Psychiatric Epidemiology Research Interview Research Articles

The Talbieh Brief Distress Inventory: A brief instrument to measure psychological distress among immigrants

The purpose of this study was to develop and test the Talbieh Brief Distress Inventory (TBDI), a 24-item self-report questionnaire that measures psychological distress among immigrants. The TBDI combines items from the Brief Symptom Inventory (BSI) and the Psychiatric Epidemiology Research Interview Demoralization Scale (PERT-D). It includes a global score and six scales (obsessiveness, hostility, sensitiveness, depression, anxiety, and paranoid ideation). A convenience sample of 966 recent immigrants to Israel from the former Soviet Union were asked to complete a Russian-language version of the BSI and PERT-D as part of a study on immigrants' psychological adjustment. The TBDI is a combination of 13 items from the BSI and 11 items from the PERI-D. Items for inclusion were based on results of a separate factor analysis for the BSI and PERT-D and removal of repetitive items. We compared the total score with the total PERT-D and BSI and developed gender-specific cutoff points of caseness for the TBDI by comparison to known PERT-D and BSI cutoff points. We also checked for reliability using Cronbach's α. The TBDI correlated highly with the PERT-D ( r = .93) and with the BSI ( r = .82). Reliability of the scales and the overall instrument ranged from Cronbach's α of .60 to .89. TBDI caseness cutoff points were in close agreement with the BSI and PERT-D as reflected by κ scores that ranged from .66 to .79. The TBDI is a promising instrument for screening populations for psychological distress and symptomatology. It is available in English, Hebrew, and Russian.

Detecting psychological distress among patients attending secondary health care clinics: Self-report and physician rating

A study was conducted to determine the prevalence of psychological distress, as reported by patients and their physicians, in orthopedic, neurology, dermatology, and ophthalmology clinics; to study their accuracy in detecting psychological distress; and to determine if there is any connection among psychological distress, accuracy of detecting distress, and use of mental health and primary health care physicians' prognosis for the somatic complaints. Five hundred and fifty-six patients, ages 18–21, responded to the Psychiatric Epidemiology Research Interview Demoralization Scale (PERI-D), a measure of psychological distress, and to questions about their mental health and use of mental health and primary health services. Physicians, who were blind to patients' responses, were asked to what extent they thought the cause of patients' complaints was physical and to what extent they thought it was psychological in nature, and to prognosticate. Based on the PERI-D, about 25% of patients were distressed, this was less for females than males and varied between clinics. Based on self-reporting, about 14% of patients (males and females) were distressed. Based on physician reporting, about 17% (males less) were distressed. Physicians identified 35% of the PERI-D-distressed cases and 79% of nondistressed cases. About 66% of patients identified their distress and 83% their lack of distress. Increased use of primary health care and mental health care was related to distress. The prognosis was negatively related to distress. Based on this study, there is a need for more attention to psychological distress among secondary health care patients. Patients' ability to identify their distress suggests the importance of involving the patient in the diagnostic process. Correct detection of distress alone does not appear to decrease the use of primary medical and mental health services.

Pain Complaints and Psychological Distress among Soldiers in Specialty Military Medical Clinics

This paper explores: (1) the relationship of pain complaints and psychological distress among orthopedic, dermatology, ophthalmology, and neurology outpatients, (2) the ability of patients with pain complaints and their physicians to detect patients' psychological distress, and (3) the connection between type of pain, prognosis as rated by physician, and patient's use of military primary health care and mental health treatment. Five hundred fifty-six soldiers in compulsory service in the Israel Defence Forces, ages 18 to 21, responded to the PERI-D (Psychiatric Epidemiological Research Interview Demoralization Scale), a measure of psychological distress, and questions about presenting medical complaint and use of mental health and primary health services. Military specialist physicians, who were blind to patients' responses, were asked the extent to which they thought that the cause of the patients' complaints were physical or psychological and to prognosticate. Almost 47% of soldiers attended clinics due to pain. In descending order were limb pain (42.5%), headache (29.1%), lower-back pain (24.5%), and right arm pain (3.8%). Right arm complainers were the most distressed and the heaviest users of primary health care and got the lowest prognosis, yet the physicians did not detect any psychological distress in this group. The least distressed and lowest users of medical services were patients with limb pain. There was a positive linear relationship between psychological distress and use of primary health care. There was a negative linear relationship between distress and prognosis. The patients' ability to detect psychological distress was better than that of the physicians. Physicians tended to find more cases of psychological distress than did the PERI-D in lower-back pain and limb pain patients. Psychologically distressed headache and limb pain patients reported using significantly more primary health care than non-distressed patients with similar pain complaints. Special attention to psychological distress among pain complainers in military secondary health care clinics is needed. Such attention may reduce the use of primary health care and may have implications for improving prognoses.

