PubMed Health⌕ Search

Biomedical subjects

H G Koenig

Publications and source records attributed to H G Koenig.

At least 91 records · Page 5Linked to original sources
PubMed1993

Should physicians screen for depression in elderly medical inpatients?: Results of a decision analysis.

OBJECTIVE: We wish to determine whether or not elderly medical inpatients should be screened for depressive disorder using either 1) a self-rated depression scale (Geriatric Depression Scale), 2) "usual clinical assessment," or 3) neither, assuming that treatment with tricyclic antidepressants (TCAs) is the primary mode of intervention. METHOD: Based on recent data from epidemiological studies on the prevalence and course of depression, the test characteristics of available screening tests, and the efficacy and side-effects of traditional antidepressants, decision analysis is used to help decide whether or not clinicians should screen for depression in this setting. RESULTS: These calculations indicate that if screening is done solely to identify depressed patients for treatment with TCAs, then the highest utility lies in not screening; however, the difference in utilities between that decision and the decisions to either screen with GDS or screen by usual clinical assessment was only .04 units on a 0 to 100 scale, making the decision virtually a toss-up. Furthermore, even a small variation in one of several clinical factors or test characteristics could give screening a higher utility. In particular, if psychotherapy is considered as the primary intervention, then the utility of screening exceeds that of not screening. CONCLUSION: Characteristics of the screening test, clinical setting, types and safety of available treatments, each impact on the usefulness of screening and must be kept in mind when diagnosing and treating depressed medically ill elders hospitalized in acute care settings.

Aged↗
PubMed1993

Legalizing physician-assisted suicide: some thoughts and concerns.

Surveys show that most Americans favor the decriminalization of physician-assisted suicide in certain circumstances. Several states are now considering legislation to bring this about and make the United States the first place in the civilized world where physician aid in dying is sanctioned. In the Netherlands, where physician-assisted suicide is practiced but officially remains illegal, 85% of assisted suicides occur in the elderly, and most involve the help of general practitioners. In the United States, family physicians provide health care to many older adults with chronic or terminal illness whose numbers will increase as the elderly population expands. The legalization of physician-assisted suicide would affect the way American physicians practice medicine in unpredictable ways, yet physicians are participating relatively little in deliberations concerning this issue. The problem of suffering in persons with chronic and terminal illness cannot be ignored. Compassionate, effective, and ethical solutions must be found. As a former family physician and now geriatric psychiatrist, I review the pros and cons of physician-assisted suicide (emphasizing arguments against legalization) and encourage family physicians to debate this matter.

Aged↗
PubMed1992

Screening for depression in hospitalized elderly medical patients: taking a closer look.

OBJECTIVE: To re-examine the test characteristics of the Geriatric Depression Scale (GDS) and the Brief Carroll Depression Rating Scale (BCDRS) in elderly medical inpatients, simulating the procedure followed by clinicians when using screening instruments. DESIGN: Masked comparison of GDS and BCDRS with psychiatric interview. SETTING: Durham VA Medical Center. PARTICIPANTS: 109 consecutively admitted persons aged 70 or over. MEASUREMENTS: Screening by a social worker using GDS and BCDRS on day one, followed the next day by an investigator's structured psychiatric interview to determine the presence of major depressive disorder (MDD). RESULTS: By this method, the sensitivity and specificity of the GDS (cutoff 11) were 82% and 76%, respectively; for the BCDRS (cutoff 6), they were 73% and 79%. Among those with a negative test, the likelihood of MDD dropped from an a priori probability of 10% to an a posteriori probability of 3% with the GDS and 4% with the BCDRS. Among those with a positive test, the likelihood of MDD was 27% for the GDS and 28% for the BCDRS. Excluding patients with cognitive impairment (MMSE < or = 25) only slightly improved test characteristics. CONCLUSION: These estimates are considerably below those reported in earlier studies where concordant screening, two-stage screening, or other methods have been utilized and may impact the decision whether or not to screen for depression using these instruments.

Aged↗
PubMed1992

Religious coping and depression among elderly, hospitalized medically ill men.

