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R C Kessler

Publications and source records attributed to R C Kessler.

At least 217 records · Page 12Linked to original sources
PubMed1979

Sex differences in the use of psychiatric outpatient facilities.

Previous research has shown that both symptoms and sociocultural factors are related to use of psychiatric outpatient facilities. However, the utility of using treatment rates from these facilities to make etiological inferences depends on whether sociocultural effects on utilization are trivial or substantial. In this paper data are presented for one such inference, that women are more in need of treatment than men. We find that observed sex differences in the use of a student psychiatric clinic are due both to differential propensities to seek help for problems and also to differential numbers of problems, both of which are higher among women than men. However, the differential propensity to seek help is found to be by far the more important of these two effects.

Female↗
PubMed1976

Reconciling unidimensional and multidimensional models of patterns of drug use.

Guttman-scale analyses and factor analyses seem to produce contradictory results in analyzing patterns of multiple drug use. Guttman-scale analyses usually show that drug use fits a unidimensional and cumulative model of involvement; factor analyses reject the unidimensional model. The two methods, however, can be reconciled. Guttman scaling is appropriate for discerning patterns of drug involvement, factor analysis for operationalizing degree of involvement within a specific pattern of use.

Amphetamines↗
PubMed1976

The epidemiology of drug use among New York State high school students: Distribution, trends, and change in rates of use.

A two-wave panel survey was carried out on a representative sample of New York State public secondary school students in fall 1971 and spring 1972. The majority of adolsecents have drunk beer or wine (82 per cent) smoked cigarettes (72 per cent) or used hard liquor (65 per cent). Better than one third (35 per cent) report the use of one or more illegal drugs. The illicit drugs most frequently used are marijuana (29 per cent) and hashish (21 per cent). About one in eight adolescents have used pills such as amphetamines and barbiturates, and about one in 12 have tried LSD or other psychedelics. Four per cent have used cocaine and 3 per cent heroin. Use of illicit drugs tends to be experimental and sporadic rather than regular. By contrast, about one in four regularly use beer or wine or smoke cigarettes. Self-reported rates of use increase over the course of a school year, and there is considerable turnover with respect to which adolescents are users. The increased number of hard liquor and marijuana users through the high school years results predominantly from more stability among users, rather than increased conversion of nonusers to users over the teen years.

Adolescent↗
PubMedDate not supplied

Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study.

CONTEXT: Studies have demonstrated strong associations between the prone sleep position (on the stomach) and sudden infant death syndrome (SIDS). In 1992, the American Academy of Pediatrics recommended that infants be placed to sleep laterally (on their side) or supine (on their back) to reduce SIDS risk, and in 1994, the national public education campaign "Back to Sleep" was launched. OBJECTIVE: To determine the typical sleep position of infants younger than 8 months in the United States, the changes that occurred after these recommendations, and the factors associated with the placement of infants prone or supine. DESIGN: Annual nationally representative telephone surveys. SETTING: The 48 contiguous states of the United States. PARTICIPANTS: Nighttime caregivers of infants born within the last 7 months between 1992 and 1996. Approximately 1000 interviews were conducted per year. MAIN OUTCOME MEASURES: The position the infant was usually placed in for sleep, and the position the infant was most commonly found in when checked during the night's sleep. RESULTS: Ninety-seven percent of respondents in each wave of the survey usually placed their infant to sleep in a specific position. Infants were placed in the prone position by 70% of caregivers in 1992, prior to the campaign, but only 24% in 1996. Supine and lateral placements increased during this time period, from 13% in 1992 to 35% in 1996 and from 15% in 1992 to 39% in 1996, respectively. Significant predictors of prone placement included maternal race reported as black (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.68-3.26), mother's age 20 to 29 years (OR, 1.28; 95% CI, 1.09-1.50), region reported as the mid-Atlantic (OR, 1.41; 95% CI, 1.12-1.78) or southern states (OR, 1.47; 95% CI, 1.22-1.70), mothers with a previous child (OR, 1.68; 95% CI, 1.43-1.97), and infants younger than 8 weeks (OR, 0.63; 95% CI, 0.46-0.85). Infants aged 8 to 15 weeks were significantly more likely to be placed nonprone over time compared with the other age groups. Most of the risk factors for prone were significantly related in the opposite direction to supine placement. CONCLUSIONS: The prevalence of infants placed in the prone sleep position declined by 66% between 1992 and 1996. Although causality cannot be proved, SIDS rates declined approximately 38% during this period. To achieve further reduction in prone sleeping, efforts to promote the supine sleep position should be aimed at groups at high risk for prone placement.

