A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, coping and psychological illness: A cross-cultural study.

This cross-cultural research study aimed to explore the relationship of stress and coping with psychological illness or symptoms among university students in Canada and India. The predictor variables were stress (hassles and life experience), 8 ways of coping (Folkman & Lazarus, 1988), and selected personal-social variables, namely, locus of control, self-esteem, and social support. The criterion variables were 9 psychological symptoms of the Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982). The results revealed that the Indian students reported more psychological symptoms compared to the Canadian students. Stepwise multiple-regression analyses also revealed considerable differences between the 2 samples with respect to the contribution of predictor variables in accounting for variance in the BSI scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pilot study of a health-focused day program on improving health behaviors, clinical functioning, and perceived wellness in individuals with severe mental illness.

Persons with severe mental illness (SMI) have poor physical health and high rates of premature death. There is limited research on health interventions for this population. This pilot study compares the health behaviors and perceived improvement of 2 day programs and comments on conducting research in health intervention in community-based persons with SMI. Nineteen individuals with SMI from a health-focused day program (HFP) and treatment-as-usual day program (TAU) were assessed for clinical functioning, health behaviors, and perceived improvement by using a semistructured interview and the Brief Psychiatric Rating Scale. The special features of the HFP included special dietary planning, a well-equipped gym, staff instruction, supervision of exercise programs, and limited time for smoking. HFP participants reported higher fruit and vegetable intake and greater perceived improvement in confidence than those at the TAU. There were no differences in the amount of exercise and rates of smoking between the programs. Methodological implications for further research in this area are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial comparing two vocational models for persons with severe mental illness.

The authors compared 2 approaches to vocational rehabilitation for individuals with severe mental illness: the individual placement and support (IPS) model of supported employment and the diversified placement approach (DPA), which emphasizes work readiness and offers a range of vocational options, including agency-run businesses and agency-contracted placements with community employers. In all, 187 unemployed participants with severe mental illness were randomly assigned to IPS or DPA. Over 2 years, IPS had significantly better competitive employment outcomes than DPA. Competitive employment rates over the 2-year follow-up were 75.0% for IPS and 33.7% for DPA. However, IPS and DPA did not differ on paid employment outcomes. The authors conclude that IPS is more effective than DPA in achieving competitive employment, but not paid employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A qualitative approach to the evaluation of psychosocial interventions for persons with severe mental illness.

This article describes the development and assessment of a qualitative interview for comprehensively assessing both the process and the outcome of interventions for persons with severe mental illness (SMI). A open-ended 16-question Narrative Evaluation of Intervention Interview (NEII) was developed. The NEII contains questions that ask the participants to evaluate and describe both process and outcome of interventions for persons with SMI. Research participants were 64 persons with SMI attending rehabilitation programs in the community. Analysis of participants' responses to the NEII, using the open step of the grounded theory approach, produced a comprehensive set of themes. Interrater reliabilities for these themes ranged from moderate to high, and these themes differentiated between the three psychosocial interventions. Ways of modifying the NEII so as to make it more sensitive to participants' expectations and experiences are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maladaptive perfectionism as an intervening variable between psychological control and adolescent depressive symptoms: A three-wave longitudinal study.

Maladaptive perfectionism has been postulated as an intervening variable between psychologically controlling parenting and adolescent internalizing problems. Although this hypothesis has been confirmed in a number of cross-sectional studies, it has not yet been examined from a longitudinal perspective. Findings from this 3-wave longitudinal study show that parental psychological control (as indexed by parent and adolescent reports) at age 15 years predicted increased levels of maladaptive perfectionism 1 year later. Maladaptive perfectionism, in turn, predicted increased levels of adolescent depressive symptoms again 1 year later and acted as a significant intervening variable between parental psychological control at Time 1 and depressive symptoms at Time 3. Multigroup analyses show that the model tested was consistent across gender for paternal psychological control but not for maternal psychological control. Suggestions for future research are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and marital satisfaction in the context of chronic disease: A longitudinal dyadic analysis.

