Family Intervention and Health Care Costs for Kansas Medicaid Patients with Schizophrenia

Despite a number of studies investigating the effect of pharmacotherapy on treatment costs for schizophrenia patients, there has been little attention given to the effect of family intervention. In this study, data from the Kansas Medicaid system were used to analyze healthcare costs for 164 schizophrenia patients who had participated in family intervention. Structural equation modeling was used to test two competing views of the role of family intervention in treatment. The results showed that a model including direct and indirect effects of family intervention provided a better fit to the data. Family intervention had a significant indirect effect on general medical costs (through other psychological treatment) that showed a savings of $586 for each unit increase in the provision of these services. In addition, the total indirect effects for family intervention showed a $580 savings for general medical costs and $796 for hospitalization costs (for each unit increase).     

Mental Health and Clinical Correlates in Lesbian,Gay, Bisexual,and Queer Young Adults

Abstract

Objective: This study examined the prevalence of mental health disorders and their clinical correlates in a university sample of lesbian, gay, bisexual, and queer (LGBQ) students. Participants: College students at a large public university. Methods: An anonymous, voluntary survey was distributed via random e-mail generation to university students during April and May of 2011. LGBQ students were compared with their heterosexual counterparts on psychological and physical status as well as academic performance. Results: LGBQ students reported worse depressive symptoms, higher levels of perceived stress, considered themselves less attractive, and were more likely to be overweight. LGBQ students were significantly more likely to report histories of affective, substance use, and certain anxiety disorders as well as compulsive sexual behavior and compulsive buying. Conclusions: The higher rates of many psychiatric conditions among LGBQ students underscore the need for universities to provide LGBQ students a nonjudgmental environment to discuss sexual orientation and health issues.     

Census-based approaches for studying aggregate changes in characteristics of the elderly

"This article illustrates a few simple techniques and approaches for using census data on the elderly more completely." The authors find that "by fully exploiting census and similar data, it is possible for analysts to gain insights about the future composition of the elderly, the changing status of the elderly in relation to younger groups, and the rate at which key cohorts are changing in various characteristics." The geographical focus is on developing countries.     

PROPOSALS FOR A PROGRAM OF EMPIRICAL RESEARCH INTO THE PROPERTIES OF TRIANGLES*

Physical geometry is viewed in this essay as the prototype of a successful generalizing empirical science. Suppose that physical geometry had been studied in ancient Egypt by empirical methods similar to those commonly used today by many researchers seeking general propositions useful in explaining, predicting, or controlling phenomena of interest to practicing managers. Would these methods have produced valid and useful geometric generalizations? This intriguing question is explored in Part I by means of a parable which suggests a negative answer to the question. The reasons for this negative conclusion are developed in Part II. In the successful generalizing sciences, general propositions (or theory) have not been the result of an a posteriori“induction” from observational data, but rather the result of an a priori“construction” of a framework for the coordination of measurement operations. Such a framework, whether explicitly articulated or not, is a necessary condition for the collection of coherent and reproducible observational data and, therefore, for explanation, prediction, and control of phenomena. Yet, despite its a priori character, an acceptable framework or theory must be “empirical” in Popper's sense of being subject to refutation by observation. If the framework is logically prior to data, however, what is its source? In the successful generalizing sciences, it is argued in Part III, theories have been generalized not from data but from the skills—the coordination of operations—of practitioners. This genesis “explains” the success of the sciences, because an effective skill includes within itself tests of its range of applicability and adapts itself to changing conditions. A discussion of the implications of this argument for making management “scientific” concludes the essay.     

Toward the Assessment of Public Values

Efforts to measure trends in citizen preferences have been curtailedby the tendency of public opinion analysts to study ephemeralissues, to depend upon single questions, and to analyze issuesindividually rather than in relation to competing concerns.An illustrative analysis uses conceptualization of opinionsin a value framework and factor analysis to overcome these limitations.     

