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New this Month - June 2006
Below are citations/abstracts of recently published articles and publications
that have been authored and/or co-authored by Pacific Institute staff.
Berkeley
Genevieve Ames, Carol Cunradi, & Roland Moore
Ames, G. M., Cunradi, C. B., & and Moore, R. S. (2006). Environmental
influences on likelihood of alcohol treatment-seeking behavior among young
adults in the military. Alcoholism, Clinical and Experimental Research,
30(4), 696-699.
Military personnel have the option of seeking treatment for an alcohol-related
problem from either a military or a civilian treatment program. Past research
has shown that most service members seek treatment from military treatment
programs (Bray et al., 2003), which include peer Drug and Alcohol Program
Advisors (DAPA). Despite the increase in heavy drinking among military
personnel over the past 4 years (Bray et al., 2003), there is a paucity
of research on the factors associated with alcohol treatment-seeking behavior
among military personnel. The purpose of the current study is to assess
the environmental influence of occupational factors (e.g., supervisor
encouragement for going to DAPA, workplace social support for going to
DAPA, belief that going to DAPA will harm one's career, and belief in
DAPA efficacy) on the likelihood of alcohol treatment seeking behavior
from either a military or civilian counselor among a cohort of young adults
in the Navy. Additionally, this study examines beliefs about perceived
consequences of alcohol treatment-seeking behavior within the military.
These data are part of a larger prevention-oriented study on the interaction
of individual and environmental factors on drinking among young adults
in the US Navy.
Genevieve Ames
Russ, A. J., & Ames, G. M. (2006). Policy and prevention as competing
imperatives in US Navy life and medicine. Culture, Health & Sexuality,
8(1), 1-15.
On the face of it, US Navy sexual health initiatives face a challenge
similar to that on college and university campuses: how to prepare individuals
coming into adulthood for both the positive and less positive health consequences
of sexual intimacy. However, rules unique to military settings that forbid
relationships between certain categories of personnel and that delimit
the appropriate context and content of sexual expression have special
implications for Navy safer sex programmes. Guided by in-depth interviews
with 58 Navy officers and enlisted members, this paper examines how official
policies regulating sexual behaviour sometimes hinder the effective prevention
and medical management of sexually transmitted infections and unplanned
pregnancies. Two findings in particular are worthy of special note: first,
perceptions of sexual risk are often displaced from concerns about health
to concerns about 'getting caught' for violating Navy rules; and second,
official prevention efforts do not adequately reflect the realities of
sexual life (especially on deployments). Current US Navy rules governing
sex may therefore have the inadvertent effects of contributing to sexual
health risk and of preventing the occurrence not of sex, but of safer
sex.
Hilary Byrnes
Tiet, Q. Q., Byrnes, H. F., Barnett, P., & Finney, J. W. (2006). A
practical system for monitoring the outcomes of substance use disorder
patients. Journal of Substance Abuse Treatment, 30(4), 337-347.
Outcomes monitoring and management are receiving mounting attention because
of increased emphasis on health care accountability and cost containment.
Efficient, practical outcomes monitoring systems (OMSs) are crucial if
health care system performance is to be determined and effective/cost-effective
treatments are to be identified, but such practical monitoring systems
generally are lacking. This article describes the features of such a system
for monitoring the care received by, and the substance use and psychosocial
outcomes of, patients treated for substance use disorders (SUDs) in the
Department of Veterans Affairs (VA). In contrast to a 15-21% follow-up
rate achieved by VA SUD program staff under a previously mandated systemwide
monitoring system, the monitoring system used in this project achieved
a 67% follow-up rate without paying patients for their participation.
We provide data on patient characteristics and treatment outcomes, estimate
the cost of implementing this type of monitoring system on a broad scale,
and provide recommendations for OMSs in other large health care organizations.
Tiet, Q. Q., Ilgen, M. A., Byrnes, H. F., & Moos, R. H. (2006). Suicide
attempts among substance use disorder patients: An Initial step toward
a decision tree for suicide management. Alcoholism, Clinical and Experimental
Research, 30(6), 998-1005.
