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Biomedical subjects

Joseph Westermeyer

Publications and source records attributed to Joseph Westermeyer.

At least 19 recordsLinked to original sources
PubMed2006

Remission from pathological gambling among Hispanics and Native Americans.

This community survey studied remission from pathological gambling (PG) among American Indian (AI) and Hispanic American (HA) veterans. Remission was defined as having a lifetime diagnosis of PG, but no gambling symptoms in the last year. Sample consisted of 1624 AI and Hispanic veterans. Instruments included demographic data, the computer-based algorithmic Quick Diagnostic Interview Schedule Symptom, and three symptom checklists, one each for substance related problems (MAST/AD), anxiety and depressive symptoms (BSI-57), and combat-related post-trauma symptoms (PCL/M). Remission was associated with absence of a current Axis 1 diagnosis, especially absence of a current post-traumatic stress disorder.

Adult↗
PubMed2006

Substance use disorder (SUD) morbidity versus number of parents with SUD.

OBJECTIVES: To assess the association between numbers of parents (i.e., 0, 1 or 2) with Substance Use Disorder (SUD) and proband's SUD severity and morbidity. DESIGN: Descriptive, cross-sectional. SETTINGS: Alcohol-drug treatment programs in two university medical centers. SUBJECTS: 597 voluntary patients aged 18 and older with SUD; adoptees excluded. RESULTS: On univariate analysis, parental SUD was associated with ten characteristics. On logistic regression analysis, having any parental SUD was associated with lower socioeconomic status, younger age at using tobacco, more severity on M-SAPS, and lower psychosocial function in the last year (Axis 5) as threshold effects. Logistic regression analysis comparing 1 versus 2 parents with SUD showed that those with 2 SUD parents began using alcohol at an earlier age as compared with having 1 SUD parent; this was an additive effect. CONCLUSIONS: Parental SUD affects the proband's SUD severity in a threshold fashion.

Adolescent↗
PubMed2006

Assessing war trauma in refugees: properties of the Comprehensive Trauma Inventory-104.

In this article, the authors describe the properties of the Comprehensive Trauma Inventory-104 (CTI-104), developed and designed empirically to improve assessment of traumatic war-related events. The mean number of events reported by 252 community dwelling Kurdish and Vietnamese refugees was 32 (SD=27) out of the 104 items. Internal and test-retest reliability was excellent, and the validity of the CTI-104 as a measure of war trauma was supported by its high correlation with standard measures of known outcomes of trauma. The CTI-104 is reliable and valid, and assesses a broader range of traumatic war-related events in a broader range of refugees than currently available instruments.

Adult↗
PubMed2006

Psychiatric morbidity and parental substance use disorder.

OBJECTIVE: To assess psychiatric morbidity associated with having no, one, or two parents with Substance Use Disorder (SUD), among patients receiving SUD care. DESIGN: Two measures of psychiatric morbidity included (a) current psychopathology and (b) lifetime use of psychiatric treatment. SETTINGS: Alcohol-drug treatment programs were located in two university medical centers. SUBJECTS: Four hundred ninety-five voluntary patients aged 18 and older and non-adopted. RESULTS: Parental SUD was directly related to (a) more current psychiatric symptoms, both self-rated and psychiatrist-rated and (b) greater likelihood of ever having ever received psychiatric treatment. Among those who had ever received psychiatric care, the number of psychotropic medications was related to parental SUD. Number of admissions, venues, visits/days, and cost of psychiatric care were not associated with parental SUD. CONCLUSIONS: Extent of parental SUD was related to increased psychiatric morbidity.

Adolescent↗
PubMed2006

Co-morbid traumatic brain injury and substance use disorder: childhood predictors and adult correlates.

PRIMARY OBJECTIVE: To examine demographic factors, childhood experiences and behaviour problems and adult psychopathology associated with a history of adult traumatic brain injury (TBI) with unconsciousness in patients with substance use disorders (SUD). DESIGN AND METHODS: Voluntary patients (n = 550) undergoing treatment for SUD were compared for clinical and demographic variables based on report of TBI. RESULTS: Among the 218 (40%) patients reporting TBI, 61% were men. Childhood conduct problems and loss of a parent were strongly associated with adult TBI. Patients with TBI had more severe SUD and higher rates of depressive and anxiety symptoms, somatic concerns, physical trauma, attempted suicide and Antisocial Personality Disorder. CONCLUSIONS: Men have a higher rate of TBI than women, but women with SUD have an increased relative risk of TBI compared to women in the general population. Childhood conduct problems and loss of a parent in childhood may predict adult risk-taking behaviour that leads to TBI in patients with SUD. TBI is associated with higher rates of psychopathology in patients with SUD.

