Psychiatry - Primary Care Faculty
Over 100 selected publications of the 20 NRSA fellows who have graduated from the program are listed below. As seen in these publications, most have been studies in the interface of psychiatry and primary care and are published in excellent medical and psychiatric journals. Ten of the former fellows have already attained federal, state or foundation research grants to continue to pursue research in the interface of medicine and psychiatry. Dr. Katon's 21-year-old NRSA fellowship program has accomplished its goal of enhancing mental health services training for physicians, as evidenced by the appointment of our fellows to 8 different major university medical schools in the United States.
Former Fellows' Selected Publicaitons:
Kym Ahrens, MD, MPH
Ahrens KR, DuBois DL, Richardson LP, Fan MY, Lozano P. Youth in foster care with adult mentors during adolescence have improved adult outcomes. Pediatrics. 2008 Feb;121(2):e246-52.
Ahrens KR, Richardson LP, Courtney ME, McCarty C, Simoni J, Katon W. Laboratory-diagnosed sexually transmitted infections in former foster youth compared with peers. Pediatrics. 2010 Jul;126(1):e97-e103.
Susan Bentley, DO
Haidet P, Kelly PA, Bentley S, et al. for the Culture Study Group. Not the same everywhere. Patient-centered learning environments at nine medical schools. J Gen Intern Med 2006;21:405-9.
Bentley SM, Melville JL, Berry BD, Katon WJ. Implementing a clinical and research registry in obstetrics: overcoming the barriers. Gen Hosp Psychiatry 2007;29:192-8.
Jennifer Brennan Braden, MD, MPH
Sullivan MD, Edlund MJ, Fan MY, DeVries A, Braden JB, Martin BC. Trends in use of opioids for non-cancer pain conditions in commercial and Medicaid insurance plans, 2000-2005: the TROUP Study. Pain 2008;138:440–449. PMCID2668925
Braden JB, Fan MY, Edlund MJ, Martin BC, DeVries A, Sullivan MD. Trends in use of opioids by non-cancer pain type 2000-2005 among Arkansas Medicaid and HealthCore enrollees: results from the TROUP Study. J Pain 2008;9:1026-1035. PMCID2661263
Thielke S, Edlund MJ, Fan MY, DeVries A, Braden JB, Martin BC, Sullivan MD. Age and sex trends in long-term opioid use in two large American health systems between 2000 and 2005: the TROUP Study. Pain Med 2010;11:248-56.
Edlund MJ, Fan MY, DeVries A, Braden JB, Martin BC, Sullivan MD. Trends in use of opioids for chronic non-cancer pain among individuals with mental health and substance use disorders: the TROUP Study. Clin J Pain 2010;26:1-8.
Braden JB, Russo JE, Fan MY, Edlund MJ, Martin BC, DeVries A, Sullivan MD. Emergency Department visits among recipients of chronic opioid therapy. Arch Intern Med. (In Press)
Lydia Chwastiak, MD, MPH
Chwastiak L, Ehde D, Gibbons L, et al: Depressive symptoms and severity of illness in multiple sclerosis. Am J Psychiatry 2002;195:1862-8.
Chwastiak LA, Von Korff M. Disability in depression and back pain: evaluation of the World Health Organization Disability Assessment Schedule (WHO DAS II) in a primary care setting. J Clin Epidemiol 2003;56:507-14.
Ehde DM, Gibbons LE, Chwastiak L, Bombardier CH, Sullivan MD, Kraft GH. Chronic pain in a large community sample of persons with multiple sclerosis. Mult Scler 2003;9(6):605-11.
Chwastiak LA, Gibbons LE, Ehde DM, Sullivan M, Bowen JD, Bombardier CH, Kraft GH.. Fatigue and psychiatric illness in a large community sample of persons with multiple sclerosis. J Psychosom Res 2005;59:291-8.
Chwastiak LA, Ehde DM. Psychiatric issues in multiple sclerosis. Psychiatr Clin North Am 2007;30:803-17.
