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Biomedical subjects

Carol S North

Publications and source records attributed to Carol S North.

At least 19 recordsLinked to original sources
PubMed2006

A comparison of agency-based and self-report methods of measuring services across an urban environment by a drug-abusing homeless population.

The purpose of this paper is to advance the methodology for studying service assessment by comparing self-report and agency-generated methods. This study compares 30-day self-reported service use for homeless individuals (N = 229) randomly recruited from a single urban environment (St Louis, Missouri) with similar data collected from a broad array of service agencies providing homeless, substance abuse and outpatient mental health services across the same environment. Comparisons were made between self-report and agency-based data on shelter use, outpatient mental health service use (case management, psychiatric treatment, group therapy), outpatient substance abuse service use (case management, counselling, group therapy) and drop-in/day treatment use. Consistently low levels of kappa scores (all under 0.4) and correlation coefficients (only shelter use demonstrated significant agreement) were found. Findings demonstrated that the two methods of collecting service data are generally not concordant at the individual level. Certain demographic characteristics (increased age, being male, non-white ethnicity) and diagnoses (cocaine abuse/dependence, mania, schizophrenia) were associated with decreased reliability between the two methods of data collection. The two methods of assessment appeared to capture overlapping but not identical information. Each method of assessment has different utility to researchers and providers wishing to assess service use.

Adult↗
PubMed2006

Living with severe mental illness--what families and friends must know: evaluation of a one-day psychoeducation workshop.

One-day "family survival" psychoeducation workshops are a promising, convenient method of disseminating basic information to families with a relative who is diagnosed with a serious mental illness such as schizophrenia, major depression, or other affective disorders. At five separate psychoeducation workshops, 83 participating families completed the self-report North-Sachar Family Life Questionnaire and open-ended "problem lists" of issues facing the families both before and after the workshops. Outcomes consistently demonstrated positive change pre- to post-workshop. Issues reported by workshop participants included desire for education about illness, identification of resources, coping with the illness, and family relationships. The workshop model demonstrated consistent achievement of the outcomes measured, meeting short-term goals. Although models such as the family responsive approach reported in this article are not designed to create long-term gains for the family, they appear to benefit families and may help connect families with more intensive services to facilitate long-term change.

Adult↗
PubMed2006

Persistent physiological reactivity in a pilot study of partners of firefighters after a terrorist attack.

Twenty-four female partners of firefighters participating in recovery efforts associated with the 1995 terrorist bombing in Oklahoma City were assessed 43 to 44 months later. Disaster experiences, psychiatric diagnoses, posttraumatic stress symptoms, and autonomic reactivity in response to an interview about the bombing were examined. Most of the participants with postbombing disorders suffered from pre-existing conditions. The majority found the bombing a "terrible" or "shocking" experience. One participant met all DSM-III-R symptom group criteria for bombing-related posttraumatic stress disorder, and 40% met both B (intrusive re-experiencing) and D (hyperarousal) criteria. More than one half of the sample exhibited autonomic reactivity on at least one measurement. Those who met symptom group criterion D evidenced greater autonomic reactivity than those who did not, suggesting a link between self-reported posttraumatic stress disorder symptoms of arousal and biological manifestations. Thus, it may be important to assess partners of disaster recovery workers for mental health and physiological consequences related to their indirect exposure as these may persist years after the event, even in the absence of a diagnosable mental disorder.

Bereavement↗
PubMed2006

Interrater reliability and coding guide for nonpsychotic formal thought disorder.

Reliable and valid assessment of abnormal speech patterns may enable earlier recognition of nonpsychotic disorders through characteristic speech patterns. This study sought to establish interrater reliability using a standardized guide for scoring. A scoring guide defining 27 elements (e.g., inappropriate self-reference, simple loss of goal, circumstantiality) of disordered thought was developed. The seminal work of Andreasen's and Holzman's groups provided 12 elements, and 15 new elements were suggested by clinical literature. Audiotaped interviews with 12 psychiatric inpatients, adults of both sexes and various ages hospitalized for acute management of nonpsychotic psychiatric disorders, provided speech samples for observation of disordered thought by two independent raters. Using the guide's definitions and accompanying examples of elements of disordered thought, reliability in scoring was high (kappa of .85 for agreement on the presence of any abnormal speech element and kappa values from .66 to 1.00 for agreement on the presence of individual elements).

