Lee N. Robins's research while affiliated with Washington University in St. Louis and other places

Publications (135)

Article
Despite its reputation as a rapidly addicting drug, heroinin the forms available in the United States in late 1974 wasno more likely to be used regularly or daily if used at all thanwere marijuana or amphetamines. It was more likely to beused regularly than other narcotics and other non-narcoticdrugs. As compared with marijuana and amphetamines,wha...
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The author emphasizes the importance of an adequate appreciation of the clinical syndromes that are the topics of the psychiatric epidemiology as well as skills in interview construction. She focuses on the difficult problem of drawing lines between non-cases and current and past cases, and the problem of estimating unmet needs for treatment in the...
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Department of Psychiatry Washington University School of Medicine 4940 Audubon Avenue St. Louis, Missouri 63110 U.S.A.
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A short history of the roots of DSM-III and the politics of its creation help to explain the extensive occasions it offers for fulfilling criteria for multiple diagnoses. With use of standardized interviews, it becomes possible to discover all the diagnoses a single person can qualify for. This should prompt rethinking how diagnoses are selected an...
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This article comments on the article by Sampson and Laub in this issue. It congratulates them on locating and interviewing at approximately age seventy a large proportion of the survivors of the Glueck and Glueck (1968) study. It also points out problems, some resulting from the impact of privacy regulations. Other problems arose from the age of th...
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Measuring the validity of psychiatric diagnoses is still an unsolved problem. Yet, revisions of the Diagnostic and Statistical Manual of Mental Disorders and of chapter V of the International Classification of Diseases are now under way, with the hope of improving the validity of the current systems. This article suggests data that could be used to...
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Full-text available
Psychiatric diagnostic interviews to be used in epidemiologic studies by lay interviewers have, since the 1970s, attempted to operationalize existing psychiatric nomenclatures. How to maximize the chances that they do so successfully has not previously been spelled out. In this article, the authors discuss strategies for each of the seven steps inv...
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This review of sociologically relevant alcohol research addresses definitions of alcohol problems, describes patterns and trends in adult drinking practices and problems and correlates of alcoholism, and describes social policy responses to alcohol. With implications for many measures of social wellbeing, alcohol research is relevant to almost all...
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To seek clues in the Vietnam study of 30 years ago that might shed light on which previous users of heroin are at special risk of relapsing and, among relapsers, to identify those likely to begin or return to injecting heroin. To analyse information in military records and in two interviews given in the first 3 years after return from Vietnam to fi...
Chapter
The authors present the history of personal interviews to assess the prevalence of mental disorders in a defined population. Standardized and semistandardized diagnostic interviews are presented and discussed. A detailed analysis of the stability and innovation in the current versions concludes the chapter.
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DSM-IV antisocial personality disorder diagnosis requires that conduct disorder be exhibited before age 15. However, recent studies have reported on men and women without conduct disorder before age 15 but qualified for the adulthood antisocial personality criterion (AAB). This general-population, retrospective study investigated the plausibility o...
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Full-text available
Current US mental disorder prevalence estimates have limited usefulness for service planning and are often discrepant. Data on clinical significance from the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) and the National Comorbidity Survey (NCS) were used to produce revised estimates, for more accurate projections o...
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Full-text available
DSM-IV antisocial personality disorder diagnosis requires that conduct disorder be exhibited before age 15. However, recent studies have reported on men and women without conduct disorder before age 15 but qualified for the adulthood antisocial personality criterion (AAB). This general-population, retrospective study investigated the plausibility o...
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There is a powerful association between antisocial behavior and substance abuse. What is still uncertain is whether the association between the two is causal, so that one disorder leads to the other, or is explained by shared symptoms or shared risk factors, or suggests that the two disorders are not distinct, but are actually variants of the same...
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This paper discusses a new method for locating errors in diagnostic computer scoring programs for structured clinical interviews. It was proposed as a test of the accuracy of the scoring program for the Composite International Diagnostic Interview, version 1.1. The proposal was to create an independent scoring program in a different computer langua...