The menstrual cycle and personal space

Sixty undergraduate women were individually tested for interpersonal distance preferences by either a male or female confederate who approached each subject from six different directions using a procedure reported by Kinzel (1970). Randomly, each participated during either the four days prior to menstrual flow (premenstrual), the four days beginning with the first day of flow (menstrual), or the four days midway between the onset of their last period and the estimated beginning of the next (midcycle). Unexpectedly, interpersonal distance preferences were greater for males than for female testers only during the midcycle phase. Moos Menstrual Distress Questionnaire scores were not reliably correlated with interpersonal distance preferences, nor were questionnaire items tapping extent of sexual experience, usage of birth-control pills, or concern about menstrual odor. Ratings of the attractiveness of the person doing the testing was inversely related to the preferred interpersonal distance with the exception of midcycle subjects. Both negative affect and sexual interest interpretations of the effects of menstrual cycle on personal space are discussed.Edgar C. O'Neal is professor of psychology at Tulane; he received his Ph.D. in social psychology from the University of Missouri at Columbia. Janet Schultz is a M.S.W. candidate at Tulane's Graduate School of Social Work; she received her B.A. with honors in psychology from Newcomb College of Tulane University. Terry E. Christenson is associate professor of psychology and biology at Tulane and received his Ph.D. in psychology from the University of California at Berkeley. Address reprint requests to the first author, Department of Psychology, 2007 Percival Stern Hall, Tulane University, New Orleans, LA 70118-5698.     

Costs of Treating Depression With Individual Versus Family Therapy

Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost‐effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost‐effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.     

An exploratory analysis of select predictors of concern for law and order

Within the last decade concern for law and order has become a major domestic issue. Presidential candidates have campaigned on the issue. Opinion polls have charted the growing public concern. Crime statistics have reported startling growth in the number of serious crimes committed in the United States. This paper attempts to assess the ability of different variables to predict and explain this high concern. Two aspects of concern will be discussed: (1) awareness of and (2) willingness to do something about crime. Theoretically little is known about how awareness for a social problem can be translated into forms of action to deal with the perceived problem. Methodologically, a technique is needed for assessing the relative importance of different variables related to the problem area. Path analysis is discussed as a possible technique. The data was collected through a random sample of heads-of-households in the State of Washington during the summer of 1970 (N=3101; response rate=75%). Some of the major findings include: (1) people in larger cities are more aware of a crime problem than people in smaller cities and towns, but people in larger cities are less willing to allocate tax dollars to combat crime; (2) the size of city, and implicitly the crime rate, is the most important variable for understanding the public awareness of crime; (3) the elderly and those of conservative orientation are more willing to allocate funds to combat crime than the young and liberal, although there exists no difference in their awarencess of the problem; and (4) relative exposure to mass media, socio-economic status, or identification with one's community make little contribution to the understanding of either awareness of crime or willingness to allocate tax dollars to combat crime.     

Estimating the cost of direct reimbursement of marriage and family therapy under Medicare

In this article, we investigated the estimated cost to the Medicare program for covering psychotherapy services provided by marriage and family therapists (MFTs). Historical trends were identified by using psychotherapy cost and utilization data for the years 1999-2001. Using these trends, projections for the years 2002-2006 were made with MFTs included as providers. Employing this methodology, the 5-year estimated net increase and gross increase in cost due to the provision of psychotherapy services by MFTs was found to be approximately dollar 10.5 million (or dollar 2.1 million per year) and dollar 13.9 million (or dollar 2.8 million per year), respectively. This represents an increase of less than 1/2 of 1% of the Medicare mental health budget, and less than .0015% of Medicare expenditures overall.     

Educational Inequality in Adult Mortality: An Assessment with Death Certificate Data from Michigan

Education was added to the U.S. Standard Certificate of Death in 1989. The current study uses Michigan’s 1989–1991 death certificates, together with the 1990 Census, to evaluate the quality of data on education from death certificates and to examine educational differences in mortality rates. With log-rates modeling, we systematically analyze the variability in educational differences in mortality by race and sex across the adult life cycle. The relative differences in mortality rates between educational levels decline with age at the same pace for all sex and race categories. Women gain a slightly greater reduction in mortality than men by reaching the secondary-education level, but a modestly smaller reduction by advancing beyond it. Blacks show a reduction in predicted mortality rates comparable to whites’ by moving from the secondary to the postsecondary level of education but experience less reduction than whites by moving from the primary to the secondary level. Thus, the secular decline in mortality rates that generally accompanies historical improvements in education might actually be associated with an increase in the relative differences between blacks’ and whites’ mortality. We discuss limitations of the data and directions for future research.