Guidelines as Topic↗
PubMedDate not supplied

Clinical characteristics of familial generalized anxiety disorder.

The authors seek to determine whether the clinical characteristics of generalized anxiety disorder (GAD) differ in individuals with a high vs. low familial vulnerability to illness. We identified 486 personally interviewed female twins from a population-based register who had both an interviewed co-twin and a lifetime history of GAD using modified DSM-III-R criteria which required a one-month minimum duration of illness. We attempted to predict risk for GAD in the co-twin from the clinical features of the GAD in the proband twin using the Cox proportional hazard model, controlling for year of birth and zygosity. Only two variables uniquely predicted an increased risk for GAD in the co-twin: number of GAD symptoms endorsed and comorbidity with bulimia. Variables that did not uniquely predict risk of illness in the co-twin included age at onset, duration of the longest episode and number of episodes. The familial vulnerability to GAD can be meaningfully indexed by clinical features of the syndrome. These results suggest that if the syndrome of GAD is to be narrowed, it would, from a familial perspective, be more valid to increase the minimum number of required symptoms rather than to increase the minimum duration of illness.

Adult↗
PubMedDate not supplied

Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder.

This is the first in a series of reports on the long-term test-retest reliability and procedural validity of the UM-CIDI, a modified version of the Composite International Diagnostic Interview used in the US National Comorbidity Survey (NCS). This report focuses on DSM-III-R Generalized Anxiety Disorder (GAD). The NCS administered the UM-CIDI to a nationally representative sample of 8098 respondents in the age range 15-54. A subsample of 36 respondents was subsequently selected for clinical reappraisal of GAD, consisting of reinterviewing by a clinical reappraisal interviewer who blindly readministered the GAD section of the UM-CIDI followed by an expanded version of the GAD section of the Structured Clinical Interview for DSM-III-R (SCID). The test-retest reliability of UM-CIDI/DSM-III-R lifetime GAD is Kappa = .53. When the requirement that the worries be excessive or unrealistic (A2) is removed, as in ICD-10 and partially in DSM-IV, reliability increases to Kappa = .78. The concordance between the baseline UM-CIDI diagnosis and the SCID diagnosis is Kappa = .35, while the cross-sectional concordance is Kappa = .47 (.66 when the Criterion A2 requirement is removed). Item-level analysis shows that lack of concordance between the UM-CIDI and the SCID is due largely to Criteria A2 and D. The A2 problem could be addressed either by deemphasizing the cognitive-evaluative component of GAD as in ICD-10, or by removing consideration of the term "unrealistic" from the criterion as in DSM-IV and more clearly specifying the meaning of the term "excessive". These options require further research on similarities and differences in risk factors, course, family history, and treatment response of more narrowly and broadly defined GAD. The Criterion D problem is due to lack of clarity in what constitutes a symptom occurring "often". This is clarified in DSM-IV. It is likely that this clarification will make it possible to develop more precisely structured questions to evaluate Criterion D in subsequent revisions of the UM-CIDI, resulting in improved reliability and validity.

Adolescent↗
PubMedDate not supplied

Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence.

Basic epidemiologic prevalence data are presented on sex differences in DSM-III-R major depressive episodes (MDE). The data come from the National Comorbidity Survey (NCS), the first survey in the U.S. to administer a structured psychiatric interview to a nationally representative sample of the general population. Consistent with previous research, women are approximately 1.7 times as likely as men to report a lifetime history of MDE. Age of onset analysis shows that this sex difference begins in early adolescence and persists through the mid-50s. Women also have a much higher rate of 12-month depression than men. However, women with a history of depression do not differ from men with a history of depression in either the probability of being chronically depressed in the past year or in the probability of having an acute recurrence in the past year. This means that the higher prevalence of 12-month depression among women than men is largely due to women having a higher risk of first onset. The implications of these results for future research are discussed in a closing section of the paper.

Adolescent↗