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In the past two decades brain tumor rates have risen in several industrialized countries, including the United States. During this time, brain tumor data have been gathered by the National Cancer Institute from catchment areas representing 10% of the United States population. In the present study, we analyzed these data from 1975 to 1992 and found...
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Associations between affective disorders, anxiety disorders, and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Com...
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To determine whether a short computer interview could be used in place of a full diagnostic interview to obtain psychiatric diagnoses, the authors examined the short interview's sensitivity, specificity, and diagnostic agreement with the full interview. Patients recently discharged from a university psychiatric service were interviewed in two back-...
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Full-text available
To identify reasons for discrepancies between parent and child reports of child/adolescents's psychiatric symptoms, parents and adolescents (51 pairs) were asked to guess what the other would answer to questions from the PC-DISC about the adolescent's psychiatric symptoms, and to explain why they expected disagreement when the answer they provided...
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This paper examines perceived barriers to mental health care reported in two very similar community surveys in two cities that are not only on opposite sides of the world but that differ substantially in their health care systems, their size, and their mix of ethnic groups, namely, St. Louis in the United States and Christchurch in New Zealand. Res...
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A variety of standardized interviews are now available that allow making specific psychiatric diagnoses according to one or more of the official diagnostic nomenclatures. The number of interviews to choose among is likely to continue to grow. It is not always obvious which instrument would be best for a particular study. This paper offers criteria...
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Between 1972 and 1974, the outcomes of army enlisted men who had served in Vietnam during 1970-71 were evaluated and compared with that of a matched group. This paper reports the major findings of that study with respect to frequency of narcotic addiction in and after Vietnam, and the major risk factors for Vietnam addiction and later relapse. Extr...
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The associations between the one-month prevalence rates of mental disorders and sociodemographic characteristics were investigated for 18,571 people interviewed in the first-wave community samples of all 5 sites in the US National Institute of Mental Health (NIMH) Epidemiologic Catchment Area program. Men were found to have a significantly higher r...
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Full-text available
Objective. —To estimate temporal trends in the rates of major depression cross-nationally.
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This article describes a comparison of Composite International Diagnostic Interview (CIDI) diagnostic results and results based on clinicians' observation of CIDI assessments. Psychiatrists scored a DSM-III-R criteria checklist either while observing or after administering 20 CIDI interviews. Overall diagnostic concordance between the checklist and...
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Full-text available
Two clinicians scored the ICD-10 Research Criteria Checklist either while observing or after administering CIDI interviews to a sample of 20 subjects. Overall diagnostic concordance between clinical and CIDI assessments was found to be good (overall kappa = 0.77). Assessment of the specific diagnoses could be done only for the three most commonly r...
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This study compared three versions of the NIMH Diagnostic Interview Schedule (DIS): "traditional" interviewer-administered DIS; computer-administered DIS (subject interacting alone with computer); computer-prompted DIS (interviewer using computer program as a guide). Kappas for 20 diagnoses ranged from .15 to .94, and averages for the three method...
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The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM-III-R and proposed ICD-10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the qu...
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Full-text available
The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD-10 and DSM-III-R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the int...
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Children with conduct disorder have long been known to be at high risk for developing externalizing disorders, alcohol and drug abuse, and antisocial personality. Relationships of conduct disorder to other adult psychiatric disorders, on the other hand, have not been definitively shown. Taking advantage of the large community sample (N = 19,482) in...
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This study reports on the performance of two forms of version I of the Diagnostic Interview Schedule (DIS) computer screening interview, using the traditional interviewer-administered DIS (T-DIS) as the standard. The screening interview was either self-administered (called the S-DISSI) with the subject keying in responses, or interviewer-administer...
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We looked at performance on the Folstein Mini-Mental State Exam (MMSE) as a predictor of hospitalization and length of stay in the coming year in community-dwelling older persons from the National Institute of Mental Health Epidemiologic Catchment Area program. They had been assessed with the MMSE at the outset and were re-evaluated with the MMSE a...