Life events and panic disorder/ agoraphobia

A patient-rated checklist adapted from the Psychiatric Epidemiology Research Interview was used to assess frequency and desirability of life events in the 12 months preceding an index evaluation of a large sample of patients with a DSM-III diagnosis of panic disorder or agoraphobia with panic, on average 12 years after onset of illness. A total of 1,360 events were reported; 25% were considered most undesirable, whereas 22% were estimated to be most desirable. Negative life events were predominantly health-related issues and interpersonal conflicts. Making new friends, having significant success at work, and taking up a new activity were examples of positive events. Correlations of life events with clinical and demographic variables and with symptom rating scales were also analyzed. Negative life events were associated with greater psychopathology and neuroticism scores. Positive life events were associated with greater extraversion scores, more years of education, better employment status, and less functional impairment due to symptoms. This exploratory study does not allow interpretation from an etiologic perspective. It begins to shed light on the possible role of life events in the course of the disorder.

Obstructive prostatic symptoms: a community survey in Jerusalem.

Benign prostatic hypertrophy has a high prevalence in men aged > or = 50, but there is little information on the correlates of obstructive symptoms. The prevalence and correlates of reported prostatic symptoms in men aged > or = 50 years were studied in a community survey in the Kiryat Hayovel neighbourhood of Jerusalem in 1985-1987. Five prostate-related questions were asked. Two indices of emotional health were used: the Psychiatric Epidemiology Research Interview demoralization scale and a scale based on the Cornell Medical Index. Associations with sociodemographic, behavioural, emotional, biochemical and physical variables and with self-appraised health were examined both controlling for age only and by multivariate logistic regression. The prevalence rates in the 839 respondents were 20.4% for hesitancy, 41.1% for weak stream, and 26.7% for terminal dribbling; the rates tended to increase with age. The associations between the symptoms (controlling for age) were significant, the strongest being between hesitancy and weak stream. All three of the urinary symptoms were associated with indices of emotional distress. In the multivariate analysis, the odds ratios when men in the highest and lowest quartiles of emotional ill health were compared were 3.0 for hesitancy, 2.2 for weak stream, and 3.8 for dribbling. Specific symptoms were associated with blood pressure, social class and educational level. The striking associations with emotional ill health underline the importance of appropriate attention to the emotional health of patients who complain of prostatic symptoms.

Plato's model of the psyche: a holistic model for nursing interventions.

Plato's theory about psychodynamic forces is used to develop a holistic model for nursing practice. The dysphoric emotional state of demoralization is conceptualized as an imbalance between Spirit, Appetite, and Reason. Interventions are designed for elderly clients who show objective and subjective signs of demoralization. The objective indicators are measured with the Psychiatric Epidemiological Research Interview (PERI), before and after the implementation of individualized interventions. Results for the 23 subjects who completed the study in an assisted-living environment are suggestive of the effectiveness of basic nursing interventions in remediating the symptoms of demoralization. Plato's model of the psyche is an elegant, yet simple, conceptual tool for understanding the mental health needs of clients.

Demoralization and gender differences in a kibbutz

Gender differences in demoralization (depressive symptoms) were examined in a first-ever true prevalence study conducted in a kibbutz. The unusual organizational arrangements of this commune, where women have achieved higher levels of equality than in most other societies, offered a laboratory-like opportunity to test the psychosocial factors imputed as a partial explanation for the higher rates of demoralization in women. Demoralization was studied using the 27-item scale of the Psychiatric Epidemiology Research Interview (PERI) in all of the adult population of a single kibbutz. The response rate was close to 95%. Univariate and multivariate analyses were conducted to assess the effects of key sociodemographic and kibbutz-related variables on gender differences. The results showed that women had higher mean scores and rates even after these variables were controlled. The female:male demoralization ratio was well within the range of results obtained in non-socialist Israeli urban settings. The paper concludes with a discussion on the tentative relevance of the study results for the interpretation of the 2:1 female-male ratio of depression found in the epidemiological literature.

Severity of psychosocial stress and outcome of alcoholism treatment.

We examined the relation between stressful life events and drinking outcome among 129 male alcoholics who had completed an alcohol treatment program. Life events were assessed for the year prior to treatment and for the 3 months after treatment and were rated on the Psychiatric Epidemiology Research Interview and the Contextual Rating System. Approximately 40% of the pretreatment stressors were found to be directly or indirectly related to alcohol use. When stressors related to drinking were excluded from consideration, we found that men who returned to drinking after treatment experienced more severe or highly threatening stress before their relapse than men who remained abstinent during the follow-up period. These data suggest that although less severe stress may not increase risk for relapse, acute severe stressors and highly threatening chronic difficulties may be associated with elevated relapse risk.

