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Biomedical subjects

D E Ford

Publications and source records attributed to D E Ford.

At least 37 records · Page 2Linked to original sources
PubMed1998

Inside "Pandora's box": abused women's experiences with clinicians and health services.

OBJECTIVE: To explore the attitudes and experiences of abused women to identify characteristics that helped or hindered abuse disclosure to clinicians and to determine how women viewed potential interventions to improve detection and treatment in a medical setting. DESIGN: Focus group data conducted and analyzed with qualitative methodology. SETTING: Three community-based mental health centers and one women's shelter. PARTICIPANTS: Twenty-one women in group therapy for domestic violence. MAIN RESULTS: Eighteen (86%) of the 21 women had seen their "regular doctor" in the prior year; only 1 in 3 had discussed the abuse with the clinician. The major discussion themes were medical problems that were exacerbated with abuse, lack of ability to access medical care due to abuser interference, emotional attitudes about abuse that acted as barriers to disclosure, clinician characteristics that helped or hindered disclosure, and treatment experiences and preferences. Women described how their medical problems began or worsened during the abusive period. one in three women described how abusers blocked them from receiving medical care. Women reported intense shame about the abuse and described their self-denial of abuse. Women stated they were inclined to discuss abuse if they felt the clinician was perceived to be caring, was easy to talk to, had a protective manner, or if the clinician offered a follow-up visit. There was no consistent clinician gender preference among the women. One in four women had received psychotropic medication for problems associated with abuse. Many feared addiction, or a loss of alertness, increasing their risk for more abuse. CONCLUSIONS: Many abused women experience worsening health and seek medical care; most do not volunteer a history of violence even to their regular clinicians. Many of the barriers to disclosure of abuse could be overcome by a physician's knowledge of the link between abuse and medical illness, an understanding of the women's emotions about abuse, and her treatment preferences.

Adult↗
PubMed1998

Evaluation of screening schemes for eye disease in a primary care setting.

BACKGROUND AND PURPOSE: Screening in a primary care setting could be an effective method for detection of eye disease. This study was designed to evaluate a questionnaire and a battery of tests for their performance in eye disease screening at a primary care clinic. METHODS: 405 patients aged 40 years or older were interviewed and received a comprehensive eye examination including visual acuity and visual field testing, tonometry, slit-lamp examination, dilated fundus examination and photography. Sensitivity and specificity for the identification of eye disease were calculated for each test and various combinations of tests. RESULTS: A questionnaire-based algorithm for detection of overall eye disease was sufficiently sensitive (90%) but less specific (44%) than an ideal screening test. Distance visual acuity with presenting correction of < or = 20/40 had a sensitivity of 61% and specificity of 72%. A dilated fundus examination had a sensitivity of 79% and specificity of 82%. In screening for glaucoma, tonometry was ineffective (sensitivity = 27% and specificity = 96%), while visual field testing by suprathreshold screening had a sensitivity of 70% and specificity of 67%. Among a variety of combinations, a two-stage strategy with the questionnaire as a first-stage and visual acuity and ophthalmoscopy as second-stage tests provided the best balance of sensitivity (83%) and specificity (76%). CONCLUSION: Among currently available ophthalmic tests, an eye examination including a thorough fundus examination is critical in detection of eye disease. A five-item questionnaire may be useful to identify patients at high risk in primary care practice. More effective tests are needed to improve performance of eye disease screening.

Adult↗
PubMed1997

Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study.

The Johns Hopkins Precursors Study, a long-term prospective study, was used to study the relation between self-reported sleep disturbances and subsequent clinical depression and psychiatric distress. A total of 1,053 men provided information on sleep habits during medical school at The Johns Hopkins University (classes of 1948-1964) and have been followed since graduation. During a median follow-up period of 34 years (range 1-45), 101 men developed clinical depression (cumulative incidence at 40 years, 12.2%), including 13 suicides. In Cox proportional hazards analysis adjusted for age at graduation, class year, parental history of clinical depression, coffee drinking, and measures of temperament, the relative risk of clinical depression was greater in those who reported insomnia in medical school (relative risk (RR) 2.0, 95% confidence interval (CI) 1.2-3.3) compared with those who did not and greater in those with difficulty sleeping under stress in medical school (RR 1.8, 95% CI 1.2-2.7) compared with those who did not report difficulty. There were weaker associations for those who reported poor quality of sleep (RR 1.6, 95% CI 0.9-2.9) and sleep duration of 7 hours or less (RR 1.5, 95% CI 0.9-2.3) with development of clinical depression. Similar associations were observed between reports of sleep disturbances in medical school and psychiatric distress assessed in 1988 by the General Health Questionnaire. These findings suggest that insomnia in young men is indicative of a greater risk for subsequent clinical depression and psychiatric distress that persists for at least 30 years.