Background: Little empirical data are available to develop profiles of
patients who attempt suicide or to formulate a decision tree for suicide
management. This study identifies profiles of patients who have a high
risk of suicide attempt and takes a first step toward developing a decision
tree to classify high-risk patients. Methods: Based on a cross-sectional,
nationwide cohort of substance use disorder patients (N = 34,251) in 150
Veterans Affairs (VA) facilities, a total of 5,671 patients who reported
suicidal ideation in the 30 days prior to intake assessment were included
in receiver operating characteristic (ROC) analyses to identify the 30-day
risk of an actual suicide attempt. Clinical diagnostic and Addiction Severity
Index interview data were used. Results: Results provide an initial decision
tree to classify high-risk patients with sensitivity ranging from 0.33
to 0.89, and specificity from 0.42 to 0.87. The factors included in the
decision tree encompass history of prior suicide attempts, current drinking
to intoxication, current cocaine use, first occasion of suicidal ideation,
and difficulty controlling violent behavior. Conclusions: To our knowledge,
this is the first attempt to use empirical data to provide information
to eventually establish a decision tree for clinical management of patients
with suicidal ideation. The findings show that profiles of patients who
are at high risk of suicide attempts can be effectively identified using
ROC, with relatively good sensitivity and specificity.
Harold Holder
Holder, H. D. (2006). The power of local alcohol prevention and the Trelleborg
Project in southern Sweden. Addiction, 101(6), 763-764.
The editorial comments on the study "A community action programme
for reducing harmful drinking behaviour among adolescents: the Trelleborg
Project," by M. Strafstöm et al. It reflects that the study
was significant for it centered its discussion on the potency of community
systems approach on alcohol problem prevention in Sweden. It also provided
various benefits of Trelleborg projects which include reduction of heavy
drinking among youth, enhancing public awareness and involving and utilitization
of efforts from local authorities in the program.
Rob Lipton, Rudy Banerjee, & Andrew Treno
Lipton, R., Banerjee, A., Dowling, K. C., & Treno, A. (2005). The
geography of COPD hospitalization in California. COPD: Journal of Chronic
Obstructive Pulmonary Disease, 2(3), 435-444.
Exposure to tobacco smoke is an important risk factor for chronic obstructive
pulmonary disease. We investigated the relationship between chronic obstructive
pulmonary disease hospitalization counts (and hospitalization-related
charges) in California and sociodemographic and smoking measures, employing
geospatial techniques that permit more sensitive scrutiny at the zip code
level while controlling for spatial confounding. We analyzed 1,707 zip
code tabulation areas in California for chronic obstructive pulmonary
disease hospitalization rates and related hospitalization charges (using
1999 hospital discharge data). After controlling for spatial auto-correlation,
positive relationships were found for age, percentage Hispanics, number
of tobacco outlets and level of smoking. Inverse relationships were found
for percentage with undergraduate degrees and income level. When examining
“hotspot” zip code tabulation areas (those with higher than
expected model-based chronic obstructive pulmonary disease hospitalization
counts), minority/immigrant status, depressed socioeconomic measures,
and elevated tobacco use were clearly associated, suggesting the need
for increased intervention among the poor and persons of color. Although
limited by the availability of air pollution monitoring data, a preliminary
descriptive analysis indicated that the numbers of particulate matter
exceedances mirrored both the hotspots of the Los Angeles air basin and
coldspots in the San Francisco Bay Area.
Mallie Paschall
Fishbein, D. H., Hyde, C., Eldreth, D., Paschall, M. J., Hubal, R., Das,
A., Tarter, R., Ialongo, N., Hubbard, S., & Yung, B. (2006). Neurocognitive
skills moderate urban male adolescents’ responses to preventive
intervention materials. Drug and Alcohol Dependence, 82(1), 47-60.
Abstract: The present experiment was designed to determine whether individual
variation in neurobiological mechanisms associated with substance abuse
risk moderated effects of a brief preventive intervention on social competency
skills. This study was conducted in collaboration with the ongoing preventive
intervention study at Johns Hopkins University Prevention Intervention
Research Center (JHU PIRC) within the Baltimore City Public Schools. A
subsample (N =120) of male 9th grade students was recruited from the larger
JHU study population. Approximately half of the participants had a current
or lifetime diagnosis of CD while the other half had no diagnosis of CD
or other reported problem behaviors. Measures of executive cognitive function
(ECF), emotional perception and intelligence were administered. In a later
session, participants were randomly assigned to either an experimental
or control group. The experimental group underwent a facilitated session
using excerpted materials from a model preventive intervention, Positive
Adolescent Choices Training (PACT), and controls received no intervention.
