Psychiatric Epidemiology Research Interview Research Articles

Combined and sequential exposure to prenatal second hand smoke and postnatal maternal distress is associated with cingulo-opercular global efficiency and attention problems in school-age children

BackgroundPrenatal exposure to secondhand (environmental) tobacco smoke (SHS) is associated with adverse neurodevelopmental outcomes, including altered functional activation of cognitive control brain circuitry and increased attention problems in children. Exposure to SHS is more common among Black youth who are also disproportionately exposed to socioeconomic disadvantage and concomitant maternal distress. We examine the combined effects of exposure to prenatal SHS and postnatal maternal distress on the global efficiency (GE) of the brain's cingulo-opercular (CO) and fronto-parietal control (FP) networks in childhood, as well as associated attention problems. MethodsThirty-two children of non-smoking mothers followed in a prospective longitudinal birth cohort at the Columbia Center for Children's Environmental Health (CCCEH) completed magnetic resonance imaging (MRI) at ages 7–9 years old. GE scores were extracted from general connectivity data collected while children completed the Simon Spatial Incompatibility functional magnetic resonance imaging (fMRI) task. Prenatal SHS was measured using maternal urinary cotinine from the third trimester; postnatal maternal distress was assessed at child age 5 using the Psychiatric Epidemiology Research Interview (PERI-D). The Child Behavior Checklist (CBCL) measured Attention and Attention Deficit Hyperactivity Disorder (ADHD) problems at ages 7–9. Linear regressions examined the interaction between prenatal SHS and postnatal maternal distress on the GE of the CO or FP networks, as well as associations between exposure-related network alterations and attention problems. All models controlled for age, sex, maternal education at prenatal visit, race/ethnicity, global brain correlation, and mean head motion. ResultsThe prenatal SHS by postnatal maternal distress interaction term associated with the GE of the CO network (β = 0.673, Bu = 0.042, t(22) = 2.427, p = .024, D = 1.42, 95% CI [0.006, 0.079], but not the FP network (β = 0.138, Bu = 0.006, t(22) = 0.434, p = .668, 95% CI [−0.022, 0.033]). Higher GE of the CO network was associated with more attention problems (β = 0.472, Bu = 43.076, t(23) = 2.780, p = .011, D = 1.74, n = 31, 95% CI [11.024, 75.128], n = 31) and ADHD risk (β = 0.436, Bu = 21.961, t(29) = 2.567, p = .018, D = 1.81, 95% CI [4.219, 39.703], n = 30). ConclusionsThese preliminary findings suggest that sequential prenatal SHS exposure and postnatal maternal distress could alter the efficiency of the CO network and increase risk for downstream attention problems and ADHD. These findings are consistent with prior studies showing that prenatal SHS exposure is associated with altered function of brain regions that support cognitive control and with ADHD problems. Our model also identifies postnatal maternal distress as a significant moderator of this association. These data highlight the combined neurotoxic effects of exposure to prenatal SHS and postnatal maternal distress. Critically, such exposures are disproportionately distributed among youth from minoritized groups, pointing to potential pathways to known mental health disparities.

Positive and negative work events attributed to the spine 2 years after lumbar surgery among patients working preoperatively.

