RESEARCH INTERESTS
Sachs-Ericsson, Natalie and, Ciarlo, James A. Gender, Social Roles and Mental Health: An Epidemiological Perspective. Submitted for Publication
Abstract
Mental health and gender were examined in a large adult general population sample (n=4,745). No gender differences were found for the overall rate of any psychiatric disorder. However, gender differences were found for specific disorders. Women were found to have higher rates for anxiety and depression related disorders than men, while men were found to have higher rates for anti-social behavior and substance use disorders than women.
Moreover, mental health and gender were examined in relation to the social roles of marriage, employment, and parenthood. Two alternative models predicting a relation between social roles and mental health were examined. The role strain theory suggest that the conflicting demands of multiple roles leads to increased rates of mental illness. Further, women are thought to have more difficulties than men in occupying multiple roles. In contrast, the role accumulation hypothesis contends that roles add meaning to one's life and serve as a buffer to stress.
While multiple roles were generally found to be associated with a lower rate of any disorder for both men and women, the association was not strong. Moreover, some roles combinations were found to be associated with a high rate of disorders. Thus neither model alone was found to adequately explain the data. A synthesis of the two models, the dual-attribute role theory, is proposed to be better account for the dynamic interplay of the stressors and protective factors associates with social roles.
Sachs-Ericsson, N., Ciarlo, J., Tweed, D., Dilts, S., Casper, E. (1994). The Colorado Homeless Mentally Ill: Users and Non-Users of Services: An Empirical Investigation of "Difficult to Treat" Characteristics. J. of Community Psychology, vol.22, 339-345.
Abstract
This study examines the mental health problems of a selected case sample of homeless mentally ill (HMI) men and women in Colorado. These HMI persons (total N=96) are compared to populations in the community including, a random sample of the Colorado general population (N=4,745), a Colorado outpatient sub-sample (N=98), a Denver inpatient sample (N=52), and large samples of Colorado public mental health system outpatients (N=24,377) and inpatients (N=1,180). Findings show that these HMI persons are more severely impaired than any of the comparison samples.
The HMI sample was selected to compare those HMI who utilize mental health services (N=46) with those who do not (N=50) in respect to psychopathology and to characteristics related to being "difficult to treat". Findings show that while the HMI current utilizers are slightly more dysfunctional than the Non-Users, high rates of serious disorders are found among both HMI groups. HMI current users of mental health services, particularly voluntary users, were found to have fewer "difficult to treat" characteristics than the Non-Users. These findings have implications for the priority placed on trying to link the HMI to public mental health services, which currently do not seem to be successfully engaging a large number of these very seriously impaired people.
Koenig, J., Sachs-Ericsson, N. , Miklowitz, D. Psychiatric Patient's Judgments of Family Interactions". Journal of Family Psychology. In press.
Numerous studies have established the prognostic validity of family attitudes and interactional behaviors in psychiatric disorders. However, most have relied on observer- rather than patient-rated measures of the family context. Bipolar patients (N=31) rated their relatives' verbal behaviors in problem-solving discussions using the Patient's Experiences of a Relative's Affective Style (PERAS) scale. The PERAS had acceptable reliability and internal consistency. Patients' PERAS judgments of the frequencies of harsh and benign criticisms in relatives correlated positively with an observer's affective style (AS) ratings of these same behaviors in relatives. However, patients' ratings of intrusiveness and support in relatives were unrelated to the observer's AS ratings. The PERAS is a promising measure of how patients experience their family interactions.
Sachs-Ericsson, N.J., Ciarlo, J. (1992). III. Determining "Cases" of Mental Health-Related Dysfunction from Continuous Scales of Everyday Functioning. Evaluation and Program Planning, vol. 15, No. 2, 149-164.
Abstract
The Colorado Social Health Survey of need for mental health and substance abuse services was designed to generate need prevalence rates using three different measures of need--diagnosable disorders, dysfunction in everyday living, and demoralization. Only the first of these measures was inherently dichotomous, allowing clear specification of which survey subjects qualified as "cases" of need. For the demoralization measure, based on the CES-D(epression) scale, a conventional cutting score employed by other researchers was also used here. For everyday dysfunction, it was necessary either to designate appropriate cutting points on continuous scales of functioning or to derive "caseness" information from specific responses to questions in the various functioning domains. Three methods of designating "cases" were studied--a statistical deviation approach, a patient criterion groups approach, and a clinical judgment approach. The first was based on having scores in highest 10% of the general population sample on two or more scales assessing specific functioning domains. The second was based on having two or more domain dysfunction scores at or above the median for CSHS outpatient and inpatient comparison groups. The third was based on endorsement of two or more "critical" dysfunction items previously judged by clinician researchers to indicate need for mental health services. Results for all procedures were reviewed for face, concurrent, and construct validity, involving comparisons with dysfunction ratings on samples of Colorado public mental health system outpatients and inpatients. On the basis of this validity examination, the clinical judgment approach was chosen as the primary method for designating "cases" of everyday dysfunction in this research.