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Biomedical subjects

E L Struening

Publications and source records attributed to E L Struening.

At least 19 recordsLinked to original sources
PubMed2001

Comorbidity, impairment, and suicidality in subthreshold PTSD.

OBJECTIVE: Reliance on the categorical model of psychiatric disorders has led to neglected study of posttraumatic sequelae that fall short of full criteria for posttraumatic stress disorder (PTSD). Substantial disability and suicidal risk is associated with subthreshold PTSD, but this association has not been well studied. In addition, no studies have examined the role of comorbidity in explaining disability and impairment in subthreshold PTSD. METHOD: On National Anxiety Disorders Screening Day 1997, 2,608 out of 9,358 individuals screened for affective and anxiety disorders at 1,521 sites across the United States reported at least one PTSD symptom of at least 1 month's duration. Impairment, comorbid anxiety disorders, major depressive disorder, and rates of suicidality were determined and compared for individuals with no, one, two, three, or four (full PTSD) symptoms on a screening questionnaire. Regression analyses examined the relative contribution of subthreshold PTSD and comorbid disorders to impairment and suicidal ideation. RESULTS: Impairment, number of comorbid disorders, rates of comorbid major depressive disorder, and current suicidal ideation increased linearly and significantly with each increasing number of subthreshold PTSD symptoms. Individuals with subthreshold PTSD were at greater risk for suicidal ideation even after the authors controlled for the presence of comorbid major depressive disorder. CONCLUSIONS: Higher numbers of subthreshold PTSD symptoms were associated with greater impairment, comorbidity, and suicidal ideation. Disability and impairment found in previous studies of subthreshold PTSD symptoms may be related in part to the presence of comorbid disorders. However, the presence of subthreshold PTSD symptoms significantly raised the risk for suicidal ideation even after the authors controlled for major depressive disorder. Given the broad public health implications of these findings, more efforts are needed to identify subthreshold PTSD symptoms in clinical populations, epidemiologic surveys, and treatment studies.

Adolescent↗
PubMed2001

Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses.

OBJECTIVE: The objective of this study was to determine whether stigma affects the self-esteem of persons who have serious mental illnesses or whether stigma has few, if any, effects on self-esteem. METHODS: Self-esteem and two aspects of stigma, namely, perceptions of devaluation-discrimination and social withdrawal because of perceived rejection, were assessed among 70 members of a clubhouse program for people with mental illness at baseline and at follow-up six and 24 months later. RESULTS: The two measures of perceptions of stigma strongly predicted self-esteem at follow-up when baseline self-esteem, depressive symptoms, demographic characteristics, and diagnosis were controlled for. Participants whose scores on the measures of stigma were at the 90th percentile were seven to nine times as likely as those with scores at the 10th percentile to have low self-esteem at follow-up. CONCLUSIONS: The stigma associated with mental illness harms the self-esteem of many people who have serious mental illnesses. An important consequence of reducing stigma would be to improve the self-esteem of people who have mental illnesses.

Adult↗
PubMed2001

Stigma as a barrier to recovery: Adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder.

OBJECTIVE: The purpose of this study was to evaluate the effect of concerns about stigma on social adaptation among persons with a diagnosis of bipolar affective disorder. METHODS: The sample comprised 264 persons who were consecutively admitted to a psychiatric inpatient or outpatient service at a university-affiliated hospital and who met research diagnostic criteria for bipolar I disorder, bipolar II disorder, or schizoaffective disorder, manic type. Patients were evaluated with use of the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-L), the Brief Psychiatric Rating Scale (BPRS), and a measure of perceived stigma. Social adjustment was measured at baseline and seven months later with the Social Adjustment Scale (SAS). RESULTS: As predicted, patients who had concerns about stigma showed significantly more impairment at seven months on the social leisure subscale but not on the SAS extended family subscale, after baseline SAS score and symptom level had been controlled for. More refined models using SAS-derived factors as dependent variables indicated that concerns about stigma predicted higher avoidance of social interactions with persons outside the family and psychological isolation at seven-month follow-up, after baseline SAS and BPRS scores had been controlled for. CONCLUSIONS: Concerns about the stigma associated with mental illness reported by patients during an acute phase of bipolar illness predicted poorer social adjustment seven months later with individuals outside the patient's family. Greater attention to patients' concerns about stigma is needed from both researchers and clinicians.

Adaptation, Psychological↗
PubMed2001

Stigma as a barrier to recovery: The extent to which caregivers believe most people devalue consumers and their families.