Return to work after lumbar surgery is not synonymous with effective job performance, and it is likely that patients who undergo spine surgery experience both positive and negative events attributable to their spine after returning to work. The authors' objectives were to measure work events attributable to the spine during the 2 years after lumbar surgery and to assess associated demographic and clinical characteristics. Employed patients scheduled for lumbar surgery were interviewed preoperatively and reported work characteristics, including amount of improvement in job performance that they expected from surgery. Clinical variables, such as comorbidities and surgical complexity, were collected using standard scales. Two years postoperatively patients completed the 22-item work domain of the Psychiatric Epidemiological Research Interview Life Events Scale (PERI) asking about major positive and negative events attributable to the spine that occurred since surgery. Event rates were assessed with logistic regression. Patients also reported the amount of improvement obtained in job performance, which was compared to the amount of improvement expected in bivariate analyses. Two hundred seven working patients (mean age 53 years, 62% men) were interviewed preoperatively. At 2 years after surgery, 86% were working and 12% reported negative events attributable to the spine (e.g., reduced workload, retirement). In multivariable analysis, high school education or less (OR 4.6, CI 1.7-12.3, p = 0.003), another spine surgery (OR 3.4, CI 1.2-10.1, p = 0.03), and new/worse comorbidity (OR 3.3, CI 1.2-8.8, p = 0.02) remained associated. Seven percent reported positive events attributable to the spine; not having postoperative complications was associated (OR 24, CI 4-156, p = 0.001). Of 162 patients queried preoperatively about expectations, 120 expected improvement in work; postoperatively, 82% reported some improvement (42% reported less improvement than expected and 40% as much as or more improvement than expected), 18% reported no improvement. No improvement was associated with less education (OR 1.5, CI 1.0-2.1, p = 0.04), older age (OR 1.1, CI 1.0-1.1, p = 0.005), more complex surgery (OR 1.1, CI 1.0-1.1, p = 0.07), and another spine surgery (OR 6.1, CI 1.9-19.8, p = 0.003). In descriptive analyses for another sample of preoperatively work-disabled patients, most had physically demanding jobs and only 33% returned to work postoperatively. Most preoperatively working patients were working postoperatively, reported spine-related improvement in job performance, and reported the occurrence of both positive and negative work events attributable to the spine. This study proposes novel work outcomes (i.e., positive and negative work events) and potential methods to measure them.

O9.8. STRESS AND COGNITIVE FUNCTION AMONG INDIVIDUALS AT CLINICAL HIGH-RISK FOR PSYCHOSIS: FINDINGS FROM THE NAPLS COHORT

BackgroundAccumulated evidence from non-human animal studies suggests that the prominent deficits in memory and executive function that characterise individuals with psychosis may, at least in part, be due to the effects of stress on the brain regions that support these functions. However, studies of patients with established psychosis have yielded inconsistent findings with regards to the relationship between stress and cognition, and research in high-risk populations is notably lacking. Utilising data from the North American Prodrome Longitudinal Study 2 (NAPLS 2), we aimed to further elucidate the relationship between stress (daily stressors, life events, and childhood trauma) and cognitive function in clinical high-risk (CHR) individuals and healthy controls (HC). We additionally explored the role of potential mediators [hypothalamic-pituitary-adrenal (HPA) axis function] and moderators (group status, sex, family history of illness).MethodsThe sample comprised 885 participants (CHR=646; HC=239) who completed measures of stress and cognitive function at the NAPLS 2 baseline assessment. Stress measures included the Daily Stress Inventory and a modified version of the Psychiatric Epidemiology Research Interview Life Events Scale, both of which provided continuous measures of stress exposure (number of events) and distress (subjective feelings of distress). Participants were also interviewed using the Childhood Trauma and Abuse Scale to determine any exposure to childhood trauma (abuse, neglect, and bullying occurring prior to age 16 years). Basal HPA axis activity was determined via salivary cortisol samples obtained at the baseline assessment and standardised scores from selected subtests from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) were used to derive two cognitive domain scores (memory and executive function). To examine relationships between stress and cognitive domain scores, linear regression analyses were performed on standardised variables.ResultsDaily stressor exposure, daily stressor distress, and life event exposure exhibited negative quadratic (i.e., inverted U-shaped) associations with both memory and executive function (P < 0.01 for all). In contrast, the reverse pattern (i.e., a negative linear relationship and a positive quadratic relationship) was shown in the model for life event distress and memory domain scores (P < 0.01) whilst trauma history showed only a trend-level association with poorer memory performance (P = 0.084). These relationships, which did not differ across CHR and healthy control groups, were largely unchanged after adjusting for demographic factors and salivary cortisol. Exploratory analyses suggested that trauma exposure and a family history of psychosis may moderate the relationship between daily stressors/life events and cognitive function.DiscussionIn this large sample of predominately CHR individuals, we observed that the association between stress and cognition is complex and differs across stressor types. The negative quadratic associations that we observed for daily stressor exposure, daily stressor distress, and life event exposure imply that whist lower levels of stress may facilitate memory and executive function, there may be a negative impact on cognition when these stressors become more frequent and distressing. Interventions aiming to minimise stress exposure and promote effective coping strategies might feasibly improve cognition in CHR individuals.

