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Performance of a general location model with an ignorable missing-data assumption in a multivariate mental health services study

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STATISTICS IN MEDICINE 1999年第22期18卷 3123-3135页

作者： Belin, TR Hu, MY Young, AS Grusky, O Univ Calif Los Angeles Ctr Hlth Sci Deot Psychiat & Biobehavioral Sci Los Angeles CA 90095 USA Univ Calif Los Angeles Ctr Hlth Sci Dept Biostat Los Angeles CA 90095 USA Univ Calif Los Angeles Ctr Hlth Sci Dept Stat Los Angeles CA 90095 USA Univ Calif Los Angeles Ctr Hlth Sci Dept Sociol Los Angeles CA 90095 USA

In a study of the impact of case management teams in a publicly funded mental health programme, mental health patients were interviewed about a variety of outcomes suggestive of successful community adaptation, such as support from family and friends and avoidance of legal problems. Because outcome data were missing for a number of patients, a follow-up study was carried out to obtain this information form previous non-responders whenever possible. Because the data of interest were multivariate and included both continuous and categorical variables, a candidate approach for handling incomplete data in the absence of follow-up data would have been to fit a general location model, presumably with log-linear constraints on cell probabilities to avoid overfitting of the data. Here, we use available follow-up data to investigate the performance of a series of general location models with ignorable non-response. We note some problems with this approach and embed the discussion of this example in a broader consideration of the role of ignorable and non-ignorable models in applied research. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：随访研究卫生服务易得程度/统计学和数值数据健康调查采访(主题) Markov链精神卫生服务/统计学和数值数据模型统计学蒙特卡罗法多元分析女(雌)性人类男(雄)性

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Utilization of psychotherapy by lesbians, gay men, and bisexuals: Findings from a nationwide survey

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AMERICAN JOURNAL OF ORTHOPSYCHIATRY 1999年第2期69卷 209-219页

作者： Jones, MA Gabriel, MA NYU Ehrenkranz Sch Social Work New York NY 10003 USA

Based on a survey of the psychotherapy histories of 600 lesbians, gay men, and bisexuals, the number, duration, and circumstances of each therapy episode, and respondents' views of their therapists and of therapy, are reported Findings suggest that lesbians and gay men are among the most active and satisfied-but least acknowledged-consumers of psychotherapy. Routine inclusion of sexual orientation as a demographic variable in mental health services research is proposed.

关键词：双重性行为卫生保健调查同性恋精神卫生服务/统计学和数值数据心理疗法美国女(雌)性人类男(雄)性

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Urban-rural mental health differences in Great Britain: findings from the National Morbidity Survey

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PSYCHOLOGICAL MEDICINE 2000年第2期30卷 269-280页

作者： Paykel, ES Abbott, R Jenkins, R Brugha, TS Meltzer, H Univ Cambridge Dept Psychiat Cambridge England Dept Hlth London SE1 6TE England Off Natl Stat London England

Background. Studies of urban-rural differences in prevalence of non-psychotic mental disorder have not given consistent findings. Such differences have received relatively little study in Great Britain. Methods. Data from 9777 subjects in the Household Survey of the National Morbidity Survey of Great Britain were analysed for differences between urban, semi-rural and rural areas. Psychiatric morbidity was assessed by scores on the Revised Clinical Interview Schedule (CIS-R), together with alcohol dependence, drug dependence, receipt of treatment from general practitioners. Associations with other characteristics were examined by logistic regression. Results. Urban subjects had higher rates than rural of CIS-R morbidity, alcohol dependence and drug dependence, with semi-rural subjects intermediate. Urban subjects also tended to be members of more deprived social groups, with more adverse living circumstances and greater life stress, factors themselves associated with disorder. Urban-rural differences in alcohol and drug dependence were no longer significant after adjustment for these factors by logistic regression, and differences on CIS-R morbidity were considerably reduced. There were no differences in reatment. Conclusions. There are considerable British urban-rural differences in mental health, which may largely be attributable to more adverse urban social environments.