OBJECTIVE: The extent to which 461 caregivers of persons with serious mental disorders believed that most people devalue consumers and their families was assessed, and the magnitude of the relationships between these beliefs and the diagnostic status of consumers was estimated. METHODS: Caregivers of 180 consumers with schizophrenia, major depression, or bipolar disorder and caregivers of 281 consumers with bipolar disorder or schizoaffective disorder, manic type, completed a 15-item instrument comprising two scales: eight of the 15 items operationally defined the devaluation of individual consumers, and seven items operationally defined the devaluation of consumers' families. RESULTS: No significant differences were observed between the two samples on the two devaluation scales or on 14 of the 15 items that constituted the scales. About 70 percent of all caregivers indicated a belief that most people devalue consumers, and 43 percent expressed a belief that most people also devalue the families of consumers. CONCLUSIONS: Strong evidence from previous research indicates that the caregiving role is very demanding, is frequently distressing, and may be harmful to health and injurious to one's quality of life. The addition of a community that is perceived to be rejecting makes life even more difficult for the caregivers and families of people with serious mental disorders. The development and implementation of effective interventions to create more supportive and understanding communities would be a challenging and worthwhile endeavor.

Adult↗
PubMed1999

Mortality among homeless shelter residents in New York City.

OBJECTIVES: This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. METHODS: Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. RESULTS: Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. CONCLUSIONS: For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness.

Adult↗
PubMed1998

Does outreach case management improve patients' quality of life?

OBJECTIVE: This study examined whether enhancing standard aftercare with an outreach case management intervention would improve patients' quality of life. METHODS: A sample of 292 patients discharged from an inpatient psychiatry service at an urban general hospital were randomly assigned either to an intervention group (N = 147), which received outreach case management services in addition to standard aftercare service, or to a control group (N = 145), which received only standard aftercare services. The follow-up period was 15 to 52 months. Individuals in both groups were reinterviewed by an independent research team about 21.6 months after discharge. The groups were compared using 39 measures of quality of life. The interviews elicited information about patients' physical well-being and competence in performing activities of daily living; their emotional well-being as shown in emotional expressiveness, sadness, suicidal thoughts, and substance abuse; and their interpersonal relationships, living arrangements, friendships, income maintenance, and employment. RESULTS: No difference was found between the groups on any of the quality-of-life variables. CONCLUSIONS: Outreach case management was not associated with improved quality of life.

Activities of Daily Living↗
PubMed1997

Perceived burden among caregivers of adults with serious mental illness: comparison of black, Hispanic, and white families.

Differences in perceived burden were investigated among black, Hispanic, and white groups of caregivers of adults with serious mental illness. Controlling for sociodemographic characteristics and caregiving-related stressors, black caregivers tended to report less burden than whites, a result not explained by protective mechanisms (social support, religious involvement, illness attributions). No statistically significant differences were found in perceived burden between Hispanic and white caregivers.

Adaptation, Psychological↗
PubMed1997

Adverse childhood experiences: are they risk factors for adult homelessness?

OBJECTIVES: We tested the hypothesis that adverse childhood experiences are risk factors for adult homelessness. METHODS: We interviewed a nationally representative sample of 92 US household members who had previously been homeless and a comparison group of 395 individuals with no prior homelessness. We assessed childhood adversity with a structured protocol that included a previously validated scale indicating lack of care from parents and single-item measures of physical and sexual abuse. RESULTS: Lack of care from a parent during childhood sharply increased the likelihood of subsequent homelessness (odds ratio [OR] = 13), as did physical abuse (OR = 16). Sexual abuse during childhood was associated with a nonsignificant trend toward homelessness (OR = 1.7). The risk of subsequent homelessness among individuals who experienced both lack of care and either type of abuse was dramatically increased compared with subjects reporting neither of these adversities (OR = 26). CONCLUSIONS: Adverse childhood experiences are powerful risk factors for adult homelessness. Effectively reducing child abuse and neglect may ultimately help prevent critical social problems including homelessness.

Adolescent↗
PubMed1997

On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse.

Numerous studies have demonstrated a strong connection between the experience of stigma and the well-being of the stigmatized. But in the area of mental illness there has been controversy surrounding the magnitude and duration of the effects of labeling and stigma. One of the arguments that has been used to downplay the importance of these factors is the substantial body of evidence suggesting that labeling leads to positive effects through mental health treatment. However, as Rosenfield (1997) points out, labeling can simultaneously induce both positive consequences through treatment and negative consequences through stigma. In this study we test whether stigma has enduring effects on well-being by interviewing 84 men with dual diagnoses of mental disorder and substance abuse at two points in time--at entry into treatment, when they were addicted to drugs and had many psychiatric symptoms and then again after a year of treatment, when they were far less symptomatic and largely drug- and alcohol-free. We found a relatively strong and enduring effect of stigma on well-being. This finding indicates that stigma continues to complicate the lives of the stigmatized even as treatment improves their symptoms and functioning. It follows that if health professionals want to maximize the well-being of the people they treat, they must address stigma as a separate and important factor in its own right.

