We should screen for major depression

This article is a response to Coyne, Thompson, Palmer, Kagee, and Maunsell's (2000) article, “Should We Screen for Depression? Caveats and Potential Pitfalls.” We address four points that we view as central to their argument: (1) current screening measures are inadequate; (2) correct identification of depressed patients does not result in improved clinical outcomes; (3) screening is too expensive; and (4) screening may have harmful negative effects. We discuss the following important issues: (1) screening and prevention are still in the research and development phase; (2) the kindling phenomenon is an important reason to screen; (3) there is a need to focus screening and prevention efforts on ethnic minorities; and (4) high depressive symptoms have a substantial public health impact. Finally, we present reasons why screening is advisable, both for prevention and treatment purposes, and provide our recommendations. Our stance is that, in order for screening and prevention to become practical, they need to be implemented in both research and practice contexts. Therefore, we should make screening for major depression a priority.     

政府与个人的责任——中国当代医疗改革的责任伦理学剖析

卫生改革的重点必须放在政府部门;公共卫生,预防与初级医疗保健是人类生存的需要,带有鲜明的公益性和福利性。应由政府投资为主筹集资源,以国家投资为主体负担费用,这个层次的卫生服务产品,属非商品经济部分,并不以赢利为目的,不能引进市场经济,个人对健康负有重要责任,包括：选择医疗保健,决定花费数额,生活方式和卫生习惯的养成,主动接受健康教育,抵抗压力,支持国家与地区的卫生保健政策;个人对自身健康负责是一种道德责任,健商（health quotient)这一重要概念,具有伦理价值和普遍的医学人类学意义;个人对健康负责是一种社会风尚。     

Predicting Resource Utilization by Children with Serious Emotional Disturbance and Their Families

Our study represents a rural case management agency's use of its data to aid in its transition from being funded by federal grant funds to self-sustainment. We wanted to learn if some characteristics of those children served could predict the resources needed to serve them. We analyzed data on 90 children and adolescents living in a rural community. Using multiple regression analysis we found that CAFAS total and CBCL total problem scores predicted Medicaid reimbursements but not flexible funds spending or case management hours. History of psychiatric hospitalization, however, predicted flexible funds spending and case management hours. Using one-way ANOVA and post hoc analysis we found that the staff members' assessments of each child and family's level of service needs were reflected in differences in mean CAFAS total scores, Medicaid reimbursements and case management hours, but not CBCL total problem scores or flexible funds spending.     

Interpersonal Conflicts of Women in Nursing Homes: An Administrative Perspective

Older women may respond to conflicts by suppressing anger. Suppressed anger is associated with depression and hypertension. Research on the everyday conflicts of community-dwelling older women has begun to emerge. Such information is not available for women in nursing homes, and is necessary for developing interventions that can help protect women in nursing homes against anger-related illness. Nursing home administrators were surveyed to evaluate women's health promotion programming in general, and the incidence of and institutional response to conflicts of women residents. About 74% of residents were women; yet, women's health promotion programs were rare (offered in 1 out of 25 facilities, or 4%). Ninety percent of administrators identified depression as the most significant women's health problem, but tended to see it as warranting medical rather than programmatic attention. Eighty percent identified strained interpersonal relationships as a significant health problem for women, requiring programmatic attention. In particular, administrators identified the need for programming to help women residents resolve conflicts with roommates and family members. Formal mechanisms for managing conflicts of residents did not exist in sample nursing homes.     

The prevalence of stalking of psychological therapists working in primary care by current or former clients

The prevalence of being a victim of harassment or stalking among the general population of the UK is held to be 11.8 per cent. There has been speculation that the prevalence rate would be higher for psychological therapists, as they could be at risk from their own clients. This study analysed the prevalence of job‐related experiences of harassment or stalking in a postal survey of psychological therapists who worked in primary care. The results showed a prevalence rate of more than twice the national average at 24 per cent. The stalkers, who were equally male or female, fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders. The implications of these findings for training and practice are discussed.     

Lorenz Curves: A New Model for the Distribution of Psychiatric Services

The growth of child and adolescent psychiatric services based on the wraparound philosophy raises new questions for medical directors, investigators, and clinicians interested in improving quality of care and outcomes. Typically, quality improvement studies have focused on standardizing care and decreasing variation while community based services following a wraparound model are by definition individualized. To date, little information on how to evaluate such services in a managed care environment has been available. We present one option for evaluating the distribution of medical services and the extent to which providers individualize services for children with severe emotional disorders. Specifically, we (a) review the philosophy and goals of wraparound services, (b) introduce the Lorenz curve as a tool for determining the degree of inequality in service distribution at a given institution, and (c) present a case study on the use of Lorenz curves by a Medicaid Behavioral Health Organization in profiling behavioral providers.     

Treatment Foster Care in a System of Care: Sequences and Correlates of Residential Placements

We examined Treatment Foster Care (TFC) in residential trajectories for youth with psychiatric disorders and aggressive behavior. We analyzed residential placements of a statewide sample of youth during the 12 months preceding and following admission to TFC. Prior to TFC, the majority of youth were residing in more restrictive settings (group homes or residential treatment). Two-thirds of youth remained in TFC throughout the follow-up year. Of those who left, nearly half returned home, and slightly fewer were discharged to group homes. By the end of the 12-month follow-up period, rates of group home use were similar to those seen in the pre-TFC period. Movement out of TFC during the year was associated with being older at placement and with increased problem behavior (particularly externalizing behaviors). TFC serves as a step-down placement for a substantial number of youth. However, this is not the only way it is used, and models based on short-term transitioning or reunification with families may not be widely implemented or relevant in practice. Additional research is needed to understand current functions of TFC in residential trajectories and to maximize its utility in systems of care.     

Improving Health Care Utilization, Improving Chronic Disease Utilization, Health Status, and Adjustment in Adolescents and Young Adults with Cystic Fibrosis: A Preliminary Report

We conducted a randomized clinical trial of a 3-session written self-disclosure intervention for patients with cystic fibrosis (CF). Patients (n = 39) who were at least 15 years of age and diagnosed with CF participated in the intervention. Participants in the intervention arm were asked to write in the health care setting about an important emotionally distressing issue of personal significance for a 20-min period of time and two additional 20-min writing episodes at the patient's home, which were prompted by telephone calls. Patients in the control condition received standard care alone. Findings revealed that the intervention resulted in a reduction of the number of days patients spent in the hospital over a 3-month period. The intervention did not have an impact on physiological (Forced Expiratory Volume and Body Mass Index or subjective markers of health status. These findings extend those of Pennebaker's (cf., J. Smyth, 1998) demonstrating an effect of the written-self-disclosure intervention on health care utilization. These preliminary findings are promising and justify further investigation of the modified intervention in other chronic illness populations.