Beliefs about mental illness as a functon of psychiatric status and psychiatric hospitalization.

Beliefs about mental illness were assessed among psychiatric inpatients at a VA hospital, the mental health staff responsible for their treatment, and a group of medical and surgical (control) patients. Results indicated that: (a) Psychiatric and nonpsychiatric patients generally hold similar opinions regarding mental illness. Severely disturbed psychiatric patients, however, view mental illness in more moralistic terms than do "normals." (b) Psychiatric hospitalization is generally accompanied by a change in the patient's beliefs concerning mental illness, toward those held by the staff. (c) Psychiatric patients whose beliefs about mental illness are most strikingly influenced by the staff tend to respond most favorably to treatment, as measured by length of hospital stay and gains in self-esteem during the 1st month of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' perceptions of care and safety within psychiatric settings.

There is growing concern over institutional measures of control (e.g., seclusion, restraint) and other potentially harmful or traumatic experiences within psychiatric hospitals. The purpose of the present study was to examine the relationship between demographic variables, potentially harmful and/or traumatic psychiatric experiences, and patients' perceptions of care and safety in psychiatric settings among 142 public-sector psychiatric patients. Data revealed 45.1% of patients reported they had been to a psychiatric facility they would never want to return to, and the majority of patients did not communicate with staff after a distressing event occurred. There were no significant differences in perceptions of care and safety by race, gender, or age. However, patients who reported potentially harmful or traumatic psychiatric events were significantly more likely to report that they had been to a psychiatric facility they would not want to return to. Encouragingly, most patients (84.5%) reported that psychiatric facilities have become safer in recent years. These data suggest the need to better understand how adverse psychiatric events influence how patients view their care and their subsequent engagement in that care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing an inpatient practicum program for patients with serious and persistent mental illness.

Training psychology students to treat patients with serious and persistent mental illness (SPMI) can provide an excellent opportunity for psychologists to help an historically disenfranchised and ignored population. With proper training, psychologists can play an important role in the development, provision, and administration of services to people with SPMI. We outline some of the issues to be considered in developing such a training program for practicum students, discuss the clinical skills and systemic issues that need to be mastered at the graduate level, and delineate the process by which this can be achieved in an inpatient, acute-care setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyses of employment incentives and barriers for individuals with psychiatric disabilities.

Objective: Individuals with psychiatric disabilities experience 90% unemployment rates; however, individuals experience 61% employment rates when engaged in high-fidelity individual placement and support programs. To build on current research of variables influencing employment outcomes, we hypothesized that an Incentive factor and a Barrier factor are related to employment status. This mixed method study developed the Employment Commitment Measure (ECM) and explored the correlation between employment commitment and employment status. Method: In our 1st phase of this mixed method study, we developed the ECM consisting of an Incentive factor with 5 items and a Barrier factor with 6 items through community-based participatory research. In our 2nd phase of this mixed method study, 198 randomly picked individuals with psychiatric disabilities completed a demographic survey and the ECM. We completed independent sample t tests with Bonferroni correction, cross-tabulated chi-square analyses, confirmatory factor analysis, Cronbach's alpha tests, a logistic regression, and a slope plotting. Results: The ECM consists of 11 items, with 5 items loading on an Incentive factor and 6 items loading on a Barrier factor. Results indicated that the Incentive factor scores were associated with employment status and significant differences on Incentive factor scores between employed and unemployed participants. Results indicated nonsignificant differences between employed and unemployed participants by age, education, gender, ethnicity, housing, mental health tenure, and agency tenure. Conclusions: Our findings indicated incentives for employment may provide a better guide for correlations of and commitment to employment when compared to barriers. We discuss the implications for employment for individuals with psychiatric disabilities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A multidimensional wellness group therapy program for veterans with comorbid psychiatric and medical conditions.

Development of a healthy lifestyle is an important aspect of mental health that is infrequently targeted in outpatient mental health settings. Although the interrelationship of psychological and physical factors has often been noted, interventions frequently focus on just one aspect of functioning. This project demonstrated the feasibility of a multidimensional weekly wellness group program focused on the overall health behaviors of patients in a Veterans Affairs mental health clinic. The modal participant was a male in his mid-50s, living alone, not employed, depressed, obese, and with many chronic medical problems. Eighty-three patients participated in a 15-week program promoting changes in such areas as stress management (abdominal breathing, muscle relaxation, visualization, and mindfulness), physical health care (exercise, nutrition, sleep routine, and substance use), and behavioral activation (activity scheduling, social affiliation, and use of community resources). Substantial improvement was found for most patients, in both psychosocial and physical functioning domains, and was maintained over time. The melding of psychoeducational and skills training into a positive psychology orientation appears to have been beneficial. In addition, the group process was quite effective in encouraging change in these highly comorbid, chronically ill veterans. The feasibility and importance of integrating psychosocial and physical interventions is underscored by this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using a Five-Factor Lens to Explore the Relation Between Personality Traits and Violence in Psychiatric Patients.

Recent work suggests that predictors of violence are similar for individuals with and without mental illness. Although psychopathy is among the most potent of such predictors, the nature of its relation to violence is unclear. On the basis of a sample of 769 civil psychiatric patients, the authors explore the possibility that measures of psychopathy provide a glimpse of higher order personality traits that predispose individuals toward violence. Results indicate that general traits captured by a measure of the 5-factor model, particularly antagonism, were relatively strongly associated with violence and shared most of their violence-relevant variance with a leading measure of psychopathy. Because interpersonal and affective features of psychopathy are less important than basic traits of antagonism in postdicting violence, it may be appropriate to broaden focus in risk assessment to patients' basic personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of stressful life events to metabolic control among adolescents with diabetes: 5-year longitudinal study.