The epidemiology of demoralization in a kibbutz

This article reports a true prevalence study of demoralization conducted in a kibbutz. This commune, which assures its members all their instrumental needs throughout the individual life span, is probably one of the few of its kind in the world. All adult members (n = 353) of a kibbutz affiliated with the most orthodox of the federations replied to a self-administered interview containing the Psychiatric Epidemiology Research interview 27-item Demoralization Scale. The response rate approached 95%. Univariate and multivariate analyses were conducted using demoralization rates and mean scores as dependent variables. The overall prevalence of demoralization was 25%. Women exhibited higher rates and mean scores. There was a clear association between occupational prestige scores and demoralization in both sexes. Discussion is based on the comparison between the study findings and those published in the literature, both in terms of the overall results and their pattern of association with key sociodemographic variables.

Severity of psychosocial stress and outcome of alcoholism treatment.

We examined the relation between stressful life events and drinking outcome among 129 male alcoholics who had completed an alcohol treatment program. Life events were assessed for the year prior to treatment and for the 3 months after treatment and were rated on the Psychiatric Epidemiology Research Interview and the Contextual Rating System. Approximately 40% of the pretreatment stressors were found to be directly or indirectly related to alcohol use. When stressors related to drinking were excluded from consideration, we found that men who returned to drinking after treatment experienced more severe or highly threatening stress before their relapse than men who remained abstinent during the follow-up period. These data suggest that although less severe stress may not increase risk for relapse, acute severe stressors and highly threatening chronic difficulties may be associated with elevated relapse risk.

Use of DSM-III axis IV in clinical practice: Rating the severity of psychosocial stressors

This study investigates the usefulness of DSM-III Axis IV ratings of Severity of Psychosocial Stressors. Multiaxial evaluations were made on a diagnostically heterogeneous group of 362 psychiatric patients. Severity ratings on Axis IV were compared to a more extensive system for measuring life event stress, embedded in the Psychiatric Epidemiology Research Interview (PERI). The results indicate that Axis IV ratings are consistent with meaningful diagnostic and demographic group differences, and correlate significantly with PERI ratings of normative change or disruption associated with rated events. The Axis IV guideline that the stressor reflect the summed effect of all psychosocial stressors listed, however, appeared to be too complex to be incorporated into routine clinical practice, even by relatively well-trained evaluators with expert supervision.

Use of DSM-III axis IV in clinical practice: rating etiologically significant stressors.

This study compared the etiologically significant stressors listed on DSM-III axis IV (severity of psychosocial stressors) with life events elicited by the Psychiatric Epidemiology Research Interview (PERI). Multiaxial evaluations of a diagnostically heterogeneous group of 362 patients were made, and all patients were subsequently administered the PERI by interviewers blind to the clinical assessments. The results indicated that axis IV functions well as a shorthand method for identifying the more severe psychosocial stressors. However, the DSM-III requirement that the stressor be important in the development or exacerbation of the current disorder resulted in discrepancies between the axis IV and PERI assessments.

The revision of axis V in DSM-III-R: should symptoms have been included?

The authors studied the relationship of psychological symptoms to clinicians' ratings on DSM-III's axis V. A total of 355 patients received multiaxial assessments and were reinterviewed under blind conditions with the Psychiatric Epidemiology Research Interview, which contains scales to measure aspects of social and occupational functioning and various symptom dimensions. The majority of symptom scales were correlated significantly with axis V ratings. Axis I diagnosis explained 19.0% of the variance in axis V; demographics, 6.5%; and symptoms, 7%. Symptoms had a larger effect, in terms of explained variance, than adaptive functioning variables and tended to detract from the latter's significance. These results have implications for axis V in DSM-III-R and for planning DSM-IV.

Toward construct validity for DSM-III axis V

This study investigates the construct validity of DSM-III Axis V ratings, made in diverse clinical settings, by means of independent assessments of adaptive functioning. Three hundred and sixty-two patients received supervised multiaxial assessments and were then blindly reinterviewed with the Psychiatric Epidemiology Research Interview, which contains scales measuring various aspects of social and occupational functioning. A subsample of 154 patients received a second independent interview that assessed characteristics of the individuals' social networks. The results indicate that Axis V ratings (1) demonstrate predictable diagnostic and demographic group differences, and (2) are determined by both social and occupational variables, but occupational factors predominate. The significance of the results for defining the adaptive functioning construct, for methods of assessment, and for the revisions of Axis V in DSM-III-R, is discussed.

