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Biomedical subjects

R C Kessler

Publications and source records attributed to R C Kessler.

At least 55 records · Page 3Linked to original sources
PubMed2000

Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades.

Previous analysis of data from the U.S. National Comorbidity Survey (NCS) [24] suggested that the lifetime prevalence of social phobia in the community has increased significantly in recent cohorts. Furthermore, a latent class analysis of NCS data [21] revealed two primary classes of persons with social phobia: those with exclusive speaking fears and those with one or more other social-evaluative fears. Social phobia in the other social fear group is more persistent, more impairing, and more highly co-morbid with other DSM-III-R disorders. The current report presents data on whether the cohort effect is a general aspect of social phobia or is specific to one of the NCS social phobia subtypes, and whether the cohort effect varies as a function of socio-demographic characteristics. Data were drawn from the NCS. Social phobia was assessed with a revised version of the Composite International Diagnostic Interview. Retrospective age of onset reports were used to estimate Kaplan-Meier survival curves for first onset of social phobia in each cohort represented in the survey. Comparison of these curves allowed us to make synthetic estimates based on retrospective reports of intercohort trends in lifetime prevalence. The lifetime prevalence of social phobia appears to have increased in recent cohorts. However, this increase does not exist among social phobics with exclusive fears of speaking. The increase is most pronounced among white, educated, and married persons, and it is not explained by increased co-morbidity with other mental disorders. The fact that the cohort effect is more pronounced for social phobia with one or more non-speaking fears is important in that this is generally a more severe form of the disorder with an earlier age of onset than social phobia with pure speaking fears. The fact that the cohort effect is most pronounced among people with social and economic advantage (i.e., white, married, well-educated) is intriguing and raises questions about the etiologic process that warrant further study in future research.

Adolescent↗
PubMed2000

Duration between onset and time of obtaining initial treatment among people with anxiety and mood disorders: an international survey of members of mental health patient advocate groups.

BACKGROUND: Self-report data obtained from members of advocate groups for patients with anxiety or mood disorders in 11 countries were used to study time to initial professional help-seeking after incident episodes. METHOD: Data were taken from 3516 self-administered questionnaires completed by members of GAMIAN, an international consortium of mental health patient advocate groups. Reports about age at onset and age at first seeking treatment were obtained retrospectively. RESULTS: Approximately 40% of respondents reported that they sought treatment in the same year as the first onset of their disorder. The median delay in help-seeking was 8 years for the remainder of respondents. Synthetic cohort analysis suggests that delays have decreased in recent cohorts. However, time to initial help-seeking in all cohorts and all countries was found to be inversely related to age at onset. CONCLUSIONS: Although caution is needed in generalizing the results beyond members of patient advocate groups, the key patterns found here were also found in previous analyses of general population surveys carried out in the US and Canada. The critical and consistent finding in all these studies is that presumably curable adolescents with early-onset disorders are, in effect, ignored by the treatment system in these countries. Aggressive outreach and intervention among early-onset cases might prove to be a cost-effective approach both to prevent the onset of secondary disorders and to improve success in treating primary disorders.

Adolescent↗
PubMed2000

Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity.

OBJECTIVE: Lifetime and 12-month prevalence of traumatic events and DSM-IV post-traumatic stress disorder as well as risk factors and comorbidity patterns were investigated in a representative community sample (n = 3021, aged 14-24 years). METHOD: Traumatic events and PTSD were assessed with the Munich Composite International Diagnostic Interview (CIDI). RESULTS: Although 26% of male subjects and 17.7% of female subjects reported at least one traumatic event, only a few qualified for a full PTSD diagnosis (1% of males and 2.2% of females). Traumatic events and PTSD were strongly associated with all other mental disorders examined. PTSD occurred as both a primary and a secondary disorder. CONCLUSION: The prevalence of PTSD in this young German sample is considerably lower than reported in previous US studies. However, the conditional probability for PTSD after experiencing traumas, risk factors and comorbidity patterns are quite similar. Traumatic events and full PTSD may increase the risk for other disorders, and vice versa.

Adolescent↗
PubMed2000

Invisible support and adjustment to stress.

Although there is abundant evidence that perceived availability of support buffers the effects of stressors on mental health, the relatively meager research on support transactions has failed to show an association between actual receipt of support and adjustment to stressors. The authors examined a possible explanation for this inconsistency, that awareness of receiving support entails an emotional cost and that the most effective support is unnoticed by the recipient. Using data from a daily diary study of support provision and receipt in couples, the authors show that many transactions reported by supporters are not reported by recipients. They also show that these invisible support transactions promote adjustment to a major stressor.

