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Biomedical subjects

D Blazer

Publications and source records attributed to D Blazer.

At least 37 records · Page 2Linked to original sources
PubMed1992

Age and impaired subjective support. Predictors of depressive symptoms at one-year follow-up.

We followed a cohort of subjects (predominantly inpatients) suffering a major depressive episode in midlife and late-life for 1 year (N = 118). In this follow-up study, we examined three hypotheses. a) Elder subjects suffering major depression, compared with middle-aged subjects, will more likely report endogenous symptoms and less likely report decreased life satisfaction symptoms at 1-year follow-up. b) Impaired social support during the index episode will predict poor life satisfaction, but not endogenous symptoms at 1-year follow-up, regardless of age. c) Impaired social support during the index episode will be more predictive of decreased life satisfaction symptoms in midlife, compared with late life, at 12-month follow-up. The first two hypotheses were not supported, but the third hypothesis was. Both decreased life satisfaction and endogenous symptoms at outcome were significantly predicted by impaired social support during the index episode. Impaired social support predicted a poor outcome from an episode of major depression in both middle life and late life in controlled analyses. However, the effect of impaired subjective social support was conditional on age. Subjective social support appears to have a decreasing influence on the report of both endogenous and decreased life satisfaction symptoms for older individuals.

Adult↗
PubMed1991

Epidemiologic data and planning mental health services. A tale of two surveys.

The Epidemiologic Catchment Area Program (ECA) is the most comprehensive community and institutionalized epidemiologic data base currently available for mental health service planning. In this report, the authors compare the ECA with a previous community survey used to plan mental health services--the Stirling County Study--in terms of conceptual framework, research design, results and implementation of service planning. Familiarity with the Stirling County Study can inform users of ECA data regarding the strengths and weaknesses of the ECA data for health services research.

Adolescent↗
PubMed1991

Subjective social support and depressive symptoms in major depression: separate phenomena or epiphenomena.

One hundred and twenty-five middle-aged and elderly adults suffering from a major depressive episode were evaluated during the index episode and at six and twelve month follow-up. Subjective (emotional) social support and depressive symptoms (CES-D) were evaluated during each interview. Contigency table and correlation analyses reveal that subjective support and depressive symptoms are interrelated but separate constructs.

Adult↗
PubMed1991

The association of age and depression among the elderly: an epidemiologic exploration.

Advanced age among the elderly has been hypothesized to be a risk factor for depression, yet extant data do not uniformly support this hypothesis. The paucity of sufficiently large and representative samples of both the young-old and old-old and the failure to control for critical variables known to confound the association between advanced age and depression have prevented testing this hypothesis. The Duke EPESE (Establishment of a Population for Epidemiologic Studies of the Elderly) assessed 3,998 community-dwelling elders (65+) for depressive symptoms using a modified version of the CES-D and relevant control variables. Depressive symptoms were associated in bivariate analysis with increased age, being female, lower income, physical disability, cognitive impairment, and social support. In a multiple regression analysis, the association of age and depressive symptoms reversed when the above confounding variables were simultaneously controlled. The oldest old suffered fewer depressive symptoms when factors associated with both increased age and depressive symptoms were taken into account. Because many of these factors can be prevented (such as decreased income, physical disability, and social support), the uncontrolled association between age and depressive symptoms can potentially be modified.

Black or African American↗
PubMed1991

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.

Adolescent↗
PubMed1989

Depression in late life: an update.

Clinical and basic research units depressive disorders in late life have expanded our knowledge base appreciably in recent years. In the process, some clinical impressions have been confirmed (e.g., the association of depression and physical disorders); others have been refuted (e.g., depression increases with age); and now phenomena have been identified (e.g., the discovery of leukoencephalopathy in depressant elders who respond to ECT). The field of study now encompasses a range from neurobiology to sociocultural factors. The latter twentieth century is an exciting and optimistic era for clinicians working with depressed elders. As Sir Martin Roth has often said, "Where there is depression in late life, there is hope."

Aged↗
PubMed1989

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.

Adolescent↗
PubMed1989

Dizziness in a community elderly population.

Dizziness was studied in 1,622 community-dwelling adults aged 60 and older who were interviewed as part of the Duke Epidemiologic Catchment Area study. The lifetime prevalence of dizziness (defined as severe enough to see a physician, to take a medication, or to interfere with daily activities) was 29.3%; the 1-year prevalence was 18.2%. When the subgroup with dizziness was compared with those who never suffered dizziness, using logistic regression, four variables displayed the strongest associations: a constructed variable of risk for multiple neurosensory deficits, a cardiovascular risk score, a depression symptom inventory, and perception of self as a nervous person. In this population, dizziness was not associated with increased risk of death or institutionalization at the 1-year follow up.

Age Factors↗
PubMed1989

The epidemiology of depression in late life.

In contrast to previous observations, which had indicated an increased prevalence of depressive symptoms among the elderly, recent epidemiological studies have shown a decreasing current and lifetime prevalence after age 20 or 30. The question whether depression is more or less common among older adults can best be resolved by turning to some of the core tasks of epidemiology: the identification of cases of depression, the distribution of cases in the population, and historical trends in the incidence of cases. In case identification there is agreement among clinicians on the signs and symptoms of depression, but controversy regarding depressive syndromes. The latter may be seen as forming a continuum (with little change in prevalence across the life cycle) or as including differing categories (with some, such as depressive reactions to physical illness, being more significant among the elderly). DSM-III and DSM-III-R do not capture all of the important subtypes of depression. Scepticism has been aroused over the recent finding of case distribution showing lower prevalence among the elderly because the lifetime prevalence has also been reported as lower. It is suggested here that a "cohort effect" may account for this finding. Recent data bearing upon historical trends suggest that the current 65- to 85-year-old group has been protected against major depression and suicide. While suicide rates do increase with advanced age in white males, current older men have lower suicide rates than previous cohorts at the same age (60 years). This may reflect better health and economic status of the current group or, perhaps, an increase of depression among younger adults now. Better case definition of depression and further epidemiological studies including consideration of cohort effects are indicated.

