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Biomedical subjects

Robert Kohn

Publications and source records attributed to Robert Kohn.

35 records · Page 2Linked to original sources
PubMed2004

Mental health-related knowledge, attitudes and practices in two kibbutzim.

BACKGROUND: This study explored mental health-related knowledge, attitudes and practices (KAP) in two kibbutzim (collective villages). These kibbutzim share many features, e. g., history, origin of the population, community institutions, and political affiliation. They differ, however, in that one of them keeps fully the collectivist ideology, while the other is undergoing privatization; this is a process that may loosen the solidarity on which the kibbutz movement was conceived. METHODS: A brief self-administered questionnaire exploring KAP within the kibbutz context was completed anonymously by 108 members in one kibbutz and 90 in the other. Univariate and multivariate methods of analyses were applied. RESULTS: Mental health literacy was high, 75% endorsed a multifactorial causation of mental disorders, and 79% thought that they were treatable. The definition of what constitutes a mental disorder, however, was limited, 43% for psychosis and 10% for depression. Kibbutz members held contrasting attitudes toward members with mental disorders; while the majority supported their social integration, 85% stated that their access to the commune's highest offices would be denied. The kibbutz would provide financial support more often to a member with cancer, 94%, than to one with depression, 81%. Attitudes towards outsiders were more negative, 68% stated that the kibbutz would refuse membership to an applicant that recovered from a mental illness. Use of mental health services was high, with a lifetime rate in the total sample of 38%. CONCLUSION: The mental health KAP among these kibbutz members have not developed in parallel. While the attitudes are mixed at best, knowledge and practice are more positive. Since the kibbutz strives to be an egalitarian society and the members are highly educated, the study of this collective may suggest the possible KAP ceiling in the general society. The privatization process initiated in one of the kibbutzim has not affected the KAP, but the process is too novel to assess its impact.

Attitude to Health↗
PubMed2004

Use of mental health services in Chile.

OBJECTIVE: S: To address the growing burden of mental illness in Latin America, a better understanding of mental health service use and barriers to care is needed. Although many Latin American countries have nationalized health care systems that could potentially improve access to care, significant barriers to care remain. The authors report the results of a study examining mental health service utilization in the general population of Chile. METHODS: The data were drawn from the Chile Psychiatric Prevalence Study, a national household survey of 2,987 persons aged 15 years and older conducted in 1992-1999. As part of the survey, psychiatric diagnoses were obtained by using the Composite International Diagnostic Interview, and respondents were asked about their use of general and mental health care services in the past six months and about their experience of barriers to treatment. RESULTS: More than 44 percent of respondents reported use of any health care services in the past six months, and 20 percent reported use of mental health services. Of the respondents who met criteria for a psychiatric disorder, a large proportion (62 percent) did not receive mental health care. Increasing severity of the psychiatric disorder correlated with increasing frequency of overall help seeking, but only a small proportion of the respondents with a psychiatric disorder sought specialized mental health services. Regional disparities and inequities in access to care were found. In addition, indirect barriers to mental health care, such as stigma and misconceptions about the course of psychiatric disorders, were important deterrents to service utilization, particularly among persons with lower socioeconomic status. CONCLUSIONS: To reduce the burden of mental illness in Chile, additional efforts are needed to address both the direct and the indirect barriers to mental health care, including regional inequities in access to care.

Adolescent↗
PubMed2004

Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

OBJECTIVES: The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. DESIGN: A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. RESULTS: Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. CONCLUSION: There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

Adult↗
PubMed2004

Population prevalence of psychiatric disorders in Chile: 6-month and 1-month rates.

BACKGROUND: Few South American studies have examined current prevalence rates of psychiatric disorders. AIMS: To examine prevalence rates in a nationally representative adult population from Chile. METHOD: The Composite International Diagnostic Interview was administered to a stratified random sample of 2978 individuals from four provinces representative of the country's population. Six-month and 1-month prevalence rates were estimated. Demographic correlates, comorbidity and service use were examined. RESULTS: Nearly a fifth of the Chilean population had had a psychiatric disorder during the preceding 6 months. The 6-month and 1-month prevalence rates were 19.7% and 16.7% respectively. For the 6-month prevalence the five most common disorders were simple phobia, social phobia, agoraphobia, major depressive disorder and alcohol dependence. Less than 30% of those with any psychiatric diagnosis had a comorbid psychiatric disorder and the majority of them had sought treatment from mental health services. CONCLUSIONS: Current prevalence studies are useful indicators of service needs. People with comorbid psychiatric conditions have high rates of service use. The low rate of comorbidity in Chile merits further study.

