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Biomedical subjects

J C Coyne

Publications and source records attributed to J C Coyne.

At least 19 recordsLinked to original sources
PubMed1998

The nature and prevalence of anxiety disorders in primary care.

Primary goals of this study were to 1) establish the prevalence, nature, and correlates of anxiety disorders in primary care, and 2) examine the comorbidity of anxiety disorders with major depressive disorder. A weighted sample of 425 patients drawn from the waiting rooms of primary care physicians was used. Anxiety disorders were highly prevalent, relatively mild, and often comorbid with depression. Anxiety disorders aided physicians in their detection of depression. However, anxiety disorders were also misdiagnosed as depression. Although anxiety disorders are common in primary care, their relative mildness may generally not warrant increased attention by primary care physicians to detection and treatment. Instead, efforts should be focused on the more severe and impairing cases of anxiety disorder.

Adolescent↗
PubMed1998

Effects of recent and past major depression and distress on self-concept and coping.

The Self-Appraisal Questionnaire (J. C. Coyne & M. M. Calarco, 1995) was used to examine how primary care and psychiatric outpatients with recent or past major depression appraised their prospects and structured their lives. They were compared with nondistressed and distressed primary care patients. Both depressed groups scored higher than the nondistressed patients for Lack of Energy, Management of Burden on Others, Need to Maintain a Balance in Life, Fear of Taking Risks, Imposition of Limitations on Life, and Sense of Stigma. The distressed group fell between the depressed psychiatric and the nondistressed groups, and generally did not differ from the depressed primary care group. Past depression did not explain differences associated with more recent depression and distress. Distress entails a need to manage its effects on others, but depression in psychiatric patients may produce a more profound reorganization of self-concept, relationships, and coping.

Adaptation, Psychological↗
PubMed1997

Short-term outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients.

The aims of this study were to determine whether detection of major depression in primary care was associated with improved outcome, and to compare the 4.5 month outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients. Primary care patients with major depression were recruited from the practices of 50 family physicians in Southeastern Michigan using a two-stage selection procedure employing the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Structured Clinical Interview for DSM-III-R (SCID); clinician detection of depression was ascertained by response to a direct query on a rating form. Depressed patients seeking treatment in an outpatient psychiatric setting also received the CES-D and the SCID. Data on patient demographics and clinical characteristics were obtained for both primary care and psychiatric patients. Initial and 4.5 month scores on the Hamilton Depression Rating Scale (HAM-D) were obtained for 34 undetected and 25 detected depressed primary care and 55 depressed psychiatric patients. Improvement in depression over time was assessed by the change in HAM-D scores over the 4.5 months. The three groups did not differ in initial severity. Both psychiatric and undetected primary care patients showed significant improvement at 4.5 months, whereas detected primary care patients did not improve. At 4.5 months there were no differences in mean HAM-D scores between undetected, depressed primary care patients and depressed psychiatric outpatients. This result did not change after controlling for age and severity of depression at initial presentation, nor did it change after exclusion of cases of mild depression to control for a possible "floor effect." However, differences among groups in the stage of depressive episodes may have affected this comparison. These findings suggest that an exclusive focus on increasing detection of depression in primary care patients is unlikely to improve outcomes, and that undetected depression among primary care patients does not necessarily represent poor quality of care. Although depressed psychiatric patients in this study had better outcomes than detected depressed primary care patients, the presence of unmeasured differences among groups in the stage of the depressive episode makes it impossible to determine whether treatment of depression by psychiatrists is superior to that provided by primary care physicians. These findings should stimulate efforts to examine a more comprehensive model for detection and treatment of depression in primary care.

Adult↗
PubMed1997

The relationship of distress to mood disturbance in primary care and psychiatric populations.

Disagreement remains as how to interpret elevated scores on measures of self-reported distress. This study compared elevated scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) in 2 samples to mood disturbance as assessed in an interview. In a primary medical care sample, most distressed patients did not have a mood disturbance, and distress without mood disturbance was associated with little impairment. Primary care patients with elevated scores on the CES-D were less distressed and less likely to have mood disturbance, major depression, or impairment than distressed psychiatric patients. Few patients with mood disturbance in either sample failed to meet criteria for major depression. Implications are discussed for research on depression using self-report measures, for generalizations across clinical and nonclinical populations, and for screening for preventive interventions.