Incidence of stressful life events and influence of sociodemographic and clinical variables on the onset of first-episode psychosis.

This study presents a quantitative analysis of the incidence of stressful life events (SLEs) and the variables gender, age at onset, family history and psychotic symptoms in patients with first-episode psychosis (FEP). A descriptive, cross-sectional methodology was used to interview 68 patients with FEP between 13 and 47 years of age. The Psychiatric Epidemiology Research Interview Life Events Scale collected one-year period prior to onset of FEP - used to analyse the subcategories academic, work, love and marriage, children, residence, legal affairs, finances and social activities-, Positive and Negative Syndrome Scale, and Clinical Global Impression-Schizophrenia scale were used to assess the relevance of certain SLEs during adolescence. Age at onset showed a significant negative correlation with the categories academic and social activities. By contrast, it showed a positive correlation with work and children. A significant relationship was found between paternal family history and social activities and between maternal family history and academic and love and marriage. Finally, an inverse relationship was observed between negative symptoms and the categories children and finance. Depressive symptoms were significantly correlated with the category academic. Our results show the importance of SLEs during adolescence and suggest that there is a clear need to develop preventive actions that promote effective strategies for dealing with the accumulation of psychosocial stress.

Looking Beyond Personal Stressors: An Examination of How Academic Stressors Contribute to Depression in Australian Graduate Medical Students

Background: Medical school is a challenging environment that requires students to deal effectively with stress borne out of the medical education environment, as well as their personal lives. Previous research has not systemically distinguished between academic and personal sources of stress, and in particular has not explored the independent contribution that academic stressors make to medical student depression. Purposes: This study aimed to investigate whether academic stressors make a unique contribution to the level of depressive symptoms in medical students, over and above the contribution made by personal stressors alone. Methods: Sixty-seven medical students completed an online questionnaire designed to measure the total number of recent life events (personal and academic), and their perceived impact, using a modified version of the Psychiatric Epidemiology Research Interview Life Events Scale. Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale. Results: Both the total number of personal stressors, r(67) = .363, p = .003, and their perceived impact, r(67) = .412, p = .001, were found to be positively related to depressive symptoms. A positive relationship was also observed between depressive symptoms and the total number of academic stressors, r(67) = .321, p = .008, and their perceived impact, r(67) = .489, p < .001. In addition, it was found that the perceived impact of academic stressors was able to explain higher levels of depressive symptoms in medical students over and above the effect afforded by personal stressors alone. Conclusion: The findings of this study suggest that stress borne out of the medical school environment contributes to depressive symptoms in medical students over and above the contribution made by personal stressors alone. This indicates that although it is important to help students cope with stress borne out of their personal lives, interventions by medical schools aimed at reducing the impact of academic stressors on medical student depression may also be of great importance.

Timing, quantity and quality of stressful life events in childhood and preceding the first episode of bipolar disorder

A large body of evidence supports the importance of genetic risk factors in bipolar disorder (BPD), but less is known about the role of stressful life events (SLE). This study assessed the role of SLE in childhood, adulthood and one year prior to first episodes of both depression and mania in BPD. Three groups of 50 matched subjects each were assessed: patients with BPD, with borderline personality disorder (BLPD) and healthy controls. Structured clinical interviews were used for diagnoses. The Coddington Life Events Schedule and the Israel Psychiatric Epidemiology Research Interview Life Event Scale measured life events and were confirmed with a semi-structured interview for subjective experience for each SLE. In BPD, the total number of SLE was lower during childhood and higher in the year preceding the first depression compared to controls and the proportion of loss-related events in childhood was higher. In the year preceding the first depressive episode, BPD subjects had more total, negative uncontrolled and independent but not positive SLE. In the year preceding the first episode of mania, the total number of uncontrolled, negative SLE were higher in BPD, whereas positive and separation-related SLE were not. After the first episode, BPD subjects had less SLE than controls. Negative and loss-related SLE are common in BPD subjects, occur in the year preceding the first episodes of depression and mania and are less common in childhood or after the onset of the disorder.

