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Biomedical subjects

B G Link

Publications and source records attributed to B G Link.

At least 19 recordsLinked to original sources
PubMed1992

Socioeconomic status and psychiatric disorders: the causation-selection issue.

Are inverse relations between psychiatric disorders and socioeconomic status due more to social causation (adversity and stress) or social selection (downward mobility of genetically predisposed)? This classical epidemiological issue is tested by focusing on ethnic status in relation to socioeconomic status. Ethnic status cannot be an effect of disorder because it is present at birth whereas socioeconomic status depends on educational and occupational attainment. A birth cohort sample of 4914 young, Israel-born adults of European and North African background was selected from the country's population register, screened, and diagnosed by psychiatrists. Results indicate that social selection may be more important for schizophrenia and that social causation may be more important for depression in women and for antisocial personality and substance use disorders in men.

Education↗
PubMed1992

The control group conundrum in chronic pain case/control studies.

The choice of an appropriate control group has been recognized as one of the most difficult problems in the methodology of case/control studies, both in theory and in practice. In the study of chronic pain, a "well control group" has frequently been employed. Although this design has intuitive appeal, it contains the potential for bias and error. In order to obtain the proper control group, the same exclusion criteria should be applied to cases and controls. Second, controls should be selected independently of exposure to the putative risk factors under investigation. To illustrate the nature of this problem we present two numerical examples, using a chronic pain disorder.

Case-Control Studies↗
PubMed1991

[Variation of response structures in relation to degree of personal involvement--a methodologic study exemplified by the "Discrimination Devaluation Scale"].

When comparing results from different populations there is an underlying assumption that the response patterns elicited by the instrument used are stabile across the study groups. But it remains an open question whether this assumption is correct or not--especially in the case when the populations are involved to a different degree into the problem which is the object of the investigation. In fact, we are able to show that the dimensional structure of an instrument developed for the evaluation of stigma psychiatric patients are exposed to, varies depending on the degree of personal involvement with psychiatric disorder. This leads us to the conclusion that a quantitative comparison of parameters appears not warranted as long as the dimensional stability of the instrument over the various populations has not been shown.

Adult↗
PubMed1991

The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided?

Recent research has assigned a prominent role to labeling and stigma as factors that impair the social and psychological functioning of people officially labeled mentally ill. But can the effects of labeling and stigma be overcome by adopting a few simple approaches to coping with these problems? If so, the stigma-induced problems of social awkwardness, demoralization and unemployment emphasized by recent research may not be as severe as claimed. Using a sample of psychiatric patients, we examine this issue by assessing whether patients can ameliorate labeling effects by keeping their history of treatment a secret, educating others about their situation, or avoiding situations in which rejection might occur. None of these coping orientations were effective in diminishing negative labeling effects on unemployment or on psychological distress/demoralization. In fact, the three coping strategies show consistent effects in the direction of producing more harm than good, and with respect to withdrawal-avoidance this effect is significant. Based on these results we argue that stigma is powerfully reinforced by culture and that its effects are not easily overcome by the coping actions of individuals. Using C. Wright Mills's (1967) distinction we conclude that labeling and stigma are "social problems" not "individual troubles."

Adaptation, Psychological↗
PubMed1990

Losing face: sources of stigma as perceived by chronic facial pain patients.

The purpose of this paper is to identify potential sources of estrangement and feeling psychologically flawed as perceived by temporomandibular pain and dysfunction syndrome (TMPDS) patients. It is our hypothesis that a primary source of patients' perceived stigma results from pejorative labeling by clinicians. The data come from a study of 151 women TMPDS patients. The results show that the lack of a known etiology or pathogenesis for the condition allows the possibility of pejorative labeling by influential others such as physicians and dentists that in turn causes TMPDS sufferers to feel stigmatized. Stigmatization is not the result of clinical factors per se or personality problems. Perceived stigma associated with TMPDS leads to the same sorts of strained interactions and feeling estranged that have been shown to be typical of people with other stigmatized conditions. These strains and feelings in turn may contribute to ill health.

Adaptation, Psychological↗
PubMed1990

Problems in measuring role strains and social functioning in relation to psychological symptoms.