Outcomes (i.e., social competency skills) were assessed using virtual
reality vignettes involving behavioral choices as well as three social
cognition questionnaires. Poor cognitive and emotional performance and
a diagnosis of CD predicted less favorable change in social competency
skills in response to the prevention curriculum. This study provides evidence
for the moderating effects of neurocognitive and emotional regulatory
functions on ability of urban male youth to respond to preventive intervention
materials.
Calverton
Jim Fell, Tara Kelley-Baker, Scott McNight, Katharine Brainard,
Elizabeth Langston, Raamses Rider, David Levy, & Joel Grube (Berkeley)
Fell, J. C., Kelley-Baker, T., McKnight, A. S., Brainard, K., Langston,
E., Rider, R., Levy, D., & Grube, J. (2005). Increasing teen safety
belt use: A Program and literature review. Washington, D.C.: Dept. of
Transportation, National Highway Traffic Safety Administration. (DOT HS
809 899). http://www.nhtsa.dot.gov/people/injury/NewDriver/TeenBeltUse/
A comprehensive review of the scientific literature, State and Federal
Government reports, and other sources of information was conducted to
determine the magnitude of the problem of teen safety belt use and to
identify and summarize programs, interventions, and strategies that can
potentially increase safety belt use by teens. Nearly 270 documents were
reviewed. Proven effective strategies that increase safety belt use in
the general population may have the most immediate and greatest potential
for increasing teen safety belt use. These include upgrading State safety
belt laws to primary enforcement and conducting highly publicized enforcement
of safety belt use laws. With regard to strategies targeting teens, graduated
driver licensing laws that explicitly include requirements for safety
belt use in all three phases of licensure and provide sanctions that prohibit
“graduation” to the next licensing phase if there is a safety
belt citation, may be very effective. It appears that community programs
that combine education, peer-to-peer persuasion, publicized enforcement,
and parental monitoring have some potential for increasing teen safety
belt use.
Technological solutions hold promise for the future. Enhanced safety belt
reminders appear to be effective for all age groups. Safety belt use recorders
could allow parents and caregivers to monitor teens’ behavior, if
this strategy is accepted by the public. Interlock systems, such as not
allowing the radio or cassette/CD player to turn on until all passengers
are wearing safety belts, also hold promise and could be very effective
in increasing safety belt use, particularly for teens.
Combinations of strategies seem to work better than one strategy alone.
A community program including education, diversity outreach, highly publicized
enforcement, and parental involvement would likely have a substantial
effect on teen belt use. However, these strategies would probably need
to be sustained for the effect to last over time. While each strategy
is not without barriers, careful planning, implementation and evaluation
can result in effective programs and add greatly to our knowledge of teen
safety belt use.
Bruce Lawrence & Ted Miller
Koehler, S. A., Weiss, H. B., Shakir, A., Shaeffer, S., Ladham, S., Rozin,
L., Dominick, J., Lawrence, B. A., Miller, T. R., & Wecht, C. H. (2006).
Accurately assessing elderly fall deaths using hospital discharge and
vital statistics data. American Journal of Forensic Medicine and Pathology,
27(1), 30-35.
Historically, fatal injury monitoring and surveillance have relied on
mortality data derived from death certificates (DC). However, problems
associated with utilizing DC have been well documented. Recently, access
to and utilization of hospital discharge data (HDD) have offered a new
and important secondary source of data regarding in-hospital deaths. However,
studies have shown that discrepancies between the HDD and the corresponding
DC often exist. This discrepancy was especially evident when comparing
HDD to the vital statistics data (VSD) for deaths by falls among those
aged 65 and over in 19 states.This was a retrospective forensic review
of elderly (age 65 and over) fall-associated fatalities (E880-E888) identified
from HDD and VSD in Allegheny County, Pennsylvania, between 1997 and 1998.
Seventy-seven cases were identified, with the original manner of death
listed as natural (34), suicide (1), and accidental (42) on the DC. Following
a forensic review of the cases, the manner of the death on the DC should
have been changed from natural to accidental in 28% (n = 12) of the cases,
representing an undercount in the VSD. Undercounts were due to a failure
of clinicians to account for the significance of a fall event that contributed
to subsequent pathology and death. In addition, in that 22% (n = 17) of
the HDD fall-associated deaths, the fall did not contribute directly or
sequentially to the underlying cause of death, thereby representing an
overcount in the HDD.Based on these findings we recommend (1) elderly
fall surveillance systems should only count HDD E-coded falls that demonstrate
a serious traumatic injury which directly or subsequently results in death,
(2) all in-hospital fall-associated deaths should be reported to and reviewed
by coroner/Medical Examiner offices for determination of the cause and
manner of death, and (3) physicians should be better educated in properly
completing death certificates.