Adult↗
PubMed2005

Posttraumatic stress disorder: a state-of-the-science review.

This article reviews the state-of-the-art research in posttraumatic stress disorder (PTSD) from several perspectives: (1) Sex differences: PTSD is more frequent among women, who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men. (2) Risk and resilience: The presence of Group C symptoms after exposure to a disaster or act of terrorism may predict the development of PTSD as well as comorbid diagnoses. (3) Impact of trauma in early life: Persistent increases in CRF concentration are associated with early life trauma and PTSD, and may be reversed with paroxetine treatment. (4) Imaging studies: Intriguing findings in treated and untreated depressed patients may serve as a paradigm of failed brain adaptation to chronic emotional stress and anxiety disorders. (5) Neural circuits and memory: Hippocampal volume appears to be selectively decreased and hippocampal function impaired among PTSD patients. (6) Cognitive behavioral approaches: Prolonged exposure therapy, a readily disseminated treatment modality, is effective in modifying the negative cognitions that are frequent among PTSD patients. In the future, it would be useful to assess the validity of the PTSD construct, elucidate genetic and experiential contributing factors (and their complex interrelationships), clarify the mechanisms of action for different treatments used in PTSD, discover ways to predict which treatments (or treatment combinations) will be successful for a given individual, develop an operational definition of remission in PTSD, and explore ways to disseminate effective evidence-based treatments for this condition.

Adaptation, Psychological↗
PubMed2005

Capitol hill staff workers' experiences of bioterrorism: qualitative findings from focus groups.

Little systematic information is available on mental health issues related to bioterrorism. Five focus groups were conducted with Capitol Hill office staff (n = 28 total participants) to learn about their experience of the anthrax incident on October 15, 2001. More than 2,000 verbal passages were coded into categories and themes by using qualitative analysis software. Issues emerging from the discussions included difficulties utilizing customary social supports, concerns over potential long-term dangers created by efforts to eradicate the anthrax, and nonadherence to antianthrax medication regimens. Nonadherence to antibiotic prophylaxis is of immediate concern for response to future bioterrorist events as well as infectious disease epidemics. Other topics that warrant attention are social support and mental health interventions.

Administrative Personnel↗
PubMed2005

Concerns of Capitol Hill staff workers after bioterrorism: focus group discussions of authorities' response.

Systematic studies of mental health effects of bioterrorism on exposed populations have not been carried out. Exploratory focus groups were conducted with an exposed population to provide qualitative data and inform empirical research. Five focus groups of 28 political worker volunteers were conducted 3 months after the October 15, 2001, anthrax attack on Capitol Hill. More than 2000 transcribed focus group passages were categorized using qualitative software. The category with the most items was authorities' response (23% passages), and much of this discussion pertained to communication by authorities. The category with the fewest items was symptoms (4%). Identified issues were less within individuals and more between them and authorities. Risk communication by authorities regarding safety and medical issues was a prominent concern among Capitol Hill office staff workers regarding the anthrax incident on Capitol Hill. This suggests focus on risk communication in developing interventions, but more systematic investigation is needed.

Anthrax↗
PubMed2005

Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City.

BACKGROUND: African disaster-affected populations are poorly represented in disaster mental health literature. AIMS: To compare systematically assessed mental health in populations directly exposed to terrorist bombing attacks on two continents, North America and Africa. METHOD: Structured diagnostic interviews compared citizens exposed to bombings of the US Embassy in Nairobi, Kenya (n=227) and the Oklahoma City Federal Building (n=182). RESULTS: Prevalence rates of post-traumatic stress disorder (PTSD) and major depression were similar after the bombings. No incident (new since the bombing) alcohol use disorders were observed in either site. Symptom group C was strongly associated with PTSD in both sites. The Nairobi group relied more on religious support and the Oklahoma City group used more medical treatment, drugs and alcohol. CONCLUSIONS: Post-disaster psychopathology had many similarities in the two cultures; however, coping responses and treatment were quite different. The findings suggest potential for international generalisability of post-disaster psychopathology, but confirmatory studies are needed.