The problems that people experience in social roles can be regarded as either causes or consequences of psychological symptoms. To reflect one of these possibilities, Pearlin et al. (1981) developed measures of "role strains" which are considered sources of psychopathology. To reflect the other position, Dohrenwend et al. (1981) constructed measures of "role functioning" which are seen as consequences of psychopathology. We show that the measures developed by these two teams of investigators are similar in content and show substantial empirical overlap despite the different meanings attributed to them. In an effort to understand whether these highly correlated measures assess, "role strain" or "role functioning," we conduct an exploratory analysis of marital and housework role problems, using a small panel sample of New York City residents. Specifically, we use instrumental variables to identify reciprocal effects between psychological distress and each role area. We find that the relationship between housework role problems and distress is more consistent with Pearlin et al.'s interpretation, whereas the relationship between marital problems and distress is more consistent with that of Dohrenwend et al. Investigators interested in measuring either role strain or role functioning must bear in mind the strong possibility of contamination from the other construct.

Educational Status↗
PubMed1989

Feelings of stigmatization in patients with psoriasis.

The concept of stigma, defined as a discrediting mark that sets a person off from others, is used in a systematic, in-depth examination of how 100 adults with psoriasis experience their illness. Information on demographic and illness variables that might predict feelings of being stigmatized were obtained. Through factor analysis of a specially designed questionnaire, six dimensions of the stigma experience were identified: anticipation of rejection, feeling of being flawed, sensitivity to others' attitudes, guilt and shame, secretiveness, and positive attitudes. There was marked variability in the presence and magnitude of these feelings. Different predictors emerged for different dimensions of the stigma experience, the most frequent being age at onset, extent of bleeding, employment status, duration, and rejection experience. Of all the aspects of the illness, bleeding proved the strongest predictor of stigma feelings and of despair, which correlates highly with stigma. Despair and feeling stigmatized may lead to noncompliance with treatment, possibly worsening the status of the psoriasis.

Adult↗
PubMed1989

The 'well control' artefact in case/control studies of specific psychiatric disorders.

An appropriate choice of controls in case/control studies of specific psychiatric disorders is crucial for valid risk-factor assessment. One suggested approach to control-group selection, the use of a well control group, is the focus of this paper. While using well controls has intuitive appeal, this paper shows that such a procedure can lead to ambiguous and biased results.

Anxiety Disorders↗
PubMed1989

Characterizing life events as risk factors for depression: the role of fateful loss events.

Empirical associations between life events and health are often weak, in part because event exposure measures may group together very different kinds of experiences within a single event category. Attempts to refine the measures (by using respondents' subjective appraisals of event stressfulness or by taking into consideration situational and personal factors that influence the contextual threat of the events) may strengthen the association, but they cloud the clarity of any causal inference by confounding the measure with extraneous variation. Instead, the use of descriptive information about what actually happened before, during, and after each event is recommended to define exposure to potent, fateful life events. In a comparison of 96 patients with major depression and 404 community residents with no apparent depression, the odds that a person would have experienced one or more events meeting criteria for fatefulness and disruptiveness was 2.5 times greater in the depressed group.

Adult↗
PubMed1988

Gender and the expression of schizophrenia.

The expression of schizophrenia was examined in 169 DSM-III diagnosed schizophrenics. Restricted maximum likelihood factor analysis was used to test the invariance of the hypothesized symptom model across gender. Findings indicated that schizophrenic women not only expressed more impulsivity and affective symptomatology than did men, but their psychotic symptoms covaried consistently with the expression of impulsivity, anger and other affective symptomatology. Men's expression of schizophrenia covaried positively with withdrawal/isolation and an inability to function, suggesting a possible negative symptom pattern. Gender differences were not attributable to misclassification, differences in diagnostic subtypes, nor to selection. Results are discussed in light of their implications for understanding the heterogeneity of schizophrenia.

Adult↗
PubMed1988

Toward construct validity for DSM-III Axis V.

This study investigates the construct validity of DSM-III Axis V ratings, made in diverse clinical settings, by means of independent assessments of adaptive functioning. Three hundred and sixty-two patients received supervised multiaxial assessments and were then blindly reinterviewed with the Psychiatric Epidemiology Research Interview, which contains scales measuring various aspects of social and occupational functioning. A subsample of 154 patients received a second independent interview that assessed characteristics of the individuals' social networks. The results indicate that Axis V ratings (1) demonstrate predictable diagnostic and demographic group differences, and (2) are determined by both social and occupational variables, but occupational factors predominate. The significance of the results for defining the adaptive functioning construct, for methods of assessment, and for the revisions of Axis V in DSM-III-R, is discussed.

