hispanic whites were seven times more likely to use outpatient mental health services than the less acculturated Mexican-Americans.

Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.

OBJECTIVE: Although posttraumatic stress disorder (PTSD) is a highly prevalent and often chronic condition, the relationship between PTSD and functioning and quality of life remains incompletely understood. METHOD: The authors undertook an archival analysis of data from the National Vietnam Veterans Readjustment Study. The study subjects consisted of the nationally representative sample of male Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. The authors estimated PTSD at the time of the interview with the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. They examined the following outcomes: diminished well-being, physical limitations, bed day in the past 2 weeks, compromised physical health status, currently not working, and perpetration of violence. Logistic models were used to determine the association between PTSD and outcome; adjustment was made for demographic characteristics and comorbid psychiatric and other medical conditions. RESULTS: The risks of poorer outcome were significantly higher in subjects with PTSD than in subjects without PTSD in five of the six domains. For the outcome domains of physical limitations, not working, compromised physical health, and diminished well-being, these significantly higher risks persisted even in the most conservative logistic models that removed the shared effects of comorbid psychiatric and other medical disorders. CONCLUSIONS: The suffering associated with combat related-PTSD extends beyond the signs and symptoms of the disorder to broader areas of functional and social morbidity. The significantly higher risk of impaired functioning and diminished quality of life uniquely attributable to PTSD suggests that PTSD may well be the core problem in this group of difficult to treat and multiply afflicted patients.

Depressed mood and major depressive disorder in two ethnic groups.

This study examines the relation of depressive mood, measured using the Center for Epidemiologic Studies Depression scale, with major depression, assessed using the Diagnostic Interview Schedule. Data are from 1244 Mexican American and 1149 non-Hispanic white randomly-selected community residents. Major depression is strongly related to depressed mood, irrespective of the persistence or content of mood, with some components of depressed mood (negative affect and somatic disturbance) more strongly associated with major depression than other components (lack of positive affect and interpersonal problems). Low socioeconomic status and social isolation contribute to depressed mood independent of major depression. Low education is associated with persistent depressed mood. Mexican Americans report more overall depressive mood than non-Hispanic whites, but there is no ethnic difference in major depression or in the mood symptoms most strongly related to major depression. Mexican Americans report more persistent symptoms than non-Hispanic whites in every content category. Ethnic differences in education appear to account for ethnic differences in all components of depressed mood except lack of positive affect, which may be attributable to language differences.

Sexual assault history and physical health in randomly selected Los Angeles women.

Associations of sexual assault history with multiple measures of physical health were examined among randomly selected women living in Los Angeles (N = 1,610). Sexually assaulted women were more likely than nonassaulted women to report poor health perceptions, functional limitation, several chronic diseases, medically explained somatic symptoms, and medically unexplained somatic symptoms. Sexual assault was associated with increased risk of symptoms in a variety of organ systems rather than solely reproductive or sexual symptoms.

Sexual assault history and health perceptions: seven general population studies.

This article uses data from 7 population surveys to evaluate the association of sexual assault history with health perceptions. It estimates the extent of generalizability across gender, ethnic groups, and studies; the extent to which depression accounts for or mediates the association; and whether some circumstances of assault are more strongly related to poor subjective health. Data from each of 18 subsamples of the surveys were analyzed (pooled N = 10,001; 7,550 women and 2,451 men), and results were combined by using meta-analysis. Assault was associated with poor subjective health (odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.36, 1.95) and this result was consistent regardless of gender, ethnicity, or sample. Controlling depression did not markedly change this result (OR = 1.46, 95% CI = 1.21, 1.77), indicating that depression did not account for or mediate the assault-health perceptions association. Multiple assaults and assaults by strangers or spouse were most strongly associated with poor subjective health.

Relationships of measures of alcohol consumption with alcohol-related problems in multiple studies: a research synthesis from the collaborative alcohol-related longitudinal project.