Adolescent↗
PubMed2004

Gay Asian men in San Francisco follow the international trend: increases in rates of unprotected anal intercourse and sexually transmitted diseases, 1999-2002.

Worldwide, studies of men who have sex with men (MSM) report increases in HIV risk-related behavior. Less is known about trends within minority subpopulations of MSM, particularly those of Asian and Pacific Islander (A&PI) ethnicity. A&PI MSM are underrepresented among AIDS cases (2.7%) with respect to their estimated makeup in the gay community of San Francisco (4.5%). However, recent trends in unprotected anal intercourse (UAI) and sexually transmitted diseases suggest a reversal in the relative risk for HIV among A&PI MSM compared with White MSM. Starting from lower levels in 1999, UAI with multiple partners, UAI with multiple partners of unknown HIV serostatus, the incidence of male rectal gonorrhea, and the incidence of early syphilis among A&PI MSM surpassed levels among White MSM by 2002. A window of opportunity to prevent further spread of HIV among A&PI MSM may be closing.

Asia↗
PubMed2004

Attitudes and opinions on corporal punishment among urban Israeli Jews.

Corporal punishment of children constitutes a human rights violation and has mental health consequences, yet it is frequently practiced in many countries. The objectives of this study were to identify attitudes and opinions with regard to corporal punishment among urban Jewish Israelis. Corporal punishment was defined as the means to discipline children by the use of physical force. A short battery of questions exploring attitudes and opinions on the use of corporal punishment of children was added to a periodic survey conducted by a private polling organization. The sample included 1,000 urban Jewish Israeli community residents. Most respondents did not endorse corporal punishment. However, when confronted with a question tapping the readiness of adults to comply with a ruling by the Supreme Court that prohibits the use of corporal punishment at home, most respondents expressed skepticism that the public will comply. Forty percent thought that most parents would agree to undergo training in the use of alternative means of discipline. Fifty-seven percent experienced physical punishment when growing up, a variable which was associated with all responses favoring its use as a means of discipline. The results of the study provide the bases for public health action, including training programs on alternative methods of discipline. Further research targeting other population groups not yet explored is needed.

Adolescent↗
PubMed2003

Etiology of clinical proctitis among men who have sex with men.

In this retrospective review of cases of clinical proctitis, we identified the frequency of common sexually transmitted diseases (STDs) among men who have sex with men on the basis of reports from the municipal STD clinic in San Francisco. Of note, gonorrhea and chlamydia were the most common STDs, followed by herpes and syphilis. Current STD treatment guidelines recommend empiric treatment for gonorrhea and chlamydia, but treatment for herpes should also be considered. The implications for human immunodeficiency virus (HIV) transmission are also discussed.

Adolescent↗
PubMed2003

The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys.

Absence of a common diagnostic interview has hampered cross-national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12-month/lifetime prevalence ratio was in the range 40% to 55%, the 30-day/12-month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio-demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co-morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE. Major depressive episodes are a commonly occurring disorder that usually has a chronic-intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE.

Adolescent↗
PubMed2002

[Chilean study on the prevalence of psychiatric disorders (DSM-III-R/CIDI) (ECPP)].

