Eastern Baltimore Mental Health Survey Research Articles

DSM-III personality disorders in the community.

The aims of this study were to estimate the prevalence and investigate the comorbidity and potential consequences of DSM-III personality disorders in the community. A total of 810 adults were examined in the second stage of the Eastern Baltimore Mental Health Survey in 1981, part of the National Institute of Mental Health Epidemiologic Catchment Area program. The subjects were directly examined by psychiatrists using a semi-structured method that allowed diagnosis of all DSM-III personality disorders as well as other DSM-III psychiatric disorders. The prevalence of personality disorders in these adults was 5.9% (9.3% when provisional cases were included). Men had higher rates than women, and subjects who were separated or divorced had the highest rates. There was little comorbidity among specific personality disorders. Subjects with personality disorders were significantly more likely to have a history of sexual dysfunctions, alcohol use disorders, and drug use disorders as well as suicidal thoughts and attempts. In addition, they reported significantly more life events in the past year. Among subjects with any axis I disorder, those with personality disorders were judged by the psychiatrists to be more in need of treatment; however, only 21% were receiving treatment. Personality disorders are relatively common in the community. They are associated with axis I disorders and life events. Only one-fifth of the individuals who qualify for diagnoses of personality disorders in the community are receiving treatment.

Obsessions and compulsions in the community

A total of 810 adults were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey. A semistructured examination, the Standard Psychiatric Examination, was used. The relationships between obsessions and compulsions and personal characteristics, childhood behaviors, family history, and other psychopathology were evaluated. The estimated prevalence of obsessions and compulsions in this population was 1.5%. Cases were significantly more likely to report having had childhood fears, learning disabilities and a family history of alcoholism and suicidal behavior. There were significant positive relationships between scores on compulsive, borderline and histrionic personality disorder scales and the probability of obsessions and compulsions. These exploratory analyses in an epidemiologic sample may identify factors of etiologic importance in this condition.

The relationship between personality and DSM-III axis I disorders in the population: results from an epidemiological survey.

The aim of this study was to assess the relationships between specific personality disorders and DSM-III axis I conditions in a community sample. A total of 810 subjects were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey, part of the Epidemiological Catchment Area Program of the National Institute of Mental Health. A semistructured examination, the Standardized Psychiatric Examination, was employed to assess axis I and axis II conditions. Scales for compulsive and antisocial personality disorders were derived from DSM-III criteria. The relationships between scores on these personality disorder scales and the presence of generalized anxiety disorder, alcohol use disorders (alcohol abuse and alcohol dependence), and simple phobia were evaluated by using logistic regression. Higher compulsive personality scores were associated with a greater odds of generalized anxiety disorder and simple phobia but a smaller odds of alcohol use disorders. In contrast, higher antisocial personality scores were associated with a greater odds of alcohol use disorders but a smaller odds of generalized anxiety disorder. There was no relationship between antisocial personality scores and simple phobia. Personality disorders have specific relationships to axis I conditions, which suggests different vulnerabilities but also different protective influences.

The epidemiology of psychiatrist-ascertained depression and DSM-III depressive disorders. Results from the Eastern Baltimore Mental Health Survey Clinical Reappraisal.

Psychiatrists used a semi-structured Standardized Psychiatric Examination method to examine 810 adults drawn from a probability sample of eastern Baltimore residents in 1981. Of the population, 5.9% was found to be significantly depressed. DSM-III major depression (MD) had a prevalence of 1.1% and 'non-major depression' (nMD), our collective term for the other depressive disorder categories in DSM-III, had a prevalence of 3.4%. The two types of depression differed by sex ratio, age-specific prevalence, symptom severity, symptom profiles, and family history of suicide. Analyses using a multiple logistic regression model discerned that both types of depression were influenced by adverse life events, and that nMD was influenced strongly by gender, marital status, and lack of employment outside the home. Neither type of depression was influenced by income, education, or race. This study validates the concept of major depression as a clinical entity. Future studies of the aetiology, mechanism, and treatment of depression should distinguish between these two types of depression.

The Epidemiology of Delirium in the Community: The Eastern Baltimore Mental Health Survey

The 1981 East Baltimore Mental Health Survey, part of the Epidemiological Catchment Area (ECA) program, provided data for the examination of the prevalence of delirium in the general adult population. From an original 3,841 households surveyed, 810 individuals were selected for psychiatric evaluation and, of these, 6 individuals were diagnosed as suffering from delirium. The estimated prevalence of delirium in the population was .4% and 1.1% among those 55 years of age and over. A comparison of these cases with cases of diagnosed dementia and individuals of the same age range who did not receive a psychiatric diagnosis found that those with a diagnosis of delirium suffer from a greater number of medical conditions, take more prescribed medications, and have a higher level of physical disability.

Screening for Psychosis in the General Population with a Self-Report Interview

This analysis applies methods of screening to the problem of psychosis. A probability sample of 810 individuals from the Eastern Baltimore Mental Health Survey was interviewed in the self-report modality with the Diagnostic Interview Schedule and shortly thereafter by a psychiatrist. It is shown that a configuration of responses in the self-report modality can screen moderately well for psychosis, as measured by psychiatrists in the clinical modality.

