Diagnostic Interview Schedule For DSM-IV Research Articles

Personality and Psychiatric Disorders among Employees of New York City Workplaces Affected by the 9/11 Attacks on the World Trade Center

Objective Personality is associated with psychopathology after disasters, but its association with the portion of postdisaster psychopathology that is incident remains unclear. It is also unclear whether any particular attributes of personality are associated with resistance to the persistence or recurrence of preexisting psychopathology after disasters. This exploratory study of employees of workplaces affected by the September 11, 2001, attacks on the World Trade Center in New York City examined the specific relationships of personality variables (specifically, novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence) to incident postdisaster psychiatric disorders and resistance to the persistence/recurrence of preexisting psychiatric disorders after the disaster. Methods Approximately 3 years after the 9/11 attacks, 379 employees were recruited from 8 selected affected workplaces (3 in the World Trade Center towers, 5 at varied distances in the geographic area). Lifetime predisaster and postdisaster psychiatric disorders were assessed retrospectively with the Diagnostic Interview Schedule for DSM-IV, disaster experience details were collected with the Disaster Supplement, and personality was assessed with the Temperament and Character Inventory. Results Underdeveloped executive functioning (low self-directedness and/or low cooperativeness) was associated with incident postdisaster psychopathology, and components of resilience (low harm avoidance, high self-directedness, and high persistence) were associated with postdisaster resistance to persistence/recurrence of preexisting psychiatric illness. Conclusions Personality is related to both incident and persistent/recurrent portions of postdisaster psychopathology, not clearly distinguished in previous research. Personality variables related to executive functioning and resilience may aid in assessing risk and developing treatments to prevent disaster-related psychopathology.

Psychosocial Effects on US Government Personnel of Exposure to the 1998 Terrorist Attack on the US Embassy in Nairobi

Objective: The mental health effects of major terrorist attacks on diplomatic government personnel have not been well studied. This study examined the psychiatric and psychosocial effects of the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya, on US government personnel exposed to the bombing. Method: At 8–10 months after the bombing, 179 US government employees (53 Americans, 126 Kenyans, 53% male, age mean = 40.6 and SD = 8.4 years ranging 21–65) were assessed with the Diagnostic Interview Schedule for DSM-IV for disaster-related psychiatric diagnoses and the Disaster Supplement Interview and Questionnaire about their immediate disaster experiences, subjective responses, mental health interventions/treatment, safety perceptions, and coping. Results: About one-third (32%) of these US government personnel developed postdisaster psychiatric disorders, mostly bombing-related PTSD (20%), but few received psychiatric treatment. Prevalence rates of all postdisaster psychiatric disorders, including bombing-related PTSD, were similar between subgroups of Americans and Kenyans, despite the Kenyans reporting more direct disaster trauma exposures, subjective postdisaster distress, and posttraumatic stress symptoms. These US government personnel had fewer psychiatric consequences of the Nairobi bombing than their previously studied civilian counterparts. Conclusions: Possible explanatory factors in the lower prevalence of postdisaster psychopathology in these government personnel compared to the civilians are selection for greater personal resilience for government employment and stigma-based underreporting of mental health needs in governmental workplaces. Stigma is a potential barrier to psychiatric treatment that needs to be addressed in government workplaces.

Social Support May Protect against Development of Posttraumatic Stress Disorder: Findings from the Heart and Soul Study