Adaptation, Psychological↗
PubMed1988

The revision of axis V in DSM-III-R: should symptoms have been included?

The authors studied the relationship of psychological symptoms to clinicians' ratings on DSM-III's axis V. A total of 355 patients received multiaxial assessments and were reinterviewed under blind conditions with the Psychiatric Epidemiology Research Interview, which contains scales to measure aspects of social and occupational functioning and various symptom dimensions. The majority of symptom scales were correlated significantly with axis V ratings. Axis I diagnosis explained 19.0% of the variance in axis V; demographics, 6.5%; and symptoms, 7%. Symptoms had a larger effect, in terms of explained variance, than adaptive functioning variables and tended to detract from the latter's significance. These results have implications for axis V in DSM-III-R and for planning DSM-IV.

Adolescent↗
PubMed1987

Life stress and psychopathology: progress on research begun with Barbara Snell Dohrenwend.

This is a progress report on some of the research that was planned and begun with Barbara Dohrenwend before she died in 1982. The main focus is on two of the studies. One was conducted in New York City; the other is still underway in Israel. The New York study is a retrospective case/control study of social and psychological factors that may put people at risk for developing schizophrenic episodes and episodes of major depression. The Israel research consists of epidemiological, case/control, and family studies of these two disorders together with other types of psychopathology that are inversely related to social class. Preliminary findings from both studies are reported, and their implications for primary prevention are discussed.

History, 20th Century↗
PubMed1987

Stigma perceived by patients attending modern treatment settings. Some unanticipated effects of community psychiatry reforms.

In recent years reforms were instituted in the Federal Republic of Germany that were designed to facilitate the integration of psychiatric services and psychiatric patients into community life. One goal of this reform was to reduce patients' feelings of stigmatization. Because such feelings were thought to arise through patients' tenure at large, isolated state hospitals, we hypothesized that patients sent to such hospitals would feel more stigmatized than would patients assigned to a modern, integrated university hospital. Further, we hypothesized that patients in the two settings would adopt different strategies to cope with the stigma they perceived and that staff members in the two settings would share patients' views concerning these matters. Although we found that the staff in both hospitals shared our prediction that state hospital patients would perceive more stigmatization, our findings showed just the opposite. State hospital patients were significantly less likely than university hospital patients to believe that most people would devalue and discriminate against mental patients. Nor did we find strong evidence of different styles of coping with stigma among patients in the two settings. Taken together, our results suggest that in the realm of stigmatization well-intentioned efforts of reforms may have had undesirable unanticipated consequences. Given this, we suggest approaches for intervening more directly with patients in the form of "Daily Living Groups," which are designed to explicitly discuss actual and feared stigmatization.

Adaptation, Psychological↗
PubMed1986

Self-reported physical and psychological effects following a malathion pesticide incident.

To assess effects attributed to malathion which escaped from an overheated tank at a chemical plant in Linden, New Jersey, researchers surveyed seamen subjects (n = 22) on board a nearby tanker and seamen control subjects (n = 21). Self-report measurement strategies included a medical review of body systems, the "demoralization" scale reflecting psychological symptoms of distress, demographics, and factors that may buffer stress, specifically, social support and knowledge regarding toxic chemicals. Self-reported postincident physical health differences between the two groups of seamen were noted. There were no differences between subjects and control subjects on demoralization levels. Further analysis indicated higher levels of demoralization among less knowledgeable seamen subjects.

Adult↗
PubMed1985

Vulnerability to stress among women with in utero diethylstilbestrol (DES) exposed daughters.

In utero exposure to diethylstilbestrol (DES) was initially linked to vaginal-cervical cancer and subsequently to reproductive difficulties. These unanticipated and ongoing health risks to female offspring may constitute a chronic source of stress for DES mothers. We interviewed 60 mothers of exposed daughters and 30 acquaintance controls. Two hypotheses were tested in regard to DES mothers: DES discovery and its aftermath have a direct, long-term, negative effect on psychological health and the DES experience intensifies the negative psychological effects of other adverse life circumstances. To operationalize psychological health, we measured symptoms of "demoralization" and positive health practices--the latter as a behavioral indicator of mastery and personal control. We also measured adversities that may mediate the threat posed by DES, including stressful events, medical problems, and chronic burdens. We found DES history to be associated with poorer psychological health only when mothers encountered other losses and threats to themselves and their families. We concluded that DES mothers may manifest increased vulnerability to subsequent stresses in their lives.

Adaptation, Psychological↗