Adult↗
PubMed1997

Identification of patient attitudes and preferences regarding treatment of depression.

OBJECTIVES: To identify attitudes that influence patient help-seeking behavior and aspects of treatment that influence patient preferences for management of depression. DESIGN: Three focus group discussions (two patient groups stratified by race and one professional group). Questions addressed experience with depression, help-seeking behaviors, treatment preferences, and perceived barriers to mental health care. SETTING: Academic medical center. PATIENTS/PARTICIPANTS: Eight black patients and eight white patients with depression: seven health care professionals (four physicians and three social workers). MEASUREMENTS AND MAIN RESULTS: Discussions were audiotaped, transcribed, and reviewed independently by two investigators to identify and group distinct comments into categories with specific themes. Differences were adjudicated by a third investigator. Comments within categories were then checked for relevance and consistency by a health services researcher and a psychiatrist. More than 90% of the 806 comments could be grouped into one of 16 categories. Black patients raised more concerns than white patients regarding spirituality and stigma. Patients made more comments than professionals regarding the impact of spirituality, social support systems, coping strategies, life experiences, patient-provider relationships, and attributes of specific treatments. They discussed the role these factors played in their help-seeking behavior and adherence to treatment. CONCLUSIONS: In-depth focus group discussions with depressed patients can provide valuable and unique information about patient experiences and concerns regarding treatment for depression. Clinicians, researchers, and policymakers need to incorporate the range of factors identified by patients into their decision making for individuals with depression.

Academic Medical Centers↗
PubMed1997

Exercise and depression in midlife: a prospective study.

OBJECTIVES: This study examined the relationship of self-reported physical activity with subsequent depression and psychiatric distress. METHODS: Physical activity was assessed in medical school and midlife in 973 physicians as part of a prospective observational study. Outcome measures were the incidence of self-reported clinical depression and psychiatric distress on the General Health Questionnaire. RESULTS: The risk of depression was similar for nonexercisers and exercisers. No relationship was observed between physical activity level and subsequent psychiatric distress. CONCLUSIONS: This study found no evidence that exercise reduces risk for depression or psychiatric distress.

Adult↗
PubMed1996

Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up.

BACKGROUND: There is suggestive evidence that depression increases risk of myocardial infarction (MI), but there are no prospective studies in which the measure of depression corresponds to clinical criteria. This study examines prospectively whether a major depressive episode increases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship. METHODS AND RESULTS: The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catchment Area Study, a survey of psychiatric disorders in the general population. A history of major depressive episode, dysphoria (2 weeks of sadness), and psychotropic medication use were assessed in 1981, and self-reported MI was assessed in 1994. Sixty-four MIs were reported among 1551 respondents free of heart trouble in 1981. Compared with respondents with no history of dysphoria, the odds ratio for MI associated with a history of dysphoria was 2.07 (95% CI, 1.16 to 3.71), and the odds ratio associated with a history of major depressive episode was 4.54 (95% CI, 1.65 to 12.44), independent of coronary risk factors. In multivariate models, use of barbiturates, meprobamates, phenothiazines, and lithium was associated with an increased risk of MI, whereas use of tricyclic antidepressants and benzodiazepines was not. Among individuals with no history of dysphoria, only lithium use was significantly associated with MI. CONCLUSIONS: These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI. The association between psychotropic medication use and MI is probably a reflection of the primary relationship between depression and MI.

Adolescent↗
PubMed1996

Influence of gender, race, and education on patient preferences and receipt of cardiac catheterizations among coronary care unit patients.

The extent to which a preference for less aggressive care explains the lower rate of invasive cardiac services for women and African-Americans is unknown. A prospective observational study of 272 patients admitted to the coronary care unit was conducted at a tertiary referral teaching hospital and a community teaching hospital. In stepwise multivariate analysis, having less than a college education, poor cardiac function, not having undergone a previous cardiac catheterization, being a patient in a nonreferral community hospital, and current smoking were positively associated with a patient's stating that he or she would disagree with a physician's recommendation for a cardiac catheterization. The step-wise multivariate model with cardiac catheterization as the dependent variable indicated that being a patient in a referral medical center, patient willingness to accept a physician's recommendation for a cardiac catheterization, severe heart disease, and having attended high school were predictive. Women did not differ from men in their preference for or receipt of cardiac catheterization. Patients in the coronary care unit with lower levels of education were less likely to undergo cardiac catheterization. This association was only partly explained by less educated patients' being less willing to accept a physician's recommendation to undergo cardiac catheterization.

Aged↗
PubMed1996

Psychiatric profile and sociodemographic characteristics of adults who report physically abusing or neglecting children.