关键词：慢性酒精中毒/诊断慢性酒精中毒/流行病学横断面研究健康调查发病率精神障碍/诊断精神障碍/流行病学精神卫生服务/统计学和数值数据农村人口/统计学和数值数据物质相关性障碍/诊断物质相关性障碍/流行病学市区人口/统计学和数值数据青少年成年人女(雌)性人类男(雄)性中年人

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Panic disorder among cambodian refugees attending a psychiatric clinic - Prevalence and subtypes

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GENERAL HOSPITAL PSYCHIATRY 2000年第6期22卷 437-444页

作者： Hinton, D Ba, P Peou, S Um, K Massachusetts Gen Hosp Dept Psychiat Boston MA 02114 USA Harvard Univ Sch Med Boston MA 02115 USA N Suffolk Mental Hlth Ctr SE Asian Clin Revere MA USA Arbour Counseling Lowell MA USA

This study surveys Khmer refugees attending two Psychiatric clinics to determine both the prevalence of panic disorder as well as panic attack subtypes in those suffering panic disorder. A culturally valid adaptation of the SCID-panic module, the Cambodian Panic Disorder Survey (CPDS), was administered to 89 consecutive Cambodian refugees attending these psychiatric clinics. Utilizing culturally sensitive panic probes, the CPDS provides information regarding both the presence of panic disorder and panic-attack subtypes during the month prior to interview. Of 89 patients surveyed at two psychiatric clinics, 53 (60%) currently suffered panic disorder. Among the 53 patients suffering panic disorder, the most common panic attack subtypes during the previous month were the following: "sore neck" [51% of the 53 panic disorder patients (PDPs)], orthostatic dizziness (49% of PDPs), gastrointestinal distress (26% of PDPs), effort induced (21% of PDPs), olfactory induced (21% of PDPs), and "while-sitting dizziness" (16% of PDPs). (C) 2000 Elsevier Science Inc.

关键词：门诊医疗/统计学和数值数据柬埔寨/人种学交谈心理学马萨诸塞/流行病学精神卫生服务/统计学和数值数据惊恐病/分类惊恐病/诊断惊恐病/人种学惊恐病/病因学惊恐病/心理学患病率精神病状态评定量表心理生理性障碍/并发症难民/心理学难民/统计学和数值数据应激障碍创伤后/并发症成年人女(雌)性人类男(雄)性

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Diagnosing mental disorders in the community.: A difference that matters?

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PSYCHOLOGICAL MEDICINE 1999年第5期29卷 1021-1027页

作者： Wittchen, HU Üstün, TB Kessler, RC Max Planck Inst Psychiat D-80804 Munich Germany

Brugha and his colleagues in this issue raise important questions about the validity of standardized diagnostic interviews of mental disorders, such as the Composite International Diagnostic Interview (CIDI) (WHO, 1990). Although their concerns refer predominantly to the use of such instruments in epidemiological research, the authors' conclusions also have significant implications for diagnostic assessments in clinical practice and research. We agree with Brugha et al. that the inflexible approach to questioning used in standardized interviews can lead to an increased risk of invalidity with regard to some diagnoses. We also agree that the use of more semi-structured clinical questions has the potential to address this problem. However, we disagree with Brugha et al. in several other ***, we disagree with the authors' initial exclusive emphasis on diagnosis with regard to need assessment and consequences for the allocation of service resources. It is becoming increasingly clear that knowledge about diagnosis does not, in itself, whether assessed by clinical or non-clinical diagnostic interviews, provide sufficient information we need for policy purposes and the determination of societal costs, or to judge clinical management guidelines and treatment needs (Regier et al. 1998). Additional, preferably dimensional, data on associated disabilities and distress as well as a focused need evaluation for those psychosocial, psychological and drug interventions that characterize modern treatment strategies are also important. It also has become evident that a great many people in the general population carry more than one diagnosis. This ‘co-morbidity’ complicates further such simple equation of diagnosis prevalence with need assessment and policy decisions. Secondly, we disagree with the conclusion of Brugha et al. that the use of a semi-structured clinical interview, like the most current version of the Structured Clinical Assessment for Neuropsychiatry (SCAN),