Two measures of alcohol consumption were used to predict groups of alcohol problems in 21 general population studies from 11 countries to determine (a) if quantity of drinking per occasion or frequency of drinking per month constituted significant "risk" for alcohol problems, having controlled for each as well as individual-level and aggregate-level variables which might confound these relationships and (b) if these associations were homogeneous across studies. A two-tiered analysis assessed these relationships within each study by modeling age, sex, quantity per occasion and frequency per month as predictors of alcohol problems. Meta-analysis combined test statistics to determine if they were homogeneous across studies. The meta-analysis was repeated, blocking for per capita consumption of alcohol (a trait of nations thought to measure drinking norms) and the female rate of suicide (a trait of nations thought to measure societal-level stress). When only individual-level variables were controlled (age and sex), both quantity and frequency were risk factors for each drinking problem. However, except in the case of the association of quantity with alcohol treatment, the magnitude of these risks were heterogeneous across studies. When blocking for the societal-level traits, each had more relevance for some, but not all, of the relationships between consumption and problems. Particularly striking was the well-documented finding that per capita consumption of alcohol significantly distinguished the relationships of frequency of drinking and health problems (while the female suicide rate did not) and the previously undocumented finding that the female suicide rate significantly distinguished the relationships of both quantity and frequency with treatment (while the per capita consumption of alcohol did not). These findings suggest that the impact of norms and the impact of societal stress in groups have different but significant consequences for the relationships of consumption to problems.

Alcohol consumption and mortality. I. Characteristics of drinking groups.

AIMS: This is the first of a set of three papers evaluating drinking status and mortality risk. Analyses of multiple studies describe associations of drinking patterns with characteristics hypothesized to confound the relationships between drinking status and mortality. Characteristics which both significantly differentiate drinking groups and are consistent across studies would suggest that mortality studies not controlling for them may be compromised. DESIGN AND PARTICIPANTS: Associations are evaluated from the raw data of 10 general population studies which contained mortality data. Long-term abstainers are compared to former drinkers, long-term abstainers and former drinkers are compared to light drinkers (by quantity, frequency and volume in separate analyses) and moderate to heavy drinkers are compared to light drinkers. Tetrachoric correlation coefficients assess statistical significance; meta-analysis determines if associations are homogeneous across studies. MEASUREMENTS: Measures of alcohol consumption are quantity, frequency and volume; long-term abstainers are differentiated from former drinkers. Multiple measures of health, social position, social integration and mental health characteristics are evaluated. FINDINGS: Across studies, adult male former drinkers are consistently more likely to be heavier smokers, depressed, unemployed, lower SES and to have used marijuana than long-term abstainers. Adult female former drinkers are consistently more likely to be heavier smokers, in poorer health, not religious, and unmarried than long-term abstainers. Both types of abstainers tend to be of lower SES than light drinkers and report poorer health (not consistent). Female abstainers are more likely to be of normal or overweight than light drinkers. CONCLUSIONS: Characteristics of two groups of abstainers, other than their non-use of alcohol, may confound the associations found between drinking and mortality risk.

Alcohol consumption and mortality. II. Studies of male populations.

AIMS: This is the second of a set of three papers evaluating drinking status and mortality risk. Analysis of eight general population surveys of men evaluated all-cause mortality rates by drinking pattern. DESIGN AND PARTICIPANTS: Raw data from three studies of youth and five studies of adults were evaluated. Logistic regression models controlled for confounding characteristics. Meta-analysis combined study results. MEASUREMENTS: Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (as well as abstinence in the youth models and long-term abstainers and former drinkers in adult models), age and other confounding variables. Models also evaluated interactions of age and, respectively, long-term abstinence and former drinking. FINDINGS: No evidence was found for the hypothesis that abstinence is associated with greater mortality risk than light drinking. In the youth samples, abstainers had a lower risk of dying than those drinking less than 15 times per month. One study of the adult samples showed a significant age by former drinker interaction; this did not alter the lack of association of former drinking with mortality risk or the homogeneity of results across studies for this finding. The most consistent finding was the association of heavy drinking with mortality among youth. Among adults, drinking 43 or more drinks per month and drinking 21 or more times per month were associated with increased mortality risk. Quantity per occasion was not significantly associated with mortality risk among adults. CONCLUSIONS: That frequent drinking was related to mortality risk, whereas heavier quantity was unrelated, is inconsistent with the belief that daily consumption of a few glasses of wine has salutary effects. Empirically, however, this pattern tends to be unusual. Findings were homogeneous across studies lending generalizability to results.