Adolescent↗
PubMed2006

Somali and Oromo refugee women: trauma and associated factors.

AIM: This paper reports a study identifying the demographic characteristics, self-reported trauma and torture prevalence, and association of trauma experience and health and social problems among Somali and Oromo women refugees. BACKGROUND: Nearly all refugees have experienced losses, and many have suffered multiple traumatic experiences, including torture. Their vulnerability to isolation is exacerbated by poverty, grief, and lack of education, literacy, and skills in the language of the receiving country. METHOD: Using data from a cross-sectional population-based survey, conducted from July 1999 to September 2001, with 1134 Somali and Oromo refugees living in the United States of America, a sub-sample of female participants with clearly identified parenting status (n = 458) were analysed. Measures included demographics, history of trauma and torture, scales for physical, psychological, and social problems, and a post-traumatic stress symptom checklist. FINDINGS: Results indicated high overall trauma and torture exposure, and associated physical, social and psychological problems. Women with large families reported statistically significantly higher counts of reported trauma (mean 30, P < 0.001) and torture (mean 3, P < 0.001), and more associated problems (P < 0.001) than the other two groups. Women who reported higher levels of trauma and torture were also older (P < 0.001), had more family responsibilities, had less formal education (P < 0.001) and were less likely to speak English (P < 0.001). CONCLUSION: These findings suggest a need for nurses, and especially public health nurses who work with refugee and immigrant populations in the community, to develop a more comprehensive understanding of the range of refugee women's experiences and the continuum of needs post-migration, particularly among older women with large family responsibilities. Nurses, with their holistic framework, are ideally suited to partner with refugee women to expand their health agenda beyond the biomedical model to promote healing and reconnection with families and communities.

Adaptation, Psychological↗
PubMed2006

Alcohol craving in outpatients with alcohol dependence: rate and clinical correlates.

OBJECTIVE: The present study was undertaken to assess the rate and severity of alcohol craving symptoms among registered alcohol-dependent patients at a Veterans Affairs outpatient clinic. We also examined the relationship between alcohol craving and the clinical characteristics of alcohol-dependent patients. METHOD: Participants included 101 alcohol-dependent veterans enrolled in an outpatient addiction clinic. Alcohol craving was measured by the Penn Alcohol Craving Scale. Alcoholism severity and clinical characteristics were assessed with the Addiction Severity Index, Timeline Followback method, and other instruments. Three alcohol-craving groups (low, moderate, and high) were identified and compared using their demographic and clinical characteristics. Multiple regression analysis was performed to evaluate the relationship between the potential predictors and alcohol craving. RESULTS: The rate of alcohol craving was as follows: low craving (46%), moderate craving (29%), and high craving (25%). When these three craving groups were compared using univariate analyses, patients with higher alcohol craving had significantly higher alcohol composite scores (last 30 days) and severe alcohol dependence (last 1 year). In multiple regression analysis, the model explained 50% of the variance in alcohol craving, with alcoholism severity (42%), withdrawal symptoms (5%), and depression (3%) as significant predictors. CONCLUSIONS: Patients in an outpatient treatment setting had a wide range of alcohol cravings. Level of alcohol craving was directly associated with several increased indices of alcohol- and non-alcohol-related morbidity.

Alcoholism↗
PubMed2005

Association of antisocial personality disorder with psychiatric morbidity among patients with substance use disorder.

OBJECTIVES: The aims were to determine among patients with Substance Use Disorder (SUD) whether patients with Antisocial Personality Disorder (ASPD) manifest less, the same, or more of the following: (1) psychiatric symptoms, (2) family history of psychiatric disorder, (3) psychiatric disorders and morbidity, and (4) psychiatric treatment, as compared to patients without ASPD. DESIGN & DEFINITION: Scheduled interview using DSM-III-R criteria for ASPD, with blinded interviewers making the ASPD classification vs. other assessments. SETTINGS: Alcohol-drug treatment programs located in two university medical centers. SUBJECTS: Six hundred and six voluntary patients aged 18 and older meeting diagnostic criteria for SUD. RESULTS: SUD patients with ASPD reported more family history of non-SUD psychiatric diagnoses and endorsed more hostility symptoms. Demographic characteristics, psychiatric disorder, and past psychiatric treatment did not differ in association with ASPD.