OBJECTIVE: In this study the authors measured the number of adults in three U.S. communities who reported abusing and neglecting children in their lifetime and assessed the relative impact of sociodemographic characteristics and lifetime diagnosis of mental disorders on both child abuse and child neglect. METHOD: A total of 9,841 respondents, identified through a household sampling procedure for the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area study, were included in the analysis. Self-reported lifetime histories of abuse and neglect of children were measured in the antisocial personality module of the NIMH Diagnostic Interview Schedule. RESULTS: In the study sample, 147 adults (1.49%) stated that they had abused children, and 140 adults (1.42%) stated that they had neglected children. A total of 58.5% of those who reported abuse of children, and 69.3% of those who reported having neglected a child, had a lifetime diagnosis of a mental disorder. Increased odds of reports of both abuse and neglect were associated with having a greater number of children in the household. Low socioeconomic status was a risk factor for neglecting, but not abusing, children. In multivariate analyses, a lifetime history of alcohol disorder was associated with abuse and neglect, affective disorders with abuse, and anxiety disorders with neglecting children. CONCLUSIONS: In light of the associations between mental disorders and mistreatment of children, public health policies designed to prevent child abuse and neglect might be enhanced by an increased focus on interventions targeted at individuals with mental disorders.

Adolescent↗
PubMed1996

Depression and risk for onset of type II diabetes. A prospective population-based study.

OBJECTIVE: To determine whether depression is associated with an increased risk for onset of diabetes. RESEARCH DESIGN AND METHODS: In 1981, a total of 3,481 household-residing adults participated in the Epidemiologic Catchment Area (ECA) Program survey at the East Baltimore site. A follow-up of that cohort after 13 years completed 1,897 interviews, amounting to > 72% of survivors. In 1981, depression was assessed with the National Institutes of Mental Health (NIMH) Diagnostic Interview Schedule and diabetes, by self-report. This prospective analysis focused on subjects at risk for onset of diabetes by removing from the analysis individuals with diabetes in 1981. RESULTS: There were 89 new cases of diabetes among 1,715 individuals at risk, yielding a 13-year cumulative incidence of diabetes of 5.2%. In logistic models, major depressive disorder, but not milder forms of depression or other forms of psychiatric disorder, predicted the onset of diabetes (estimated relative risk, 2.23; 95% CI 0.90-5.55). Controlling for age, race, sex, socioeconomic status, education, use of health services, other psychiatric disorders, and body weight did not weaken the relationship. CONCLUSIONS: Major depressive disorder signals increased risk for onset of type II diabetes. Limitations of the findings arise from the difficulty in determining temporal order with two chronic conditions, even when the temporal order of measurement is clear. In addition, even though control variables were introduced for the use of health services, it is possible that the treatment for depression led to an earlier diagnosis of diabetes in this sample.

Adult↗
PubMed1995

Recognizing and managing depression in primary care.

Depression is a common disorder in the primary care setting; it is associated with considerable distress and dysfunction. The management of depressed primary care patients can be complicated by the fact that these patients may lack insight into the cause of their symptoms and report only the somatic manifestations of their disorder to their physicians. Primary care patients may also be reluctant to accept a diagnosis of depression or referral to a mental health specialist. Primary care physicians may feel they lack the time or the training to adequately address their patients' depressive disorders. This paper presents a model for identifying, evaluating, and treating depression which has been specifically developed to help primary care physicians overcome these barriers.

Antidepressive Agents↗
PubMed1995

Health care financing reform in the United States: the community equity model.

The paper discusses the practical structural aspects required for implementing 'managed competition' reform policy which are often overlooked by policy designers of change. Namely, without fundamentally new organisational structures to mediate among the parties of interest, the policies for change will not be sufficient to meet the future. The paper discusses in some detail an organisational mediating structure called the Community Equity Model which organises care at the local neighbourhood or community level using the community as actual fundsholder. This puts the critical stakeholders in a practical mutual ownership relationship by making allocation, services and resource accountability a local act. The paper briefly discusses the organisational and information technology for this type of health care system redesign.

Community Health Planning↗
PubMed1995

The psychosocial work environment of physicians. The impact of demands and resources on job dissatisfaction and psychiatric distress in a longitudinal study of Johns Hopkins Medical School graduates.

This study examines the relationship between the psychosocial work environment and cross-sectional job dissatisfaction and prospective psychiatric distress in a cohort of Hopkins Medical School graduates in midcareer. An instrument was constructed consisting of five scales: psychological job demands, patient demands, work control, physician resources, and coworker support. The results of scale reliability and factor analysis are presented. Higher job demands were found to be associated with increases in job dissatisfaction and psychiatric distress and greater resources were associated with decreased levels of dissatisfaction and distress. In multiple-regression analysis, only work control and social support were found to be independently associated with dissatisfaction and distress. These results suggest that the presence of control and social support at work protects physicians from developing job dissatisfaction and psychiatric distress.

Adult↗
PubMed1994

Identifying suicidal ideation in general medical patients.

