Psychiatric disorders. A rural/urban comparison.

We studied rural/urban differences in the prevalence of nine psychiatric disorders from a community survey (part of the Epidemiologic Catchment Area Program) of 3,921 adults living in the Piedmont of North Carolina. Crude comparisons disclosed that major depressive episodes and drug abuse and/or dependence were more common in the urban area, whereas alcohol abuse/dependence was more common in the rural area. When prevalence for these disorders was stratified for age, sex, race, and education (factors that may confound urban/rural comparisons), a number of significant differences were identified, such as higher prevalence of major depression in female and white subjects and higher prevalence of alcohol abuse/dependence in the less educated subjects. A logistic-regression analysis was used to determine if significant urban/rural differences persisted when these potential confounders were controlled. Major depressive disorders were found to be twice as frequent in the urban area in this controlled analysis.

Somatization disorder in a community population.

The data recently collected in the Piedmont region of North Carolina as part of the National Institute of Mental Health Epidemiologic Catchment Area Program were used to examine somatization disorder in a community population. The authors found an adjusted prevalence of 0.38% for somatization disorder diagnosed according to the Diagnostic Interview Schedule and DSM-III. Respondents with somatization disorder demonstrated demographic characteristics (female, unmarried, nonwhite, from a rural area, less educated) that are consistent with findings from past clinical and epidemiologic studies of somatization disorder. The adjusted prevalence is higher than that of other Epidemiologic Catchment Area sites, and possible explanations for this findings are discussed.

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. DESIGN: A survey. SETTING: The Piedmont region of North Carolina. PARTICIPANTS: The sample included 2602 community-dwelling women over the age of 65 who were interviewed for the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). MEASUREMENTS: Current and past use of estrogen. RESULTS: Of the women surveyed, 6.1% reported current estrogen use, and 18.5% reported past use. Approximately half of the participants reported using estrogen for more than 2 years. Multivariate analysis demonstrated that current estrogen users were younger, more affluent, had smaller families, and were more likely to be white and to live in an urban area than were never users. Current users were also more likely to drink alcohol and to take calcium supplements; and compared with past estrogen users, they were more likely to be white, have smaller families, and to drink alcohol. CONCLUSION: Estrogen replacement therapy is used by a small minority of older women, especially blacks. Moreover, although women with some risk factors for osteoporosis are more likely to use estrogen, the chief determinants of estrogen utilization are socioeconomic.

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 Briquet's 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.

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.

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.

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.

Somatization symptoms in the community: a rural/urban comparison.

Somatization is conceptualized as a bodily or somatic expression of psychic distress. Unexplained somatic symptomatology was assessed by use of the National Institute of Mental Health Diagnostic Interview Schedule among community respondents in the Piedmont of North Carolina participating in the Epidemiologic Catchment Area program. Previous literature suggests that somatization is associated with rural residence, less education, lower socioeconomic class, and particular ethnicities. Through use of a multiple regression analysis, lifetime unexplained somatic-symptom counts were regressed on urban residence and other sociodemographic variables. Rural residence was not associated with somatization; rather, somatization was more common among urban residents. The urban/rural differences were greatest among women and high school graduates. Somatization was also associated with being aged 45 to 64, and being separated, widowed, or divorced; it was not associated with race. Overall, somatization was also associated with less education.

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.

Somatization disorder in a US southern community: use of a new procedure for analysis of medical classification.

The authors examine somatization disorder in a community population, using grade of membership analysis, a new multivariate analytical technique for the analysis of medical classification. The technique is used to examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no a priori assumptions are made about the interrelationship of somatic symptoms or their clustering into clinical syndromes. Grade of membership analysis is applied to all respondents in the US National Institute of Mental Health Epidemiological Catchment Area Project of the Piedmont region of North Carolina reporting three or more somatic symptoms from the somatization disorder section of the Diagnostic Interview Schedule. The analysis indicates that seven 'pure' types, roughly analogous to clusters in cluster analysis, best describe the interrelationship of the symptoms included in the analysis. One 'pure' type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics consistently found among patients with DSM-III somatization disorder. The present results demonstrate that symptoms associated with this disorder do cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.

Psychosocial risk factors and urban/rural differences in the prevalence of major depression.

The Piedmont Health Survey interviewed 3798 adult community residents in a region of North Carolina. Current major depression was nearly three times more common in the urban than in the rural counties; rural residence decreased the risk of major depression for some, but not all, demographic subgroups. The risk of major depression was decreased for young rural residents, compared with their urban age peers; rural residence was more protective for young women than for young men. Rural residence appears to be a buffer against major depression.

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.

Association of race and other potential risk factors with nonvertebral fractures in community-dwelling elderly women.

This study determined potential associations of sociodemographic, lifestyle, health, and drug use factors known to affect bone metabolism with incident nonvertebral fractures. The baseline sample consisted of 2,590 female, nonproxy subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly, which focuses on five adjacent counties in the Piedmont area of North Carolina. Information about potential risk factors was collected during a baseline in-home interview during 1986-1987. Subsequent nonvertebral fractures were reported at follow-up interviews during the annual follow-up periods (1988-1993). The authors used multivariate analyses in which weighted data were adjusted for sampling design. After controlling for other potential confounding sociodemographic, lifestyle, health, and drug use factors, they found that African American race (adjusted odds ratio (OR) = 0.43, 95% confidence interval (CI) 0.31-0.58), age (adjusted OR = 1.04, 95% CI 1.01-1.06), alcohol consumption (adjusted OR = 1.61, 95% CI 1.01-2.57), being underweight (adjusted OR = 1.63, 95% CI 1.13-2.34), cognitive impairment (adjusted OR = 1.67, 95% CI 1.12-2.48), impaired mobility (adjusted OR = 1.15, 95% CI 1.03-1.29), and phenytoin use (adjusted OR = 2.93, 95% CI 1.04-8.30) were associated with first fracture occurrence. Similar findings were observed for nonhip, nonvertebral fractures. African Americans were less likely than Whites to have nonvertebral fractures, and these differences were not related to lifestyle or health factors examined in this study.