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In pursuing diverse goals over the years, psychiatric epidemiology has produced a rich variety of enterprises. But the core concern of psychiatric epidemiology from its earliest days has been the estimation of the overall prevalence of psychiatric disorder in the total population, in an effort to estimate need for services and to identify demograph...
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This study was designed to evaluate the effectiveness of a large scale program to improve health care for high-risk adolescents. Seven clinics, funded to provide comprehensive primary care to adolescents, were compared to three non-funded clinics. The majority of the 2,788 adolescent patients sampled in these clinics were female (78 percent) and Bl...
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The CIDI-SAM is a fully-structured interview that ascertains DSM-III, DSM-III-R, Feighner, RDC and ICD-10 diagnoses for alcohol, tobacco and nine classes of psychoactive drugs. It was designed at the request of the WHO/ADAMHA Task Force on Psychiatric Assessment instruments to expand the substance abuse sections of the CIDI. Using a test-retest des...
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To assess the usefulness of interviewing older adults with cognitive impairment, we analyzed data from the NIMH Epidemiologic Catchment Area Study. People aged 65 and older with cognitive impairment were twice as likely as age-matched unimpaired elders to report sufficient symptoms of psychiatric disorders to qualify for a current diagnosis (16% vs...
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Synopsis There has been concern about whether standardized psychiatric interviews make valid diagnoses. Agreements between the Diagnostic Interview Schedule (DIS), as an example of a standardized interview, with independent assessments by a clinician are reasonably high in most studies, but the clinical assessment is itself of uncertain validity. U...
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Full-text available
The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination items. It is...
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Full-text available
One-month prevalence results were determined from 18,571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemiologic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled c...
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In this study, 2787 adolescents between the ages of 13 and 18 years living in inner-city communities were interviewed about their mental and physical health and their clinic use. The patients used consolidated mental and physical health clinics located in neighborhoods, hospitals, or schools; of traditional neighborhood or hospital health clinics....
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Awareness of child abuse has been growing over the past several decades as more cases have come to the attention of medical personnel and school and police authorities. Information-gathering systems have become more effective, and the long-term deleterious effects of abusive treatment have been brought into focus (American Humane Association 1981;...
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The DIS has been a response to the new opportunities for highly-reliable, large-scale psychiatric diagnostic surveys that arose with the development of well-define diagnostic criteria and fully described algorithms for combining them. Because it has made use of the power of computers to store and combine many bits of data for a given individual, it...
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To increase the feasibility of identifying persons with depressive disorders in a large-scale health policy study, we tested the concordance between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule (DIS). This section was administered over the telephone to 230 English-speaking part...
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There have been numerous studies of post-traumatic stress disorder in trauma victims, war veterans, and residents of communities exposed to disaster. Epidemiologic studies of this syndrome in the general population are rare but add an important perspective to our understanding of it. We report findings on the epidemiology of post-traumatic stress d...
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Full-text available
The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination Items. It is...
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PIP This paper examines the association between adolescentpregnancy and socioenvironmental, physical, and mental health problems in 1590 inner-city US females aged 13-18 who use health clinics. Adolescents who have become pregnant, those who are sexually active but never have been pregnant, and those who are sexually inactive are compared. The sexu...
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In this case-control study, respondents from the general population with a lifetime diagnosis of major depressive disorder, alcohol abuse and/or dependence, or the absence of any psychiatric disorder ascertained by the St. Louis Epidemiological Catchment Area Study were reinterviewed about their early home environments during the period when they w...
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Data on respondents from household and institutional samples from the St. Louis Epidemiologic Catchment Area Study who reported a depressive spell within the last year were analyzed to determine the type of recent depressive symptoms, sociodemographic and personal characteristics related to recent discussion with a doctor about depressive illness....
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Generous contact efforts were used to recruit 3,004 respondents into the first wave of the St. Louis Epidemiologic Catchment Area (ECA) project, a psychiatric epidemiologic study of the general population, conducted from 1981-1982. These efforts were analyzed to establish which sociodemographic characteristics or current psychiatric disorders were...