P03-411 - The mental health consequences of protracted asylum seeking in Australia

The mandatory detention of asylum seekers in Australia and the administrative, legal and ministtreal appeal processes have lead to protracted process of refugee determination.Further compounding of trauma/ torture, diminished sense of self future and purpose leading to high levels distress including anxiety depressive and somatoform disorders. High levels of distress appear to persisit after refgugees are settled.Study/methods•Harvard Trauma Questionnaire-R (HTQ-R) •Hopkins Symptoms Checklist (HSCL-25) •Post-Migration Living Difficulties Checklist (PMLDC) •Psychiatric Epidemiology Research Interview - Demoralisation Scale (PERI-D)f •ResultsN = 124. 84% Male; 93% conversant in English •Age: 20–62 years (μ = 35 yrs, SD = 10.8) •Residency Status: PR n = 32 (25%) Asylum Seeker n = 92 (75%) •Visa status: BVE (30%) BVA (23%) Student Visa (10%) •Time since application: 0 – 178 months (14.8 yrs) (μ = 31.2, SD = 48.4) •Not economic refugees. &gt; 99% arrived by plane. • 34% without Medicare &amp; 23% no work rights.ConclusionMultiple fold higher than the general population. -Highly traumatised population -Marginal reduction when granted protection •Inter-correlation between clinical measures à indicates pan-distress. •Clinical measures with number of rejections &amp; time since app •Comparable number of pre-migration traumas yet difference in ‘refugee’ trauma &amp; PTSD for AS vs. PR may reflect that current state of trauma is due to RDP ∨ perpetuating psychosocial factors •It has characteristics of many disorders but its own identity lication à weak association. -Ceiling effect of distress? -current state of trauma is due to RDP &amp;/or perpetuating psychosocial factors •It has characteristics of many disorders but its own identity.

Stressful life events and major depressive disorders

This study examined the relationship between stressful life events (SLE) and recurrent major depressive disorders. Three groups of 50 subjects were assessed: Patients with recurrent major depressive disorder with melancholic features; patients with borderline personality disorder; and healthy controls. Interviews for AXIS I and II DSM-IV Disorders were used for diagnosis. The Israel Psychiatric Epidemiology Research Interview Life Event Scale and the Coddington Life Events Schedule were used to measure life events and were confirmed with an interview. Beck Depression Inventory was also administered. The proportions of loss-related events in childhood and in the year preceding the first episode were higher in the depressed group than in the control groups during the same time period. Proportions of SLE, uncontrolled and independent events were also more common in the depressed patients in the year preceding the first episode. No category of SLE differentiated the groups following the first depressive episode. The study's conclusion is that SLE play an important role in the onset of depressive disorders. There are specific kinds of SLE that occur in childhood and in the year preceding the first episode. SLE has a less significant role in the maintenance of this illness.

Socio-demographic and clinical features associated with demoralization in medically ill in-patients

In the present study we tried to identify which socio-demographic and clinical characteristics are associated with demoralization in medically ill in-patients. Patients (n. 296), consecutively admitted to medical wards in a 120 day period, were evaluated with the Demoralization Scale of the Psychiatric Epidemiological Research Interview (PERI-D) to assess demoralization , with the Mini International Neuropsychiatric Interview (MINI) to assess mental disorders (DSM-IV), with the Brief Disability Questionnaire for the evaluation of the functional disability, with the Duke Severity of Illness to assess severity of the medical illness. Moreover, the family support and threatening life events were also evaluated. A significant effect in increasing the demoralization score was observed for presence of Major Depression or Adjustment Disorder, poor family support, severity of functional disability, number of threatening life events in the past year and female gender. Major Depression needs to be recognized in demoralized medically ill in-patients, because it is one of the most important conditions associated with demoralization, which successfully responds to adequate treatment.

Anticipatory Stress in the Population Facing Forced Removal From the Gaza Strip

The Israeli government decided in March 2005 to remove the settlers of the Gaza Strip, a process known as "disengagement." One person per household residing in 13 settlements was randomly selected for a telephone interview that included the Demoralization Scale of the Psychiatric Epidemiology Research Interview. Women respondents and those with fewer years of education, higher risk perception, greater alienation from government, poorer perceived health, no social support outside the West Bank or Gaza, worse religious coping, and residence in a secular settlement had enhanced risk for higher emotional distress. Positive current satisfaction with life was associated with greater place attachment, less risk perception, stronger ideological stand, less feeling of alienation from the government, a more positive view of the future, and plans to return to Gaza. This population, as others in transitional states, may be at risk for emotional distress compared with some but not all stable Israeli groups.