Stress and Its Relationship to Acute Exacerbations in Multiple Sclerosis

The relationship of stressful life events (SLEs) to acute exacerbations of multiple sclerosis (MS) was prospectively studied in 55 consecutive patients with a relapsing-remitting disease course. The quantity and quality of SLEs were determined by the Psychiatric Epidemiology Research Interview (PERI-M) administered at 4-month intervals. Exacerbating cases (n = 20) did not experience a greater number of SLEs than nonexacerbating controls (n = 35); however, patients who experienced qualitatively extreme events were 3.7 times as likely to exacerbate as those not exposed to such events. The quality rather than the quantity of SLEs was associated with acute exacerbations of MS.

Stressful Life Events and Criminal Homicide

Stressful life events experienced by a 50 percent random sample of criminal homicide offenders (270) and a 30 percent random sample of nonviolent felonious property offenders (194) incarcerated in North Carolina over a two-year period are analyzed. Dohrenwend et al. Psychiatric Epidemiological Research Interview (PERI) was expanded to include occurrences in childhood and was used to assess the extent of stressful life events. These events were divided into loss and nonloss items; and whether the event occurred in the early life of the offender (past event) or in closer proximity to the crime (recent event). Murderers were divided into primary offenders, those whose victims were family members or close friends; and nonprimary offenders, those who killed strangers or mere acquaintances. The findings show that criminal homicide offenders experienced stressful life events in greater number and more consistently than did nonviolent felons. Further, primary homicide offenders tended to suffer more stressful life events involving loss, although nonprimary offenders experienced more nonloss stress events.

Perceived self-other differences in life events and mental health among Mexicans and Americans.

The social context of reported stressful life events was examined as a determinant of psychiatric symptoms in four cultural groups: Anglo-Americans (n = 132), Mexican-Americans (n = 108), Mexicans in El Paso (n = 90), and Mexican nationals (n = 133). The perceived difference between life events experienced by the self and spouse or by the self and significant others constituted preliminary operational definitions of the social context of life events. Ten Psychiatric Epidemiology Research Interview (PERI) psychiatric symptom scales as well as a suicidal tendency scale and a hopelessness index constituted the measures of the dependent variables. The potential predictive value of the social contextual measures of life-event stress for mental health variables was generally supported by the findings. Results indicated a rank ordering of predicted effects, with Mexican nationals most susceptible to the psychological effects of the social context of life events and Anglo-Americans least susceptible.

Urinary cortisol levels, cellular immunocompetency, and loneliness in psychiatric inpatients.

This study examined the associations among loneliness, stressful life events, urinary cortisol levels, and immunocompetency. Blood and urine were obtained from 33 psychiatric inpatients on the day after admission, at which time the patients completed the UCLA Loneliness Scale, the Psychiatric Epidemiology Research Interview Life Events Scale (PERI), and the MMPI. Patients who scored above the median on loneliness had significantly higher urinary cortisol levels. The high loneliness group also had significantly lower levels of natural killer cell activity, as well as a poorer T-lymphocyte response to phytohemagglutinin. The high loneliness subjects described themselves as more distressed than the low loneliness group on the MMPI. There were no consistent significant effects on either the immunologic measures or the MMPI associated with the PERI.

Social functioning of psychiatric patients in contrast with community cases in the general population.

Most cases in epidemiologic surveys of community populations have never been treated by mental health professionals. We studied how community cases and patients may be similar or different with respect to their social functioning in such areas as work, marriage, and parenting. There are grounds for two contrasting hypotheses: the universal hypothesis (disorder is accompanied by disability independently of treatment status) and the patient-specific hypothesis (disorder is accompanied by disability only for cases who become patients). We investigated these hypotheses using data from symptom scales and social functioning scales that are part of the Psychiatric Epidemiology Research interview. The sample consisted of 205 adults from the general population and 204 psychiatric patients from Jerusalem. The results provided some support for each hypothesis depending on the types of symptoms and functioning and disorder involved; however, the relationship between symptoms and social functioning in patients as well as cases from the community was weaker than had been supposed.

Nonspecific psychological distress and other dimensions of psychopathology. Measures for use in the general population.

This interview study investigated nonspecific psychological distress in the general population. A probability sample of 200 adults was drawn from heterogenous sex, class, and ethnic groups in New York City. Twenty-five scales were developed. Eight reflect a single dimension of nonspecific distress (eg, Poor Self-esteem, Sadness, and Perceived Physical Health) and 17 are distinct from these and from each other (eg, False Beliefs and Perceptions, Manic Characteristics, Insomnia, Antisocial History, and illness-linked Somatic Problems). Both sets of scales have become part of a new interview instrument, the Psychiatric Epidemiology Research Interview (PERI). Questions are raised about the nature of nonspecific distress in relation to Frank's construct of "demoralization," the value of the measured dimensions of psychopathology that contrast with it, and the relation of PERI, which uses a self-report format, to diagnostic interviews developed here and abroad.