Chwastiak LA, Rosenheck RA, Kazis LE. Utilization of primary care by veterans with psychiatric illness in the National Department of Veterans Affairs Health Care System. J Gen Intern Med 2008 Sep 16. [Epub ahead of print]
Paul Ciechanowski, MD, MPH
Ciechanowski PS, Katon WJ, Russo JE, Hirsch IB. The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. Gen Hosp Psychiatry 2003;25:246-52.
Ciechanowski P, Sullivan M, Jensen M, Romano J, Summers H. The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain 2003;104:627-37.
Ciechanowski PS, Katon WJ, Russo JE. The association of depression and perceptions of interpersonal relationships in patients with diabetes. J Psychosom Res. 2005;58:139-44.
Ciechanowski P, Russo J, Katon W, Von Korff M, Ludman E, Lin E, Simon G, Bush T. Influence of patient attachment style on self-care and outcomes in diabetes. Psychosom Med 2004;66:720-8.
Ciechanowski PS, Walker EA, Russo JE, Newman E, Katon WJ. Adult health status of women HMO members with posttraumatic stress disorder symptoms. Gen Hosp Psychiatry 2004;26(4):261-8.
Ciechanowski P, Wagner E, Schmaling K, et al. Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA 2004;291:1569-77.
Ciechanowski PS, Russo JE, Katon WJ, Walker EA. Attachment theory in health care: the influence of relationship style on medical students' specialty choice. Med Educ 2004;38:262-70.
Ciechanowski P, Katon W, Russo J. The association of depression and perceptions of interpersonal relationships in patients with diabetes. J Psychosomatic Med 2005;58:139-44.
Ciechanowski PS, Russo JE, Katon W, et al. Association of patient relationship style and outcomes in collaborative care treatment for depression in patients with diabetes. Med Care 2006;44:283-91.
Ciechanowski P, Katon W, Russo J, et al. Where is the patient? The association of psychosocial factors with missed primary care appointments in patients with diabetes. Gen Hosp Psychiatry 2006;28:9-17.
Ciechanowski P, Katon WJ. The interpersonal experience of health care through the eyes of patients with diabetes. Soc Sci Med 2006;63:3067-79.
Young BA, Lin E, Von Korff M, Simon G, Ciechanowski P, et al. Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization. Am J Manag Care 2008; 1:15-23.
Michael Clark, MD, MPH
Clark MR: Chronic Dizziness: an integrated approach. Hosp Pract 1994;29:57-64.
Clark M R. Katon W. Russo J: Chronic fatigue: risk factors for symptom persistence in a 2 1/2 year follow up study. Am J Med 1995;98:187-95.
Koenig T, Clark M: Advances in comprehensive pain management. Psychiatr Clin North Am 1996;19:589 611.
Swartz KL, Clark MR. Psychiatry and general medicine. Curr Opin Psychiatr 1996;9:162-6.
Lin G, Clark MR, Eaton WW. Structural factor analyses for medically unexplained somatic symptoms of somatization disorder in the Epidemiolgic Catchment Area Study. Psychol Med 1997;27:617-26.
Russo J, Katon WJ, Buchwald D, Clark M. Longitudinal changes associated with improvement in chronic fatigue patients. J Psychosom Res 1998;45 (1 Spec No):67-76.
Clark MR, Heinberg, LJ, Haythornthwaite JA, Quatrano-Piacentrini AL, Pappagallo M, Raja SN. Psychiatric symptoms and distress differ between patients with postherpetic neuralgia and peripheral vestibular disease. J Psychosom Res 2000;48:51-7.
Clark MR, Swartz KL. A conceptual structure and methodoloy for the systematic approach to the evaluation and treatment of patients with chronic dizziness. J Anxiety Disord 2001;15:95-106.
Clark MR. Psychogenic disorders: a pragmatic approach for formulation and treatment. Semin Neurol 2006;26:357-65.
Wu CL, Agarwal S, Tella PK, Klick B, Clark MR, et al. Morphine versus mexiletine for treatment of postamputation pain: a randomized, placebo-controlled, crossover trial. Anesthesiology 2008;109:289-96.