Adaptation, Psychological↗
PubMed2005

The Oklahoma City bombing study and methodological issues in longitudinal disaster mental health research.

Several methodological issues may affect the findings of studies of the mental health effects of disasters over time. These issues include analysis of the course of individual disorders over time that may be lost when they are presented embedded in general summary statistics, consideration of assessment of psychiatric disorders versus symptoms, adherence to established criteria in assigning psychiatric diagnoses, and orientation of mental health issues to the type of disaster exposure of the sample. This report will explore these methodological issues in a review of disaster literature and in data obtained from study of survivors of the Oklahoma City bombing. Clinical implications of the data obtained from the Oklahoma City bombing study of survivors of the direct bomb blast are presented in the context of these methodological concerns.

Chronic Disease↗
PubMed2004

The Homeless Supplement to the Diagnostic Interview Schedule: test-retest analyses.

This study sought to extend previous work on reliability of self-reported residential history in a homeless population with high rates of drug abuse. The latest version of the Homeless Supplement to the Diagnostic Interview Schedule (DIS/HS) was used to achieve reliability on homelessness experience, use of shelters, transience, and recent residential patterns. Homeless study volunteers were recruited for a test-retest study from a drop-in day centre for mentally ill homeless people (N = 25) and a substance abuse day programme (N = 30). They were administered the instrument approximately one to two days apart. Kappa and intraclass correlation analyses were performed to assess reliability. Overall, the reliabilities of most variables were acceptable, ranging from fair to excellent. Six items were reconstructed to achieve reliability and two were dropped. Substance dependence and adult antisocial behaviour patterns did not affect reliability on most items. This study has developed a reliable self report instrument for measuring residential history that can be used with homeless and drug abusing populations. Replication is needed in larger, more representative samples and comparison of reliability with other psychiatric and cognitive characteristics.

Adult↗
PubMed2004

Approaching disaster mental health research after the 9/11 World Trade Center terrorist attacks.

The article describes the author's experiences with disaster research in the post-9/11 period, first in application of prior research findings to the new situation and later in consultation on the design and development of new research specific to 9/11. The article begins by reviewing the important role of the science of disaster mental health, which was reinforced by the many requests for information from prior research for application to the post-9/11 situation. Next, the article summarizes enduring principles of disaster research application that apply across disaster sites, including 9/11. Addressing unique aspects of the post-9/11 setting, novel considerations for the disaster mental health field are introduced with a new model for conceptualization of subpopulations based on exposure level. Experience in developing research in the post-9/11 setting encountered a number of issues, suggesting need for new policy recommendations that may facilitate research in future disaster settings.

Disasters↗
PubMed2004

The presentation of irritable bowel syndrome in the context of somatization disorder.

BACKGROUND AND AIMS: Somatization disorder, a female predominant disorder, has been found with higher than expected prevalence in previous studies of irritable bowel syndrome (IBS) and might be responsible for some of the comorbidity and excessive health care resource use associated with IBS. The study's aim was to determine within a female IBS population the degree of segregation of psychiatric illness, functional disorders, and health care utilization with somatization disorder. METHODS: In a prospective, 6-month follow-up study, psychiatric disorders were assessed with the Diagnostic Interview Schedule, gastrointestinal and other symptoms with self-report questionnaires, and medically unexplained complaints by thorough chart review. The setting was a university gastroenterology clinic. The participants were a convenience sample of female clinic attendees with IBS (N = 56). RESULTS: Somatization disorder was diagnosed in 25% of patients and highly probable in another 5%. Somatization disorder was associated with significantly greater numbers of gastrointestinal and other symptoms, psychiatric disorders, physicians consulted, telephone calls to physicians, urgent care visits, medication changes, and missed work days and with benzodiazepine use. On follow-up, somatization disorder was associated with psychiatric and IBS symptoms, medication changes, and treatment dissatisfaction. Both somatization disorder and other psychiatric illnesses were associated with other functional gastrointestinal disorders; only somatization disorder remained predictive in a regression model that controlled for the presence of other psychiatric illness. CONCLUSIONS: Among female IBS patients attending a university gastroenterology clinic, many aspects of comorbidity and health care behaviors previously associated with IBS segregated with the diagnosis of somatization disorder. Recognition and appreciation of somatization disorder in IBS have important ramifications for the conduct of research and clinical practice.