No prospective studies have examined the association of poor social support and development of posttraumatic stress disorder (PTSD) in patients with chronic illness. This study addresses this knowledge gap. This prospective study examines the relationship of social support to the subsequent development of PTSD during a 5-year period. San Francisco Veterans Affairs Medical Center. A total of 579 participants with cardiovascular disease did not have PTSD at baseline and returned for the 5-year follow-up examination. PTSD measured by Computerized Diagnostic Interview Schedule for DSM-IV. Social support measured by Interpersonal Support Evaluation List (ISEL). Unconditional ordered logistic regression analyses were performed to yield the odds ratio of developing PTSD for a one-standard-deviation change in ISEL score. Of 579 participants who did not have PTSD at baseline, approximately 6.4% (n = 37) developed PTSD. Higher baseline perceived social support was strongly protective against development of PTSD (OR = .60, p = .001). Results remained significant after adjustment for age, sex, race, income, and depression (OR = .69, p = .04). Of social support types examined, the "tangible" and "belonging" domains were most strongly associated with future PTSD status. Social support may impact development of PTSD. Interventions that optimize social support may be part of a PTSD prevention program designed to help individuals at risk of developing PTSD.

Extended Mental Health Service Utilization Among Survivors of the Oklahoma City Bombing

The study assessed survivors of Oklahoma City's 1995 bombing seven years postdisaster to identify long-term mental health service use. Psychiatric disorders and disaster-related variables were assessed for 99 survivors at seven years postdisaster with the Diagnostic Interview Schedule for DSM-IV and its Disaster Supplement. Of the 99 survivors, 86% received services during the seven years. Use was associated with female sex, injury or hospitalization, and posttraumatic stress disorder (PTSD) or major depression. Informal interventions were usually initiated in the first six months. Treatment by psychiatrists, other professionals, and family doctors increased after the first month. Half the survivors with PTSD or depression received treatment from a psychiatrist. Only 15% of survivors took psychotropic medications. Although 33% received treatment for more than one year, only 7% were receiving services at seven years. Although service needs decreased over time, results support provision of diverse services adapted to changing needs.

Lifetime Trauma Exposure and Prospective Cardiovascular Events and All-Cause Mortality

Little is known about the effect of cumulative psychological trauma on health outcomes in patients with cardiovascular disease. The objective of this study was to prospectively examine the association between lifetime trauma exposure and recurrent cardiovascular events or all-cause mortality in patients with existing cardiovascular disease. A total of 1021 men and women with cardiovascular disease were recruited in 2000 to 2002 and followed annually. Trauma history and psychiatric comorbidities were assessed at baseline using the Computerized Diagnostic Interview Schedule for DSM-IV. Health behaviors were assessed using standardized questionnaires. Outcome data were collected annually, and all medical records were reviewed by two independent, blinded physician adjudicators. We used Cox proportional hazards models to evaluate the association between lifetime trauma exposure and the composite outcome of cardiovascular events and all-cause mortality. During an average of 7.5 years of follow-up, there were 503 cardiovascular events and deaths. Compared with the 251 participants in the lowest trauma exposure quartile, the 256 participants in the highest exposure quartile had a 38% greater risk of adverse outcomes (hazard ratio = 1.38, 95% confidence interval = 1.06-1.81), adjusted for age, sex, race, income, education, depression, posttraumatic stress disorder, generalized anxiety disorder, smoking, physical inactivity, and illicit drug abuse. Cumulative exposure to psychological trauma was associated with an increased risk of recurrent cardiovascular events and mortality, independent of psychiatric comorbidities and health behaviors. These data add to a growing literature showing enduring effects of repeated trauma exposure on health that are independent of trauma-related psychiatric disorders such as depression and posttraumatic stress disorder.

Specific psychiatric correlates of acute care utilization among unstably housed HIV-positive adults

The role of specific psychiatric diagnoses in emergency department use and/or inpatient hospitalizations (acute care) has not been extensively examined among HIV-infected, unstably housed persons. A community-recruited sample of 284 HIV-infected, unstably housed adults completed the Diagnostic Interview Schedule for DSM-IV. One-third of participants screened positive for major depression and stimulant use disorders. Sleeping on the street [adjusted odds ratio (AOR) = 4.21], major depression (AOR = 2.88) and stimulant use disorders (AOR = 4.45) were associated with greater odds of acute care use. Housing and effective treatment of depression and stimulant use disorders may decrease use of acute care services in this population.