These analyses examined the longitudinal relationships between depressive symptoms and marital satisfaction over a 2-year period as experienced by 315 patients with end-stage renal disease and their spouses. Using multilevel modeling, the authors examined both individual and cross-partner effects of depressive symptoms and marital satisfaction on patients and spouses, testing bidirectional causality. Results indicate that mean and time-varying depressive symptoms of both patients and spouses were associated with their own marital satisfaction. Although mean marital satisfaction was associated with own depressive symptoms for both patients and spouses, time-varying marital satisfaction did not affect depressive symptoms for either patients or spouses. Significant cross-partner effects reveal that both mean enduring and time-varying depressive symptoms of the spouse affected marital satisfaction of the patient. Findings highlight the complex nature of the relationship between depressive symptoms and marital satisfaction in late-life couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness.

The purpose of this study was to develop an understanding of the design elements that influence the ability of persons with severe mental illness (SMI) and cognitive deficits to use a website, and to use this knowledge to design a web-based telehealth application to deliver a psychoeducation program to persons with schizophrenia and their families. Usability testing was conducted with 98 persons with SMI. First, individual website design elements were tested. Based on these results, theoretical website design models were used to create several alternative websites. These designs were tested for their ability to facilitate use by persons with SMI. The final website design is presented. The results indicate that commonly prescribed design models and guidelines produce websites that are poorly suited and confusing to persons with SMI. Our findings suggest an alternative model that should be considered when designing websites and other telehealth interventions for this population. Implications for future studies addressing the characteristics of accessible designs for persons with SMI and cognitive deficits are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and the metabolic syndrome in childhood and adulthood: A prospective cohort study.

Objective: To examine the reciprocal associations between depressive symptoms and clinical definitions of the metabolic syndrome in childhood and adulthood. Design: Population-based prospective cohort study of 921 participants (538 women and 383 men) in Finland. The components of the metabolic syndrome were measured in childhood (mean age 12 years) and again in adulthood (mean age 33 years). A revised version of the Beck Depression Inventory was used to assess depressive symptoms at the mean ages of 24 and 33. Main Outcome Measures: Metabolic syndrome defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP), the European Group for the Study of Insulin Resistance, and the International Diabetes Federation criteria. Results: In women, depressive symptoms were associated with increased risk of the metabolic syndrome in adulthood (odds ratio for NCEP metabolic syndrome per 1 SD increase in depressive symptoms 1.40, 95% confidence interval 1.05-1.85). The metabolic syndrome in childhood, in turn, predicted higher levels of depressive symptoms in adulthood (p = .03). In men, no associations were found between depressive symptoms and the clinical definitions of the metabolic syndrome. Conclusion: The process linking depressive symptoms with the metabolic syndrome may go into both directions and may begin early in life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and close relationships during the transition to adulthood: Perspectives from dysphoric women, their best friends, and their romantic partners.

Late adolescent women's depressive symptoms and interpersonal functioning were assessed using reports from participants, their best friends, and their romantic partners. As predicted, the associations between relationship dysfunction and dysphoria were stronger in romantic relationships than in friendships. Unlike friends, romantic partners perceived dysphoric women as having poorer social skills. Romantic partners also reported providing less emotional support to dysphoric women, whereas friends reported providing more. Finally, romantic partners of dysphoric women had more Cluster A (odd-eccentric) personality disorder symptoms; these symptoms mediated the relation between women's depression and partners' nonsupportiveness. The findings suggest that dysphoric women may find themselves in emotionally nonsupportive romantic relationships because they have paired (through assortative pairing or mutual influence) with symptomatic partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Forgiveness, spiritual instability, mental health symptoms, and well-being: Mediator effects of differentiation of self.