Longitudinal study of negative workplace events among employed rheumatoid arthritis patients and healthy controls

Most studies of employment in patients with rheumatoid arthritis (RA) have focused on job loss. Less is known about workplace events in patients who continued to work. The goal of this longitudinal study was to compare the incidence of negative workplace events between employed patients with RA and healthy controls. Participants completed the work domains of the Psychiatric Epidemiology Research Interview Life Events Scale and the Inventory of Small Life Events Scale measuring major and minor workplace events. Events were compared between groups according to psychosocial, clinical, and job characteristics. A total of 122 patients with RA and 122 healthy controls were enrolled with similar demographic and occupational characteristics. There were no differences in percentages of patients and controls who had at least 1 major (35% versus 31%) or 1 minor (48% versus 55%) negative event. For patients with RA, negative events were associated with having more pain, more fatigue, more social stress, and less job autonomy (P < or = 0.05). For controls, in addition to social stress, negative events were associated with job characteristics, functional status, and social support (P < or = 0.05). A comparable number of patients with RA and controls had negative workplace events. In addition to the well-known contributions of job autonomy and pain, social stress and fatigue also were found to be important variables related to negative events in patients with RA. These potentially modifiable variables have not been fully evaluated with respect to long-term employment in these patients.

Psychosocial determinants of relapse in ulcerative colitis: a longitudinal study

Objectives To determine the association between psychosocial characteristics and time to relapse in patients with inactive ulcerative colitis. Methods Sixty patients with clinically and endoscopically inactive ulcerative colitis were followed for 1 yr, or less if they relapsed. Demographic, psychosocial, and clinical data were obtained. Stressful life events (Psychiatric Epidemiology Research Interview Life Events Scale), psychological distress (Symptom Checklist-90R), and perceived stress (Perceived Stress Scale) were recorded monthly by self-report. Multivariate time-dependent Cox regression was used to identify the independent determinants of earlier time to clinical relapse. Results The patients' mean age was 39 yr (SD = 9.4), 37 (62%) were female, and 22 (37%) relapsed during the 1-yr follow-up. Univariate Cox regression indicated a weak association between number of stressful events in the preceding month and time to relapse ( p = 0.09). This association strengthened in multivariate analysis ( p = 0.02, hazard ratio = 1.26 per event, 95% CI = 1.04–1.53) after adjustment for significant covariates. Conclusions After controlling for demographic and clinical variables, more recent stressful events were associated with earlier time to relapse. These findings, which support a biopsychosocial model of disease, might help clinicians identify patients who might benefit from more intensive maintenance medical therapy and behavioral medicine interventions to reduce stress and improve coping.

Increased early life stress and depressive symptoms in patients with comorbid substance abuse and schizophrenia.

Early adverse events have been associated with increased rates of substance abuse and depression. To investigate the association between early adverse events and comorbid substance abuse in schizophrenia patients, early life stress, depressive symptoms, positive and negative symptoms, anxiety, and cognitive function were measured in an age-, sex-, and race-matched sample of 40 schizophrenia patients with and without comorbid substance abuse. Compared to patients without substance abuse, patients with schizophrenia and a history of substance abuse had a significantly higher incidence of early life trauma, as well as significantly higher scores on the Modified Hamilton Rating Scale for Depression and the Psychiatric Epidemiology Research Interview Life Events Scale. No differences between groups were found in positive or negative symptoms, anxiety, or cognitive function. The results emphasize the importance of early life stress and affective symptoms and their potential relationship to substance abuse disorders in schizophrenia patients.