OBJECTIVE: The investigators examined the frequency of religious coping among older medical inpatients, the characteristics of those who use it, and the relation between this behavior and depression. METHOD: The subjects were 850 men aged 65 years and over, without psychiatric diagnoses, who were consecutively admitted to the medical or neurological services of a southern Veterans Administration medical center. Religious coping was assessed with a three-item index. Depressive symptoms were assessed by self-rating (the Geriatric Depression Scale) and observer rating (the Hamilton Rating Scale for Depression). RESULTS: One out of every five patients reported that religious thought and/or activity was the most important strategy used to cope with illness. Variables that were associated with religious coping included black race, older age, being retired, religious affiliation, high level of social support, infrequent alcohol use, a prior history of psychiatric problems, and higher cognitive functioning. Depressive symptoms were inversely related to religious coping, an association which persisted after other sociodemographic and health correlates were controlled. When 202 men were reevaluated during their subsequent hospital admissions an average of 6 months later, religious coping was the only baseline variable that predicted lower depression scores at follow-up. CONCLUSIONS: These findings suggest that religious coping is a common behavior that is inversely related to depression in hospitalized elderly men.

Adaptation, Psychological↗
PubMed1992

Religious affiliation and major depression.

Data from the Duke Epidemiologic Catchment Area survey were used to examine the relationship between religious affiliation and major depression among 2,850 adults in the community. Religious affiliations were categorized into six groups: mainline Protestant (27 percent), conservative Protestant (59 percent), Pentecostal (4.2 percent), Catholic (2.4 percent), other religions (2.6 percent), and no affiliation (4.4 percent). The six-month prevalence of major depression among Pentecostals was 5.4 percent, compared with 1.7 percent for the entire sample. Even after psychosocial factors such as gender, age, race, socioeconomic status, negative life events, and social support were controlled for, the likelihood of major depression among Pentecostals was three times greater than among persons with other affiliations. Carefully designed studies are needed to understand the complex interactions of religion and mental health.

Adolescent↗
PubMed1992

Self-rated depressive symptoms in medical inpatients: age and racial differences.

One thousand and eleven men under age forty (n = 161) or over age sixty-four (n = 850) admitted to medical and neurological services of an acute care hospital were screened for depressive symptoms as part of the Durham VA Mental Health Survey. Thirty-three percent of younger and 22 percent of older men scored 11 or higher on the Geriatric Depression Scale. Self-rated symptoms were most prevalent among younger whites (40%) and least common in older blacks (19%). Other exogenous factors such as being retired or unemployment and prior psychiatric history were also related to depressive symptoms, as were poor functional status, impaired cognitive status, and respiratory illness. Coping resources associated with fewer symptoms were social support and moderate alcohol use. In a subgroup of 443 patients, self-rated symptoms were compared with observer-rated symptoms. Agreement was highest among young Whites and lowest in older Blacks. Other correlates also varied depending on whether self-rated or observer-rated symptoms were considered. We conclude that self-rated symptoms are common among medical inpatients, are linked with and confounded by certain health and sociodemographic factors, and may be relatively insensitive as a measure of depression in elderly blacks.

Adult↗
PubMed1992

A brief depression scale for use in the medically ill.

OBJECTIVE: Using items from two existing depression scales, we have sought to develop a brief self-rated instrument for detecting major depressive disorder (M.D.D.) in medically ill, hospitalized patients. METHOD: Forty-two items from the Geriatric Depression Scale (G.D.S.) and Carroll Depression Scale were administered to 559 men under age 40 or over age 70 consecutively admitted to the hospital. Eighty-two M.D.D.'s were diagnosed in this group by structured psychiatric interview. After eliminating 12 items confounded by medical illness, 11 items were selected using regression analysis, correlation with the total score, and factor analysis. The 11-item scale includes an assessment of the five DSM-III-R criteria for M.D.D. which are least confounded by medical illness (mood, suicidal intent, guilt or worthlessness, concentration, and psychomotor agitation). The scale was then tested in 78 medical inpatients who were later assessed for M.D.D. using a structured psychiatric interview. RESULTS: Ten out of twelve M.D.D.'s were identified (83% sensitivity) and depression excluded in 51 of 66 non-depressed subjects (77% specificity) (compared with 82% sensitivity and 76% specificity for the 30-item G.D.S.). Scores on the 11-item scale were also correlated with the G.D.S. (.92), the Zung Depression Scale (.58), and the C.E.S.-D (.67). CONCLUSION: The 11-item scale is a practical tool for clinicians who screen patients for depression and for investigators who need a brief measure of depression in studies involving medical inpatients.

