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Biomedical subjects

H C Schulberg

Publications and source records attributed to H C Schulberg.

At least 19 recordsLinked to original sources
PubMed1991

Factors affecting service utilization for depression in a white collar population.

The present study examines rates of mental health service utilization among depressed individuals in a large white collar cohort. Clinical and psychosocial features of a recent depressive episode, as well as preexisting psychiatric and psychosocial characteristics, are examined for their ability to distinguish between individuals who (a) did and did not seek help during their episode and (b) chose to consult one professional source rather than another. Results showed that approximately one-third of the sample sought professional help. Respondents consulting mental health specialists were more clinically impaired and had poorer work performance and fewer psychosocial assets than both those consulting nonpsychiatric physicians and those seeking no help. Respondents in the latter two groups were indistinguishable from one another on many of the assessed variables.

Adult↗
PubMed1991

Strategies for evaluating treatments for major depression in primary care patients.

Primary care physicians are being urged to provide patients experiencing a major depression treatments validated with psychiatric patients. The propriety of transferring clinical technologies from one care-giving sector to another is questionable, however, as it has little scientific support. We suggest that clinical trials be initiated so as to expand the available knowledge base. This paper analyzes the methodologic issues involved in pursuing such experimental research and urges that it be conducted despite the possible need for initial design compromises.

Adult↗
PubMed1991

Mental disorders in the primary care setting. Research priorities for the 1990s.

New research directions should be pursued during the coming years if mental illness is to be properly managed in primary medical care practice. Among needed studies are those pertaining to the validity of diagnostic classifications specific to psychiatric morbidity in ambulatory medical settings; the nature of clinical decision-making by primary care physicians; how diagnostic formulations influence treatment choices; and the effectiveness of treatments transferred from the specialist to generalist settings.

Cross-Sectional Studies↗
PubMed1991

Work stress, family stress and depression in professional and managerial employees.

Detailed interviews were conducted with 1523 married professional and managerial employees of a major US corporation to test associations of acute and chronic occupational and domestic stress with DSM-III-R major depression and current depressive symptoms. After controlling for demographic and clinical risk factors, both sources of stress were significantly associated with the two measures of depression. On the other hand, neither the demographic and clinical risk factors, nor several psychosocial characteristics (social support, sense of mastery and organizational commitment) moderated the relationship between stress and depression.

Adaptation, Psychological↗
PubMed1990

Depressive symptomatology and medical co-morbidity in a primary care clinic.

Most primary care patients exhibiting significant depressive symptomatology fail to meet DSM-III criteria for a major depressive disorder (MDD). Yet, such patients have substantial morbidity and dysfunction attributable to their affective syndrome. Since surprisingly little is known about this group's clinical characteristics, we studied 618 general medicine patients aged eighteen to sixty-four years. In this population, fifty-seven (9.2%) scored quite high when screened on the Center for Epidemiological Studies Depression Scale (greater than or equal to 27) while not meeting MDD criteria on the Diagnostic Interview Schedule. Membership in the "depression symptoms only" (DSO) group was predicted by a logistic regression model including female gender, more severe medical illness, higher likelihood of operative procedures, and less frequent cardiovascular diagnoses. Our findings suggest that the DSO state is associated with substantial "medical" morbidity. Prospective studies of subclinical depression in the primary care setting are urged to clarify etiologic and treatment concerns.

Adjustment Disorders↗
PubMed1990

Medical comorbidity of major depressive disorder in a primary medical practice.

Despite much speculation about the relationship between depression and medical comorbidity in primary care settings, few investigators have examined this issue empirically. Using a two-stage screening procedure, we assessed 618 patients aged 18 to 64 years in an academic general medicine clinic. Forty-one patients (6.6%) suffered from a current episode of major depressive disorder (MDD). We compared this group with a 20% random sample of nondepressed patients. While patients with MDD were younger (mean age, 41.1 vs 47.2 years), they were assessed by the Duke University Severity of Illness Scale as having more severe medical illness. Patients with MDD were more likely to have malignant tumors and "ill-defined conditions" than nondepressed patients. The 18 patients with MDD (44%) who were correctly diagnosed by their physicians had less severe medical illness than those whose depression was clinically undetected. A logistic regression model predicting MDD group membership included female gender, younger age, higher Duke University Severity of Illness Scale score, and more frequent inactive ill-defined diagnoses. These findings are consistent with assertions: (1) patients with MDD have more physical illness than nondepressed patients and/or (2) somatic symptoms and disability caused by MDD add to the burden of physical illness.

Adult↗
PubMed1990

Epidemiology of depression and alcohol abuse/dependence in a managerial and professional work force.

Detailed clinical interviews focusing on depression and alcohol abuse/dependence were conducted with 1870 managers and professionals drawn from a major US corporation. Among men, the lifetime and 1-year prevalence rates of DSM-III-R major depression were 23% and 9%, respectively. Among women, the rates were 36% and 17%, respectively. Lifetime and 1-year prevalence rates of DSM-III-R alcohol abuse/dependence were 16% and 4% for men, and 9% and 4% for women. Imposing a requirement that alcohol-related symptoms cluster together in time reduced the lifetime and 1-year prevalence rates to 11% and 3% for men and 5% and 2% for women. The odds ratio for the lifetime occurrence of depression and alcohol abuse/dependence with such clustering was 2.28. The three most important risk factors for depression were being female, separated or divorced, and having a family history of depression. For alcohol abuse/dependence, the most important risk factors were being male, unmarried, and having a family history of alcoholism. Manager/professional status, length of employment, hours worked per day, and supervisory responsibility were not statistically associated with either DSM-III-R major depression or alcohol abuse/dependence.