Ted Miller, Eduard Zaloshnja, & Bruce Lawrence
Finkelstein, E., Corso, P. S., & Miller, T. R. & Associates. (2006).
The incidence and economic burden of injuries in the United States. New
York: Oxford University Press.
Link to the Oxford University Press website for ordering information:
http://www.us.oup.com/us/catalog/general/subject/Medicine/PublicHealth/?view=usa&ci=9780195179484
Contents
1. Incidence of Injuries
2. Lifetime Medical Costs of Injuries
3. Lifetime Productivity Losses Due to Injuries
4. Total Lifetime Costs of Injuries
5. The Burden of Injuries: Trends and Implications
Injuries are one of the most serious public health problems facing the
United States today. Through premature death, disability, medical cost
and lost productivity, injuries impact the health and welfare of all Americans.
Deaths only begin to tell the story. Although many injuries are minor,
a large proportion result in fractures, amputations, burns, or significant
injuries that have far-reaching consequences. Now, for the first time
in over 15 years, we have comprehensive estimates of the impact of these
injuries in economic terms.
This book updates a landmark Report to Congress from 1989. Since that
report,no undertaking has addressed the incidence and economic burden
of injuries with more timely data, despite major changes in the fields
of prevention, reporting and surveillance. Since the mid-eighties, new
safety technologies have been developed to prevent injuries or to decrease
the severity of injuries, and new policies and laws have been enacted
to promote injury prevention. Chapter topics include incidence by detailed
categorisations, lifetime medical costs and productivity losses as a result
of injuries, and a discussion of recent trends. Lavishly illustrated with
tables and graphs, this volume is a valuable reference for public health
practitioners, researcher, and students alike.
Ted Miller, David Levy, Rebecca Spicer, & Dexter Taylor
Miller, T. R., Levy, D. T., Spicer, R. S., & Taylor, D. M. (2006).
Societal costs of underage drinking. Journal of Studies on Alcohol, 67(4),
519-528.
ABSTRACT. Objective: Despite minimum-purchase-age laws, young people regularly
drink alcohol. This study estimated the magnitude and costs of problems
resulting from underage drinking by category-traffic crashes, violence,
property crime, suicide, burns, drownings, fetal alcohol syndrome, high-risk
sex, poisonings, psychoses, and dependency treatment-and compared those
costs with associated alcohol sales. Previous studies did not break out
costs of alcohol problems by age. Method: For each category of alcohol-related
problems, we estimated fatal and nonfatal cases attributable to underage
alcohol use. We multiplied alcohol-attributable cases by estimated costs
per case to obtain total costs for each problem. Results: Underage drinking
accounted for at least 16% of alcohol sales in 2001. It led to 3,170 deaths
and 2.6 million other harmful events. The estimated $61.9 billion bill
(relative SE = 18.5%) included $5.4 billion in medical costs, $14.9 billion
in work loss and other resource costs, and $41.6 billion in lost quality
of life. Quality-of-life costs, which accounted for 67% of total costs,
required challenging indirect measurement. Alcohol-attributable violence
and traffic crashes dominated the costs. Leaving aside quality of life,
the societal harm of $1 per drink consumed by an underage drinker exceeded
the average purchase price of $0.90 or the associated $0.10 in tax revenues.
Conclusions: Recent attention has focused on problems resulting from youth
use of illicit drugs and tobacco. In light of the associated substantial
injuries, deaths, and high costs to society, youth drinking behaviors
merit the same kind of serious attention. (J. Stud. Alcohol 67: 519-528,
2006).
Elizabeth Mumford, David Levy, & Ken Blackman
Mumford, E. A., Levy, D. T., Gitchell, J. G., & Blackman, K. O. (2006).
Smokeless tobacco use 1992-2002: trends and measurement in the Current
Population Survey-Tobacco Use Supplements. Tobacco Control, 15(3), 166-171.
