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The relationship between pediatrician training and the identification and management of current and ongoing emotional or behavioral problems in 4-8 year old children is examined. Findings reveal that pediatricians with advanced training in psychosocial issues were more likely to identify children's psychosocial problems and use multiple management strategies compared to pediatricians with no specialized training.

Objective: This study sought to determine how comorbidity of psychiatric and substance abuse disorders affects the likelihood of using mental health services. Method: The analysis was based on data on adults aged 18-54 years in the National Comorbidity Survey (N = 5,393). Users and nonusers of mental health and substance abuse services were compared in terms of their demographic characteristics, recent stressful life events, social support, parental history of psychopathology, self-medication, and symptoms of alcohol abuse/dependence. Results: The prevalence of service utilization varied by diagnostic configurations. Comorbid psychiatric or alcohol disorders were stronger predictors of service utilization than a pure psychiatric or alcohol disorder. Factors predicting utilization of services differed for each disorder. Conclusions: Since comorbidity increases the use of mental health and substance abuse services, research on the relationship of psychiatric and alcohol-related disorders to service utilization needs to consider the coexistence of mental disorders. Attempts to reduce barriers to help seeking for those in need of treatment should be increased.

Objective: To evaluate the affect of families' altitudes about the appropriateness of discussing psychosocial concerns on pediatric providers' identification of psychosocial problems. Design: These data were collected as part of the Greater New Haven Child Health Study, New Haven, Conn. The study design was a prospective cohort. Setting: Families were recruited from a stratified random sample of all primary care practices in the greater New Haven area. Nineteen of 23 invited practices agreed to participate including 2 prepaid practices, 2 neighborhood health centers, and 7 fee-for-service group and 8 fee-for-service solo practices. Participants: All families of children aged 4 to 8 years who attended these practices during 2 separate 3-week periods (1 in fall 1987 and 1 in spring 1988) were invited to participate in the study. Families were invited to participate only once, on the first contact with any eligible child, using approved procedures. Of 2006 eligible families, 1886 (94%) chose to participate. Main Outcome Measure: The outcome variable for these analyses is the identification of any behavioral, emotional, or developmental problem by the pediatrician on the 13-category checklist. Overall, pediatric clinicians identified 27.5% of children with 1 or more psychosocial problems. Results: Our data suggest that there is a great deal of discrepancy between what parents report is appropriate to do when their children have psychosocial problems and what they actually do when they recognize such problems in their children. Most (81.1%) believed it was appropriate to discuss 4 or more of the 6 hypothetical situations with their children's physician, while only 40.9% actually did discuss any of these problems with a physician when a problem occurred. Given the correlates of parents who intended to discuss such problems (higher education, older age, Euro-American ethnicity, higher income, married, availability of medical insurance) the possibility that parents are providing socially acceptable responses to such questions seems likely. Further, our data indicate that parents' actual reports of discussions of psychosocial problems is unrelated to whether physicians identified those problems in children. Conclusions: Pediatricians' judgments about the presence of psychosocial problems in their young patients seem to be based on their own observations rather than on what parents report. Physician-parent communication about psychosocial problems will be increasingly important as primary care physicians assume their role as gatekeepers to more expensive services such as mental health interventions. Arch Pediatr Adolesc Med. 1998;152:367-371, Parents appear to be much more likely to discuss a child's annoying habits with a pediatrician than a child's peer and social relationship problems. Researchers surveyed 1,886 families with young children about hypothetical behavioral, social, and emotional problems in children. Eighty-one percent of parents felt it was appropriate to discuss most of the issues with the child's pediatrician, but only 41% actually discussed such problems when they arose in their own children. When a problem existed, 60% of parents reported habits, but only 22% reported social difficulties to the doctor.

Objective: This study examined the effects of nine axis I psychiatric disorders, as assessed by the Diagnostic Interview Schedule, on the risk of mortality over a 9-year period among a community sample of 3,560 men and women aged 40 and older. Method: The study identified the vital status as of Oct. 1, 1989, of respondents who were first interviewed in 1980 by the New Haven Epidemiologic Catchment Area study. Mortality risk by psychiatric status was estimated by using Cox proportional hazards models. Results: Nine years after the baseline interview, it was confirmed that 1,194 (33.5%) of the respondents were deceased and 2,344 (65.8%) survived; the vital status of 22 (0.6%) remained unknown. When the relative risk of mortality was adjusted for age, several disorders - major depression, alcohol abuse or dependence, and schizophrenia - increased the likelihood of mortality. Conclusions: These data are further evidence of the negative outcome of some psychiatric problems even when assessed in community samples. The relatively high prevalence of depression and alcohol disorders indicates the far-reaching impact that these problems have on community health in general.

Objective and Method: A mail survey was conducted in 1988-1989 to study the professional activities of U.S. psychiatrists. Data from the 19,431 active respondents are reported. Results: Nineteen percent of the psychiatrists were women, an increase from the 17% reported in 1982. The median age of the respondents was 50 years. Nearly one-third of the respondents expressed interest in each of the following areas of subspecialization: adolescent psychiatry, substance abuse, geriatrics, and consultation-liaison psychiatry. More than one-fifth reported formal fellowship training in child/adolescent psychiatry. The psychiatrists worked an average of 48 hours per week - two-thirds in direct patient care - in an average of 2.3 different settings. The proportion of psychiatrists reporting private practice as their primary work setting showed a marked decline from 53% in 1982 to 45% in 1988. There was an increase from 4% in 1982 to 11% in 1988 in those whose primary work setting was a private psychiatric hospital. The typical caseload was over 60 patients, with roughly half that number seen each week. For inpatients treated, the two most common diagnoses were affective disorders and schizophrenic disorders. In a typical weekly psychiatrists treated about one-half of their outpatients with individual psychotherapy; three-fifths of these were also treated with medications. The average net income for psychiatrists working 35 hours or more per week was $99,850 for men and $73,174 for women. Conclusions: Major trends evident from this study are subspecialization, medicalization, privatization, feminization, and organizational diversification. (Am J Psychiatry 1992: 149:1499-1505)

Depression as a result of the loss of a spouse has been well documented, and is considered to be a normal expression of grief. However, there are no methods for clearly differentiating depressive episodes that are a normal part of the grieving process from more serious major depressive episodes in individuals who have recently lost a spouse. The variation in grief reactions was examined by evaluating three interviews that were conducted as a part of the New Haven Epidemiologic Catchment Area sample. During the course of the study, 39 individuals out of 1,180 participants were widowed. All of the subjects were over 45 years old and were equally as likely to have had a previous episode of dysphoria at the time they first entered the study. The findings were similar to those of previous studies, which have reported high rates of depressive symptoms among individuals who are newly bereaved. Both depressive episodes and dysphoria (feelings of anxiety, restlessness, and depression) were more common in the bereaved group than in the married group. Of the 39 individuals who had lost a spouse, almost two thirds reported having periods of dysphoria that lasted for two weeks or more. Nearly one third of this group met the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), criteria for a major depressive episode. No significant differences were found that related to sex, age, and household size among the depressed. However, those who were bereaved lacked feelings of guilt or worthlessness compared with the married depressed subjects. No suicide attempts were reported, and none of the bereaved subjects reported suicidal thoughts, but the majority did report a preoccupation with death. It was concluded that a significant number of newly widowed individuals have symptoms of major depression as defined in the DSM-III. More information is needed on the long- and short-term effects of the serious episodes which accompany or may be a part of the grieving process. Those having prolonged depressive symptoms should be carefully monitored and assessed for further complications or additional disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)