Autonomic reactivity and hypothalamic pituitary adrenal axis dysregulation in spouses of Oklahoma City bombing survivors 7 years after the attack

ObjectiveThe objective of this exploratory pilot study was to examine autonomic reactivity and hypothalamic pituitary adrenal axis dysregulation in spouses of highly exposed survivors of the 1995 Oklahoma City bombing. MethodsThis study compared psychiatric diagnoses and biological stress markers (physiological reactivity and cortisol measures) in spouses of bombing survivors and matched community participants. Spouses were recruited through bombing survivors who participated in prior studies. Individuals with medical illnesses and those taking psychotropic medications that would confound biological stress measures were excluded. The final sample included 15 spouses and 15 community participants. The primary outcome measures were psychiatric diagnoses assessed with the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Biological stress markers were physiological reactivity and recovery in heart rate and blood pressure responses to a trauma interview and cortisol (morning, afternoon, and diurnal variation). ResultsCompared to the community participants, spouses evidenced greater reactivity in heart rate, systolic blood pressure, and diastolic blood pressure; delayed recovery in systolic blood pressure; and higher afternoon salivary cortisol. ConclusionsThe results support the need for further research in this area to clarify post-disaster effects on biological stress measures in the spouses of survivors and the potential significance of these effects and to address the needs of this important population which may be overlooked in recovery efforts.

Personality and Major Depression among Directly Exposed Survivors of the Oklahoma City Bombing.

Background. Few disaster studies have specifically examined personality and resilience in association with disaster exposure, posttraumatic stress disorder (PTSD), and major depression. Methods. 151 directly-exposed survivors of the Oklahoma City bombing randomly selected from a bombing survivor registry completed PTSD, major depression, and personality assessments using the Diagnostic Interview Schedule for DSM-IV and the Temperament and Character Inventory, respectively. Results. The most prevalent postdisaster psychiatric disorder was bombing-related PTSD (32%); major depression was second in prevalence (21%). Bombing-related PTSD was associated with the combination of low self-directedness and low cooperativeness and also with high self-transcendence and high harm avoidance in most configurations. Postdisaster major depression was significantly more prevalent among those with (56%) than without (5%) bombing-related PTSD (P < .001) and those with (72%) than without (14%) predisaster major depression (P < .001). Incident major depression was not associated with the combination of low self-directedness and low cooperativeness. Conclusions. Personality features can distinguish resilience to a specific life-threatening stressor from general indicators of well-being. Unlike bombing-related PTSD, major depression was not a robust marker of low resilience. Development and validation of measures of resilience should utilize well-defined diagnoses whenever possible, rather than relying on nonspecific measures of psychological distress.

Post-traumatic stress disorder is associated with poor health behaviors: findings from the heart and soul study.

Posttraumatic stress disorder (PTSD) results in substantial disability, including increased risk of cardiovascular disease (CVD). Poor health behaviors are major risk factors for initial and recurrent CVD events. Therefore, this study investigated whether PTSD is associated with poor health behaviors in patients with CVD. Cross-sectional study of 1,022 men and women with CVD. PTSD was assessed with the Computerized Diagnostic Interview Schedule for DSM-IV. Physical activity, medication adherence and smoking history were determined by self-report questionnaires. Multivariate logistic and linear regression models were used to evaluate the association of PTSD with health behaviors. Of the 1,022 participants, 95 (9%) had PTSD. PTSD was associated with significantly higher rates of physical inactivity in terms of overall exercise (OR 1.6, 95% CI [1.0-2.6]; p = .049), light exercise (OR 1.7, 95% CI [1.0-2.9]; p = .045), and self-rated level of exercise compared to others of their age and sex (OR 1.8, 95% CI [1.0-3.0]; p = .047). Participants with PTSD were more likely to report medication nonadherence, including forgetting medications (OR 1.8, 95% CI [1.0-3.3]; p = .04) or skipping medications (OR 1.7, 95% CI [1.1-2.9]; p = .03). Participants with PTSD also reported a greater smoking history (β 6.4 pack years, 95% CI [1.8-10.9]; p = .006), which remained significant after adjustment for depression and income. Among patients with heart disease, those with PTSD were more likely to report physical inactivity, medication nonadherence and smoking. The majority of these associations were explained by adjustment for comorbid depression and lower income.

Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India

Context:Longer duration of untreated psychosis (DUP) is known to be associated with poorer outcome of schizophrenia. DUP is also known to be longer in lower- and middle-income countries. Methodologically sound studies that have examined the association of DUP and outcome of schizophrenia in these countries are lacking.Aim:The aim was to evaluate the association between DUP and outcome of never-treated schizophrenia patients.Setting and Design:This study was conducted at the National Institute of Mental Health and Neurosciences, Bangalore, using a prospective cohort design.Materials and Methods:119 patients with schizophrenia/schizophreniform disorder diagnosed using the computerized diagnostic interview schedule for DSM-IV (CDIS-IV) were further assessed for DUP with the interview for retrospective assessment of onset of schizophrenia (IRAOS). After a mean (SD) follow-up period of 55.9 (37.2) weeks, the social and occupational functioning and psychopathology of 93 (80.2% of the surviving patients) patients were assessed using the social and occupational functioning scale (SOFS) and the positive and negative syndrome scale (PANSS), by raters blind to the DUP data. Spearman's correlation and Kendall's tau-B test were used to analyze the relationship between DUP and the outcome variables.Results:The mean DUP was 90.2 (median=30.1; SD=121.9) weeks. SOFS and PANSS scores at follow-up were statistically significantly associated with DUP, but not with other baseline variables (SOFS: rho=0.22, P=0.03; PANSS: rho=0.23, P=0.03). Among those with the shortest DUP (<16 weeks; n=33), 45.5%, 30.3%, and 24.2% had no impairment, mild-moderate impairment, and severe impairment, respectively. In contrast, 19.4%, 38.7%, and 41.9% of those with the longest DUP (>72 weeks; n=31) had no, mild-moderate, and severe impairment, respectively (Kendall's Tau-b=0.194; P=0.025).Conclusions:The delay in accessing treatment among patients with psychosis is considerable in India, a lower- to middle-income country. Longer DUP is associated with poorer psychopathological and functional outcomes in persons with schizophrenia/schizophreniform disorder.

Trajectories of Depression Symptoms among Older Youths Exiting Foster Care.

The purpose of this study was to determine the trajectories of depressive symptoms as older youths from the foster care system mature while also examining the correlates of these trajectories. Data came from a longitudinal study of 404 youths from the foster care system in Missouri, who were interviewed nine times between their 17th and 19th birthdays. Depression was assessed with the Depression Outcomes Module and the Diagnostic Interview Schedule for DSM-IV. Data best fit a model of three trajectory classes, describing young people (1) maintaining low levels of depressive symptoms (never depressed class, 78%), (2) with increasing symptoms (increasing class, 6%), and (3) with decreasing symptoms (decreasing class, 15%). The increasing depression group was mostly male youths who were working or in school; the decreasing class was mostly highly maltreated female youths exiting the foster care system from residential care, with low levels of employment, and in school. Implications for social work practice are discussed.

Posttraumatic Stress Disorder and Health-Related Quality of Life in Patients With Coronary Heart Disease