Megan Dwight-Johnson, MD, MPH
Dwight MM, Kowdley KV, Russo JE, Ciechanowski PS, Larson AM, Katon WJ. Depression, fatigue and functional disability in patients with hepatitis C. J Psychosom Res 2000;49:311-7.
Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB. Treatment preferences among depressed primary care patients. J Gen Intern Med 2000;15:527-34.
Sherbourne CD, Dwight-Johnson M, Klap R. Psychological distress, unmet need, and barriers to mental health care for women. Women's Health Issues 2001;11:231-43.
Dwight-Johnson M, Unützer J, Sherbourne CD, Tang L, Wells KB. Can QI programs for depression in primary care address patient preferences for treatment? Med Care 2001;39:934-44.
Dwight-Johnson M, Lagomasino IT, Aisenberg E, Hay J. Using conjoint analysis to assess depression treatment preferences among low-income Latinos. Psychiatr Serv. 2004;55:934-6.
Dwight-Johnson M. The partners in care approach to ethics outcomes in quality improvement programs for depression. Psychiatr Serv. 2004;55:532-9.
Dwight-Johnson M, Ell K, Lee PJ. Can collaborative care address the needs of low-income Latinas with comorbid depression and cancer? Results from a randomized pilot study. Psychosomatics 2005;46:224-32.
Dwight-Johnson M, Lagomasino IT. Addressing depression treatment preferences of ethnic minority patients. Gen Hosp Psychiatry 2007;29:179-81.
Andrew Elliott, MD, MPH
Eilliott A, Roy-Bynre P. Major depressive disorder and HIV-1 infection: A review of treatment trials. Sem Clin Neuropsychiatry 1998;3:137-50.
Elliott AJ, Russo J, Bergam K, Clypoole K, Uldall KK, Roy-Byrne PP. Antidepressant efficacy in HIV-seropositive outpatients with major depression an open trial of nefazodone. J Clin Psychiatry 1999;60:226-31.
Elliott A, Russo J, Roy-Byrne P. The effect of changes in depression on health-related quality of life (HRQOL) in HIV infection. Gen Hosp Psychiatry 2002;24:43-7.
Charles Engel, MD, MPH
Engel CC Jr, Walker EA, Katon WJ: Factors related to dissociation among patients with gastrointestinal complaints. J Psychosom Res 1996;40:643-53.
Engel CC Jr, Katon WJ: Somatization in Primary Care, in Primary Care & General Medicine, Noble J, Greene H, Levinson W, Modest G, Young M, eds. St. Louis, Mosby; 1996.
Engel CC Jr, Walker EA, Engel AL, Bullis J, Armstrong A. A randomized, double blind crossover trial of sertraline in women with chronic pelvic pain. J Psychosom Res 1998;67:203-7.
Engel CC Jr, Roy M, Kayanan D, Ursano RJ. Multidisciplinary treatment of persistent symptoms after Gulf War service. Military Med 1998;163:202-8.
Engel CC Jr., Liu X, Miller RF, McCarthy BD, Ursano RJ. Relationship of physical symptoms to post-traumatic stress disorder among veterans seeking care for Gulf War-related health concerns. Psychosomatic Med 2000;62:739-45.
Engel CC Jr, Lui X, Hoge C, Smith S. Multiple idiopathic physical symptoms in the ECA study: competing-risks analysis of 1-year incidence, mortality, and resolution. Epidemiogical Catchment Area. Am J Psychiatry 2002;159:998-1004.
Donta ST, Clauw DJ, Engel CC Jr, et al. Cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: a randomized controlled trial. JAMA 2003;289:1396-404.
Engel CC. Improving Primary Care for Military Personnel and Veterans with Posttraumatic Stress Disorder - The Road Ahead. Gen Hosp Psychiatry 2005;27:158-60.
Donta ST, Engel CC, Collins JF et al and the VA Cooperative #475 Study Group. Benefits and harms of doxycycline treatment for Gulf War veterans' illnesses: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2004;141.:85-94.
Engel CC, Locke S, Reissman DB, DeMartino R, Kutz I, McDonald M, Barsky AJ. Terrorism, trauma, and mass casualty triage: how might we solve the latest mind-body problem? Biosecur Bioterror 2007;5:155-63.