Administrative Personnel↗
PubMed1989

Treating depression in primary care practice. An application of decision analysis.

Decision analysis approaches complex treatment issues by considering alternative strategies in an explicit and logical manner, and examining their outcomes in the face of varied assumptions. Significant data gaps impede full application of this framework to the treatment of depressed primary care patients. Nevertheless, decision analysis already can be useful in emphasizing needed clinical information in treating these patients and highlighting future directions for research.

Curriculum↗
PubMed1988

Mental disorders in primary care: epidemiologic, diagnostic, and treatment research directions.

An extensive series of investigations over the past 2 decades clearly demonstrate that mental disorders are present in approximately 25% of primary care patients and that physicians underdiagnose these illnesses. The factors producing this bias are poorly understood and should be focused upon in future research. Also requiring much more study is the efficacy of pharmacologic and psychosocial treatments initially validated with psychiatric populations. Clinical trials should determine whether standardized interventions can be utilized with medical patients whose symptom profiles and organic comorbidity may differ from those of psychiatric populations.

Cross-Sectional Studies↗
PubMed1988

Symptom patterns of depression in ambulatory medical and psychiatric patients.

The failure of primary care physicians to recognize depressive disorders in medical patients has been attributed to the differing clinical syndromes presented by these persons in comparison with psychiatric patients. Earlier British studies have found intersector difference in the prevalence and severity of somatic, affective, and cognitive symptoms. Our investigation with American patients did not replicate these findings. The need for further research along these lines is discussed, as are the implications for assessing depression in generalist and specialist practices.

Adult↗
PubMed1987

Screening procedures in psychiatric care. A practice whose time has come.

The papers by Cleary et al. and Koran et al. extend the boundaries of psychiatric screening practice in several significant directions. They illustrate procedures for resolving both scientific and practical issues intrinsic to the construction of screening procedures and, thereby, advance the state of the art. It is hoped that ROC analyses will be used more commonly to establish cohort-specific screening cutpoints and that diagnostic prediction rules will increasingly utilize fiscal as well as clinical parameters. If these developments should come to pass, the contributions by these authors are certain to be recalled for the critical impetus they have provided.

Diagnosis↗
PubMed1979

Community support programs: program evaluation and public policy.

The plight of chronic psychiatric patients in the community has led to a major federal effort to resolve fragmented and disorganized care. The Community Support Programs (CSPs) recently funded by NIMH offer the promise of reducing these difficulties by creating comprehensive human service systems at the local and state levels. However, the author points out that these demonstration projects should be evaluated lest they continue to operate on the basis of rhetoric rather than fact. He presents an evaluation framework whereby indexes pertinent to each program goal of the CSPs can be measured and the resulting data used for public policy purposes.

Community Mental Health Services↗
PubMed1978

Effects of community mental health services on state hospital admissions: a clinical-demographic study.

In a study to refine the methodology for evaluating the impact of community mental health centers on state hospital admissions, data were gathered on hospital patients' demographic and clinical characteristics as well as on total admission rates. The study covered total inpatients admissions to a Pennsylvania state hospital from two counties for ten time periods, both before and after the establishment of local community mental health services. The authors found few consistent changes on most of the clinical and demographic factors for patients from either county, which indicated that the expansion of community services did not lead to changes in the type of patients admitted to the state hospital. However, the data did suggest that the expanded community services reduced the state hospital admission rates and shortened the length of hospital stay.

Adult↗
PubMed1976

Phasing out state hospitals -- a psychiatric dilemma.

Whether state hospitals have a role in caring for mentally ill persons has been intensely debated for the past decade. During this time the inpatient census of public mental hospitals has fallen dramatically from 490,000 to 215,000 owing to increasingly effective treatment programs for acutely and chronically psychotic patients. The vast majority of patients currently cared for in state hospitals could be adequately treated in the community if a comprehensive spectrum of psychiatric services and residential alternatives were established. The failure to establish this network of community services before the discharge of thousands of patients has discredited the deinstitutionalization programs in many states, including California and New York, and forced California to abandon its plan to phase out all its state hospitals. Thus, although phase out of state hospitals is clinically feasible, it is unlikely at present since the fiscal and ideologic commitment to shift to community-based treatment is lacking.

Acute Disease↗
PubMed1976

Community mental health ideology scale: social work norms.

The present study reports mean scores obtained by two groups of professionals deeply involved in the community mental health movement on the Community Mental Health Ideology Scale. Professional social workers and social work graduate students were not included in the scale makers original criterion group. The high mean scores obtained by these groups led the authors to the conclusion that social workers show the potential for a strong role in the "third phase" of mental health care and delivery.

Attitude of Health Personnel↗