BACKGROUND: The Diagnostic and Statistic Manual (DSM) solved the problem of diagnostic criteria for psychiatric diseases. Highly structured interviews such as Composite International Diagnostic Interview (CIDI) allow the evaluation of psychiatric disorders in large samples, with great accuracy. AIM: To report the prevalence rates of psychiatric disorders in a representative sample of Chilean individuals. MATERIAL AND METHODS: The CIDI was administered to 2978 Chilean individuals coming form four provinces. Lifetime and prevalence rates of psychiatric disorders, based in the third revision of the DSM, were calculated. RESULTS: Thirty six percent of the population had a psychiatric disorder at least once in their lifetime and 23% had a disorder in the last six months. The most common lifetime diagnoses were agoraphobia in 11%, major depressive disorders in 9%, dysthymia in 8% and alcohol dependence in 6%. Only 49% of those with a psychiatric disorder sought medical care, while 4% of those individuals considered devoid of psychiatric illnesses, consulted in a mental health facility. CONCLUSIONS: The prevalence of psychiatric disorders in the Chilean population is similar to that of other Spanish speaking populations in Latin or North America.

Adolescent↗
PubMedDate not supplied

The prevalence of treated and untreated mental disorders in five countries.

We analyzed survey data from Canada, Chile, Germany, The Netherlands, and the United States to study the prevalence and treatment of mental and substance abuse disorders. Total past-year prevalence estimates range between 17.0 percent (Chile) and 29.1 percent (U.S.). Many cases are mild. Although disorder severity is strongly related to treatment, one- to two-thirds of serious cases receive no treatment each year. Most treatment goes to minor and mild cases. Undertreatment of serious cases is most pronounced among young poorly educated males. Outreach is needed to reduce barriers to care among serious cases and young people at risk of serious disorders.

Adolescent↗
PubMedDate not supplied

[Mental disorders in Latin America and the Caribbean: a public health priority].

OBJECTIVE: The growing burden of mental disorders in Latin America and the Caribbean has become too large to ignore. There is a need to know more about the prevalence of mental disorders and the gap between the number of individuals with psychiatric disorders and the number of those persons who remain untreated even though effective treatments exist. Having that knowledge would make it possible to improve advocacy, adopt better policies, formulate innovative intervention programs, and apportion resources commensurate with needs. METHODS: Data were extracted from community-based psychiatric epidemiological studies published in Latin America and the Caribbean from 1980 through 2004 that used structured diagnostic instruments and provided prevalence rates. Estimates of the crude rates in Latin America and the Caribbean for the various disorders were determined by calculating the mean and median rates across the studies, by gender. In addition, data on service utilization were reviewed in order to calculate the treatment gap for specific disorders. RESULTS: Nonaffective psychosis (including schizophrenia) had an estimated mean one-year prevalence rate of 1.0%; major depression, 4.9%; and alcohol use abuse or dependence, 5.7%. Over one-third of individuals with nonaffective psychosis, over half of those with an anxiety disorder, and some three-fourths of those with alcohol use abuse or dependence did not receive mental health care from either specialized or general health services. CONCLUSIONS: The current treatment gap in mental health care in Latin America and the Caribbean remains wide. Further, current data likely greatly underestimate the number of untreated individuals. The epidemiological transition and changes in the population structure will further widen the treatment gap in Latin America and the Caribbean unless mental health policies are formulated or updated and programs and services are expanded.

Adolescent↗
PubMedDate not supplied

[Service use patterns among adults with mental health problems in Chile].

OBJECTIVE: To describe the patterns in the use of general health services and specialized health services among adults with mental health problems in Chile, as well as those persons' level of satisfaction with the services. The overall objective was to optimize the use of the limited resources available for mental health care in the countries of the Americas, especially Chile. METHODS: The diagnoses and the patterns of use of mental health services were obtained from the Chilean Study of Psychiatric Prevalence (Estudio Chileno de Prevalencia Psiquiátrica). That representative research on the adult population of Chile was based on a stratified random sample of 2,987 people 15 years old and older, done over the period of 1992 to 1999. The psychiatric diagnoses were obtained using the Composite International Diagnostic Interview (CIDI). The interviewees were also asked about their use of general health care services and of mental health services in the preceding six months, as well as any barriers to accessing the services. RESULTS: More than 44% of the interviewees had had contact with some type of health service during the six months prior to the study, but only 5.6% received specialized care. Those who presented with a diagnosis of obsessive-compulsive disorder or of panic disorder consulted more frequently, but not in specialized centers. Consumption of substances such as alcohol and drugs as well as antisocial personality disorder were associated with a low level of consultation. When asked about sources of assistance for mental health problems, the majority of the interviewees mentioned only the formal health care system. More than 75% of the interviewees said that they were satisfied or very satisfied with the care that they had received. CONCLUSIONS: Our results confirm the existence of a wide gap between the need for care and the treatment that is actually received. The informal and folkloric alternative resources (priests, family members, healers, herbalists, etc.) were used less frequently than is generally believed to be true. The indirect barriers of access to services--linked to a lack of knowledge and to stigma--were more frequent than were the direct barriers. A sizable number of people who did not have a positive diagnosis on the CIDI utilized mental health services.