Posttraumatic stress disorder (PTSD) is increasingly recognized as a cause of substantial disability. In addition to its tremendous mental health burden, PTSD has been associated with worse physical health status and an increased risk of cardiovascular disease. To determine whether PTSD is associated with cardiovascular health status in patients with heart disease and whether this association is independent of cardiac function. Cross-sectional study. The Heart and Soul Study, a prospective cohort study of psychological factors and health outcomes in adults with stable cardiovascular disease. One thousand twenty-two men and women with coronary heart disease. Posttraumatic stress disorder was assessed using the Computerized Diagnostic Interview Schedule for DSM-IV. Cardiac function was measured using left ventricular ejection fraction, treadmill exercise capacity, and inducible ischemia on stress echocardiography. Disease-specific health status was assessed using the symptom burden, physical limitation, and quality of life subscales of the Seattle Angina Questionnaire. We used ordinal logistic regression to evaluate the association of PTSD with health status, adjusted for objective measures of cardiac function. Of the 1022 participants, 95 (9%) had current PTSD. Participants with current PTSD were more likely to report at least mild symptom burden (57% vs 36%), mild physical limitation (59% vs 44%), and mildly diminished quality of life (62% vs 35%) (all P < or = .001). When adjusted for cardiovascular risk factors and objective measures of cardiac function, PTSD remained independently associated with greater symptom burden (odds ratio, 1.9; 95% confidence interval, 1.2-2.9; P = .004); greater physical limitation (odds ratio, 2.2; 95% confidence interval, 1.4-3.6; P = .001); and worse quality of life (odds ratio, 2.5; 95% confidence interval, 1.6-3.9; P < .001). Results were similar after excluding participants with depression. Among patients with heart disease, PTSD is more strongly associated with patient-reported cardiovascular health status than objective measures of cardiac function. Future studies should explore whether assessing and treating PTSD symptoms can improve function and quality of life in patients with heart disease.

Evaluating the validities of different DSM‐IV‐based conceptual constructs of tobacco dependence*

To compare the concurrent and predictive validities of two subsets of DSM-IV criteria for nicotine dependence (tolerance and withdrawal; withdrawal; difficulty controlling use; and use despite harm) to the concurrent and predictive validity of the full DSM-IV criteria. Analysis of baseline and outcome data from three randomized clinical trials of cigarette smoking treatment. San Francisco, California. Two samples of cigarette smokers (n = 810 and 322), differing with regard to baseline characteristics and treatment received, derived from three randomized clinical trials. DSM-IV nicotine dependence criteria were measured at baseline with a computerized version of the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Additional baseline measures included the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, breath carbon monoxide (CO) level, the Minnesota Nicotine Withdrawal Scale (MNWS), the Michigan Nicotine Reinforcement Questionnaire (M-NRQ) and the Profile of Mood States (POMS). Seven-day point-prevalence abstinence was assessed at week 12. Full DSM-IV criteria displayed greater concurrent validity than either of the two subsets of criteria. However, DSM-IV symptoms accounted for only a nominal amount of the variance in baseline smoking-related characteristics and were unrelated to smoking abstinence at week 12. Cigarettes smoked per day was the only significant predictor of abstinence at week 12. Although the findings do not provide a compelling alternative to the full set of DSM-IV nicotine dependence criteria, its poor psychometric properties and low predictive power limit its clinical and research utility.