BACKGROUND: As smoking prevalence declines in the United States, it is
important to understand if smokeless tobacco (SLT) use is also changing
and if so, among what groups. METHODS: We examine the prevalence of SLT
use and smoking, 1992-2002, using the Current Population Survey-Tobacco
Use Supplements (CPS-TUS), which used US nationally representative samples
based on stratified clusters of households. RESULTS: Consistent with declines
in smoking, the prevalence of current SLT use declined over the period
1992-2002 for males and females ages 18 and older. The overall separate
declines in SLT use and in smoking are mirrored by a decline in concurrent
use of SLT and cigarettes. SLT use is becoming more associated with white
males, but use is declining faster among the youngest males. CONCLUSIONS:
The findings indicate that relative reductions in smoking prevalence are
exceeded by relative reductions in SLT use, with sizeable reductions in
concurrent use. These results suggest that the stricter cigarette policies
of recent years may not only reduce cigarette use, but also the use of
alternative tobacco products. In light of potential policy implications
of SLT use as a potential reduced exposure product (PREP), current survey
methods require more careful measurement of SLT use in terms of initiation,
duration, quantity, and cessation.
George Yacoubian
Yacoubian, G. S., Jr., & Wish, E. D. (2006). Exploring the validity
of self-reported Ecstasy use among club rave attendees. Journal of Psychoactive
Drugs, 38(1), 31-34.
While several empirical studies have focused on Ecstasy use among rave
attendees, only one study has explored the validity of self-reported Ecstasy
use within this population. To address this limitation, the authors collected
self-report drug use information and oral fluid (OF) specimens from 96
club rave attendees within the Baltimore-Washington corridor between August
and October 2000. The Kappa statistic is 0.59, suggesting a moderate relationship
between the self-report and OF measures. Such accurate reporting bodes
well for researchers interested in eliciting sensitive information from
this population.
Yacoubian, J., George S. Jr., Astvatsaturova, A. N., & Proietti, T.
M. (2006). Iraq and the ICC: Should Iraqi Nationals be prosecuted for
the crime of genocide before the International Criminal Court? War Crimes,
Genocide & Crimes against Humanity: An International Journal, 1(1),
47-74.
The international legal community has been contemplating the creation
of a permanent international criminal court for more than seven decades.
That goal was finally realized with the formation of the International
Criminal Court (ICC). Established in July 2002, the ICC will investigate
and prosecute the most egregious violations of international criminal
law - the crime of genocide, crimes against humanity, war crimes, and
the crime of aggression. Since its inception, however, the Court’s
jurisdictional power has been a matter of considerable controversy, particularly
the extent to which nationals of non-signatory states may be eligible
for prosecution. The situation in Iraq exemplifies this problem. While
not a party to the Rome Statute of the ICC, there is strong evidence to
suggest that Iraqi nationals may be guilty of genocide. Moreover, the
government of the United States, also a non-signatory state, has a clear
incentive to see that Iraqi nationals are prosecuted for these crimes.
Part I of this essay reviews the crime of genocide and the use of ad hoc
tribunals for prosecuting genocidal offenses. Part II describes the development
of the ICC and discusses its prosecutorial alternatives. Part III describes
genocidal events in Iraq and discusses whether Iraqi nationals are eligible
for prosecution for the crime o genocide before the ICC. Part IV discusses
the future of the ICC.
Eduard Zaloshnja & Ted Miller
Zaloshnja, E., Miller, T., Council, F., & Persaud, B. (2006). Crash
costs in the United States by crash geometry. Accident; Analysis and Prevention,
38(4), 644-651.
MAIN OBJECTIVES: This study was conducted to estimate the costs per crash
for three police-coded crash severity groupings within 16 selected crash
geometry types and within two speed limit categories (</=45 and >/=50mph).
METHODS: We merged previously developed costs per victim by abbreviated
injury scale (AIS) score into U.S. crash data files that scored injuries
in both the AIS and police-coded severity scales to estimate injury costs,
then aggregated the estimates into costs per crash by maximum injury severity.
RESULTS: The most costly crashes were non-intersection fatal/disabling
injury crashes on a road with a speed limit of 50 miles per hour or higher
where multiple vehicles crashed head-on or a single vehicle struck a human
(over $1.69 and $1.16 million per crash, respectively). The annual cost
of police-reported run-off-road collisions, which include both rollovers
and object impacts, represented 34% of total costs. CONCLUSIONS: This
paper provides cost estimates useful for evaluating roadway countermeasures
and for designing vehicles to minimize crash harm. It gives unit costs
of crashes by type in the coding system used by the police. The costs
are in an appropriate form for economic analysis of countermeasures addressing
locally defined problems identified by analyzing police crash reports.