Gore KL, Engel CC, Freed MC, Liu X, Armstrong DW 3rd. Test of a single-item posttraumatic stress disorder screener in a military primary care setting. Gen Hosp Psychiatry 2008;30:391-7.
Jesse Fann, MD, MPH
Fann Jr, Roth-Roemer S, Burington BE, Katon WJ, Syrjala KL. Delirium in patients undergoing hematopoietic stem cell transplantation. Cancer 2002;95:1971-81.
Fann JR, Leonetti A, Jaffe K, et al. Psychiatric illness and subsequent traumatic brain injury: a case control study. J Neurol Neurosurg Psychiatry 2002;72:615-20.
Fann JR. Neurological effects of psychopharmacological agents. Semin Clin Neuropsychiatry 2002;7:196-205.
Fann JR, Roth-Roemer S, Burington B, Katon W, Syrjala K. Delirium in patients undergoing hematopoietic stem cell transplantation: incidence and pre-transplant risk factors. Cancer 2002;95:1971-81.
Fann JR, Sullivan AK. Delirium in the course of cancer treatment. Sem Clin Neuropsychiatry 2003;8:217-28.
Fann JR, Burington B, Leonetti A, Jaffe K, Katon WJ, Thompson RS. Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Arch Gen Psychiatry 2004;61:53-61.
Fann JR, Alfano CM, Burington BE, Roth-Roemer S, Katon WJ, Syrjala KL. Clinical presentation of delirium in patients undergoing hematopoietic stem cell transplantation: delirium and distress symptoms and time course. Cancer 2005;103:810-20.
Fann JR, Bombardier C, Dikmen S, et al. Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehab 2005;20:501-11.
Fann JR, Alfano CM, Roth-Roemer S, Katon WJ, Syrjala KL. Impact of delirium on cognition, distress, and health-related quality of life after hematopoietic stem-cell transplantation. J Clin Oncol 2007;25:1223-31.
Fann JR, Berry DL, Wolpin S, Austin-Seymour M, et al. Depression screening using the Patient Health Questionnaire-9 administered on a touch screen computer. Psychooncology 2008 May 6. [Epub ahead of print]
Robert Ferrer, MD, MPH
Ferrar R: Screening for prostate cancer: the role of prostate specific antigen. Maryland Med J 1996;45:938-40.
Ferrer RL. Problem-oriented diagnosis series: Lymphadenopathy. Am Fam Physician 1998;58:1313-20.
Ferrer RL. Graphic methods for detecting bias in meta-analysis: Fam Med 1998;30:579-83.
Ferrer RL, Sibai BM, Mulrow CD, Chiquette E, Stevens KR, Cornell J: Management of mild chronic hypertension during pregnancy: a systematic review of the evidence. Obstet Gynecol 2000;96:849-60.
Ferrer RL, Palmer R, Burge S. The family contribution to health status: a population-level estimate. Ann Fam Med 2005;3:102-8.
Katerndahl D, Ferrer R, Best R, Wang CP. Dynamic patterns in mood among newly diagnosed patients with major depressive episode or panic disorder and normal controls. Prim Care Companion J Clin Psychiatry 2007;9:183-7.
Gwen Glew, MD, MPH
Glew G, Rivera F, Feudtner C: Bullying: children hurting children. Pediatr Rev 2000;21:183-9.
Zimmerman FJ, Glew GM, Christakis DA, Katon W. Early cognitive stimulation, emotional support, and television watching as predictors of subsequent bullying among grade-school children. Arch Pediatr Adolesc Med. 2005;159:384-8.
Glew GM, Fan MY, Katon W, Rivara FP, Kernic MA. Bullying, psychosocial adjustment, and academic performance in elementary school. Arch Pediatr Adolesc Med 2005;159:1026-31.
Glew GM, Fan MY, Katon W, Rivara FP. Bullying and school safety. J Pediatr 2008;152:123-8.
Rosemary Kelly, MD, MPH
Hilty, D.M., Kelly, R.H., Hales, R.E. Diagnosis and treatment of bipolar disorder in pregnant women. Prim Care Update OB/GYN 2000;7:105-12.
