Research in Psychiatry: Issues, Strategies, and Methods PDF
Preview Research in Psychiatry: Issues, Strategies, and Methods
RESEARCH IN PSYCHIATRY ISSUES, STRATEGIES, AND METHODS CRITICAL ISSUES IN PSYCHIATRY An Educational Series for Residents and Clinicians Series Editor: Sherwyn M. Woods, M.D., Ph.D. University of Southern California School of Medicine Los Angeles, California Recent volumes in the series: CASE STUDIES IN INSOMNIA Edited by Peter J. Hauri, Ph.D. CLINICAL DISORDERS OF MEMORY Aman U. Khan, M.D. CONTEMPORARY PERSPECTIVES ON PSYCHOTHERAPY WITH LESBIANS AND GAY MEN Edited by Terry S. Stein, M.D., and Carol J. Cohen, M.D. DECIPHERING MOTIVATION IN PSYCHOTHERAPY David M. Allen, M.D. DIAGNOSTIC AND LABORATORY TESTING IN PSYCHIATRY Edited by Mark S. Gold, M.D., and A. L. C. Pottash, M.D. DRUG AND ALCOHOL ABUSE: A Clinical Guide to Diagnosis and Treatment, Third Edition Marc A. Schuckit, M. D. EMERGENCY PSYCHIATRY: Concepts, Methods, and Practices Edited by Ellen L. Bassuk, M.D., and Ann W Birk, Ph.D. ETHNIC PSYCHIATRY Edited by Charles B. Wilkinson, M.D. EVALUATION OF THE PSYCHIATRIC PATIENT: A Primer Seymour L. Halleck, M.D. NEUROPSYCHIATRIC FEATURES OF MEDICAL DISORDERS James W Jefferson, M.D., and John R. Marshall, M.D. THE RACE AGAINST TIME: Psychotherapy and Psychoanalysis in the Second Half of Life Edited by Robert A. Nemiroff, M.D., and Calvin A. Colarusso, M.D. RESEARCH IN PSYCHIATRY: Issues, Strategies, and Methods Edited by L. K. George Hsu, M.D., and Michel Hersen, Ph.D. STATES OF MIND: Configurational Analysis of Individual Psychology, Second Edition Mardi J. Horowitz, M. D. A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. RESEARCH IN PSYCHIATRY ISSUES, STRATEGIES, AND METHODS EDITED BY L. K. Hsu, GEORGE M.D. Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania AND MICHEL HERSEN, PH.D. Center for Psychological Studies Nova University Fort Lauderdale, Florida SPRINGER SCIENCE+BUSINESS MEDIA, LLC Library of Congress Cataloglng-ln-PublIcatlon Data Research 1n psychiatry : Issues, strategies, and methods / edited by L.K. George Hsu, and Michel Hersen. p. cm. — (Critical Issues In psychiatry) Includes bibliographical references and Index. 1. Psychiatry—Research. 2. Psychiatry—Research—Methodology. I. Hsu, L. K. George (Lee Keung George) II. Hersen, Michel. III. Series. [DNLM: 1. Psychiatry. 2. Research—methods. WM 20 R4321] RC337.R474 1992 616.89'0072—dc20 DNLM/DLC for Library of Congress 92-14368 CIP ISBN 978-1-4899-0690-8 ISBN 978-1-4899-0688-5 (eBook) DOI 10.1007/978-1-4899-0688-5 © Springer Science+Business Media New York 1992 Originally published by Plenum Publishing Corporation New Yor k in 1992 Softcover reprint of the hardcover 1st edition 1992 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors JACQUES P. BARBER, Center for Psychotherapy Research, Department of Psychi atry, University of Pennsylvania, 3600 Market Street, Philadelphia, Penn sylvania 19104-2648. CAROLYN BRODBECK, Division of Psychology, Hahnemann University, Phila delphia, Pennsylvania 19102. KENT E BuRNEIT, Counseling Psychology Program and Department of Psychol ogy, University of Miami, Coral Gables, Florida 33124-2040. DENNIS P. CANfWELL, Department of Psychiatry, University of California at Los Angeles, Los Angeles, California 90024. DuNCAN B. CLARK, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsyl vania 15213. NANCY 1. DAY, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213. AL K. DERoY, Office of Research, University of Pittsburgh, Pittsburgh, Penn sylvania 15260. JOHN W. DOUARD, Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, Texas 77550. CARL EISDORFER, Department of Psychiatry and Center for Adult Development and Aging, University of Miami School of Medicine, Miami, Florida 33136. JEROME A. FLEMING, Harvard Medical School Department of Psychiatry, Psychi atry Service, BrocktonlWest Roxbury Veterans Administration Medical Center, Harvard School of Public Health, Program in Psychiatric Epidemi ology, Brockton, Massachusetts 02401. SHIRLEY M. GLYNN, Veterans Administration Medical Center of West Los Angeles, Los Angeles, California 90073. v vi CONTRIBUTORS GERALD GOLDSTEIN, Highland Drive, Veterans Administration Hospital, Pitts burgh, Pennsylvania 15206. DONALD W. GOODWIN, Department of Psychiatry, University of Kansas Medical Center, Kansas City, Kansas 66160. SILVIA S. GRATZ, Department of Psychiatry, Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Philadelphia, Pennsylvania 19129. JOEL B. GREENHOUSE, Department of Statistics, Carnegie-Mellon University, Pittsburgh, Pennsylvania 15213. MICHEL HERSEN, Center for Psychological Studies, Nova University, Fort Lauderdale, Florida 33314. CHUNG-CHENG HSIEH, Harvard Medical School Department of Psychiatry, Psychiatry Service, BrocktonlWest Roxbury Veterans Administration Medi cal Center, Harvard School of Public Health, Program in Psychiatric Epide miology, Brockton, Massachusetts 02401. GAIL H. IRONSON, Departments of Psychology and Psychiatry, University of Miami, Coral Gables, Florida 33124-2040. ROLF G. JACOB, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsyl vania 15213. BRIAN W. JUNKER, Department of Statistics, Carnegie-Mellon University, Pitts burgh, Pennsylvania 15213. DAVID J. KUPFER, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213. DAVID A. loEWENSTEIN, Department of Psychiatry and Center for Adult Devel opment and Aging, University