Primary care physicians' and psychiatrists' approaches to treating mild depression.

OBJECTIVE: To measure how primary care physicians (PCPs) and psychiatrists treat mild depression. METHOD: We surveyed a national sample of US PCPs and psychiatrists using a vignette of a 52-year-old man with depressive symptoms not meeting Major Depressive Episode criteria. Physicians were asked how likely they were to recommend an antidepressant counseling, combined medication, and counseling or to make a psychiatric referral. RESULTS: Response rate was 896/1427 PCPs and 312/487 for psychiatrists. Compared with PCPs, psychiatrists were more likely to recommend an antidepressant (70% vs. 56%), counseling (86% vs. 54%), or the combination of medication and counseling (61% vs. 30%). More psychiatrists (44%) than PCPs (15%) were 'very likely' to promote psychiatric referral. PCPs who frequently attended religious services were less likely (than infrequent attenders) to refer the patient to a psychiatrist (12% vs. 18%); and more likely to recommend increased involvement in meaningful relationships/activities (50% vs. 41%) and religious community (33% vs. 17%). CONCLUSION: Psychiatrists treat mild depression more aggressively than PCPs. Both are inclined to use antidepressants for patients with mild depression.

Factors influencing physicians' advice about female sterilization in USA: a national survey.

BACKGROUND: Tubal ligation can be a controversial method of birth control, depending on the patient's circumstances and the physician's beliefs. METHODS: In a national survey of 1800 US obstetrician-gynecologist (Ob/Gyn) physicians, we examined how patients' and physicians' characteristics influence Ob/Gyns' advice about, and provision of, tubal ligation. Physicians were presented with a vignette in which a patient requests tubal ligation. The patient's age, gravida/parity and her husband's agreement/disagreement were varied in a factorial experiment. Criterion variables were whether physicians would discourage tubal ligation, and whether physicians would provide the surgery. RESULTS: The response rate was 66% (1154/1760). Most Ob/Gyns (98%) would help the patient to obtain tubal ligation, although 9-70% would attempt to dissuade her, depending on her characteristics. Forty-five percent of physicians would discourage a G2P1 (gravida/parity) woman, while 29% would discourage a G4P3 woman. Most physicians (59%) would discourage a 26-year-old whose husband disagreed, while 32% would discourage a 26-year-old whose husband agreed. For a 36-year-old patient, 47% would discourage her if her husband disagreed, while only 10% would discourage her if her husband agreed. Physicians' sex had no significant effect on advice about tubal ligation. CONCLUSIONS: Regarding patients who seek surgical sterilization, physicians' advice varies based on patient age, parity and spousal agreement but almost all Ob/Gyns are willing to provide or help patients obtain surgical sterilization if asked. An important limitation of the study is that a brief vignette, while useful for statistical analysis, is a rough approximation of an actual clinical encounter.

A new measure of contemporary life stress: development, validation, and reliability of the CRISYS.

OBJECTIVE: To develop and validate a measure of contemporary life stressors. STUDY SETTING: Three interview studies: Study 1 (pilot), 32 caregivers receiving case management services for a child with chronic illness; Study 2 (validation), 311 caregivers of children receiving general pediatric care at a university clinic; Study 3 (reliability), 17 caregivers of children with a complex medical diagnosis. STUDY DESIGN: Study 1: item development via discussions with case managers; piloted with caregivers. Study 2 examined psychometric properties of the measure and correlated it with the CES-D, a measure of depressive symptomatology and the PRQ85-Part 2, a measure of perceived social support, to establish its convergent construct validity. Study 3 established the test-retest reliability of the measure over two weeks by correlating two administrations of the index. DATA COLLECTION: Face-to-face interviews in homes (Study 1) or in clinic waiting rooms (Studies 2 and 3) and by telephone (Study 3 retest). PRINCIPAL FINDINGS: The CRISYS is a flexible, multidimensional tool that demonstrates strong face, content, and construct validity, and excellent test-retest reliability. The format is easy to use and well accepted by respondents and is suitable for low-income populations. CONCLUSIONS: Researchers will find the CRISYS useful when evaluating the success of a clinical model or a healthcare system, and the effectiveness of an insurance plan or a government program. Clinicians may also find that the CRISYS is an effective screen for family needs.

What's fair is fair--or is it? Value differences underlying public views about social justice.

Individual differences in judgments of the fairness of various sociopolitical phenomena were examined in three surveys. Scales measuring two value dimensions thought to underlie the meaning of fairness were constructed, and survey respondents endorsing these different values were compared on their evaluation of the procedural and distributive fairness of political objects. Those endorsing the value of proportionality, hypothesized by equity theorists to underlie fairness judgments, judged equity-based public policies to be fairer than equality-based policies and judged that Ronald Reagan would be a fairer president than Walter Mondale. These people also emphasized the procedural aspects of government when judging government fairness. Respondents endorsing the value of egalitarianism, hypothesized by developmental theorists and some political philosophers to underlie fairness judgments, judged equality-based public policies to be fairer than equity-based policies and judged that Mondale would be a fairer president than Reagan. These people emphasized the distributive aspects of government when judging government fairness. Results support the naive moral philosopher image of the individual as judge of political objects (Tyler, 1984a). Political fairness judgments are ideological responses and are subject to the influence of the value structure of the judge (Tetlock, 1986).

Another look at sex stereotypes and social judgments: an analysis of the social perceiver's use of subjective probabilities.

Locksley, Borgida, Brekke, and Hepburn (1980) assert that subjects fall prey to the base-rate fallacy when they make stereotype-related trait judgments. They found that subjects ignored their stereotypes when trait judgments were made in the presence of trait-related behavioral information. The present article reexamines those findings with respect to two issues: (a) the use of a normative criterion in comparison with subjects' judgments and (b) the level of analysis (group vs. individual) of subjects' judgments. We conducted a replication of the Locksley et al. (1980) Study 2, and the results were examined with respect to these two issues. We found no support for the base-rate fallacy. When a Bayesian normative criterion was constructed for each subject based on the subject's own stereotype judgments and was compared with assertiveness judgments made in the presence of individuating information, there was no evidence that subjects ignored or underused their stereotypes as the base-rate fallacy predicts.