Kelly R, Zatzick D, Anders T. The detection and treatment of psychiatric disorders and substance use among women cared for in obstetrics. Am J Psychiatry 2001;158:213-9.
Kelly R, Russo J, Katon W: Somatic complaints among pregnant women cared for in obstetrics: normal pregnancy or depressive and anxiety symptom amplifications revisited? Gen Hosp Psychiatry 2001;23:107-13.
Zatzick D, Kang S, Hinton W, Kelly R, Hilty D, Franz C, Le L: Post-traumatic concerns of a patient-centered approach to outcome assessment. Med Care 2001;39:327-39.
Kelly R, Russo J, Holt V, Danielsen B, Zatzick D, Walker E, Katon W. Psychiatric and substance abuse disorders as risk factors for low birth weight and perterm delivery. Ostet Gynecol 2002;100:297-304.
Lawrence Li, MD, MPH
Walker E, Roy Byrne P, Katon W, et al: Psychiatric illness and irritable bowel syndrome: A comparison with inflammatory bowel disease. Am J Psychiatry 1990;147:1656-61.
Li L, Williams S, Scammon D: Practicing with the urban underserved. A qualitative analysis motivations, incentives, and disincentives. Arch Fam Med 1995;4:124-33.
Scammon D, Li L, Williams S: Increasing the supply of providers for the medically underserved: marketing and public policy issues. J Pub Policy Marketing 1995;14:35.
Li LB: Becoming an integrated physician: first step is acupuncture training. West J Med 1999;171:210-11.
Shereen Morse, MD, MPH
Morse SA, Ciechanowski PS, Katon WJ, Hirsch IB. Isn't this just bedtime snacking? The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes. Diabetes Care 2006;29:1800-4.
Carol Rockhill, MD, PhD, MPH
Rockhill C, Fan MY, Katon W, McCauley E, Crick N, Pleck J. Friendship interactions in children with and without depressive symptoms: observation of emotion during game-playing interactions and post-game evaluations. J Abnorm Child Psychol 2007;35:429-41..
Rockhill C, Russo J, McCauley E, Katon W, Richardson L, Lozano P: Agreement between parents and children regarding anxiety and depression diagnoses in children with asthma. J Nervous Ment Dis 2007;195:897-904.
Rockhill CM, Vander Stoep A, McCauley E, Katon WJ. Social competence and social support as mediators between comorbid depressive and conduct problems and functional outcomes in middle school children. J Adolesc 2008 Aug 10. [Epub ahead of print]
Alex Thompson, MD, MBA, MPH
Thompson A, Fan MY, Unützer J, Katon W. One extra month of depression: the effects of caregiving on depression outcomes in the IMPACT trial. Int J Geriatr Psychiatry 2008;23:511-6.
Karina Uldall, MD, MPH
Uldall KK, Berghuis JP: Delirium in AIDS patients: recognition and medication factors. AIDS Patient Care and STD’s. AIDS Patient Care 1997;11:435-41.
Uldall KK, Koutsky LA, Bradshaw DH, Krone M: Use of hospital services by AIDS patients with psychiatric illness. Gen Hosp Psychiatry 1998;20:292-301.
Berghuis JP, Uldall KK, Lalonde B: Validity of two scales in identifying HIV-associated dementia. J Acquir Immune Defic Syndr 1999;21:134-40.
Uldall KK, Harris VL, Lalonde B. Outcomes associated with delirium in acutely hospitalized acquired immunology patients. Compr Psychiatry 2000;41:88-91.
Lalonde B, Uldall KK, Huba GJ, Panter AT, Zalumas J, et al. Impact of HIV/AIDS education on health care provider practice: results from nine grantees of the Special Projects of National Significance Program. Eval Health Prof 2002;25:302-20.
Uldall KK, Palmer NB, Whetten K, Mellins C; HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Group. Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: a review of the literature. AIDS Care 2004;16:S71-96.
Tegger MK, Crane HM, Tapia KA, Uldall KK, et al. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDS 2008;22:233-43.