Adolescent↗
PubMed2005

Lifetime prevalence of pathological gambling among american Indian and Hispanic American Veterans.

OBJECTIVES: We examined the prevalence and clinical correlates of pathological gambling among 1228 American Indian and Hispanic American veterans in the southwest and north central regions of the United States. METHODS: We surveyed a community sample of American Indian and Hispanic American veterans to obtain data on psychiatric disorder and treatment. RESULTS: American Indian veterans had a 10% lifetime prevalence of pathological gambling. The Hispanic American lifetime prevalence was less than that of the American Indian veterans but higher than the prevalence found for Hispanic American veterans in other surveys. Comorbid conditions associated with pathological gambling included substance, mood, and antisocial personality disorders. Ready access to casino gambling may encourage, support, or contribute to high rates of pathological gambling in both men and women. CONCLUSIONS: A 70% lifetime comorbidity of psychiatric disorders suggests that early interventions for pathological gambling should consider common psychiatric conditions rather than focusing on pathological gambling alone.

Adolescent↗
PubMed2005

Association of antisocial personality disorder and substance disorder morbidity in a clinical sample.

OBJECTIVES: The aims were to determine among patients with substance use disorder (SUD) whether those with antisocial personality disorder (ASPD) manifest less, the same, or more of the following: 1) temporal course of substance use, 2) severity of substance-related symptoms and problems, 3) familial SUD, 4) number and type of SUD diagnoses, and 5) extent of SUD treatment, as compared to patients without ASPD. DESIGN AND DEFINITION: Scheduled interviews using Diagnostic and Statistical Manual (DSM) criteria were used to determine ASPD, which required childhood conduct disorder plus adult antisocial behavior. Clinicians blind to the ASPD assessment collected the remainder of the data. SETTINGS: Alcohol-drug treatment programs were located in two university medical centers. SUBJECTS: Six hundred and six voluntary patients aged 18 and older met diagnostic criteria for SUD. RESULTS: SUD patients with ASPD reported more substance-related problems in seven out of eight areas of the interview-based Minnesota-Substance Abuse Problems scale. On a self-rated scale, the Michigan Assessment Screening Test/Alcohol-Drug, the difference was unremarkable. The ASPD group reported slightly, but significantly, more relatives with SUD. Lifetime use of tobacco and most illicit drugs was greater in the ASPD group. Age at first use of alcohol and tobacco was less in the ASPD group, but age at first use of other substances did not show a difference. Indicators of SUD course, such as years of use, days of use in the last year, duration of periods of abstinence, and number of self-help efforts showed no differences between the two groups. Types and numbers of SUD diagnoses showed no difference. However, all treatment indicators (i.e., lifetime number of admissions, modalities of care, days of care, and cost of care) were significantly higher in the ASPD group. A regression analysis revealed that family and legal problems remained strongly associated with ASPD, but other substance-related problems and SUD treatment dropped out. CONCLUSIONS: Despite the many similarities in SUD among those with and without ASPD, the morbidity in the ASPD as measured by number and types of substance-related problems and by all treatment variables is considerably greater. Legal and family problems appear to be powerfully associated with ASPD and predictive of other problems as well as SUD treatment.

Adult↗
PubMed2004

Somali and Oromo refugees: correlates of torture and trauma history.

OBJECTIVES: This cross-sectional, community-based, epidemiological study characterized Somali and Ethiopian (Oromo) refugees in Minnesota to determine torture prevalence and associated problems. METHODS: A comprehensive questionnaire was developed, then administered by trained ethnic interviewers to a nonprobability sample of 1134. Measures assessed torture techniques; traumatic events; and social, physical, and psychological problems, including posttraumatic stress symptoms. RESULTS: Torture prevalence ranged from 25% to 69% by ethnicity and gender, higher than usually reported. Unexpectedly, women were tortured as often as men. Torture survivors had more health problems, including posttraumatic stress. CONCLUSIONS: This study highlights the need to recognize torture in African refugees, especially women, identify indicators of posttraumatic stress in torture survivors, and provide additional resources to care for tortured refugees.

Adult↗
PubMed2003

Sampling in difficult to access refugee and immigrant communities.