of Miami School of Medicine, Miami, Florida 33136. LESTER B. luBORSKY, Center for Psychotherapy Research, Department of Psy chiatry, University of Pennsylvania, 3600 Market Street, Philadelphia, Pennsylvania 19104-2648. WENDY REICH, Department of Psychiatry, Division of Child Psychiatry, Wash ington University School of Medicine, St. Louis, Missouri 63110. STEPHEN D. SAMUELSON, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-7729. GEORGE M. SIMPSON, Department of Psychiatry, Medical College of Pennsyl vania, Eastern Pennsylvania Psychiatric Institute, Philadelphia, Pennsyl vania 19129. CONTRIBUTORS vii MARK D. SULLIVAN, Department of Psychiatry, University of Washington, Seattle, Washington 98195. C. BARR TAYLOR, Laboratory for the Study of Behavioral Medicine, Department of Psychiatry, Stanford University School of Medicine, Stanford, California 94305. JAMES W THOMPSON, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201. MING T. TSUANG, Harvard Medical School Department of Psychiatry, Psychia try Service, BrocktonlWest Roxbury Veterans Administration Medical Cen ter, Harvard School of Public Health, Program in Psychiatric Epidemiology, Brockton, Massachusetts 02401. GARY J. TUCKER, Department of Psychiatry, University of Washington, Seattle, Washington 98195. A. HUSSAIN TUMA, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213. GEORGE WINOKUR, Department of Psychiatry, College of Medicine, University of Iowa, Iowa City, Iowa 52242. WILLIAM J. WINSLADE, Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, Texas 77550. Preface This multiauthored textbook is directed to the psychiatric resident and other professionals who are interested in the issues, strategies, and methods of psychiatric research. Although the field of psychiatry has not attained the scientific rigor and clinical sophistication of some of its sister disciplines in the medical arena, considerable progress has been made in the last decade or two, and a full understanding of the types of articles that now appear in such publications as the American Journal of Psychiatry, the Archives of General Psychi atry, and the Journal of the American Academy of Child and Adolescent Psychiatry requires a fair amount of knowledge about research design and strategy. Whereas articles in psychiatric journals 20 years ago dealt mainly with psycho dynamic topics and utilized nonexperimental observations, today their counter parts are concerned mostly with psychobiology, clinical features, diagnosis, and treatment, and employ scientific experimental designs. The trend of applying scientific methodology to research in psychiatry is increasing and undoubtedly will continue to do so in the future. Regrettably, however, only about 1 of every 10 psychiatric residents turns to clinical research as a career. Fewer than half of all the articles that are published in psychiatric journals are first-authored by psychiatrists, and in psychological journals, psychiatrists are first authors of fewer than 5% of the articles. Further more, the number of psychiatrists who received Alcohol, Drug Abuse, and Mental Health Administration funding for traditional research project (R01) grants in fiscal year 1990 was less than half the number of psychologists. It is therefore apparent that the majority of psychiatrists are not clinical researchers, even though all of them are affected by the current emphasis on scientific research in psychiatry and are consumers of the resulting data. Our contention is that whether research is eventually pursued as a career or not, residents should be exposed to its subtleties and nuances, at least so that they will be able to appraise the validity of what is being presented to them in the archival literature. We believe that this volume will enable residents to appreciate research better and perhaps even encourage some of them to participate as active investigators. ix x PREFACE The book is divided into six parts that contain a total of 19 chapters. Part I, General Issues, includes two chapters that deal with research in psychiatry as a career and with ethical issues in psychiatric research. Part II, Research Design Strategies, consists of four chapters that deal with the single-case, group com parison, and correlational approaches, and with statistical principles. Part III, Assessment Issues, contains three chapters that consider structured and semi structured inventories, physiological and behavioral assessment, and biological markers. Part Iv, Research Topics, includes six chapters on some of the major areas that are researched by psychiatrists and their mental health colleagues. Part V, Special Populations, includes three chapters that cover research in child and adolescent psychiatry, geriatric research, and the chronically mentally ill. Finally, in Part VI, Epilogue, the future of psychiatric research is discussed. Many people have contributed their efforts to the publication of this book. First and foremost are our gracious authors, who agreed to share their experi ences and expertise with us. Second, we thank Mary Anne Frederick, Beth Fryman, and Mary Newell for their fine technical assistance. Finally, we thank Eliot Werner, Executive Editor at Plenum Press, who agreed with us as to the timeliness of this project. 1. K. GEORGE Hsu Pittsburgh, Pennsylvania MICHEL HERSEN Fort Lauderdale, Florida
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