OBJECTIVES: To describe characteristics of general medical patients with suicidal ideation and to develop an efficient clinical strategy for identifying these patients. DESIGN: Cross-sectional analysis of data without intervention. SETTING: A representative sample of community respondents interviewed as part of the National Institute of Mental Health Epidemiologic Catchment Area surveys. SUBJECTS: A total of 6041 individuals who reported receiving care in general medical settings in the 6 months preceding the baseline interview. MAIN OUTCOME MEASURE: Suicidal ideation within the year preceding the baseline interview. RESULTS: A total of 154 patients (2.6%) had experienced suicidal thoughts within the previous year. In multivariate analyses, the following sociodemographic factors were significantly associated with having suicidal ideation: being white (odds ratio [OR], 2.8; P < .001) relative to African American, separated or divorced (OR, 1.8; P = .03) relative to married, and aged 18 to 30 years (OR, 2.3; P = .02) or aged 31 to 50 years (OR, 2.1; P = .03) relative to those older than 65 years. Gender, educational level, and socioeconomic status were not statistically associated with suicidal ideation. Psychiatric disorders significantly associated with suicidal ideation were major depression (OR, 10.3; P < .001), panic disorder (OR, 5.2; P < .001), alcohol disorder (OR, 2.0; P = .04), and phobic disorder (OR, 1.6; P = .02) within the previous year. However, only 34% of respondents with suicidal ideation met criteria for major depression. With the aid of stepwise logistic regression, a four-item screening questionnaire, the Suicidal Ideation Screening Questionnaire, was developed to predict patients with suicidal ideation. Likelihood ratios for suicidal ideation increased from 0.21 to 32.8 with more positive responses to questions concerning symptoms of hopelessness, guilt, depressed mood, and sleep disturbances. CONCLUSIONS: If the results from the four-item screen are reproduced in a clinical setting, general medical patients with a high likelihood for suicidal ideation may be identified with a brief screening questionnaire. This screen would have greater sensitivity than would be achieved by assessing suicidal ideation only in those patients who meet criteria for a distinct psychiatric disorder.

Adult↗
PubMed1994

Perceived risk of cancer and practice of cancer prevention behaviors among employees in an oncology center.

METHODS: A survey of oncology center employees was conducted to determine those factors associated with perceived risk of cancer and compliance with preventive care guidelines. Five hundred six employees participated in the survey. RESULTS: The average perceived absolute risk of developing cancer in the next 20 years was 29%. Perceived risk for cancer was higher among women than men. Among men, only current smoking and duration of employment, adjusting for age, were significantly associated with the perceived risk of developing cancer. For women, in addition to smoking, personal experience with cancer among family and friends and perceived health status were significantly associated with the perceived risk of cancer. The practice of cancer preventive behaviors was unrelated to personal risk perception. Less than one-fourth of participants age 40 years and older had a sigmoidoscopy in the last 3 years and less than one-third reported having had their stool checked for blood. The majority of women had a pap smear in the past 10 years; 89% had a pap smear in the past 3 years. Eighty-eight percent of women over 40 and 94% of women over 50 had ever had a mammogram; the majority of these women had had mammograms in the past two years. CONCLUSION: Perceived risk of developing cancer was significantly higher than in projected probabilities based on the incidence of cancer in the United States. Despite the high perceived risk of developing cancer, the practice of colon cancer screening was low. Factors other than perception of personal risk of cancer may be important in encouraging participation in screening programs.

Adult↗
PubMed1994

Characteristics of patients with major depression who received care in general medical and specialty mental health settings.

The purpose of this analysis was to compare depressed patients receiving care in the general medical setting with depressed patients receiving care in specialty mental health settings. The analysis was limited to 559 respondents from the NIMH Epidemiologic Catchment Area (ECA) study who met criteria for the diagnosis of major depression sometime in the year before the interview as defined by the Diagnostic Interview Schedule. Patients who received care in the general medical sector were more likely to be black, older than age 65, have a high school education or less, and to be women, and less likely to be in the highest socioeconomic quartile. A higher proportion of specialty mental health patients reported a lifetime history of delusions, met criteria for the diagnosis of panic disorder, obsessive-compulsive disorder, or schizophrenia, and had a lifetime history of psychiatric hospitalization. Depressed patients seen in the general medical sector had a lower chance of meeting criteria for major depression one year later than those seen in the specialty mental health sector. A multivariate analysis limited to an investigation of the relative importance of sociodemographic factors indicated that the following factors were significantly associated with receiving care in the specialty mental health care sector: age groups 31-50 and 51-65, and single marital status. Black race was inversely correlated with use of specialty mental health care. These results suggest that data generated from the specialty mental health sector can be generalized to the general medical sector only after assessing demographic differences between the two groups. Demographic differences could be associated with differences in knowledge, attitudes, interpretation of symptoms, and treatment preferences related to depression.

Adolescent↗