Prevalence and Diagnostic Correlates of DSM-IV Pathological Gambling in Psychiatric Outpatients

Studies of the prevalence of pathological gambling (PG) in psychiatric and substance abusing patients suggest that the disorder is not rare. Most studies have been of substance abusers in treatment, and the rate of PG has been found to be several times higher than the rate found in community based epidemiological surveys. However, only one study has examined the prevalence of PG in a heterogeneous sample of patients, and this was a study of psychiatric inpatients. We are not aware of any prior study of the prevalence of PG in a psychiatric outpatient sample. In the present report from the Rhode Island Methods to Improve Diagnosis and Services (MIDAS) project we examined the current and lifetime prevalence of PG in 1,709 psychiatric outpatients interviewed with a semi-structured diagnostic interview that included a module to diagnose DSM-IV PG. Forty (2.3%) patients had a lifetime history of DSM-IV PG, all of whom had at least one other DSM-IV axis I disorder. Patients with PG had significantly more axis I disorders than patients without PG, and had significantly higher rates of bipolar disorder, social phobia, panic disorder with agoraphobia, alcohol use disorder, and other impulse control disorders. Possible reasons for the low prevalence of PG in our sample are discussed.     

An improved comorbidity summary score for measuring disease burden and predicting mortality with applications to two national cohorts

Abstract

Research involving administrative healthcare data to study patient outcomes requires the investigator to account for the patient’s disease burden in order to reduce the potential for biased results. Here we develop a comorbidity summary score based on variable importance measures derived from several statistical and machine learning methods and show it has superior predictive performance to the Elixhauser and Charlson indices when used to predict 1-year, 5-year, and 10-year mortality. We used two large Veterans Administration cohorts to develop and validate the summary score and compared predictive performance using the area under ROC curve (AUC) and the Brier score.     

Differential Labeling of Mental Illness Revisited: Patterns Before and After the Rise of Managed Care

With the National Comorbidity Survey of the early 1990s, Thoits (2005) recently showed that lower-status mentally ill individuals were not more often hospitalized or pressured into psychiatric treatment than comparably ill persons of higher status, disconfirming a central hypothesis of labeling theory. However, that finding may have been due to changes in the mental health treatment system introduced by the spread of managed care. The differential labeling hypothesis is reexamined here with data from the Epidemiological Catchment Area Studies (ECA) collected in the early 1980s before managed-care plans began to dominate the insurance marketplace and from the National Comorbidity Survey Replication conducted in the early 2000s when managed care had saturated the market. Little systematic support for the differential labeling hypothesis was found in the three studies, although, over time, the higher rates of mental hospitalization among less educated and low-income individuals found in the ECA survey disappeared. Trends across the studies suggest that educated and affluent persons with psychiatric problems more frequently sought hospital care. These findings further undermine the validity of the differential labeling hypothesis and suggest that service utilization or treatment-seeking factors may help explain mental hospitalization rates.     

Erectile dysfunction is a marker for obstructive sleep apnea

Purpose: To investigate the prevalence of erectile dysfunction (ED) in patients with obstructive sleep apnea (OSA) with and without any other comorbidities.

Methods: The patient group was newly diagnosed as having OSA (apnea–hypopnea index [AHI]?>?5/h) using a polysomnographic examination. A group of subjects with simple snoring were included into the control group. Clinically relevant comorbidities were systematically assessed in face-to-face interviews. All patients were asked to complete the 15-item International Index of Erectile Function (IIEF-15) questionnaire for the evaluation of ED. The patients with OSA and ED were evaluated according to these comorbidities.

Results: Of the 94 patients, 39 patients were excluded because of severe diseases. OSA was observed in 38 (69.1%) of the 55 patients. ED was seen in 24 (63.2%) patients with OSA, and in 8 (47.1%) patients without OSA (p?>?0.05). There were no statistical differences between the groups’ ages, IIEF scores, and body mass index (BMI) scores. There were statistically significant differences between the groups’ AHI scores (p?p?Conclusion: The rate of ED was higher in patients with OSA who had no other comorbidities. Therefore, ED can be a sensitive marker of OSA.     

Chronic illness and social network bridging in later life

Chronic disease has profound impacts on the structural features of individuals’ interpersonal connections such as bridging — ties to people who are otherwise poorly connected to each other. Prior research has documented competing arguments regarding the benefits of network bridging, but less is known about how chronic illness influences bridging and its underlying mechanisms. Using data on 1555 older adults from the National Social Life, Health, and Aging Project (NSHAP), I find that older adults diagnosed with chronic illness tend to have lower bridging potential in their networks, particularly between kin and non-kin members. They also report more frequent interactions with close ties but fewer neighbors, friends, and colleagues in their networks, which mediates the association between chronic illness and social network bridging. These findings illuminate both direct and indirect pathways through which chronic illness affects network bridging and highlight the context-specific implications for social networks in later life.     

Integrated Behavioral Health and Counseling Gender and Sexual Minority Populations

abstract

Counselors are increasingly expected to operate within an integrated behavioral health framework across systems of care. This critical literature review provides an overview of the integrated behavioral health paradigm, including the practice of interprofessional collaboration, with specific application to lesbian, gay, bisexual, transgender, queer (LGBTQ), and other gender and sexual minority issues. Implications for practice and research are discussed, along with a focus on concrete recommendations for application practicing interprofessionally with and on behalf of LGBTQ clients.     

Physical-psychiatric comorbidity: Implications for health measurement and the Hispanic Epidemiological Paradox

Few studies examine the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity), and whether these patterns differ across social groups. Using the National Comorbidity Survey-Replication and National Latino and Asian American Study, the current study asks: what are the patterns of physical-psychiatric comorbidity (PPC) between non-Hispanic Whites and Latino subgroups, further differentiated by gender and nativity? Does the PPC measurement approach reveal different patterns across groups compared to when only physical or only psychiatric health problems are the health outcomes of interest? To what extent do sociodemographic characteristics (SES, stress exposure, social support, immigration-related factors) explain PPC differences between groups? Results reveal that compared to U.S.-born non-Hispanic White men, island-born Puerto Rican men experience elevated PPC risk. Mexican and Other Latino women and men experience relatively lower risk of PPC relative to their non-Hispanic White counterparts. Social factors explain some of the health disadvantage of island-born Puerto Rican men, but do not explain the health advantage of Mexicans and Other Latinos.     

Examining Protective Factors for Dysthymia Among Individuals Attending Substance Abuse Treatment

ABSTRACT

Dysthymia affects millions of people and has been associated with impaired psychosocial and occupational functioning and poor clinical treatment outcomes. Yet few studies have examined protective factors that can be utilized to help individuals with dysthymia in clinical settings, particularly among individuals with comorbid substance use disorders. The purpose of this study was to examine the potential protective quality of adult attachment dimensions, spirituality, and meaning in life among clients with and without dysthymia in treatment for addiction. Data were obtained from 305 self-report questionnaires administered to clients attending a residential substance abuse treatment center. Approximately 25% of the sample met criteria for dysthymia. Results from logistic regression analyses indicated that purpose and meaning in life and attachment anxiety were the most important protective factors against having dysthymia. These results suggest that mental health professionals may need to integrate these protective factors into the treatment of individuals with dysthymia and substance use disorders, which may enhance treatment outcomes and maximize treatment effectiveness. Future studies should continue to explore protective factors that can assist individuals who experience these comorbid conditions and consider replicating this study using an ethnically diverse sample and other clinical settings to determine the generalizability of the findings.