Adult↗
PubMed1995

Predictors of emergency room use by homeless adults in New York City: the influence of predisposing, enabling and need factors.

Employing data from a 1987 shelter survey of 1260 homeless adults in New York City, multivariate models of emergency room (ER) use are developed which include an array of risk factors for visiting a hospital ER including health and mental health problems, victimization and injuries. The study's primary goal is to identify factors that predict ER use in this population. Multivariate logistic and linear regression models were tested separately for men and women predicting three outcomes: any use of the ER during the past 6 months, use of the ER for injuries vs all other reasons (given any ER use), and the number of ER visits (given any ER use). Lower alcohol dependence, health symptoms and injuries were strong predictors for both men and women; other significant predictors differed markedly by gender. Both models were highly significant and produced strikingly high risk profiles. A high prevalence of victimization and injuries underlies ER use among the homeless. Based upon the findings, we recommend expanded health and victim services as well as preventive measures. Until primary care becomes available for this population, we advise against policies that discourage ER use by the homeless.

Adult↗
PubMed1994

Childhood out-of-home care and current depressive symptoms among homeless adults.

Previous research indicates that adverse childhood experiences are associated with depression during adulthood under conditions of social stress. This relationship was examined in a large sample of homeless adults (n = 1849). Subjects with evidence of severe mental disorders such as schizophrenia were excluded. Those with out-of-home care (e.g., foster, group, or institutional care) during childhood were significantly more likely than those without such care to report current severe depressive symptoms (CES-D score greater than or equal to 30). The finding, which held up in multivariate analysis when potential confounders were statistically controlled, supports the theory that certain developmental experiences are risk factors for subsequent depressive symptoms.

Adult↗
PubMed1992

Victimization and traumatic injuries among the homeless: associations with alcohol, drug, and mental problems.

Data from a 1987 survey of 1,260 homeless adults in New York City show that mental problems and substance dependence were significantly linked to beating and sexual assault among women and to several types of injury and victimization among men. The extremely high rates of victimization and injury underscore a need for greater attention to the safety and welfare of homeless people.

Adult↗
PubMed1991

Diagnostic predictors of treatment patterns in a cohort of adolescents.

Data on 776 American adolescents studied longitudinally were used to show treatment patterns related to psychiatric disorders. When DSM-III-R diagnoses based on mother and youth Diagnostic Interview Schedule for Children interviews were used prospectively to determine subsequent treatment seeking, it was found that consultation with mental health specialists, but not with pediatricians or general practitioners, was elevated in those with disorders. The specific diagnoses most associated with treatment seeking were conduct disorder and oppositional/defiant disorder. No compensation for differences in mental health service usage between children with internalizing disorders and those with externalizing disorders in the form of help from informal or other professional sources was present.

Adolescent↗
PubMed1991

Childhood antecedents of homelessness in psychiatric patients.

OBJECTIVE: This study examined the relationship between childhood experience and homelessness in psychiatric patients. METHOD: Three large and diverse samples of homeless patients (N = 512) were compared with a sample of patients who had never been homeless (N = 271), with respect to childhood experience of foster care, group home placement, and running away. One of the homeless samples and the never homeless sample were drawn from patients admitted to a state mental hospital. In this state hospital population, risk ratios for lifetime prevalence of homelessness could be derived. RESULTS: In the three homeless samples, over 15% had a history of foster care, over 10% had a history of group home placement, and over 20% had a history of running away. These figures compared with 2%, 1%, and 5%, respectively, in the never homeless sample. In the state hospital, the lifetime prevalence of homelessness in patients with any one of these childhood experiences was about threefold that of other patients. A history of homelessness was reported by the great majority of state hospital patients who had had one of these childhood experiences. CONCLUSIONS: These childhood experiences were strongly associated with adult homelessness in these psychiatric patients. It might be possible to prevent homelessness in some cases by interventions aimed at patients with such childhood histories.

Adolescent↗
PubMed1991

Influence of substance abuse and mental disorders on emergency room use by homeless adults.

Substance abuse and mental disorders increase the health care needs of homeless persons, whose primary source of care is often the emergency room. In this study, associations between substance abuse and mental health problems and use of emergency rooms were examined using data from a 1987 survey of 1,152 homeless adults in New York City shelters. Two-thirds (N = 767) of the sample reported using an emergency room at least once in their lives, and 27.2 percent (N = 313) reported use within the previous six months. Traumatic injury was the most frequently cited reason for the last emergency room visit. Respondents who reported psychotic ideation during the previous year or severe depressive symptoms during the previous week were much more likely to have used an emergency room within the previous six months. The preliminary findings suggest that substance abuse and mental disorders play a significant role in emergency room use by homeless adults.

Adolescent↗