Adult↗
PubMed1992

Epidemiology of geriatric affective disorders.

Recent Epidemiologic Catchment area studies found the prevalence of major depression to be only about 1% in community-dwelling elders; other less severe depressive disorders, however, may be present in over 25% of this population. Furthermore, at least 8000 persons over age 60 commit suicide each year, making up nearly one quarter of the total number reported, a rate much higher than expected given the proportion of elderly in the US population. Bipolar disorder, on the other hand, is much less common than unipolar depression at a rate of about 0.1% in the community; in nursing homes, however, as many as 10% of residents may have this condition. Sociodemographic correlates of depression in late life include female sex, divorced or separated marital status, low income or educational level, inadequate social support, and recent negative and unexpected life events. In particular, physical health has a major impact on mood and well-being; consequently, rates of major depressive disorder in elders hospitalized with medical illness are over 10 times that reported in the community.

Aged↗
PubMed1991

Major depressive disorder in hospitalized medically ill patients: an examination of young and elderly male veterans.

OBJECTIVE: To study the epidemiology of depressive disorder in younger and older medical inpatients. DESIGN, PATIENTS, & SETTING: Depressive disorders were examined using the Diagnostic Interview Schedule in 116 young and 332 elderly medically ill men hospitalized in a VA medical center. RESULTS: Major depressive disorder was diagnosed in 22.4% of men under 40 and 13.3% of those age 70 or over; minor depression was found in 18.1% of young and 29.2% of older men. Besides age, other risk factors for major depression were impaired social support, severe medical illness or functional disability in older men, and history of psychiatric problems primarily in younger men; specific medical diagnosis was not a risk factor. Major depression was associated with more severe symptomatology in younger patients; in both age groups, however, symptoms were of prolonged duration and frequently included suicidal thoughts. CONCLUSIONS: Depressive disorder in hospitalized male veterans is common, varies with age, severity of medical illness, degree of social support, and history of psychiatric problems and is associated with considerable psychological morbidity.

Adult↗
PubMed1991

Religious perspectives of doctors, nurses, patients, and families.

Reports the results of a survey examining religious denomination, belief in a higher power, church attendance, and religious coping among physicians (N = 130), nurses (N = 39), patients (N = 77), and families (N = 60). Differences are noted and discussed. Notes that while a large proportion of patients and families found religion to be the most important factor enabling them to cope, only a small percentage of physicians felt that way. Observes that the results of this and other studies may indicate a gap in religious orientation between health care providers and patients and that such a gap could hinder the recognition of and proper care for spiritual needs in the hospital setting.

Adaptation, Psychological↗
PubMed1991

Pastoral research in a hospital setting: a case study.

Provides a summary of research procedures and outcome data of a utilization review of the pastoral services of a large university medical center. Notes particularly the value of such a project both in terms of concrete knowledge gained and in terms of serendipitous discoveries leading to further research.

Chaplaincy Service, Hospital↗
PubMed1991

Depressive disorders in older medical inpatients.

Symptoms of depression that are temporary or caused by physical illness can be difficult to differentiate from those that represent a depressive disorder. A diagnosis of depressive disorder depends on the underlying cause, and on the nature, severity and duration of symptoms. Management involves accurate diagnosis and treatment of medical illness, practical interventions to resolve concurrent family, social and economic stressors, and emotional support. Cognitive, behavioral and brief psychodynamic therapies may be helpful in selected cases. Antidepressants and electroconvulsive therapy have a role in the treatment of severe or persistent depression associated with suicidal behavior, marked psychomotor retardation, starvation or other life-threatening symptoms. Suicidal thoughts are frequent in older patients with concurrent major depression and chronic illness, and measures to ensure patient safety are a priority.

Aged↗
PubMed1990

Use of antidepressants in medically ill older patients.