We evaluated sampling strategies and trust-building activities in a large multiphase epidemiologic study of torture prevalence in populations that were difficult to locate and enroll. Refugee groups under study were Somalis from Somalia and Oromos from Ethiopia who were living in Minneapolis and St. Paul, Minnesota, in 1999-2002. Without a complete sampling frame from which to randomly recruit participants, we employed purposive sampling methods. Through comparative and statistical analyses, we found no apparent differences between our sample and the underlying population and discovered no effects of recruiting methods on study outcomes, suggesting that the sample could be analyzed with confidence. Ethnographic trust and rapport-building activities among investigators, field staff, and immigrant communities made it possible to obtain the sample and gather sensitive data. Maintaining a culture of trust was crucial in recovering from damaging environmental events that threatened data collection.

Analysis of Variance↗
PubMed2002

Measuring trauma and health status in refugees: a critical review.

CONTEXT: Refugees experience multiple traumatic events and have significant associated health problems, but data about refugee trauma and health status are often conflicting and difficult to interpret. OBJECTIVES: To assess the characteristics of the literature on refugee trauma and health, to identify and evaluate instruments used to measure refugee trauma and health status, and to recommend improvements. DATA SOURCES: MEDLINE, PsychInfo, Health and PsychoSocial Instruments, CINAHL, and Cochrane Systematic Reviews (searched through OVID from the inception of each database to October 2001), and the New Mexico Refugee Project database. STUDY SELECTION: Key terms and combination operators were applied to identify English-language publications evaluating measurement of refugee trauma and/or health status. DATA EXTRACTION: Information extracted for each article included author; year of publication; primary focus; type (empirical, review, or descriptive); and type/name and properties of instrument(s) included. Articles were excluded from further analyses if they were review or descriptive, were not primarily about refugee health status or trauma, or were only about infectious diseases. Instruments were then evaluated according to 5 criteria (purpose, construct definition, design, developmental process, reliability and validity) as described in the published literature. DATA SYNTHESIS: Of 394 publications identified, 183 were included for further analyses of their characteristics; 91 (49.7%) included quantitative data but did not evaluate measurement properties of instruments used in refugee research, 78 (42.6%) reported on statistical relationships between measures (presuming validity), and 14 (7.7%) were only about statistical properties of instruments. In these 183 publications, 125 different instruments were used; of these, 12 were developed in refugee research. None of these instruments fully met all 5 evaluation criteria, 3 met 4 criteria, and 5 met only 1 of the criteria. Another 8 standard instruments were designed and developed in nonrefugee populations but adapted for use in refugee research; of these, 2 met all 5 criteria and 6 met 4 criteria. CONCLUSIONS: The majority of articles about refugee trauma or health are either descriptive or include quantitative data from instruments that have limited or untested validity and reliability in refugees. Primary limitations to accurate measurement in refugee research are the lack of theoretical bases to instruments and inattention to using and reporting sound measurement principles.

Health Status↗
PubMed2002

Daily charting of posttraumatic stress symptoms: a pilot study.

This pilot study describes a prospective life-charting method for posttraumatic stress (PTS) symptoms. This method summarizes daily symptoms, functional impairment, life events, substance use, and treatment. Findings include experience with 17 cases over periods lasting from 3 to 25 months, with a description of 4 case examples that are characteristic of the pilot sample. People with posttraumatic stress disorder (PTSD) can complete day charting of their symptoms over an extended period of time. Some people reported that day charting distressed them mildly as they analyzed daily thoughts or feelings that they ordinarily avoided or pushed from awareness. Nonetheless, most people reported that they learned and benefited from daily symptom charting. In addition to enhancing patient self-understanding (or "insight"), the method may prove useful in assessing treatments for PTSD. Finally, these preliminary findings have suggested hypotheses regarding the clinical phenomenology and course of PTSD. For example, PTS symptom cluster exacerbation, severity, and duration appear to be highly consistent within any given patient, but highly variable across patients. Daily charting of PTS symptoms over prolonged periods is feasible. This prospective PTSD symptom charting method may have therapeutic, clinical, and research potential for understanding individual and group patterns in PTSD over time.

Acute Disease↗
PubMed2002

Perceived barriers to VA mental health care among Upper Midwest American Indian veterans: description and associations.