关键词：流行病学方法健康调查采访(主题)/方法普查精神障碍/诊断精神卫生服务/统计学和数值数据精神病学结果可重复性人类

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Perceived need for mental health care, findings from the Australian National Survey of Mental Health and Well-being

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PSYCHOLOGICAL MEDICINE 2000年第3期30卷 645-656页

作者： Meadows, G Burgess, P Fossey, E Harvey, C Univ Melbourne Dept Psychiat Parkville Vic 3052 Australia

Background. The Australian National Survey of Mental Health and Well-being was designed to detect and describe psychiatric morbidity, associated disability, service use and perceived need for care. The survey employed a single-phase interview methodology, delivering a field questionnaire to a clustered probability sample of 10641 Australians. Perceived need was sampled with an instrument designed for this survey, the Perceived Need for Care Questionnaire (PNCQ). This questionnaire gathers information about five categories of perceived need, assigning each to one of four levels of perceived need. Reliability and validity studies showed satisfactory performance of the instrument. Methods. Perceived need for mental health care in the Australian population has been analysed using PNCQ data, relating this to diagnostic and service utilization data from the above survey. Results. The survey findings indicate that an estimated 13.8 % of the Australian population have perceived need for mental health care. Those who met interview criteria for a psychiatric diagnosis and also expressed perceived need make up 9.9 % of the population. An estimated 11.0% of the population are cases of untreated prevalence, a minority (3.6% of the population) of whom expressed perceived need for mental health care. Among persons using services, those without a psychiatric diagnosis based on interview criteria (4.4% of the population), showed high levels of perceived met need. Conclusions. The overall rate of perceived need found by this methodology lies between those found in the USA and Canada. The findings suggest that service use in the absence of diagnosis elicited by survey questionnaires may often represent successful intervention. In the survey, untreated prevalence was commonly not accompanied by perceived need for mental health care.

关键词：澳大利亚卫生保健调查卫生服务需求精神障碍/流行病学精神障碍/治疗精神卫生服务/统计学和数值数据患病率舆论成年人老年人女(雌)性人类男(雄)性中年人

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The first contact of patients with schizophrenia with psychiatric services: social factors and pathways to care in a multi-ethnic population

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PSYCHOLOGICAL MEDICINE 1999年第2期29卷 475-483页

作者： Burnett, R Mallett, R Bhugra, D Hutchinson, G Der, G Leff, J Inst Psychiat Social Psychiat Sect London SE5 8AF England

Background. African-Caribbean patients have less desirable routes of entry into the psychiatric services than other ethnic groups in Britain but this may not apply to the first contact with services. Methods. Patients' pathways to care, type of admission or referral and sectioning details were recorded for all first contact patients presenting to south London psychiatric services over a 2-year period. We also conducted a retrospective analysis of data from the Camberwell Register, comparing rates of compulsory admission between 'Whites' and 'African-Caribbeans' for first and readmissions, over a 20-year period. Results. Our first contact sample comprised 38 White, 38 African-Caribbean and 24 Asian patients with CATEGO defined broad schizophrenia. GP referral was found to be the most common mode of contact and there were no significant differences between the ethnic groups with regard to compulsory admission. Similarly, data from the Camberwell Register showed no significant difference in rates of compulsory admission between first admission White: and African-Caribbean patients. However, when all readmissions were examined, African-Caribbeans were more likely to be admitted involuntarily. Conclusions. Our findings suggest that reports of less desirable routes of entry for African-Caribbean patients into the psychiatric service do not apply to their first admission but are likely to develop over time and repeated contact with the services.