Lack of effect of psychosocial stress on maternal corticotropin-releasing factor and catecholamine levels at 28 weeks' gestation

Corticotropin-releasing factor (CRF) and catecholamines are among the major hormones activated during the adaptive response to stressful stimuli. In pregnant women, serum CRF and catecholamines levels increase during labor and preterm delivery. The aim of the present study was to evaluate whether psychosocial stress measures are correlated with serum CRF or urinary catecholamine [ie, epinephrine, norepinephrine (NE), dopamine (DA)] levels in healthy midtrimester pregnant women. A large group of white pregnant women (n = 382) participated in the present study. The Work Conditions Questionnaire and the Psychiatric Epidemiology Research Interview were administered to measure job stress and general life stress, respectively. Urine and blood specimens were collected at 28 weeks of gestation at the time of psychosocial evaluation. Epinephrine, NE, and DA were quantified in the urine by a highly sensitive method based on an amperometric detector. Serum CRF and cortisol levels were measured in blood specimens by using specific radioimmunoassays. Serum CRF and cortisol levels did not vary between patients with high and low scores on psychological tests, and no correlation was found between CRF and cortisol levels. One job stress measure, low job latitude, was significantly associated with a mild increase in NE and DA levels in the afternoon and night (P < .05, analysis of variance). Serum cortisol levels were inversely correlated with NE in the morning (r = -0.447; P =.002) and night segments (r = -0.391; P = .007) and with DA in the night period (r = -0.367; P = .013). The absence of a significant relationship between CRF/cortisol and psychosocial stress measures in pregnant women suggests that the hypothalamic-pituitary-adrenal response to psychosocial stress may be masked at midtrimester by the constantly high levels of placental CRF, whose control is beyond the influence of environmental stressors.

Risk factors for behavioral and emotional problems in childhood: a community study in Uruguay

To explore some of the demographic risk factors that are associated with the risk of behavioral or emotional problems in children, and to examine the possibility of an association between psychological stress in the parents and psychological problems in their children. In this study, the presence of psychological stress in the parents and certain psychosocial characteristics that increase the risk of mental problems in childhood were examined in a sample of Uruguayan children from three communities, two urban and one rural. The study, which was carried out in Ciudad Vieja and Barrio Sur, in the city of Montevideo, and in Colonia de Sacramento, a rural town, comprised 115 children between the ages of 5 and 15. Mothers answered the Child Psychiatric Morbidity Questionnaire (QMPI), an instrument for the detection of behaviors pointing to the presence of emotional problems in children. Both parents also supplied the demographic information requested in the Psychiatric Epidemiology Research Interview Demoralization Scale; they answered the CAGE questionnaire, a screening tool for alcoholism; they responded to the Social Support Network Inventory; and they answered questions about their self-perceived mental health. Fifty-three percent of the children had scores greater than 6 on the QMPI, which indicates the possible presence of behavioral or emotional problems. Fathers' self-perception of emotional problems and mothers' feeling of being demoralized showed a statistically significant association with a greater risk of behavioral or emotional problems in their children. In light of our results, mental health in childhood is a social and public health problem that warrants further epidemiologic study in Uruguay.

Multidimensional scaling analysis of paranoid symptoms in the context of depressive and psychotic disorders.

The present study examined a continuum of paranoid symptoms in the context of depressive and psychotic disorders from a multidimensional perspective on psychopathology. Based on the self-ratings of 404 community residents, 96 depressed patients, and 65 psychotic patients, similarities or dissimilarities among multiple measures of paranoia (i.e. mild, moderate, and severe types), along with 16 other psychiatric symptom scales taken from the Psychiatric Epidemiology Research Interview (PERI; Dohrenwend, Shrout, Egri & Mendelsohn, 1980, Dohrenwend, Levav & Shrout, 1986b, were analysed using multidimensional scaling supplemented by cluster analysis. Four hypotheses were tested. Only one hypothesis was fully supported and two were partially supported. No distinct dimension for the continuum of paranoia emerged, but a global dimension of severity of psychopathology was pervasive and stable across diagnostic subgroups. The latter finding replicated and extended previous multidimensional studies of psychopathology.

Social class and substance use disorders: The value of social class as distinct from socioeconomic status