Alcohol consumption and mortality. III. Studies of female populations.

AIMS: This is the third of a set of three papers evaluating drinking status and mortality risk. Analysis of three general population surveys of women evaluated all-cause mortality rates by drinking pattern. DESIGN AND PARTICIPANTS: Raw data from three studies of adult women were evaluated. Logistic regression models controlled for confounding characteristics. Meta-analysis combined study results. MEASUREMENTS: Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (including long-term abstainers and former drinkers) as well as age and other confounding variables. Models also evaluated interactions of age and, respectively, long-term abstinence and former drinking. FINDINGS: In models in which age was controlled, odds of death for long-term abstainers and former drinkers (defined by volume or quantity) were greater than those for light drinkers; odds of death for moderate and heavy drinkers (defined by quantity) were greater than those for light drinkers. When other psychosocial attributes were controlled, odds of death were similar for abstainers and light drinkers. When other psychosocial attributes were controlled, odds of death for heavy drinkers (defined by volume and quantity) were greater than those for light drinkers. When interactions of age and the two forms of abstinence were introduced, one study showed a significant effect of age and former drinking. CONCLUSIONS: Results were consistent with the hypothesis that characteristics of abstainers other than their non-use of alcohol may account for their higher mortality risk. With the exception of former drinkers compared to light drinkers, when interactions were introduced into models (for measures of quantity and frequency) findings were homogeneous across studies, lending generalizability to results.

Acculturation and the probability of use of health services by Mexican Americans.

How does level of acculturation affect the probability that Mexican Americans use general health, mental health, and human social services? We studied this question using data from a general population sample of Mexican Americans (N = 1,055). Data were elicited in face-to-face interviews. After controlling for sociodemographic and economic factors, health status, and insurance coverage, Mexican Americans who were less acculturated had significantly lower probabilities of an outpatient medical visit for physical health problems and of a visit to a mental health specialist or human service provider for emotional problems. The less acculturated with good perceived general health were especially unlikely to receive outpatient medical care. Having Medicaid coverage was associated with a larger increase in the probability of an inpatient medical admission for the more acculturated than for the less acculturated. Other individual characteristics had generally similar effects on use of medical and mental health services for both the more and the less acculturated Mexican Americans.

Affective, substance use, and anxiety disorders in persons with arthritis, diabetes, heart disease, high blood pressure, or chronic lung conditions.

The authors estimated the sex- and age-adjusted prevalence of affective, substance use, and anxiety disorders in persons in a general population sample who identified themselves as having arthritis, diabetes, heart disease, high blood pressure, chronic lung disease, or no chronic medical conditions. Persons who reported ever having arthritis, heart disease, chronic lung disease, or high blood pressure had a significantly increased adjusted prevalence of each of the three groups of lifetime psychiatric disorders, relative to a no-chronic conditions comparison group (each p less than 0.05). Persons who ever had diabetes had an increased adjusted prevalence of lifetime affective and anxiety but not substance use disorder. Persons with current (i.e., active) arthritis, heart disease, or high blood pressure had a significantly increased adjusted prevalence of recent (6-month) anxiety disorder, whereas those with current chronic lung disease had an increased adjusted prevalence of recent affective and substance use but not anxiety disorder.

Patterns of inner experience: daydreaming styles, depressive moods, and sex roles.

This study explored relations among daydreaming styles, normal depressive moods, and psychological sex roles. Factor analyses indicated that three orientations toward events characterize inner experience: Positive, Expressive, and Instrumental perspectives. Regression analyses showed that a unique pattern of inner experience is associated with each of the two types of depressive mood. These patterns are consistent with the two modes of emotional response and superego functioning--shame and guilt--that Lewis (1976) identified. Examination of sex differences and sex role differences in the data suggests that (a) psychological sex roles have more consistent relations to daydreaming styles and depressive experiences than does biological sex, (b) previous reports of sex differences in depression may be partly explainable in terms of differences in distractability and sex roles, and (c) psychological sex roles have different meanings for women and men.