Jürgen Unützer, MD, MA, MPH
Unützer J, Simon G, Belin T, Datt M, Katon WJ, Patrick D. Care for depression in HMO patients age 65 and older. J Am Geriatr Society 2000;48:871-8.
Unützer J, Sturm R, Young A, Klap R, Marmon T, Shatkin J, Wells KB. Mental disorders and the use of complementary and alternative medicine: results from a national study. Am J Psychiatry 2000;157:1851-7.
Unützer J, The Impact Study Investigators. Improving primary care for depression in late life: the design of a multi-center trial. Med Care 2001;39:789-99.
Unützer J, Patrick DL, Marmon T, Simon GE, Katon WJ: Depressive symptoms and mortality in a prospective study of 2,558 older adults. Am J Geriatr Psychiatry 2002;10:521-30.
Unützer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002;288:2836-45.
Unutzer J, Katon WJ, Russo J, Simon G, Von Korff M, Lin E, Walker E, Ludman E, Bush T. Psychopharmacology plus psychotherapy for depression treatment. Psychiatr Serv 2003;54:1042-3.
Hegel MT, Unützer J, Arean PA, Tang L, Katon W, Hitchcock Noel P, Williams JW Jr, Lin EHB. Impact of co-morbid panic and posttraumatic stress disorders on outcomes of collaborative care for late-life depression in primary care. Am J Geriatr Psychiatry 2005;13:48-58.
Katon W, Unutzer J. Collaborative care models for depression: time to move from evidence to practice. Arch Intern Med 2006;166:2304-6.
Unutzer J, Tang L, Oishi S, Katon W, et al. for the IMPACT Investigators. Reducing suicidal ideation in depressed older primary care patients. J Am Geriatr Soc 2006;54:1550-6.
Frederick JT, Steinman LE et al (include Unutzer J) for the Late Life Depression Special Interest Project Panelists. Community-based treatment of late life depression an expert panel-informed literature review. Am J Prev Med 2007;33:222-49.
Katon W, Fan MY, Unützer J, Taylor J, Pincus H, Schoenbaum M. Depression and diabetes: a potentially lethal combination. J Gen Intern Med 2008;23:1571-5.
Unützer J, Hantke M, Powers D, Higa L, Lin E, D Vannoy S, Thielke S, Fan MY. Care management for depression and osteoarthritis pain in older primary care patients: a pilot study. Int J Geriatr Psychiatry 2008 May 20. [Epub ahead of print]
Karl Weyrauch, MD, MPH
Weyrauch K F. Boiko P E. Alvin B: Patient sex role and preference for a male or female physician. J Fam Pract 1990;30:559-62.
Weyrauch K F. The personal knowledge of family physicians for their patients. Fam Med 1994;26:452 5.
Weyrauch K F. Rhodes L. Psaty B M. Grubb D. The role of physicians' personal knowledge of the patient in practice. J Fam Pract 1995;40:249-56.
Weyrauch K F. Does continuity of care increase HMO patients' satisfaction physician performance? J Am Board Fam Pract 1996;9:31-6.
Weyrauch KF. Malpractice, patient satisfaction, and physician-patient communication. JAMA 1995;274:22-4.
Weyrauch K, Roy-Byrne P, Katon W, Wilson L: Stressful life events and impulsiveness in failed suicide. Suicide Life Threat Behav 2001;31:311-19.
Weyrauch KF, Boiko PE, Keifer M. Building informed consent for cholinesterase monitoring among pesticide handlers in Washington State. Am J Ind Med 2005;48:175-81.
Thomas Zaubler, MD, MPH
Zaubler TS. Katon W. Panic disorder and medical comorbidity: a review of the medical and psychiatric literature. Bull Menninger Clin 1996;60:S12-S38,
Zaubler TS, Sullivan MD. Psychiatry and physician assisted suicide. Psychiatr Clin North Am 1996;19:413-27.
Zaubler TS. Viederman M, Fins JJ, et al. Ethical, legal, and psychiatric issues in capacity, competency, informed consent: an annotated bibliography. Gen Hosp Psychiatry 1996;18:155-72.
Zaubler TS. The unexamined death is not worth dying. Psychosomatics 2000;41:193-4.