Adolescent↗
PubMed1997

Emotional and physical intimacy in coping with lupus: women's dilemmas of disclosure and approach.

This study examined whether self-rated physical and emotional intimacy of 74 women with their heterosexual partner, during an illness episode of lupus, was related to their affect and relationship satisfaction. It was predicted that greater intimacy would be related to better psychosocial adjustment. Women who engaged in physically intimate behavior with their partner more often reported greater relationship satisfaction. Women who frequently avoided or who were often the initiators of physical intimacy, however, reported greater negative affect. Concerning emotional intimacy, women who disclosed more information about illness symptoms and women who concealed more information about their symptoms and feelings experienced the highest levels of negative affect. Results identify dilemmas that women with recurrent illness may face when trying to maintain intimacy during illness periods.

Adaptation, Psychological↗
PubMed1997

Depression in primary care--more like asthma than appendicitis: the Michigan Depression Project.

OBJECTIVE: To explore the relationships between detection, treatment, and outcome of depression in the primary care setting, based upon results from the Michigan Depression Project (MDP). METHODS: A weighted sample of 425 adult family practice patients completed a comprehensive battery of questionnaires exploring stress, social support, overall health, health care utilization, treatment attitudes, self-rated levels of stress and depression, along with the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D), and the Structured Clinical Interview for DSM-III (SCID), which served as the criterion standard for diagnosis. A comparison sample of 123 depressed psychiatric outpatients received the same assessment battery. Family practice patients received repeated assessment of depressive symptoms, stress, social support, and health care utilization over a period of up to 60 months of longitudinal follow-up. RESULTS: The central MDP findings confirm that significant differences in past history, severity, and impairment exist between depressed psychiatric and family practice patients, that detection rates are significantly higher for severely depressed primary care patients, and that clinicians use clinical cues such as past history, distress, and severity of symptoms to "detect" depression in patients at intermediate and mild levels of severity. As well, there is a lack of association between detection and improved outcome in primary care patients. CONCLUSION: These results call into question the assumption that "depression is depression" irrespective of the setting and physician, and they are consistent with a model of depressive disorder as a subacute or chronic condition characterized by clinical parameters of severity, staging, and comorbidity, similar to asthma. This new model can guide further investigation into the epidemiology and management of mood disorders in the primary care setting.

Adolescent↗
PubMed1996

Differences between detected and undetected patients in primary care and depressed psychiatric patients.

The aim of this study was to explore differences between primary care and tertiary psychiatry patients meeting DSM-III-R criteria for depressive disorders in terms of a wide range of demographic and clinical variables including psychiatric comorbidity. A weighted sample of 153 depressed primary care patients was obtained from the waiting rooms of family physicians using a two-stage selection and assessment procedure including the Structured Clinical Interview for the DSM-III-R (SCID). A measure of physician detection was also obtained. The 123 depressed psychiatric patients were seeking evaluation and treatment at a university-based depression program, and DSM-III-R diagnoses were also obtained using the SCID. Overall, fewer depressed primary care patients met criteria for major depressive disorder, and more of those who did were only midly depressed. Depressed primary care patients were more likely to be women, older, and had less education, less past treatment, and greater lifetime comorbidity. Clinical differences were greatest for the depressed patients who had gone undetected by their physicians: they were higher functioning, less distressed, and more mildly depressed. Findings are discussed in terms of the validity and acceptability of practice guidelines for depression in primary care.

Adult↗
PubMed1996

Sense of belonging and indicators of social and psychological functioning.

Sense of belonging has recently been described and defined as one specific interpersonal process that influences health. The purpose of this study was to examine the relationships between sense of belonging and personal characteristics and selected indicators of social and psychological functioning in men and women. Using a sample of 379 community college students, sense of belonging was examined in relation to social support, conflict, involvement in community activities, attendance at religious services, loneliness, depression, anxiety, history of psychiatric treatment, and suicidality. Results indicated that sense of belonging is closely related to indicators of both social and psychological functioning. These relationships were generally stronger for women than for men. It appears that sense of belonging is a useful concept pertinent to exploration of social and psychological functioning.

Adaptation, Psychological↗
PubMed1996

The mismeasure of coping by checklist.