The present study tested the theoretical formulation based on Bowenian theory and Volfian theology that differentiation of self (DoS) serves as a mediator variable by which dispositional forgiveness is associated with indices of spiritual and mental health. Data were collected in a sample (N = 213) of graduate students (mean age = 34.46 years) at a Protestant-affiliated university. Results supported the hypotheses with DoS mediating the relationship between dispositional forgiveness and (a) spiritual instability, (b) mental health symptoms, and (c) psychological well-being. Implications are considered for future research on forgiveness, DoS, and spirituality, as well as clinical interventions related to self-regulation and trauma symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study.

We present evidence from a 5-year longitudinal study for the prospective associations between loneliness and depressive symptoms in a population-based, ethnically diverse sample of 229 men and women who were 50–68 years old at study onset. Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms, considered simultaneously. We used variations on this model to evaluate the possible effects of gender, ethnicity, education, physical functioning, medications, social network size, neuroticism, stressful life events, perceived stress, and social support on the observed associations between loneliness and depressive symptoms. Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support. The importance of distinguishing between loneliness and depressive symptoms and the implications for loneliness and depressive symptomatology in older adults are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The mental hospital. A study of institutional participation in psychiatric illness and treatment.

Reviews the book, The mental hospital. A study of institutional participation in psychiatric illness and treatment by Alfred H. Stanton and Morris S. Schwartz (see record 2005-02933-000). This is a rich and rewarding book. It is a report of research, conducted in collaboration by a psychiatrist and a sociologist, into the social organization of a psychiatric hospital and into the effects of this social organization on the behavior of patients. Although it is primarily intended as a contribution to administrative psychiatry, it is also a major contribution to the general literature of social science and, in particular, to the broad area of personality and social structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Underdiagnosing and nontreatment of posttraumatic stress disorder in community mental health: A case study.

Research indicates that trauma is extremely prevalent among populations seeking community-based services. However, underdiagnosis and nontreatment of trauma-related disorders is widespread. This study explored how one urban community mental health center (CMHC), serving a severely mentally ill (SMI) population, assessed, diagnosed, and treated reported trauma histories. Results indicate that of the 72 consumers in this sample who reported trauma histories (51%), only 2 were diagnosed with posttraumatic stress disorder (PTSD). Instead, those with a reported trauma history were likely to be diagnosed with affective disorders and were almost seven times as likely to be recommended therapy as were those without a trauma history. However, even those recommended therapy were not likely to receive it. Findings indicate significant barriers to PTSD diagnoses and the receipt of therapy services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations between spouses' depressive symptoms and marital conflict: A longitudinal investigation of the role of conflict resolution styles.

This study investigated longitudinal relations between spouses' depressive symptoms and styles of conflict resolution displayed by husbands and wives in marital conflict, including angry, depressive, and constructive patterns of expression. Behavioral observations were made from a community sample of 276 couples during marital conflict resolution tasks once a year for 3 years. Couples were observed engaging in a major and minor conflict resolution task. Constructive, angry, and depressive conflict resolution styles were derived from the behavioral observation coding. Couples self-reported on depressive symptoms and marital dissatisfaction. Path analyses provided support for an extension of the marital discord model of depression (Beach, Sandeen, & O'Leary, 1990). Specifically, angry, depressive, and constructive styles of conflict each mediated the link between marital dissatisfaction and depressive symptoms. Significant cross-spouse effects were found. Implications for the treatment of depressed and/or relationally discordant couples are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Coercion and empowerment in the treatment of individuals with serious mental illness: A preliminary investigation.