Adolescent↗
PubMed2004

The course of PTSD, major depression, substance abuse, and somatization after a natural disaster.

Flood research has used a variety of methods, yielding inconsistent findings. Universal definitions of illness are paramount to the science of psychiatric epidemiology of disasters. St. Louis area survivors (N = 162) of the Great Midwestern Floods of 1993 received a structured diagnostic assessment at 4 and 16 months postdisaster, with 88% follow-up. The purpose of the assessment was to examine predisaster and postdisaster rates of disorders and symptoms. Flood-related posttraumatic stress disorder was diagnosed in 22% and 16% at index and follow-up, respectively. Comorbidity with major depression determined whether the posttraumatic stress disorder would have remitted by 1 year later. Nearly one half of the men in the sample had a pre-existing alcohol use disorder. Virtually no new substance abuse followed the floods, and hence, substance abuse did not develop in response to the disaster or as part of coping with its aftermath. Somatization disorder was not observed; new somatoform symptoms represented a fraction of postflood somatic complaints. Findings are inconsistent with causal attribution of floods in the etiology of alcohol abuse and somatization. Methodological differences may account for much of the apparent discrepancy of these findings, with recent reports of increased alcohol use and somatic symptoms observed after other disasters.

Adolescent↗
PubMed2004

Are rates of psychiatric disorders in the homeless population changing?

OBJECTIVES: We examined the prevalence of psychiatric illness among 3 homeless populations in St. Louis, Mo, in approximately 1980, 1990, and 2000. The 3 studies were conducted with the same systemic research methodology. METHODS: We compared selected demographics and lifetime substance abuse and dependence and other mental illness among the 3 populations. RESULTS: Among the homeless populations we studied, the prevalence of mood and substance use disorders dramatically increased, and the number of minorities within these populations has increased. CONCLUSIONS: The prevalence of psychiatric illness, including substance abuse and dependence, is not static in the homeless population. Service systems need to be aware of potential prevalence changes and the impact of these changes on service needs.

Adolescent↗
PubMed2003

Deriving service costs for a clubhouse psychosocial rehabilitation program.

This article (a) discusses "function cost," a concept to estimate costs where consumers are involved both in delivery and receipt of services; (b) develops a methodology for costing service units for psychosocial rehabilitation clubhouses; and (c) presents a case study of a clubhouse program. Using function cost to estimate the value of member time leads to costs being on average about 10% higher than when using opportunity cost. Because the case-study clubhouse is typical in key dimensions, the methods used here appear generalizable to other programs and should have utility for other rehabilitation-based services for individuals with mental illness.

Adult↗
PubMed2003

Is self-mastery always a helpful resource? Coping wiith paradoxical findings in relation to optimism and abstinence self-efficacy.

This study investigated the relationship between three personal resources (self-mastery, optimism, and abstinence self-efficacy) and ways of coping among recovering substance abusers (n = 52) residing in Oxford Houses. Although residents' scores on optimism and abstinence self-efficacy were significantly correlated in a positive direction, residents' self-mastery scores were significantly and negatively related to both optimism and abstinence self-efficacy scores. However, residents reported using significantly more emotion-focused than problem-focused coping even though there was a significant positive relationship between emotion-focused coping and self-mastery. These paradoxical findings might be due to communal living and 12-step philosophy that is antithetical to a sense of control, which may have facilitated residents' emotional regulation to stress. Furthermore, significant relationships between coping strategies and personal resources imply that active coping strategies are instrumental in recovering substance abusers' use of optimism and abstinence self-efficacy, whereas passive coping strategies are involved with self-mastery. In addition, African American residents reported using significantly more wishful thinking coping, suggesting ethnicity might be an important aspect of the coping process. Overall, findings suggest that optimism and abstinence self-efficacy are effective personal resources for recovering substance abusers in 12-step programs.

Adaptation, Psychological↗