Hundreds of studies have now used standardized checklists to assess respondents' self-reports of coping with naturally occurring stress. This article presents a critical review of the conceptual and methodological issues involved in the use of these checklists. As they are currently employed, conventional checklists render an incomplete and distorted portrait of coping. Specifically, these checklists are grounded in too narrow a conception of coping; the application and interpretation of checklists in the typical study are not faithful to a transactional model of stress and coping; statistical controls cannot eliminate the effects of key person and situation variables on coping; and no consistent interpretation can be assigned to coping scale scores. Researchers are encouraged to consider a broader range of methods for assessing coping, including semistructured interviews, customized checklists tailored to their specific hypotheses and objectives, daily diaries, and traditional trait measures.

Adaptation, Psychological↗
PubMed1996

Parents' sense of "entitlement" in adoptive and nonadoptive families.

The literature suggests that problems with developing a sense of entitlement are unique to adoptive families, but this assumption has not been examined empirically. In this study, a questionnaire was constructed to define operationally those characteristics associated with the construct of entitlement, and was administered to adoptive and nonadoptive families with children averaging 11.5 years in age who presented either for mental health service or were recruited as a comparison-control sample. Factor analysis yielded four factors on which the four groups of subjects were compared. Results indicated that problems with entitlement are not specific to adoptive families. Instead, differences in sense of entitlement occurred primarily between clinic and nonclinic control families, regardless of whether the target child had been adopted. Findings are discussed in terms of methodological shortcomings in the adoption research literature and how problems in entitlement may be associated with other family characteristics.

Adolescent↗
PubMed1995

Nondetection of depression by primary care physicians reconsidered.

This article examines the rates of detection for major depression and other depressive disorders by family physicians as well as the differences between detected and undetected cases in terms of a variety of demographic and clinical variables. A total of 1,580 family practice patients completed a screening form and were rated by their physician. Patients with elevated Center for Epidemiologic Studies-Depression Scale (CES-D) scores were oversampled for possible interviews using the Structure Clinical Interview for DSM-III-R (SCID). In the resulting weighted sample, family physicians detected 34.9% of cases of major depression and 27.9% of cases of any depressive disorder. Detection was associated with pharmacological and psychological intervention. However, the undetected cases tended to be mildly depressed and higher functioning. Presence of a current anxiety disorder facilitated detection. Overall, the mildness of undetected depression and associated impairment have implications for estimates of the consequences of primary care physicians' low rates of nondetection and for the development of interventional strategies to improve their performance.

Adult↗
PubMed1995

Issues in personality as diathesis for depression: the case of sociotropy-dependency and autonomy-self-criticism.

A congruency between personality and life stress is assumed to pose a particular risk for depression. The authors review relevant research as a way of examining broader issues entailed in diathesis-stress models of depression. Topics include the identification of distinct personality modes and the differentiation of these modes from the phenomena of depression and the influence of the social context. Diathesis-stress models face formidable conceptual and methodological challenges. More complex models are needed to accommodate the dynamics of a person's life course, involvement in significant social contexts, and fluctuations in vulnerability to depression. Base rates of key phenomena favor development of models of depression recurrence in high-risk samples rather than its onset in the general population.

Adult↗
PubMed1995

Effects of the experience of depression: application of focus group and survey methodologies.

The popularity of cognitive theories of depression has not appreciably increased attention to the effects of depression on how its sufferers subsequently think about themselves and structure their lives. As a first step in a program of systematic research, we recruited recent and former depressed psychiatric patients to participate in focus group discussions of their experience of depression and how it has affected them. Statements elicited in two focus groups were classified into eight categories: lack of energy and the loss of self-efficacy, fear of recurrence, fear of taking risks, inability to trust oneself, self-presentation and concealment, concern about being a burden to others, secondary guilt about having been depressed, and reduced involvement in interpersonal relationships. These results were then used as the basis for the construction of a survey instrument, the Self-Appraisal Questionnaire (SAQ), and strong differences were found between recently recovered depressed women and a sample of women without a history of depression. Taken together, results of the focus groups and the survey study support the utility of a limited "sick role" for recovering depressed persons.

Adaptation, Psychological↗
PubMed1994

Prevalence, nature, and comorbidity of depressive disorders in primary care.