Recently, treatment approaches for individuals with serious mental illness (SMI) have sought to increase autonomy to prevent frequent hospitalizations. Two of these strategies are coercive treatment and empowerment. Both coercive treatment and empowerment attempt to increase an individual's freedom from illness as well as rehospitalization. In the literature coercion is viewed as a barrier to empowerment, yet the long-term goals of both approaches are similar. Thus, coercive treatment may not serve as a barrier to empowerment. This study is a preliminary investigation of the empirical relationship between and among coercion, functioning, and empowerment. Participants were recruited from treatment centers in Mississippi and were at varying stages of treatment including inpatient and outpatient (N = 64). Variables of interest were measured with the MacArthur Admissions Experience Survey, Brief Symptom Inventory, Multnomah Community Ability Scale, MacArthur Competence Assessment Tool-Treatment, and Empowerment Scale. In this sample, only functioning was predictive of empowerment, suggesting that empowerment is dependent on an individual's level of functioning. In addition, coercion may not necessarily disempower individuals with SMI. Implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of successful dietary restriction to change in bulimic symptoms: A prospective study of adolescent girls.

Recent experimental evidence that dietary restriction results in decreased bulimic and depressive symptoms seems inconsistent with findings from prospective studies and etiologic theory. However, because the dieting manipulated in these experiments may be unrepresentative of real-world weight loss dieting, the authors tested whether successful dietary restriction was associated with decreases in these outcomes by using longitudinal data from a school-based study of 496 adolescent girls. Moderately overweight participants who evidenced successful dietary restriction showed significantly greater decreases in bulimic symptoms than weight-matched participants who did not show successful dietary restriction; however, there were no effects for depressive symptoms. In conjunction with past experimental findings, results seem to imply that successful dietary restriction curbs bulimic symptoms, suggesting that current etiologic models may need revision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Revisiting the effect of marital support on depressive symptoms in mothers and fathers: A genetically informed study.

This article uses a genetically informed design to evaluate whether (1) the well-documented association between marital support and depressive symptoms is accounted for by genetic and/or shared environmental selection, (2) gender differences are found after controlling for selection effects, and (3) parenthood moderates any nonshared environmental relation between depressive symptoms and marital support. We used a sample of 1,566 pairs of same-sexed, married twins from the Australian Twin Registry to evaluate our hypotheses that (1) the predicted effect of marital support on depressive symptoms is not fully an artifact of selection, (2) the etiological sources accounting for this effect differ between husbands and wives, and (3) parenthood status moderates the effect of marital support on depressive symptoms adjusting for selection effects. The results support the first hypotheses. However, after controlling for selection, the effect of marital support on depressive symptoms was not significantly different for husbands and wives. Parenthood moderated the effect of marital support, such that after controlling for selection, marital support is more strongly associated with depressive symptoms for full-time parents than nonfull-time parents. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The prevention of depressive symptoms in rural school children: A randomized controlled trial.

A controlled trial was conducted to evaluate a prevention program aimed at reducing depressive and anxious symptoms in rural school children. Seventh-grade children with elevated depression were selected. Nine primary schools (n=90) were randomly assigned to receive the program, and 9 control schools (n=99) received their usual health education classes. Children completed questionnaires on depression, anxiety, explanatory style, and social skills. Parents completed the Child Behavior Checklist (T. M. Achenbach, 1991). No intervention effects were found for depression. Intervention group children reported less anxiety than the control group after the program and at 6-month follow-up and more optimistic explanations at postintervention. Intervention group parents reported fewer child internalizing and externalizing symptoms at postintervention only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure to terrorism, stress-related mental health symptoms, and defensive coping among Jews and Arabs in Israel.

The authors conducted a large-scale study of terrorism in Israel via telephone surveys in September 2003 with 905 adult Jewish and Palestinian citizens of Israel (PCIs). Structural equation path modeling indicated that exposure to terrorism was significantly related to greater loss and gain of psychosocial resources and to greater posttraumatic stress disorder (PTSD) and depressive symptoms. Psychosocial resource loss and gain associated with terrorism were, in turn, significantly related to both greater PTSD and depressive symptoms. PCIs had significantly higher levels of PTSD and depressive symptoms than Jews. Further, PTSD symptoms in particular were related to greater authoritarian beliefs and ethnocentrism, suggesting how PTSD may lead to a self-protective style of defensive coping. (PsycINFO Database Record (c) 2010 APA, all rights reserved)