Chapel Hill
Rebecca Sanchez
Bray, R. M., Rae Olmsted, K. L., Williams, J., Sanchez, R. P., & Hartzell,
M. (2006). Progress toward Healthy People 2000 objectives among U.S. military
personnel. Preventive Medicine, 42(5), 390-396.
Abstract: Objective. : Examine progress toward Healthy People 2000 objectives
among active-duty military personnel and identify subgroups at risk for
not meeting objectives. Methods. : Comprehensive Department of Defense
surveys were completed in 1995, 1998, and 2002. Target behaviors were
analyzed for achievement of objectives and demographic factors for their
relationship to unmet objectives. Results. : The military met 7 of 15
objectives assessed in 2002. Achieved objectives, such as drug use, exercise,
and safety equipment use, were generally behaviors monitored by military
requirements. Unmet risk behavior and health maintenance objectives were
related to military demographics, civilian trends, and societal norms.
Smoking was more likely not met by enlisted (OR = 2.7, CI = 2.0–3.9),
male, white, less educated, younger, single, Army, and Navy personnel.
Overweight was more likely not met by male (OR = 3.4, CI = 3.0–4.0),
African American, Hispanic, more educated, aged 35 or older, married,
enlisted, and Navy personnel. Health maintenance goals were more likely
not met by enlisted (OR = 1.5, CI: 1.1–2.2), male, nonwhite, less
educated, younger, single, Navy, and Marine personnel. Conclusions. :
Objectives are more likely met when regulatory mechanisms encourage compliance.
Future studies are needed to understand mechanisms accounting for achievement
of objectives. Next steps for unmet objectives are to target interventions
for high-risk groups.
Martha Waller, Denise Hallfors, & Bonita Iritani
Waller, M. W., Hallfors, D. D., Halpern, C. T., Iritani, B. J., Ford,
C. A., & Guo, G. (2006). Gender differences in associations between
depressive symptoms and patterns of substance use and risky sexual behavior
among a nationally representative sample of U.S. adolescents. Archives
of Women's Mental Health, 9(3), 139-150.
Objective: This study uses a cluster analysis of adolescents, based on
their substance use and sexual risk behaviors, to 1) examine associations
between risk behavior patterns and depressive symptoms, stratified by
gender, and 2) examine gender differences in risk for depression.Methods:
Data are from a nationally representative survey of over 20,000 U.S. adolescents.
Logistic regression was used to examine the associations between 16 risk
behavior patterns and current depressive symptoms by gender.Results: Compared
to abstention, involvement in common adolescent risk behaviors (drinking,
smoking, and sexual intercourse) was associated with increased odds of
depressive symptoms in both sexes. However, sex differences in depressive
symptoms vary by risk behavior pattern. There were no differences in odds
for depressive symptoms between abstaining male and female adolescents
(OR = 1.07, 95% CI 0.70-1.62). There were also few sex differences in
odds of depressive symptoms within the highest-risk behavior profiles.
Among adolescents showing light and moderate risk behavior patterns, females
experienced significantly more depressive symptoms than males.Conclusions:
Adolescents who engage in risk behaviors are at increased risk for depressive
symptoms. Girls engaging in low and moderate substance use and sexual
activity experience more depressive symptoms than boys with similar behavior.
Screening for depression is indicated for female adolescents engaging
in even experimental risk behaviors.
Providence
Bob Stout
Phillips, K. A., Pagano, M. E., Menard, W., & Stout, R. L. (2006).
A 12-month follow-up study of the course of body dysmorphic disorder.
American Journal of Psychiatry, 163(5), 907-912.
OBJECTIVE: This study investigated the course of body dysmorphic disorder
(BDD), a relatively common and severe disorder, in the first prospective
follow-up study, to the authors' knowledge. METHOD: In this study, the
authors obtained data with the Longitudinal Interval Follow-Up Evaluation
on weekly BDD symptom status and treatment received over 1 year for 183
broadly ascertained subjects. Probabilities of full remission, partial
remission, and relapse during this year were examined. Full remission
was defined as minimal or no BDD symptoms and partial remission, as meeting
less than full DSM-IV criteria for at least 8 consecutive weeks. Relapse
was defined as meeting full BDD criteria for at least 2 consecutive weeks
after attaining partial or full remission from BDD. RESULTS: Over 1 year,
the probability of full remission from BDD was only 0.09, and the probability
of partial remission was 0.21. Although 84.2% of the subjects received
mental health treatment during the 1-year period, mean BDD severity scores
during the year reflected full DSM-IV criteria for BDD, and the mean proportion
of time that the subjects met full BDD criteria was 80%. Gender and ethnicity
did not significantly predict remission from BDD. Among the subjects whose
BDD symptoms partially or fully remitted, the probability of relapse was
0.15. CONCLUSIONS: These findings indicate that BDD tends to be chronic.
Remission probabilities were lower than reported for mood disorders, most
anxiety disorders, and personality disorders in studies with similar methods.