Relationship between psychiatric distress and alcohol use: findings from the Eastern Baltimore Mental Health Survey.

This study examined the nature and strength of relationships between levels of alcohol use and concurrent psychiatric distress among adults in the community aged 18-64 years. Data for this project were gathered by standardized interview methods during the 1981-1982 Eastern Baltimore Mental Health Survey. The 2558 survey respondents were initially selected by means of multistage probability sampling of adult household residents in eastern Baltimore, Maryland. This project's findings indicated gender differences in the relationships under study. There was a moderate degree of association between heavy alcohol use and psychiatric distress among women; at moderate levels of alcohol use, a modest association was also noted. In contrast, for males, the results suggested a small positive association between heavy alcohol use and concurrent psychiatric distress, although these findings were not conclusive.

An epidemiologic study of alcohol use as a predictor of psychiatric distress over time.

This longitudinal epidemiologic study examined how levels of psychiatric distress over one year may be influenced by both concurrent levels of alcohol use and by prior drinking levels. The study's data were gathered during the 1981-1982 Eastern Baltimore Mental Health Survey (EBMHS), as part of the 5-site National Institute of Mental Health Epidemiologic Catchment Area (NIMH-ECA) Program. The 2091 respondents (18-64 years of age) reinterviewed after one year were initially selected by means of multistage probability sampling of adult household residents in eastern Baltimore, Maryland. The findings for men and women indicated that both high psychiatric distress at baseline interview and concurrent heavy alcohol use were associated with higher levels of psychiatric distress at one-year follow-up. Differences across population subgroups were also noted. Among women, the results further suggested that prior heavy alcohol use was an additional predictor of psychiatric distress levels after one year; this was not found for men.

Strategies for investigating effects of residential context. A study of depressed mood and major depression.

This article calls attention to two procedures for investigating relationships between residential environments and behavior: geocoding of respondent data and a strategy based on age of respondent as an indicator of residential exposure. These procedures are illustrated in terms of data from the Eastern Baltimore Mental Health Survey (Baltimore site of the National Institute of Mental Health Epidemiologic Catchment Area Program) and 1980 census data from the Health Demographic Profile System.

Measuring Need for Mental Health Services in a General Population

This article presents measures of need for mental health services estimated from the 1981 Eastern Baltimore Mental Health Survey, one of five sites participating in the NIMH Epidemiologic Catchment Area Program. Data were collected on the prevalence of specific psychiatric disorders, as determined by the standardized Diagnostic Interview Schedule (DIS), functional status, personal characteristics, patterns of medical and mental health care, and sources of care used. Need is based on mental health services use in the prior 6 months or the presence of two or more manifestations of emotional problems: a) one or more DIS disorders present in the past 6 months, b) a General Health Questionnaire (GHQ) score of four or more current symptoms, or c) the respondent's report of having been unable to carry out usual activities in the past 3 months for at least 1 entire day because of an emotional problem. Approximately 14% of adults met the criteria for need, half of whom had made no mental health visits in the prior 6 months and were considered to have unmet need. Need for care was influenced by a variety of sociodemographic and economic characteristics: it was low among the aged and high among persons living alone and the poor on Medicaid. The proportion of need that was unmet varied less but was relatively large for two groups, the aged and nonwhites. Those on Medicaid through public assistance were more likely to have their need met than the near poor.

Mental health of the elderly: use of health and mental health services.

The utilization of services by older patients with mental morbidity is examined in this paper. The population is drawn from a large, multi-site study, the Epidemiological Catchment Area studies, and reports on the findings from the Baltimore, Maryland, site, The Eastern Baltimore Mental Health Survey. The fact that older individuals with mental disorders are less likely to be seen and treated for these disorders than are younger individuals was substantiated by data from this study. Of those under age 65, 8.7 per cent have made a visit to a specialty or primary care provider for mental health care; for those age 65 to 74, the rate is 4.2 per cent, and of those 75 and over, only 1.4 per cent have had such care. In this last group, 75 and over, not a single person saw a specialty mental health provider. The likeliest source of care for older individuals for emotional or psychiatric problems is their primary care providers within the context of a visit made for physical medical problems. Past work and these data suggest that the factors that influence this low level of care can be found in the characteristics of the population as well as in the characteristics of the health care system. The implications of these findings are discussed.

Diagnostic Interview Schedule

<h3>To the Editor.</h3> — A recent article in theArchivesby Robins et al (1981;38:381-389) described a new structured interview, the National Institute of Mental Health Diagnostic Interview Schedule (DIS), that yields DSM-III diagnostic data and that is suitable for administration by lay interviewers. We have used this instrument in our work on the Eastern Baltimore Mental Health Survey, part of the NIMH Epidemiologic Catchment Area program,¹and have some observations that may be of interest to potential users of the DIS. Srole and Fischer²questioned whether community respondents will provide the detailed information on psychiatric symptoms required by a DIS interview. Our experience, both in a pilot test in the community and in field work, has been that respondents do not resist providing information on psychiatric symptoms. In both, we experienced very low rates of item refusal, and only nine of more than 3,400 interviewees broke off the interview