关键词：文化多样性人口统计学人种群/心理学伦敦精神卫生服务/统计学和数值数据病人入院转诊和会诊回顾性研究精神分裂症/治疗青少年成年人女(雌)性人类男(雄)性中年人

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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

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PSYCHOLOGICAL MEDICINE 2000年第3期30卷 693-703页

作者： Christiana, JM Gilman, SE Guardino, M Mickelson, K Morselli, PL Olfson, M Kessler, RC Harvard Univ Sch Med Dept Hlth Care Policy Boston MA 02115 USA Freedom Fear Staten Isl NY USA Columbia Univ Coll Phys & Surg New York State Psychiat Inst New York NY USA Harvard Univ Sch Publ Hlth Boston MA 02115 USA Fdn IDEA Milan Italy Kent State Univ Kent OH 44242 USA

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.

关键词：焦虑症/诊断焦虑症/治疗队列研究健康行为卫生保健调查精神卫生服务/统计学和数值数据情绪障碍/诊断情绪障碍/治疗病人辩护回顾性研究时间因素青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis

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PSYCHOLOGICAL MEDICINE 2000年第1期30卷 177-185页

作者： Croudace, TJ Kayne, R Jones, PB Harrison, GL Univ Nottingham Sch Community Hlth Sci Div Psychiat Nottingham NG3 6AA England Univ Bristol Div Psychiat Bristol BS8 1TH Avon England

Background. Indicators of population socio-economic disadvantage expressed as weighted deprivation indices show strong relationships with mental health and underpin national funding of psychiatric services. A new index of social deprivation, the Mental Illness Needs Index, has been devised specifically to predict need for psychiatric services. Its validity has not been established outside the area in which it was developed. Methods. We explored the relationship between the Mental Illness Needs Index and two alternative indicators of need for mental health services: the prevalence: of psychiatric admission for electoral wards in Nottingham (calculated from Hospital Episode Statistics for the years 1992 and 1993) and ward-based incidence rates for psychosis (ICD-10 F1X-F33). Relationships were explored graphically using local regression models, and estimated using Generalized Linear and Additive Models, and Poisson regression. Results. Social deprivation was strongly related to admission prevalence and psychosis incidence (Spearman's rho 0.63 and 0.44 respectively). Neither admission prevalence, nor the incidence of psychosis were linearly related to social deprivation. Areas with above average social deprivation had both more new cases of psychoses and a higher proportion of the population admitted than expected from a linear function. Conclusions. Application of a linear function to funding gradients may underfund high and low need areas and overfund median need areas. Improving the precision of estimates of the relationship between social deprivation and need for services is crucial to more equitable resource allocation.

关键词：卫生服务需求发病率精神卫生服务/统计学和数值数据病人入院贫困患病率精神病科医院精神病/流行病学精神病/病因学精神病/心理学社会阶级青少年成年人女(雌)性人类男(雄)性中年人

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Goodness-of-fit for GEE: An example with mental health service utilization

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STATISTICS IN MEDICINE 1999年第2期18卷 213-222页

作者： Horton, NJ Bebchuk, JD Jones, CL Lipsitz, SR Catalano, PJ Zahner, GEP Fitzmaurice, GM Harvard Univ Sch Publ Hlth Dept Biostat Boston MA 02115 USA Dana Farber Canc Inst Boston MA 02115 USA Harvard Univ Sch Med Dept Psychiat Boston MA 02115 USA

Suppose we use generalized estimating equations to estimate a marginal regression model for repeated binary observations. There are no established summary statistics available for assessing the adequacy of the fitted model. In this paper we propose a goodness-of-fit test statistic which has an approximate chi-squared distribution when we have specified the model correctly. The proposed statistic can be viewed as an extension of the Hosmer and Lemeshow goodness-of-fit statistic for ordinary logistic regression to marginal regression models for repeated binary responses. We illustrate the methods using data from a study of mental health service utilization by children. The repeated responses are a set of binary measures of service use. We fit a marginal logistic regression model to the data using generalized estimating equations, and we apply the proposed goodness-of-fit statistic to assess the adequacy of the fitted model. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：年龄因素卡方分布儿童保健服务/统计学和数值数据康涅狄格精神卫生服务/统计学和数值数据模型统计学回归分析性别因素美国儿童女(雌)性人类男(雄)性

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