Adolescent↗
PubMedDate not supplied

Psychological and psychopathological reactions in Honduras following Hurricane Mitch: implications for service planning.

BACKGROUND: Posttraumatic stress disorder (PTSD) and other psychopathological outcomes have not been sufficiently studied in community-based samples in Latin America. This study explored various psychopathological reactions and their respective risk factors two months after Hurricane Mitch struck Honduras in October 1998. METHODS: In the Honduran capital of Tegucigalpa, 800 respondents age 15 and older were selected from residential areas of high, middle, or low socioeconomic status that had suffered either high or low impact from the devastating effects of the hurricane. The Composite International Diagnostic Interview was used to diagnose PTSD. Depression, alcohol misuse, and grief reaction were examined using screening instruments, and the Self-Reporting Questionnaire was used to measure demoralization. The Impact of Event Scale was administered to ascertain the severity of the posttraumatic reaction. RESULTS: PTSD was present in 10.6% of the sample. Respondents from the high-impact residential areas were more distressed, had higher scores on the grief inventory, and showed greater severity in PTSD symptoms. The respondents from the high-impact residential areas also had higher prevalence rates of major depression, alcoholism, and prior emotional problems. The best explanatory model for the risk of developing PTSD included the degree of exposure based on reported traumatic events, and associated increased demoralization. Among the persons with PTSD, its severity was predicted by being female and by the degree of exposure to hurricane-related traumatic events. CONCLUSIONS: Out of a total population of 3.3 million adults (age 15 and older) in Honduras, it is estimated that over 492,000 of them may have developed PTSD due to Hurricane Mitch. Adequate health disaster preparedness and response requires full acknowledgement of the multiple psychological effects that victims experience.

Adult↗
PubMedDate not supplied

Treatment of homebound mentally ill elderly patients: the multidisciplinary psychiatric mobile team.

Authors evaluated the general feasibility of using a multidisciplinary psychiatric mobile team model for homebound elderly patients. Information was collected with a semistructured interview on 235 homebound elderly patient referrals over a 2.5-year period. Ninety-three subjects were accepted into the program; 12.9% of those accepted required psychiatric hospitalization during the follow-up. Maintaining individuals in the community was achieved with intense case management and significant increases in home-care hours. The multidisciplinary team approach appeared to lessen psychiatric disability in homebound mentally ill elderly patients.

Aged↗
PubMedDate not supplied

The course of depression in elderly patients.

OBJECTIVE: Studies on the course of major depressive disorder (MDD) among elderly persons are limited to short periods of follow-up, seldom provide comparisons with younger cohorts, and raise other methodological concerns. METHODS: Utilizing 15 years of prospective data from the NIMH Collaborative Depression Study, the authors examined the index episode of MDD and the time until first observed recurrence in those who recovered for subjects in four age-groups defined by age at intake: 17-30, 31-50, 51-64, and 65-79 years. Assessments were conducted every 6 months for 5 years and annually thereafter. Survival analysis examined time until recovery and time to first recurrence. RESULTS: Median time-to-recovery was similar for the four groups. Median time-to-first recurrence was significantly shorter for oldest versus the 51-64-year-old group but not the two other groups. The oldest age-group was distinguished from the younger groups by being more likely to be divorced/widowed/separated, to have primary depression, and to have a history of medical illness, particularly cardiovascular disease or cancer. There was no difference in the generally low levels of pharmacotherapy prescribed during the index episode or the subsequent well interval. CONCLUSIONS: Elderly patients with MDD may have a greater risk of recurrence than younger individuals. Low levels of treatment characterize the somatic treatment in all the study subjects, regardless of age-group.

Adolescent↗