Comorbid Psychiatric Illness Often Found in Adults With ADHD

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessComorbid Psychiatric Illness Often Found in Adults With ADHDJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:5 May 2006https://doi.org/10.1176/pn.41.9.0022Between 2001 and 2003, Ronald Kessler, Ph.D., a professor of health care policy at Harvard Medical School, and colleagues undertook a formidable challenge—determining the status of Americans' mental health.Their assessment—called the National Comorbidity Survey Replication—was based on detailed interviews with more than 9,000 Americans, representative of the American population. The major results from the survey were published in the June 2005 Archives of General Psychiatry (Psychiatric News, July 15, 2005).Now in the April American Journal of Psychiatry, Kessler and his team reported what they have learned from their survey about adult attention-deficit/hyperactivity disorder (ADHD). This illness was not addressed by the last two major American psychiatric epidemiology surveys—the Epidemiologic Catchment Area Study and the National Comorbidity Survey.Because of concern about recall failure among older adults, Kessler and his coworkers decided to assess only 3,199 of their survey participants, all between 18 and 44 years of age, for the presence of adult ADHD. The assessments were conducted by lay interviewers using the Diagnostic Interview Schedule for DSM-IV. Respondents who indicated that they had had ADHD in childhood were then asked an additional question—whether they continued to have any ADHD symptoms. Of the 3,199 participants, 3 percent were found to have had childhood ADHD as well as current ADHD symptoms.Then 154 of the 3,199 participants—representing an oversampling of those with adult ADHD symptoms—were assessed in reappraisal interviews for adult ADHD. These interviews were conducted by clinical psychologists who used the Adult ADHD Clinical Diagnostic Scale. Although there is no standard method for diagnosing adult ADHD, this scale has been used in adult-ADHD clinical trials.Kessler and his team then used both the initial interview results and the reappraisal-interview results to derive an estimated prevalence of adult ADHD for the entire sample of 3,199 participants. The estimate prevalence they obtained was 4 percent.Few Get TreatmentMoreover, Kessler and his colleagues learned, survey participants who had adult ADHD were more often male than female; were often unemployed, no longer married, and impaired in such areas as thinking, taking care of themselves, and getting about; and often had other mental illnesses, notably anxiety, depression, a substance use disorder, or intermittent explosive disorder.Only 10 percent of those diagnosed with adult ADHD were receiving treatment for it. This is a much lower percentage than the number of Americans being treated for anxiety, mood, and substance use disorders.Their results, Kessler and his coworkers noted, make one wonder whether treatment of adult ADHD might mitigate the mental illnesses that often accompany the condition. After all, they explained, a diagnosis of adult ADHD requires that at least some of the symptoms of ADHD began before the age of 7, so the mental conditions that often accompany it probably occurred at a later age and perhaps in response to the ADHD.Indeed, the researchers pointed out, successful treatment of ADHD in children often reduces the symptoms of mental disorders that frequently occur along with ADHD.Taken together, Kessler and his team concluded, their results regarding adult ADHD were mostly what they had expected. However, one finding did surprise them—a lower prevalence of adult ADHD among blacks and Hispanics than among whites. This outcome, they reasoned, could reflect true racial or ethnic differences or perhaps a greater acceptance of ADHD symptoms by blacks and Hispanics.More Screening Needed“This is a well-designed, cross-sectional study of the prevalence of adult ADHD,” Tony Rostain, M.D., director of education in the University of Pennsylvania Department of Psychiatry and an adult ADHD authority, told Psychiatric News. “The authors used rigorous methods to screen and interview 154 respondents in order to determine the rate of ADHD diagnosis, as well as demographic correlates and comorbid disorders seen in subjects with ADHD.“Their finding that 4.4 percent of the adult population meets criteria for ADHD is credible, as are the findings of significantly increased rates of depression, anxiety, substance abuse, and intermittent explosive disorder in this group. Finally, the low rates of treatment for ADHD that these patients are receiving underscores the importance of careful screening for the disorder, especially in adult patients being treated for depression, anxiety, and substance abuse.”The National Comorbidity Survey Replication was funded by the National Institute of Mental Health, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation, and the John W. Alden Trust. Additional support for the adult ADHD assessments came from a grant from Eli Lilly and Co.“The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication” is posted at<http://ajp.psychiatryonline.org/cgi/content/full/163/4/716>.▪ ISSUES NewArchived

Psychiatric Disorders and Their Correlates Among Young Adult MDMA Users in Ohio

This study describes the lifetime prevalence, correlates, and age of onset of selected psychiatric disorders among a community sample of MDMA users (n = 402), aged 18 to 30, in Ohio. Participants responded to interviewer-administered questionnaires, including sections of the computerized Diagnostic Interview Schedule for DSM-IV. Fifty-five percent of the sample had at least one lifetime disorder, with major depression (35.3%) and antisocial personality disorder (ASPD) (25.4%) the most common. Proportionately more women were diagnosed with depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD), while proportionately more men were diagnosed with ASPD. Proportionately more non-White participants had attention deficit/hyperactivity disorder (AD/HD). Higher levels of education were associated with proportionately less PTSD, ASPD, and AD/HD. Higher frequencies of MDMA use were associated with proportionately more ASPD and AD/HD. Comparing the age of first MDMA use with the age of onset for selected psychiatric disorders revealed that for most participants disorders preceded use. Multivariate analysis revealed participants with more than a high school education were less likely to have experienced a lifetime disorder, while those who had used MDMA more than 50 times were more likely. Variations in the prevalence of psychiatric disorders have practical implications for drug abuse prevention and treatment programs.