Adaptation, Psychological↗
PubMed2000

Recent care of common mental disorders in the United States : prevalence and conformance with evidence-based recommendations.

OBJECTIVE: To relate the presence of recent mental disorders to use of mental health services. DESIGN: Cross-sectional survey. STUDY POPULATION: The study population was 3,032 respondents to the Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-and-mail survey conducted in 1996. Twelve-month diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition, of major depressive episode, panic disorder, generalized anxiety disorder, and serious mental illness were made using a structured assessment. Information was obtained on 12-month treatment for mental health problems in the general medical, mental health specialty, human services, and self-help sectors. Definitions of treatments consistent with evidence-based recommendations were developed using available practice guidelines. MEASUREMENTS AND MAIN RESULTS: Crude and adjusted likelihoods of receiving any mental health care and guideline-concordant care were measured. Although 53. 8% of respondents with at least one 12-month mental disorder received any mental health care in the previous year, only 14.3% received care that could be considered consistent with evidence-based treatment recommendations. Even among those with the most serious and impairing mental illness, only 25% received guideline-concordant treatment. Predictors of receiving guideline-concordant care included being white, female, severely ill, and having mental health insurance coverage. CONCLUSIONS: An epidemic of untreated and poorly treated mental disorders exists in the United States, especially among vulnerable groups such as African Americans and the underinsured. Cost-effective interventions are needed to improve both access to and quality of treatment.

Adult↗
PubMed2000

Marital quality and psychological adjustment to widowhood among older adults: a longitudinal analysis.

OBJECTIVES: This study examined whether psychological adjustment to widowhood is affected by three aspects of marital quality--warmth, conflict, and instrumental dependence-assessed prior to the loss. METHODS: The Changing Lives of Older Couples (CLOC) is a prospective study of a two-stage area probability sample of 1,532 married individuals aged 65 and older. The CLOC includes baseline data on marital quality and mental health and data on grief, anxiety, and depression collected 6, 18, and 48 months after spousal loss. RESULTS: Widowhood was associated with elevated anxiety among those who were highly dependent on their spouses and lower levels of anxiety among those who were not dependent on their spouses. Levels of yearning were lower for widowed persons whose relationships were conflicted at baseline and higher for those reporting high levels of marital closeness and dependence on their spouses. Women who relied on their husbands for instrumental support had significantly higher levels of yearning than men who depended on their wives. DISCUSSION: The findings contradict the widespread belief that grief is more severe if the marriage was conflicted and suggest a more complex relationship between bereavement and characteristics of the marriage.

Adaptation, Psychological↗
PubMed2000

Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey.

Using a nationally representative sample, this study examines the disease-specific impairments of DSM-IV generalized anxiety disorder (GAD) by comparing them to the impairments associated with major depressive disorder (MDD). Results are based on 4181 respondents between the ages of 18-65 years who were interviewed with the 12-month version of the Munich-Composite International Diagnostic Interview as part of the German National Health Interview and Examination Survey-Mental Health Supplement (GHS). After controlling for age, gender, and other psychopathology, 'pure' current GAD without MDD (n = 33), pure MDD (n = 344) and comorbid GAD and MDD (n = 40) were each associated with high impairment as defined by poor self-perceived health, at least 3 days limited or impaired in the past month, and low quality of life scores [from the Short Form-36 Health Survey (SF-36)]. Quality of life scores on several of the SF-36 scales were significantly lower for respondents with pure GAD as compared to respondents with pure MDD. Overall, the results show that DSM-IV GAD is associated with high impairment even after controlling for other psychopathology. The impairment outcomes for GAD were comparable in size to those for MDD. These findings underline the significance of this disorder from a clinical and social perspective and provide support for the independent diagnostic status of GAD.

Adolescent↗
PubMed2000

Initiation of and adherence to treatment for mental disorders: examination of patient advocate group members in 11 countries.

OBJECTIVE: Greater understanding of the help-seeking process is needed to reduce the level of unmet need for mental health treatment. DESIGN: Cross-sectional mail survey. STUDY POPULATION: The study population consisted of 3,516 respondents to a survey of members of 14 patient advocacy groups in 11 countries. Respondents reported whether they initiated and adhered to the treatment most recently recommended to them. OUTCOMES: Crude and adjusted likelihoods of initiating and adhering to recommended treatment were studied. RESULTS: The vast majority of respondents reported initiating the most recent treatment recommended to them (94%), and most of those who initiated treatment also adhered to such treatment (83%). Predictors of initiation by the respondents included higher levels of education, having pharmacotherapy recommended to the respondent, and having received explanations about the diagnosis and treatment. Predictors of adherence to therapy included male gender, receipt of pharmacotherapy, and presence of insurance coverage. Side effects were an important reported reason for treatment dropout, with 44% of respondents reporting lifetime treatment dropout due to side effects. CONCLUSIONS: Successful initiation and adherence to mental health treatments depend critically on patients' knowledge and awareness, clinicians' communication skills, treatment side effects, and barriers such as lack of insurance. Further study and intervention focused on these modifiable factors are needed to improve the adequacy of mental health treatment.

