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Biomedical subjects

C C Attkisson

Publications and source records attributed to C C Attkisson.

11 recordsLinked to original sources
PubMed1990

Screening for depression in primary care clinics: the CES-D and the BDI.

The present study was undertaken to examine the utility of the Center for Epidemiological Studies-Depression (CES-D) scale and the Beck Depression Inventory (BDI) as screening instruments for primary care clinic patients. We examined: 1) patients' willingness to complete the scales; 2) the level of agreement between the screening instruments and DSM-III diagnosis of Major Depressive Episode, based on the NIMH Diagnostic Interview Schedule (DIS); 3) the effect on detection rates of raising the cut-off score for each depression screen; and 4) the factor structure of the CES-D in our primary care sample versus findings from general population studies. The CES-D and BDI performed comparably as depression screening instruments. Both produced too many false positives when standard (low) cut-off scores were applied. However, when straight cut-off scores were used, results suggested that either the CES-D or BDI might assist physicians in reliably detecting depressed patients, without an overload of false positives. Comparison of our findings with those from other studies suggest that depression screening instruments may be particularly helpful with older primary care patients. The CES-D factor analysis highlights the need to look more closely at the relevance of positive affect to the detection, diagnosis, and treatment of depressive disorders in primary care practices.

Bipolar Disorder↗
PubMed1989

Factor structure of a brief symptom checklist for acute psychiatric inpatients.

A 36-item symptom checklist (the HSCL-36) was assembled and assessed based on previous factor-analytic research with the Hopkins Symptom Checklist-90 (HSCL-90), which had focused on outpatients. Acute psychiatric inpatients (N = 243) completed the HSCL-36 after admission to a university hospital. The responses were factor analyzed using a principal axis extraction. Varimax rotation yielded six interpretable factors, for which factor-based subscales were derived. Five of the six subscales were found to be reliable using coefficient alpha. Results are compared with studies that used self-report symptom checklists with outpatients. Future directions for research are discussed.

Acute Disease↗
PubMed1987

A method for comparing two systems of acute 24-hour psychiatric care.

A quasi-experimental method was developed to evaluate the cost-effectiveness of a public system of 24-hour acute psychiatric care in Santa Clara County, California, before and after a new treatment setting was introduced. The original system relied on a 54-bed psychiatric unit in a county general hospital; the new system consisted of a 20-bed unit in the general hospital plus a 45-bed nonhospital psychiatric health facility. The study demonstrated that the per diem cost of the psychiatric health facility was approximately 60 percent that of the original general hospital unit, but the average difference in cost per episode between the two systems was only about +25, primarily due to longer lengths of stay in the new system. In addition, patients treated in the new, combined system appeared sicker at discharge than those treated in the old system. The findings suggest the importance of simultaneously evaluating both cost and treatment effectiveness to make sure that one element does not dominate program direction at the expense of the other.

Acute Disease↗
PubMed1986

Characteristics of useful evaluation data: an example from community mental health centers.

The results of an empirical study of the use of evaluation data in community mental health centers are reported. A mailed survey on evaluation use was conducted among the directors of 164 community mental health centers in 19 states; 140 completed questionnaires were returned. Results indicate that certain types of data have important impacts in a majority of centers. Systems resources management data were most highly used, followed by need assessment data, and client utilization data. Least used were data on outcomes of intervention and community impact. Data use appears closely tied to the utility of the data in carrying out priority management tasks in a center. Findings have important implications for community psychologists who plan, administer, or evaluate mental health services. The broader role of evaluation in community psychology is also discussed.

Adult↗
PubMed1984

The use of reception checks in client pretherapy orientation research.

The psychotherapy research literature abounds with evidence of the problems of premature termination and unsatisfactory outcome, especially among low-SES clients. In attempting to enhance the success rate of therapeutic services, some researchers have instituted pretherapy orientation procedures that convey information to clients with regard to the goals and processes of therapy. Although research in this area has continued for two decades, the efficacy of such procedures has not been established firmly. Even when orientations have demonstrable positive effects, the processes through which these results are achieved usually remain unknown. In order to gain an understanding of these mechanisms, researchers must employ measures to assess directly the immediate effects of the orientation. In a recent study, the authors developed a questionnaire to determine whether clients had attended to and understood a pretherapy videotape presentation and whether they recalled the material 1 month later. The results obtained on this measure facilitated the interpretation of the overall research findings.

Consumer Behavior↗
PubMed1984

Restrictiveness of care among the severely mentally disabled.

Restrictiveness of care was assessed among 286 severely mentally disabled individuals known to an urban community mental health center. By examining clinical records, the authors rated each subject for each month during a period of up to 85 months on four dimensions of restrictiveness: physical freedom, time constraints, legal status, and conservatorship. The maximum restrictiveness experienced by most of the subjects was high, reflecting periodic involuntary hospitalization. The average restrictiveness they experienced, however, was well below the level represented by state hospital care. Thus the authors suggest that the average restrictiveness experienced by this population has been reduced since the initiation of deinstitutionalization.

Commitment of Persons with Psychiatric Disorders↗
PubMed1983

Enhancing the utilization of outpatient mental health services.

This article describes two sets of field studies undertaken by the program evaluation unit of a community mental health center. These studies analyzed clients' utilization of service and assessed service impact in the process of testing procedural variations in service delivery. In the first set of studies, a procedure for ensuring verbal client-therapist contact prior to the first appointment was developed and tested. This procedure reduced the no-show rate for initial appointments from 22 to 12%. In the second set of studies, a brief pretherapy orientation nearly eliminated dropout during the first month of therapy. Orientation had both short- and long-range impact on the amount of services used by clients as well as on their outcomes. Therapist's global ratings of client functioning reflected more change for oriented clients, who reported greater short-term symptom reduction as well. Non-oriented clients were more likely to drop out early and to impress their therapists less favorably. The results of these studies suggest that a combination of pretherapy orientation and verbal client-therapist contact prior to the initial appointment might greatly reduce the failure to complete treatment.

Community Mental Health Services↗