The relationship between social class and substance use disorders (SUDs) is explored and compared to the relationship between SES and SUDs. Social class and SES are two different conceptualizations of socioeconomic inequality (SEI) which emanate from two different theoretical orientations in sociology. SES is commonly used in epidemiological research and is usually measured in terms of education, income or occupational prestige. Social class is less known and less used. Here, following the work of Wright et al. (Wright, E. O., Hachen, D. and Costello, C. et al. (1982) The American class structure. American Sociological Review47, 709–726) it is measured in terms of four types of control people have in their work place: ownership, control over budget decisions, control over other workers, and control over one's own work. Data are derived from an epidemiological survey, conducted in Israel, using a two stage sampling procedure for the identification of cases. In the first stage 4914 respondents were screened with the Psychiatric Epidemiological Research Interview (PERI). In the second stage (n=2741), those who screened positive (and a sample of the negatives) were diagnosed by psychiatrists using a structured interview that yielded diagnoses according to the Research Diagnostic Criteria (RDC). The results indicate that those who are advantaged in terms of ownership, i.e. self-employed, have higher rates of SUDs compared to employees. Furthermore, it appears that most disorders have an onset subsequent to entry into the current job, indicating that ownership plays a causal role in the onset of SUDs rather than the other way around. These results are contrasted with those of a previous report from the same study by Dohrenwend et al. (Dohrenwend, B. P., Levav, I. and Shrout, P. E. et al. (1992) Socioeconomic status and psychiatric disorders: the causation selection issue. Science 255, 946–952) which showed just the opposite association between SES and SUDs, i.e. those who are advantaged in terms of SES have lower rates of SUDs. As an explanation of these apparently conflicting results, the possibility is entertained that social class and SES represent independent causal pathways to the onset of SUDs with social class mainly related to primary SUDs and SES mainly to secondary SUDs.

Ethnicity/race, paranoia, and psychiatric diagnoses: Clinician bias versus sociocultural differences

Two contradictory assumptions underlie research on race differences in psychiatric diagnoses: (1) the “clinician bias” (CB) hypothesis, which assumes that Blacks and Whites exhibit symptomatology similarly, but diagnosticians mistakenly judge them differently; and (2) the “cultural relativity” (CR) hypothesis, which assumes that Blacks and Whites have different modes of expressing psychopathology but diagnosticians are unaware of or insensitive to such cultural differences. The purpose of the present study is to conduct a comparative test of the CB and CR hypotheses focusing on paranoid symptoms. The study examines race differences on the scales of Distrust (DST), Perceived Hostility of Others (PHO), and False Beliefs and Perceptions (FBP) from the Psychiatric Epidemiology Research Interview (PERI), which measure different types of symptoms ranging from relatively ordinary suspiciousness (i.e., mild paranoia) to the severe kind of paranoia often observed in schizophrenia, in relation to rigorous research diagnoses of depression and schizophrenia-like disorders. In effect, the CB and CR hypotheses become the null and alternative hypotheses, respectively, under conditions where the diagnoses are made according to research criteria. The present findings support the CR hypothesis over the CB hypothesis. The implications of these results for the psychiatric misdiagnosis of Black individuals are discussed.

Violence and psychiatric disorders: results from an epidemiological study of young adults in Israel.

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.

Effects of immigration on the mentally III—Does it produce psychological distress?

This report explores psychological distress among immigrants seeking help from psychiatric outpatient clinics as compared with control nonpatient immigrants. Our hypothesis is that nonpsychotic mentally ill immigrants will react to acculturation by psychological distress similarly to healthy individuals. Three questionnaires were used in this survey: Demographic Psychosocial Inventory, Brief Symptom Inventory (BSI), and Psychiatric Epidemiology Research Interview—Demoralization Scale (PERI-D). They were completed by patient and control groups consisting of recent adult immigrants to Israel from the former Soviet Union. The patient group included 158 subjects seeking psychiatric help from outpatient clinics. Among them, 51 met ICD-10 criteria for neurotic, stress-related, and somatoform disorders; 41 for schizophrenia; 32 for mood disorders; 18 for organic illnesses; and 16 for personality disorders. The control group consisted of 222 immigrants with no previous psychiatric history, matched by gender and age to the patient group. Although all distress symptoms were signficantly more severe in the patient group than in the control group, the BSI profile, showing a high level of depression, anxiety, interpersonal sensitivity, and obsessive-compulsive dimensions, was similar in both groups. The psychological distress level as measured by the PERT-D was 1.4 times higher in patients than in the control group. Within the patient group, the lowest distress level was found in patients suffering from organic disorders. No significant differences in the level of psychological distress were found among other diagnostic subgroups. The results suggest that mentally ill immigrants react to acculturation by a psychological distress syndrome similarly to nonpatient immigrants but more severely than nonpatient immigrants.