Coles, M. E., Phillips, K. A., Menard, W., Pagano, M. E., Fay, C., Weisberg,
R. B., & Stout, R. L. (2006). Body dysmorphic disorder and social
phobia: cross-sectional and prospective data. Depression and Anxiety,
23(1), 26-33.
Much attention has been paid to the relationship between body dysmorphic
disorder (BDD) and obsessive-compulsive disorder (OCD). However, to our
knowledge, no published study has focused directly on the relationship
between BDD and social phobia (SP). This is striking given similar clinical
features of the two disorders, data showing elevated comorbidity between
them, and Eastern conceptualizations of BDD as a form of SP. In this study,
39.3% of 178 individuals with current BDD had comorbid lifetime SP, and
34.3% had current SP. SP onset was typically before BDD. Individuals with
BDD, with and without lifetime SP, were similar on many general characteristics
(e.g., age of BDD onset, gender distribution, BDD severity, overall functional
disability). However, subjects with BDD+SP were significantly less likely
to be employed, were more likely to report lifetime suicidal ideation,
and had poorer global social adjustment on one of two measures. Both BDD
and SP were associated with elevated social anxiety; subjects with BDD+SP
experienced additional social anxiety that appeared independent of BDD
symptoms. Examining 1-year prospective data available for 161 subjects,
BDD+SP subjects were somewhat less likely to experience remission (partial
or full) of their BDD symptoms over 1-year follow-up, although this difference
was not statistically significant (hazard ratio = .64, P = .18). In summary,
these findings, including elevated rates of SP in patients with BDD, highlight
a need for additional research on the relationship between BDD and SP.
Phillips, K. A., Menard, W., Pagano, M. E., Fay, C., & Stout, R. L.
(2006). Delusional versus nondelusional body dysmorphic disorder: clinical
features and course of illness. Journal of Psychiatric Research, 40(2),
95-104.
DSM-IV's classification of body dysmorphic disorder (BDD) is controversial.
Whereas BDD is classified as a somatoform disorder, its delusional variant
is classified as a psychotic disorder. However, the relationship between
these BDD variants has received little investigation. In this study, we
compared BDD's delusional and nondelusional variants in 191 subjects using
reliable and valid measures that assessed a variety of domains. Subjects
with delusional BDD were similar to those with nondelusional BDD in terms
of most variables, including most demographic features, BDD characteristics,
most measures of functional impairment and quality of life, comorbidity,
and family history. Delusional and nondelusional subjects also had a similar
probability of remitting from BDD over 1 year of prospective follow-up.
However, delusional subjects had significantly lower educational attainment,
were more likely to have attempted suicide, had poorer social functioning
on several measures, were more likely to have drug abuse or dependence,
were less likely to currently be receiving mental health treatment, and
had more severe BDD symptoms. However, when controlling for BDD symptom
severity, the two groups differed only in terms of educational attainment.
These findings indicate that BDD's delusional and nondelusional forms
have many more similarities than differences, although on several measures
delusional subjects evidenced greater morbidity, which appeared accounted
for by their more severe BDD symptoms. Thus, these findings offer some
support for the hypothesis that these two BDD variants may constitute
the same disorder. Additional studies are needed to examine this issue,
which may have relevance for other disorders with both delusional and
nondelusional variants in DSM.
Gunderson, J. G., Daversa, M. T., Grilo, C. M., McGlashan, T. H., Zanarini,
M. C., Shea, M. T., Skodol, A. E., Yen, S., Sanislow, C. A., Bender, D.
S., Dyck, I. R., Morey, L. C., & Stout, R. L. (2006). Predictors of
2-year outcome for patients with borderline personality disorder. American
Journal of Psychiatry, 163(5), 822-826.
