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Objectives: To assess family functioning and consumer decision-making about vaccinations and to compare the results with age at vaccination. Design: Self-administered survey that was mailed to parents with comparison to vaccination records from chart audits. Settings: Two inner-city health centers in Pittsburgh, Pa, that receive free vaccine supplies. Participants: Systematic sample from the billing computer records of parents whose children were aged 2 to 4 years as of July 2, 1993. Interventions: The survey used simplified versions of the Family Profile and the Triandis model of consumer decision-making that includes perceived consequences of vaccinations, attitude about vaccinations, social influences, and facilitating conditions (eg, ease of obtaining an appointment). Main Outcome Measures: Variables associated with age at vaccination for third diphtheria and tetanus toxoids and pertussis vaccine immunization and first measles-mumps-rubella immunization. Result: Of 395 families, 167 responded. Higher family dysfunction scores and lower family concordance scores each were associated with receiving first measles-mumps-rubella vaccination (P [less than or equal to] .02) and third diphtheria and tetanus toxoids and pertussis vaccination (P [less than or equal to] .02) at later ages. Many (30%-54%) of the respondents reported that they knew little about the risks and benefits of vaccination. However, knowledge about vaccines was not associated with vaccination status. Those respondents with an annual income of less than $10 000 received the first measles-mumps-rubella vaccination later than those with an annual income $10 000 or greater (P < .02) when the data were analyzed by age at vaccination but not when the data were analyzed as on-time vs late vaccinations. Conclusions: To increase vaccination rates in inner-city clinics, strategies need to consider family dysfunction and income and not merely focus on education. The use of age at vaccination as a continuous variable offers advantages over the dichotomy of immunized vs not immunized., Family dysfunction may interfere with immunizing children in low-income families. A group of 167 families with children two to four years old responded to a survey. All children received care at two inner-city clinics that received free vaccine supplies. Delay in receiving the first measles-mumps-rubella vaccine and the third diphtheria-tetanus-pertussis vaccine was associated with higher family dysfunction scores, lower family cohesion scores, and lower income. Knowledge of the risks and benefits of immunization did not influence timing of immunization.

Major depression occurs in 6 to 9 percent of patients in primary care. In spite of this high frequency, only a minority of these patients are diagnosed correctly by their physicians, partly because in some cases the patients do not report mood or emotional symptoms. In addition, some diseases cause depression, as do many commonly prescribed drugs. The disorder is difficult to treat because of the relationship between the disease and the depression, and also because seriously ill patients are often unable to tolerate antidepressant medications. In order to determine the relationship between major depressive disorder (MDD) and physical illness, 618 clinic patients were tested. Forty-one (6.6 percent) were found to be suffering from MDD, a rate that is similar to those found in other studies. The depressed patients in this study were found to be sicker than nondepressed patients, although they were, on average, several years younger. Those who had been correctly diagnosed by their physicians had less severe physical illnesses, perhaps because depression was easier to notice when there was less ''contamination'' from medical disorders. Patients with MDD were far more likely to suffer from malignant tumors (10 percent) than the nondepressed group (1 percent), but there were differences in the prevalence of other medical conditions. Depressed patients were more likely to be diagnosed with ''unexplained'' symptoms, which were actually symptoms of depression that the physicians failed to diagnose correctly. The excess of medical illness among depressed patients could be a result of being sick, but with the exception of cancer, the diseases were present equally frequently among nondepressed patients. Symptoms may be more severe among depressed patients because of the interaction between psychological and physical symptoms. It is also possible that depression was caused by the medications that the patients were taking. However, nondepressed patients were equally likely to be taking these medications. The study raises complex questions about cause and effect in the relationship between mental and physical illness. (Consumer Summary produced by Reliance Medical Information, Inc.)