This article examines the prevalence, nature, and comorbidity of depressive disorders using DSM-III-R criteria among patients recruited from the waiting rooms of family physicians. A total of 1928 family practice patients completed a screening form including the Center for Epidemiologic Studies-Depression Scale (CES-D), and patients with elevated CES-D scores were oversampled for possible interviews using the Structured Clinical Interview for the DSM-III-R (SCID). In the resulting weighted sample of 425, a prevalence of 13.5% was obtained for major depression and 22.6% for all depressive disorders. Over 40% of the patients with major depressive disorder (MDD) were only mildly depressed. Gender and other demographic variables failed to distinguish depressed patients, but a variety of self-ratings did. Depression was associated with comorbid anxiety disorders and substance abuse. Results are discussed in terms of the implications of depression in primary care as a public health problem, but also in terms of some diagnostic issues, particularly the use of an impairment criterion for major depression.

Adult↗
PubMed1994

The relationship of self-reported distress to depressive disorders and other psychopathology.

The relationship between self-reported depression and a clinical diagnosis of depression was investigated. Within 2 weeks of completing the Center for Epidemiologic Studies Depression Scale (CES-D), a stratified sample of 425 primary medical care patients received the structured interview for the DSM-III-R. In the weighted data set, the CES-D was significantly related to a diagnosis of depression but also to other Axis I disorders. Most distressed subjects were not depressed, a fifth of the patients with major depressive disorder (MDD) had low distress, and the CES-D performed as well in detecting anxiety as in detecting depression. MDD, other depression diagnoses, and anxiety and substance use disorders were all significant predictors of CES-D score. Differences in demographic variables, treatment history, and impairment highlight the nonequivalence of the self-report scale and diagnosable depression. The use of a self-report in place of an interview-based diagnostic measure in the study of depression, as well as the use of such a report as a screening device, is discussed.

Adolescent↗
PubMed1994

Self-reported distress: analog or Ersatz depression?

Vredenburg, Flett, and Krames's (1993) conclusion that self-reported distress in college students is an appropriate analog for diagnosable depression is examined in light of a broader literature. Self-reported distress is conceptually and empirically distinct from depression and depressive symptoms. Distress has stronger correlates with common psychological and social factors. Distress in college students tends to be mild and transient, and most distressed college students are not depressed. Some other features of college life also make generalizations to clinical and community samples of adults problematic. Overall, ubiquitous misunderstandings in the literature have limited recognition of the pitfalls of studying distress as an analog for diagnosable depression. It is undesirable for reasons of science, social responsibility, and the credibility of psychological models of depression.

Depression↗
PubMed1993

The health status and health care utilization of deaf and hard-of-hearing persons.

OBJECTIVE: To evaluate whether health habits, self-reported health status, and communication with physicians play a role in the known altered health care utilization patterns of deaf and hard-of-hearing persons. DESIGN: A cross-sectional survey. Respondents were given the choice of completing either a self-administered written survey or an American Sign Language interview-administered survey. POPULATION: Eighty-seven deaf and hard-of-hearing members of various organizations serving this population in southeastern Michigan and 88 hearing patients from a family practice clinic in the same area. RESULTS: Deaf and hard-of-hearing persons visit physicians more frequently (P = .01), have a lower incidence of ever smoking tobacco (P < .0006) and of alcohol use (P = .04), have more difficulties communicating with physicians (P < .001), have trouble understanding physicians (P < .001), and feel less comfortable with physicians (P < .001). Lower current tobacco use among deaf and hard-of-hearing persons was only seen in persons who were not educated beyond high school. Increased frequency of physician visits for deaf and hard-of-hearing persons was especially noticeable in the group of persons 60 years of age and older. Our finding that use of interpreters is associated with increased utilization and decreased understanding suggests deaf and hard-of-hearing patients presenting with interpreters warrant more focused attention from physicians. Reasons for seeing physicians did not explain the difference in frequency of physician visits between the two groups. CONCLUSIONS: Deaf and hard-of-hearing persons report a lower subjective health status and higher physician utilization, as well as substantial communication difficulties with physicians. They also report better health-related behaviors, namely less use of tobacco and alcohol. The use of interpreters did not decrease physician utilization or improve the understanding of physicians by these persons. Overall, our results underscore the fact that deaf and hard-of-hearing persons constitute a minority population that experiences considerable difficulties in the patient-physician relationship.

Adult↗