Adolescent↗
PubMed2000

Sexual orientation in a U.S. national sample of twin and nontwin sibling pairs.

OBJECTIVE: Although previous studies have suggested that sexual orientation is influenced by familial factors, which may be partly genetic, these studies have relied on unrepresentative and potentially biased samples. The authors attempted to estimate the role of genetic and environmental factors in the determination of sexual orientation in a more representative sample. METHOD: Sexual orientation was assessed by a single item on a self-report questionnaire in a U.S. national sample of twin and nontwin sibling pairs. Sexual orientation was classified as heterosexual or nonheterosexual (bisexual or homosexual). The authors compared the similarity of sexual orientation in the monozygotic twins to the similarity in the same-sex dizygotic twins, all dizygotic twins, the same-sex dizygotic twins and sibling pairs, and all dizygotic twins and sibling pairs. Biometrical twin analyses were performed. RESULTS: All analyses demonstrated familial resemblance for sexual orientation. Resemblance was greater in the monozygotic twins than in the dizygotic twins or in the dizygotic twins plus nontwin siblings. Biometrical twin modeling suggested that sexual orientation was substantially influenced by genetic factors, but family environment may also play a role. No evidence was found for a violation of the equal-environment assumption regarding monozygotic and dizygotic twin pairs. CONCLUSIONS: Familial factors, which are at least partly genetic, influence sexual orientation. The results of these analyses should be interpreted in the context of low statistical power and the use of a single item to assess the complex phenotype of sexual orientation.

Adult↗
PubMed2000

Lifetime panic-depression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking.

BACKGROUND: Most prior studies of panic-depression comorbidity have been limited methodologically by use of small clinical samples and incomplete analyses. AIMS: General population data were used to study the association of lifetime and recent (12 months) panic-depression comorbidity with symptom severity, impairment, course and help-seeking in the National Comorbidity Survey (NCS). METHOD: The NCS is a nationally representative survey of the prevalences and correlates of major DSM-III-R disorders in the US household population. RESULTS: Strong lifetime and current comorbidity were found between panic and depression. Comorbidity was associated with greater symptom severity, persistence, role impairment, suicidality and help-seeking, with many findings persisting after controlling for additional comorbid diagnoses. Findings did not differ according to which disorder was chronologically primary. CONCLUSIONS: Both lifetime and current panic-depression comorbidity are markers for more severe, persistent and disabling illness. Neither additional comorbid diagnoses nor the primary-secondary distinction were important moderators of these associations.

Adolescent↗
PubMed2000

Posttraumatic stress disorder: the burden to the individual and to society.

BACKGROUND: Little is known about the total population prevalence and societal costs of posttraumatic stress disorder (PTSD); this report reviews relevant literature on these topics. METHOD: A literature search of computerized databases for published reports on trauma and PTSD was conducted. This literature was reviewed to find data on general population exposure to trauma, conditional risk of PTSD among those exposed to trauma both in focused samples of trauma victims and in general population samples, and the adverse consequences of PTSD. RESULTS: PTSD was found to be a commonly occurring disorder that often has a duration of many years and is frequently associated with exposure to multiple traumas. The impairment associated with PTSD in U.S. samples, where the majority of research on these consequences has been carried out, is comparable to, or greater than, that of other seriously impairing mental disorders. Risk of suicide attempts is particularly high among people with PTSD. Available evidence suggests that the prevalence of PTSD and the adverse emotional and psychological consequences of PTSD are much greater in the many countries around the world that are in the midst of armed conflicts involving political, racial, or ethnic violence. CONCLUSION: PTSD is a highly prevalent and impairing condition. Only a minority of people with PTSD obtain treatment. Early and aggressive outreach to treat people with PTSD could help reduce the enormous societal costs of this disorder.

Comorbidity↗
PubMed2000

Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety.

OBJECTIVE: To provide primary care clinicians with a better understanding of management issues in posttraumatic stress disorder (PTSD) and guide clinical practice with recommendations on the appropriate management strategy. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty invited by the chair were Edna B. Foa, Ronald C. Kessler, Alexander C. McFarlane, and Arieh Y. Shalev. EVIDENCE: The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSION: PTSD is often a chronic and recurring condition associated with an increased risk of developing secondary comorbid disorders, such as depression. Selective serotonin reuptake inhibitors are generally the most appropriate choice of first-line medication for PTSD, and effective therapy should be continued for 12 months or longer. The most appropriate psychotherapy is exposure therapy, and it should be continued for 6 months, with follow-up therapy as needed.