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This paper examines data from a psychiatric epidemiologic survey of 3004 households in St Louis to determine whether there are distinctions between black and white Americans in their propensities to seek treatment for episodes of depression and to discover those groups least likely to seek care. The process initiated by the experiencing of unusual...
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The literature on the occurrence of moderate drinking in ex-alcoholics that has been published since the Rand report in 1976 is reviewed. Although differences in diagnosis, definitions of moderate drinking and length of follow-up make strict comparisons of the studies difficult, the majority of studies seem to indicate that the earlier reports of t...
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Mortality was studied in 1289 Black and White alcoholics. The overall proportion of mortality over 5-9 years was 22.0%. No overall differences were found between Black and White mortality rates by crude death proportions or standardized mortality ratios. Blacks were significantly younger at death than were Whites and were also significantly younger...
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Laboratory tests that validate psychiatric disorder are unavailable. Accordingly, the validity of structured diagnostic interviews such as the Diagnostic Interview Schedule have been assessed through a double-blind test-retest design. This approach compares the Diagnostic Interview Schedule to a clinician's assessment and evaluates its results by t...
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We examined the level of agreement between diagnoses derived from data gathered by lay interviewers using the Diagnostic Interview Schedule (DIS) in a general population survey (the Epidemiologic Catchment Area project) and both DIS and clinical diagnoses made by psychiatrists. Overall percent agreement between the lay DIS and the psychiatrists cli...
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To assess the frequency of an evolution to stable moderate drinking among alcoholics coming to medical or psychiatric treatment facilities, we examined the five- to seven-year outcome for 1289 diagnosed alcoholics treated in our facilities during a two-year period (between 1973 and 1975). We obtained data from personal interviews, records, or both...
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Case control studies are a reasonably rapid and inexpensive method of developing causal hypotheses concerning the role of early environment on the development of psychiatric pathology. The current study tested an interview designed to assess early home environment on a group of patients with alcoholism or depression, on a control group free of psyc...
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Full-text available
Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominate...
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The National Institute of Mental Health multisite Epidemiologic Catchment Area (ECA) program is described in the context of four previous psychiatric epidemiologic surveys that included a combined total of 4,000 subjects from Stirling County, the Baltimore Morbidity Study, Midtown Manhattan, and the New Haven third-wave survey. The ECA program is d...
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Comments on the article by Pulver and Carpenter (see record 1984-08451-001). The article attempts to demonstrate two major points: (1) that the Diagnostic Interview Schedule (DIS) fails to elicit psychotic symptoms now in remission but ascertained earlier, and (2) that this failure will lead to a serious underestimation of the prevalence of psychot...
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Full-text available
In a sample of 1,289 alcoholics from four clinical sites, the overall mortality rate after five to eight years of observation was 22.0 per cent, 3.1 times the expected rate. Patients from the medical and surgical services of a general hospital suffered 4.0 times the rate of expected mortality and died most often of medical causes associated with al...
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To the Editor.— In response (Archives 1982;39:1443-1445) to a letter by Ganguli and Saul (Archives 1982;39:1442-1443), Robins and Helzer noted that the Mini-Mental State Examination,1 incorporated into the Diagnostic Interview Schedule (DIS) to assess cognitive impairment, had been reported by Folstein et al to differentiate between pseudodementia...
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Synopsis A new diagnostic instrument, The Diagnostic Interview Schedule, was evaluated for use by lay interviewers by comparing its DSM-III diagnoses when given by lay interviewers with results obtained through an independent interview by a psychiatrist using the same schedule, his clinical judgement after the interview, his clinical judgement afte...
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In Reply. — It was good to read that Drs Ganguli and Saul have been using the DIS for new purposes—to study the recognition and management of depressive disorders in the medical care sector. Of course, we are also pleased that they consider it the best completely structured interview available.They cited the previous letter from Dr Endicott that q...
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Similarities and differences in three sets of research criteria - DSM-III, the RDC, and Feighner et al. - are discussed for eight psychiatric diagnoses: major depressive episode, manic episode, schizophrenic disorder, alcohol abuse or dependence, somatization disorder, panic disorder, antisocial person