Objective: To determine the relation of stressful life events to metabolic control. Design: We interviewed adolescents with Type 1 diabetes (n = 132; average age at enrollment = 12 years) annually for 5 years. Measures: Each year we administered measures of stressful life events, psychological distress, and self-care behavior. We downloaded data from blood glucose meters, and obtained measures of metabolic control (hemoglobin A1c) from medical records. Results: Using longitudinal growth curve modeling, stressful life events predicted greater psychological distress, poorer self-care behavior, and worse metabolic control in both cross-sectional and longitudinal (lagged) analyses. Cross-sectionally, many of these relations were stronger among older than younger adolescents. Self-care behavior partly mediated this association. Conclusion: Stressful life events are related to poor metabolic control—especially for older adolescents. A primary mechanism appears to be a lack of good self care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.

Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New subscales for an anchored version of the Brief Psychiatric Rating Scale: Construction, reliability, and validity in acute psychiatric admissions.

Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification of mental disorders in an in-patient prison psychiatric unit: Examining the criterion-related validity of the Personality Assessment Inventory.

Identifying inmates with mental disorders is a crucial function of correctional mental health services. This study examined the utility of several theoretically relevant scales and subscales of the Personality Assessment Inventory (PAI; Morey, 1991, 2007) to identify various broad diagnostic categories (i.e., mood, psychotic, and substance use disorders) in a sample of prisoners in an inpatient psychiatric facility (N = 57). Results indicated moderate effect sizes and classification accuracy for most but not all PAI scales and subscales. Experimental scales for the detection of substance use disorders performed worse than the PAI Drug Problems scale in isolation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantifying staff and patient perceptions of quality of care improvement in the psychiatric inpatient setting: Preliminary psychometrics of a new measure.

A recent emphasis has been placed on improving the quality of care psychiatric inpatients receive. Although it appears a number of behaviorally specific strategies to reduce seclusion and restraint are being implemented around the country, efforts to systematically measure and evaluate the effectiveness of these strategies are limited by a lack of intervention specific instruments. In order to address this gap, two new measures, the Quality of Care Measure, Staff Form (QOC-S) and the Quality of Care Measure, Patient Form (QOC-P) were developed. The psychometric properties of the QOC-S and the QOC-P were evaluated in a sample of 68 staff and 81 patients in one of five psychiatric units of a large, southeastern hospital. Results indicated that both forms of the measure were internally consistent. Principal Component Analyses yielded three reliable components underlying the QOC-S (Environment, Staff Sensitivity to Patient Trauma History, and Engagement Model) and three reliable components underlying the QOC-P (Environment, Staff Sensitivity to Patient Trauma History, and Patient Involvement). These components, which are based on the Engagement Model of care, were strongly associated with theoretical factors posited by the developers of the measure. Clinical implications and future directions for research involving the QOC-S and QOC-P are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental health of men with a psychiatric disorder or traumatic brain injury: Wives' labeling and husbands' perceived control.

Objective: To investigate the relations among wives' labeling of their husbands' psychiatric disorder or brain injury as an organic illness, the husbands' perceived control over their disabilities, and the husbands' mental health. Participants: 57 male clients of the Department of Rehabilitation, Israel's Ministry of Defence (26 with a psychiatric disorder and 31 with a traumatic brain injury) and their wives. Measures: Illness Labeling Questionnaire, the Perceived Control Over Illness Questionnaire, and the Mental Health Inventory. Results: Husbands' mental health was low but did not differ according to disability; wives' labeling of husbands' condition was negatively related to the husbands' mental health; husbands' perceived control was positively related to their mental health for both disabilities. Conclusion: Organic illness labels, even when adopted by the wives of the persons with the disability, seem to be negatively related to that person's mental health, whereas perceived control over a mental disorder or a brain injury seems to contribute positively to mental health, independently of how the disorder or injury is labeled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality is associated with perceived health and functional status in older primary care patients.

Using data collected on 265 primary care medical patients 60 years of age and older, the authors examined the personality bases of subjective health (perceived health, functional status) after controlling for observer-rated depression and medical burden. Four hypotheses were tested: High Neuroticism is associated with poorer perceived health, low Extraversion is associated with poorer perceived health, low Openness to Experience is associated with worse functional status, and age moderates the relationships between personality and subjective health. Findings supported the notion that personality is associated with subjective health, moreover, this effect appeared to grow more pronounced with increasing age. This study underscores the conceptual and heuristic value of examining moderators of the links between personality variables and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An examination of the physical health, health care use, and psychological well-being of spouses of people with fibromyalgia syndrome.

The present study compared the physical and mental health and the health care use of spouses of patients with fibromyalgia syndrome (FS group; n=135) with that of spouses of healthy individuals ( n=153). FS group participants reported lower health and affective states and scored higher on depression, loneliness, and subjective stress than comparison group participants ( p=.017). Husbands in the FS group who reported more illness impact and whose wives reported worse sleep quality and less self-efficacy had more psychological difficulties. No differences were found in health care costs between groups. These findings suggest that chronic illness in a partner may negatively affect an individual's physical and mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)