Cost of Illness↗
PubMed2000

Psychiatric epidemiology: selected recent advances and future directions.

Reviewed in this article are selected recent advances and future challenges for psychiatric epidemiology. Major advances in descriptive psychiatric epidemiology in recent years include the development of reliable and valid fully structured diagnostic interviews, the implementation of parallel cross-national surveys of the prevalences and correlates of mental disorders, and the initiation of research in clinical epidemiology. Remaining challenges include the refinement of diagnostic categories and criteria, recognition and evaluation of systematic underreporting bias in surveys of mental disorders, creation and use of accurate assessment tools for studying disorders of children, adolescents, the elderly, and people in less developed countries, and setting up systems to carry out small area estimations for needs assessment and programme planning. Advances in analytical and experimental epidemiology have been more modest. A major challenge is for psychiatric epidemiologists to increase the relevance of their analytical research to their colleagues in preventative psychiatry as well as to social policy analysts. Another challenge is to develop interventions aimed at increasing the proportion of people with mental disorders who receive treatment. Despite encouraging advances, much work still needs to be conducted before psychiatric epidemiology can realize its potential to improve the mental health of populations.

Epidemiology↗
PubMed2000

Why do people with anxiety disorders become depressed? A prospective-longitudinal community study.

OBJECTIVE: To examine the temporal relationships of anxiety and depressive disorders, their risk factors and to explore why people with anxiety develop depression. METHOD: Data from an original 4-5-year prospective-longitudinal community study (N= 3,021) of adolescents and young adults with DSM-IV anxiety and depressive disorders identified with the Composite International Diagnostic Interview are used to examine risk factors, as well as course and outcome. RESULTS: (i) Anxiety disorders, except for panic disorder, are almost always primary conditions. (ii) Over the follow-up period, rates of comorbid anxiety-depression increased substantially and resulted in increased impairment and disabilities. (iii) Predictors for first onset of 'pure' depressive and 'pure' anxiety disorders revealed recognizable differences. (iv) Baseline clinical characteristics of anxiety disorders were significantly associated with an increased risk to develop major depression over the follow-up period. CONCLUSION: Findings suggest that most anxiety disorders are primary disorders that substantially increase the risk for secondary depression.

Adolescent↗
PubMed2000

The epidemiology of pure and comorbid generalized anxiety disorder: a review and evaluation of recent research.

OBJECTIVE: Research documenting high rates of comorbidity among patients with generalized anxiety disorder (GAD) has led to the suggestion that GAD might best be conceptualized as a prodrome, residual or severity marker of other disorders. Recent research investigating this suggestion is reviewed in this report. METHOD: A computer search cross-classified the terms 'Generalized Anxiety' and 'Comorbidity'. RESULTS: Results arguing that GAD is an independent disorder include the finding that GAD is usually temporally primary in cases of comorbidity with major depression, that primary GAD is a significant predictor of subsequent depression and that the course of GAD is independent of comorbidity. Studies in both patient and community samples show that the impairment associated with pure GAD is equivalent to the impairment associated with pure depression. CONCLUSION: The results reviewed here support the view that GAD as an independent disorder is a major public health problem.

Anxiety Disorders↗
PubMed1999

Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network.

Despite extensive studies on the epidemiology of mental disorders and advances in the treatment of these conditions, there is a paucity of detailed information concerning the characteristics of psychiatric patients and how treatments are administered in routine psychiatric practice. This 1997 observational study collected detailed information from 417 psychiatrists on the demographic, diagnostic, clinical, and treatment characteristics of a systematic sample of 1228 patients. Six hundred thirty-seven patients (51.9%) were women and the mean patient age was 41.9 years. The most common diagnostic category (53.7%) was mood disorders, followed by schizophrenia/psychotic disorders (14.6%), anxiety disorders (9.3%), and disorders of childhood (7.7%). Six hundred seventy-one patients (54.6%) had at least one comorbid Axis I condition and almost half (49.8%) had a history of psychiatric hospitalization. Patients received a mean of 2.0 psychotherapeutic medications, most commonly antidepressants (62.3%). Findings demonstrate that psychiatrists in routine practice treat a patient population with severe, complex conditions.

Adolescent↗
PubMed1999

Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.

BACKGROUND: General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied. METHODS: Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis. RESULTS: Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt. CONCLUSIONS: Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.

Cohort Studies↗