Aged↗
PubMed1988

Depressive symptoms and depressive diagnoses in a community population. Use of a new procedure for analysis of psychiatric classification.

A multivariate classification technique was used to examine whether depressive symptoms and symptoms frequently associated with depressive disorders would cluster into recognizable syndromes that parallel traditional DSM-III psychiatric diagnoses. An analysis was made of all respondents in the Epidemiologic Catchment Area (ECA) project of the Piedmont region of North Carolina who reported suffering from depressive symptoms (n = 406) at the second wave of the ECA study. The analysis identified five profiles of symptoms that adequately described the interrelationships of the symptoms as reported in the population. One profile included a set of symptoms nearly identical to the symptoms associated with the DSM-III classification of major depression. Other depressive syndromes emerged and included a premenstrual syndrome among younger women and a mixed anxiety/depression syndrome. The existence of these other depressive syndromes may explain the present discrepancy in the epidemiologic literature between a high prevalence of depressive symptoms and a low prevalence of traditional depressive diagnoses in community populations.

Adolescent↗
PubMed1988

Trends in US suicide mortality rates 1968 to 1982: race and sex differences in age, period and cohort components.

Interest has recently emerged in increases in suicide among US teenagers. Nonetheless suicide remains one of the major causes of death among the fastest growing components of the US population--the elderly. We examine the trends in US age-specific suicide rates for the period 1962 to 1981 for four elderly race and sex groups. The trends were analysed using a Poisson regression model which isolated the age, period, cohort effects for suicide mortality for demographic groups. Age, period and cohort effects all significantly contributed to these trends. The race and sex differences were largest for the age pattern of changes in suicide mortality. Of particular interest was the different contribution of each of these factors to recent increases in mortality at advanced ages for black males--a hitherto little recognized or studied trend.

Adult↗
PubMed1988

New concepts in the diagnosis and management of depression.

The diagnosis and therapy of the depressive disorders has entered a new era in the 80s. Though primarily driven by breakthroughs in the neurosciences, such as neuroendocrinology, neurochemistry, and psychopharmacology, the increased sophistication of our diagnostic procedures and therapies of these disorders is by no means limited to the biomedical laboratory. A move away from preconceived concepts of the causes and course of depression has ushered in an era of empirical investigation of the clinical presentation and clinical course of the depressive disorders. This empirical approach has contributed to a new wave of epidemiologic investigations. The psychiatrist's diagnostic and therapeutic approach to the depressive disorders, more so than with any other primary psychiatric disorder, closely parallels the approach of physicians from other specialties, and has thereby increased the bond between psychiatry and the other medical specialties. Some caution, however, must be expressed. First, depressive disorders are considered by many primary care physicians to be easily understood and managed, or to be unworthy of serious attention. The requirement for specialty care in the management of treatment-resistant depressive disorders is as essential as the requirement for the coronary care unit in treating the unstable cardiac patient. In addition, the movement toward the medical management of the depressive disorders should not bias the clinician to the point that he neglects these illnesses and the patients who suffer them. We may view the depressive disorders as being primarily of biomedical causes, but patients still interpret their depressive symptoms within the context of their values, their lifestyles, and the events that impact them.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1987

Alcohol abuse and dependence in the rural South.

We studied rural-urban differences in the prevalence of Diagnostic Interview Schedule (DIS)-DSM-III alcohol abuse or dependence from a community survey (part of the Epidemiologic Catchment Area program) of 3921 adults living in the Piedmont of North Carolina. Bivariate analyses disclosed that current alcohol-related problems, as identified by the DIS, were more common in the rural area (4.2% vs 2.6%). In a logistic regression analysis that controlled for potential confounders, including age, sex, race, socioeconomic status, and the DIS-DSM-III diagnoses of major depression and antisocial personality disorder, the elevated odds of alcohol abuse or dependence in the rural area remained significant for the interactive variable "rural blacks" (relative risk, 2.88). Factors leading to urban-rural differences in psychiatric disorders, such as current alcohol abuse or dependence, are therefore more complex than can be explained by geographic boundaries alone.

Adolescent↗
PubMed1987

Noninvasive evaluation of mid-left ventricular obstruction by two-dimensional and Doppler echocardiography and color flow Doppler echocardiography.

Three patients with midventricular obstruction resulting from three different pathophysiologic mechanisms and differing anatomic bases for the development of obstruction are presented. In the first patient, a membrane-like structure appeared to cause some fixed obstruction, but a superimposed dynamic component to the obstruction was also evident. Papillary muscle hypertrophy with approximation of the papillary muscles during systole was the mechanism in the second patient. In the third patient, apical infarction with hyperdynamic contraction of the mid- and basal portions of the myocardium appeared to be the pathophysiologic mechanism. Color flow Doppler echocardiography was particularly useful in localizing the site of obstruction and allowed further evaluations by pulsed and continuous-wave Doppler techniques to precisely determine pressure gradients.

Blood Pressure↗