Major depression is common in older medical patients, and it can exert a deleterious effect on the treatment, course, and outcome of physical illnesses. Tricyclic or tetracyclic antidepressants (TCAs) and psychosocial interventions often play a role in the treatment of depressed medically ill patients, but well-founded doubts about the efficacy and the safety of TCAs in older, frail medical patients have developed. Based on a review of current knowledge about antidepressant use in these patients, the authors recommend the cautious use of TCAs in medically ill older patients until more data are available.

Aged↗
PubMed1990

Religious cognitions and use of prayer in health and illness.

Forty adults aged 65-74 were asked about God's role in health and illness and about their use of prayer in response to recent physical symptoms. Most held a belief in a benevolent God but were not clear about God's role in health and illness. Over half had prayed about at least one symptom the last time they had it. The least-educated respondents and the Baptists were most likely to pray. Symptoms discussed with a physician or for which drugs were taken were more likely than others to be prayed over, suggesting that prayer may be used for symptoms seen as serious and that prayer and medical help-seeking are not mutually exclusive.

Aged↗
PubMed1989

Survival and health care utilization in elderly medical inpatients with major depression.

Forty-one elderly medical inpatients with active major depression were matched with nondepressed controls from the same population. Survival and health care utilization were examined during a mean follow-up period of five months. Cases and controls were matched by age, functional status, severity and type of medical illness, and extent of disease. In-hospital mortality was significantly higher among depressed compared with nondepressed controls (6 vs 0 deaths, P = .03). For patients discharged from the hospital alive, however, depression did not have a substantial impact on mortality (31.4% cases, 31.7% controls). Health care utilization--in terms of days of inpatient care--was significantly higher both during the index admission (25 vs 14 days, P less than .005) and during the follow-up period (16 vs 7 days, P less than .05) for depressed patients compared with controls. Hence, older medically ill patients with major depression consume more healthcare resources and experience greater mortality during their initial hospital stay. After discharge, while survival is little affected, excess resource utilization persists among those with depression.

Activities of Daily Living↗
PubMed1989

Major depression and the NIMH Diagnostic Interview Schedule: validation in medically ill hospitalized patients.

The authors validate the usefulness of the Diagnostic Interview Schedule (DIS) in prevalence studies of major depression (MD) in medically ill male veterans. The affective disorders portion of the DIS was administered by a trained interviewer to a representative sample of 408 medically-ill hospitalized patients (75% over age 70). Using a standardized handscoring method for the DIS, the patients were categorized as having or not having MD. Using a two-stage design, sixty-nine patients scoring above a cutoff score on a self-rated depression scale were referred for blind evaluation by a psychiatrist. The psychiatrist made a clinical diagnosis of MD using a standard checklist of DSM-III criteria. The DIS correctly diagnosed MD in 78 percent (14/18) of older and 69 percent (9/13) of younger patients, and correctly ruled out the disorder in 65 percent (15/23) of older and 67 percent (10/15) of younger patients; the kappa statistic of agreement was .40 in older and .36 in younger patients.

Adult↗
PubMed1989

Physician perspectives on the role of religion in the physician-older patient relationship.

A study of 160 family physicians and general practitioners found that the majority of physicians believed that religion has a positive effect on the mental health of older patients, and many believed that religion has a positive effect on physical health. While more than one half reported that patients only rarely, if ever, mentioned religious issues during a medical visit, a significant proportion of the physicians felt they should address religious issues when an older person indicates religion's importance and that religious issues should not be reserved completely for the clergy. Nearly two thirds of the physicians felt that prayer with patients was appropriate under certain circumstances, and over one third reported having prayed with older patients during extreme physical or emotional distress. Older physicians were less likely than younger to have positive attitudes toward addressing religious issues. The strongest predictors of physicians' belief in the appropriateness of addressing religious concerns were two attitudinal variables that indicated an understanding of the importance of religion in the lives of older adults and an awareness that patients might desire to engage in prayer with them. Hence, the beliefs and attitudes of the physician appear to be important factors in determining their receptivity to discussion of religious issues, which in turn may influence whether patients mention such issues in the context of the medical visit.

Aged↗