OBJECTIVES: This community-based study was undertaken to understand why Native-American veterans in the Upper Midwest choose not to use VA mental health services despite high rates of certain psychiatric disorders. RESEARCH DESIGN: A sample consisting of 543 Native-American veterans was obtained using a focused-intensive nonprobability sampling method, structured to over-sample urban and female veterans. Data sources included (1) interview (ie, an open-ended query regarding barriers to VA mental health care), (2) questionnaire (demography, psychiatric rating scales), and (3) computer-based diagnostic questionnaire, the Quick Diagnostic Interview Schedule, and a treatment questionnaire. RESULTS: These data confirmed that Native-American veterans were less apt to employ VA mental health services as compared with other professional and nonprofessional mental health services. Perceived barriers to VA mental health care were coded using a schema developed among Native American and Hispanic VA workers. Types of perceived barriers were qualitatively similar to those obtained from the VA workers, ie, barriers in the VA system, among Native-American veterans themselves, in VA staff members, and among Native American families and communities. Demographic and clinical characteristics among these 543 veterans were not associated with presence-versus-absence of barrier reporting. Among those who did report any barriers, veterans who used more traditional-alternative-complementary (TAC) care reported more barriers than did other veterans. Secondary analysis of those who reported barriers and used TAC revealed that this group had high current rates of Mood Disorder and PTSD symptoms, and high lifetime rates of PTSD and Mood Disorder. Although this latter group had tended to use VA mental health services in the past, they had generally not used them in the last year.

Adult↗
PubMed2000

Course and Severity of Substance Abuse in Women with Comorbid Eating Disorder.

The objective of this study is to ascertain whether the course and severity of Substance Abuse among female patients with comorbid Substance Related Disorder and Eating Disorder (SRD-ED) is similar to or different from the course and severity of SRD among female patients with Substance Related Disorder but no Eating Disorder (SRD). Subjects were voluntary patients, obtained in two addiction programs located within departments of psychiatry in two state university medical centers, and included 66 women with SRD-ED and 211 women with SRD. Data were collected on demography, course and severity of SRD, and associated biomedical conditions. SRD-ED patients were significantly younger and more apt to be single, more highly educated, living with family and friends, employed, and of higher socioeconomic status. SRD-ED and SRD patients were more similar than different on most indicators of course and severity, although several clinical differences prevailed. These clinical differences were primarily ascribed to age. In most respects, patients with comorbid SRD-ED manifest course and severity of SRD similar to patients with SRD. Demographic differences between the two groups can mostly be ascribed to the younger mean age of SRD-ED patients rather than to the comorbid ED. Some biomedical problems are related to the specific consequences of ED.

Journal Article↗
PubMed1994

Religiosity and Psychosocial Adjustment Among 100 Homng Refugees.

PURPOSE OF THE PAPER. The purpose of this paper is to study the relationship between religiosity and psychosocial adjustment in a group of Asian refugees from Laos. SUMMARY OF METHODS UTILIZED. Subjects consisted of 100 adult Hmong refugees from Laos who had relocated one decade earlier to Minnesota. At the time of the interview, about 80% remained in Minnesota; the remainder were interviewed in their respective communities. Five measures of religiosity were operationalized: Religious Belief (animism versus monotheism); recent Religious Practice (present/absent in previous monthrpar;; Religious Conversion lpar;present/absent in the U.S.rpar;; having a Home Altar (present/absent today); and having a shamanistic Trance Ritual (present/absent in the last five years). These five indices of religiosity were then compared against four general areas of psychosocial adaptation as follows: demographic characteristics lpar;5 itemsrpar;; sociocultural indices of adaptation lpar;5 items, including 2 scales&rpar; health care seeking over the previous five years (6 items); and psychiatric signs and symptoms (4 psychiatric scales). SUMMARY OF METHODS UTILIZED. Methods of data collection were as follows: (1) questionnaire-based interviewing by Hmong research assistants to provide data on religion affiliation, belief and practice; demographic information; psychosocial function; cultural affiliations and behaviors; and health care seeking; (2rpar; a psychiatric interview by the senior author followed by completion of two psychosocial scales (Axis 4 Psychosocial Stressors and Axis 5 Psychosocial Function using DSM-III criteriarpar; and several psychiatric rating scales lpar;Hamilton Anxiety Scale, Hamilton Depression Scale, Brief Psychiatric Rating Scale, and Global Assessment Scalerpar;. PRINCIPAL FINDINGS. Religious Pracitice in the last month was highly associated with several measures of psychosocial adaptation. Conversely, any Trance Ritual in the last five years was associated with increased anxiety and health care seeking. Religious Belief (animism versus monotheism) and having a Home Altar were associated with the other cultural factors, but not with psychosocial, heatlh and mental health measures. CONCLUSIONS. Aspects of religiosity among Hmong refugees were related to psychosocial adaptation in diverse ways, with some factors associated with better adaptation, some factors associated with maladaptation, and some factors related to other cultural dimensions but not psychosocial adaptation. KEY WORDS. Hmong; psychosocial adjustment.

Journal Article↗