Hospitalization and presenting problems

Abstract

as cultural or subcultural affiliation, administrative policy, and a history of previous hospitalization. These findings, including those pertaining to inpatient versus outpatient treatment assignment decisions, continue to receive corroboration from more recent studies conducted at the urban mental health center with which the authors are associated. '4-2° Yet many of these correlations are difficult to interpret. They can be and often are cited to support diametrically opposed conelusions and inferences. For example, does the association between lower socioeconomic status and inpatient treatment assignment signify mere correlation or, more important, a causal relationship reflecting class bias of middle-class professionals in their response to lower-class behavioral styles? The charge is often enough and easily enough made, but what truth it contains has been difficult to ascertain. Similarly, does the repeatedly demonstrated association e'-24 between inpatient treatment and previous inpatient experience mean that such experience functions as a biasing factor inducing the decision-maker, in assessing the current difficulty, to assume greater severity and gravity than is warranted, thus increasing the likelihood of certain inpatient treatment assignments, as was thought to be the case, for instance, by Richart and Milner? z~ Addressing these two questions and presenting data from a recent communitywide survey, this paper examines the presenting problems of all adults, 18 years and over, who applied for psychiatric care over a period of 1 year (unduplicated count). Except for some important work of a few investigators, 26-28 presenting problems remain a relatively unexplored area. Insofar as they are a link between the observed and the inferred, they can be treated clinically or nonclinically (or both simultaneously) and thus constitute one of the few variables that stand at the interfaces between demographic, psychosocial, and clinical phenomena. Taken at face value and uninterpreted, they can bypass clinical inferences and thereby provide a fruitful, empirically grounded research tool. At times a presenting