OBJECTIVE: The primary purpose of this report was to investigate whether
characteristics of subjects with borderline personality disorder observed
at baseline can predict variations in outcome at the 2-year follow-up.
METHOD: Hypothesized predictor variables were selected from prior studies.
The patients (N=160) were recruited from the four clinical sites of the
Collaborative Longitudinal Personality Disorders Study. Patients were
assessed at baseline and at 6, 12, and 24 months with the Structured Clinical
Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV
Personality Disorders, a modified version of that instrument; the Longitudinal
Interval Follow-Up Evaluation; and the Childhood Experiences Questionnaire-Revised.
Univariate Pearson's correlation coefficients were calculated on the primary
predictor variables, and with two forward stepwise regression models,
outcome was assessed with global functioning and number of borderline
personality disorder criteria. RESULTS: The authors' most significant
results confirm prior findings that more severe baseline psychopathology
(i.e., higher levels of borderline personality disorder criteria and functional
disability) and a history of childhood trauma predict a poor outcome.
A new finding suggests that the quality of current relationships of patients
with borderline personality disorder have prognostic significance. CONCLUSIONS:
Clinicians can estimate 2-year prognosis for patients with borderline
personality disorder by evaluating level of severity of psychopathology,
childhood trauma, and current relationships.
Phillips, K. A., Grant, J. E., Siniscalchi, J. M., Stout, R., & Price,
L. H. (2005). A retrospective follow-up study of body dysmorphic disorder.
Comprehensive Psychiatry, 46(5), 315-321.
BACKGROUND: Although research on body dysmorphic disorder (BDD) is increasing,
no follow-up studies of this disorder's course of illness have been published.
METHODS: The status of 95 outpatients with BDD treated in a clinical practice
was assessed by chart review. Standard scales were used to rate subjects
at baseline and the most recent clinic visit (mean duration of follow-up,
1.7 +/- 1.1; range, 0.5-6.4 years). Ratings were also done at 6-month
intervals over the first 4 years of follow-up. RESULTS: Allowing for censoring,
life table analysis estimated that the proportion of subjects who achieved
full remission from BDD at the 6-month and/or 12-month assessment was
24.7%; the proportion who attained partial or full remission at 6 months
and/or 12 months was 57.8%. After 4 years of follow-up, 58.2% had experienced
full remission, and 83.8% had experienced partial or full remission, at
one or more 6-month assessment points. Of those subjects who attained
partial or full remission at one or more assessment points, 28.6% subsequently
relapsed. Between baseline and the most recent assessment, BDD severity
and functioning significantly improved: at the most recent assessment,
16.7% of subjects were in full remission, 37.8% were in partial remission,
and 45.6% met full criteria for BDD. Greater severity of BDD symptoms
and the presence of major depression or social phobia at baseline were
associated with more severe BDD symptoms at study end point. All subjects
received at least one medication trial, and 34.3% received some type of
therapy during the follow-up period. CONCLUSIONS: A majority of treated
patients with BDD improved, although improvement was usually partial.
Prospective longitudinal studies are needed to further elucidate the course
of BDD.
William Zywiak & Bob Stout
Zywiak, W. H., Stout, R. L., Trefry, W. B., Glasser, I., Connors, G. J.,
Maisto, S. A., & Westerberg, V. S. (2006). Alcohol relapse repetition,
gender, and predictive validity. Journal of Substance Abuse Treatment,
30(4), 349-353.
Earlier exploratory work on a scoring algorithm for the Reasons for Drinking
Questionnaire [Zywiak, W. H., Westerberg, V. S., Connors, G. J., &
Maisto, S. A. (2003). Exploratory findings from the Reasons for Drinking
Questionnaire. Journal of Substance Abuse Treatment, 25, 287-292.] presented
a number of interesting findings, but was limited by a fairly low consistency
in type of relapse between the first relapse and the second relapse (63%).
This scoring algorithm objectively classifies alcohol relapses into one
of three types (negative affect, social pressure, or craving/cued). While
examining gender differences in the type of first relapse, evidence indicating
that relapses were more consistent for men (81%) than for women (44%)
was uncovered. For initial posttreatment relapses, women were more likely
to have negative affect relapses, and men were more likely to have social
pressure relapses. For men, negative affect relapses were predicted by
the Beck Depression Inventory score. For women, negative affect relapses
were predicted by the Alcohol Dependence Scale score, and craving/cued
relapses were predicted by situational craving.
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