Prevalence of Psychiatric Disorders Among Older Youths in the Foster Care System

To estimate the lifetime and past year prevalence rates of major psychiatric disorders in a sample of older youths in the foster care system, to examine the timing of disorder onset and system entry, and to explore variations in past year prevalence rates. Using the Diagnostic Interview Schedule for DSM-IV, interviews were conducted with 373 17-year-old youths (90% of those eligible) in one state's foster care system between December 2001 and June 2003. : Sixty-one percent of the youths qualified as having at least one psychiatric disorder during their lifetime; of these youths, 62% reported onset of their earliest disorder before entering the foster care system. In addition, 37% of youths met criteria for a psychiatric disorder in the past year. The number of types of maltreatment experienced was the most robust predictor of psychiatric disorder among several maltreatment variables. There were no differences in prevalence rates for youths in kinship care and those in nonkin foster families. Older youths in the foster care system have disproportionately high rates of lifetime and past year psychiatric disorders. Results support recommendations for initial and periodic mental health assessments for these youths and mechanisms to continue mental health services for young adults transitioning out of the foster care system.

Suppression of cellular immunity in men with a past history of posttraumatic stress disorder.

High rates of medical morbidity have been reported in subjects with posttraumatic stress disorder (PTSD). The authors examined immune function in subjects in remission from past PTSD. The initial study group was composed of 1,550 Japanese male workers. Japanese versions of the Events Check List, the Impact of Event Scale-Revised, and the Diagnostic Interview Schedule for DSM-IV were used to identify subjects who had a past history of PTSD. Twelve of the workers were identified as having such a history. These men were matched in age and smoking habits, which affect immunity, to 48 comparison subjects who had similar stressful life experiences but no current or past history of PTSD. Natural killer (NK) cell activity, lymphocyte subset counts, and production of interferon gamma (IFN-gamma) and interleukin-4 (IL-4) were measured in the 60 men by means of phytohemagglutinin stimulation. The number of lymphocytes, number of T cells, NK cell activity, and total amounts of IFN-gamma and IL-4 were significantly lower in the 12 men with a past history of PTSD. PTSD leaves a long-lasting immunosuppression and has long-term implications for health.

Short screening scale for DSM-IV posttraumatic stress disorder.

The authors' goal was to construct a short screening scale for DSM-IV posttraumatic stress disorder (PTSD). They used data from the Detroit Area Survey of Trauma, which is a representative population sample of 2,181 subjects 18-45 years of age. Random digit dialing was used to select the sample, and a computer-assisted telephone interview was used to collect data on traumatic experiences and PTSD. Presence or absence of PTSD was assessed with a telephone-administered structured interview that closely followed the National Institute of Mental Health Diagnostic Interview Schedule for DSM-IV and the World Health Organization Composite International Diagnostic Interview, version 2.1. Best-subset regression analysis and receiver operating characteristic analysis were used to select a subset of items from the structured interview that most efficiently predicted PTSD as diagnosed in the full-length interview. A seven-symptom screening scale for PTSD was selected; five of the symptoms were from the avoidance and numbing group, and two were from the hyperarousal group. A score of 4 or greater on this scale defined positive cases of PTSD with a sensitivity of 80%, specificity of 97%, positive predictive value of 71%, and negative predictive value of 98%. The short screening scale is an efficient method to screen for PTSD in epidemiologic and clinical studies, given limitations on resources and burden on respondents.