A new statistical test for age-of-onset anticipation: application to bipolar disorder

Sixty 2nd, 5th, and 8th graders were interviewed on their moral and ecological reasoning about the 1990 Exxon Valdez oil spill that occurred in Prince William Sound, Alaska. Results showed that children understood that the oil spill negatively affected the local Alaskan shoreline, marine life, fishermen, recreationists, and the oil company. Children cared that harm occurred to the shoreline and marine life and conceived of both types of harm as violating a moral obligation. Fifth and 8th graders, compared with 2nd graders, used a greater proportion of anthropocentric reasoning (e.g., that nature ought to be protected to protect human welfare) and biocentric reasoning (e.g., that nature has intrinsic value, rights, or a teleology). Discussion focuses on how studying children's reasoning about nature not only extends the bounds of what counts as moral--to include a relationship with the natural world--but also provides a unique means by which to conduct basic research on children's moral development.     

Children's moral and ecological reasoning about the Prince William Sound oil spill.

Sixty 2nd, 5th, and 8th graders were interviewed on their moral and ecological reasoning about the 1990 Exxon Valdez oil spill that occurred in Prince William Sound, Alaska. Results showed that children understood that the oil spill negatively affected the local Alaskan shoreline, marine life, fishermen, recreationists, and the oil company. Children cared that harm occurred to the shoreline and marine life and conceived of both types of harm as violating a moral obligation. Fifth and 8th graders, compared with 2nd graders, used a greater proportion of anthropocentric reasoning (e.g., that nature ought to be protected to protect human welfare) and biocentric reasoning (e.g., that nature has intrinsic value, rights, or a teleology). Discussion focuses on how studying children's reasoning about nature not only extends the bounds of what counts as moral—to include a relationship with the natural world—but also provides a unique means by which to conduct basic research on children's moral development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and predictors of posttraumatic stress in women undergoing an ovarian cancer investigation.

This study assessed posttraumatic stress disorder (PTSD) in women being investigated for an ovarian cancer diagnosis to determine prevalence and factors predicting PTSD in these patients. Participants (N = 75) were recruited from the Princess Margaret Hospital in Toronto, Ontario, after their initial clinic appointment and given a prediagnostic assessment that included measures of PTSD, depression, stress and pain. One month later, patients received an identical postdiagnostic assessment. No cases of clinical PTSD were detected, although 13.6% of participants were identified with subsyndromal PTSD. Multiple regression analyses showed that those participants reporting significant baseline depressive symptoms, definitively diagnosed with ovarian cancer, and with shorter treatment wait times were more likely to have a significant increase in PTSD symptoms. Supportive interventions aimed at reducing PTSD symptoms, launched prior to an ovarian cancer diagnosis, might optimally be directed at patients with baseline depressive symptoms and those with shorter treatment wait times. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Industry''s perception and use of occupational exposure limits

OBJECTIVE: To examine posttraumatic stress disorder (PTSD) in mothers of survivors of childhood cancer. Comorbidity of anxiety and depressive disorders, prevalence of subclinical PTSD, and the utility of a self-report measure as a screening instrument for PTSD were also investigated. METHOD: Mothers (n = 65) completed a questionnaire self-report PTSD checklist (PCL-C). Mothers were administered several modules of the SCID: nonpatient edition by telephone, including the PTSD, Generalized Anxiety, and Major Depressive Disorder modules. RESULTS: We diagnosed 6.2% of the sample with current PTSD. An additional 20% had subclinical PTSD. One of four mothers with PTSD diagnoses had a comorbid diagnosis of an anxiety and depressive disorder. The PCL-C evidenced diagnostic utility as a screening instrument. However, a moderate number of false-positives would result if the recommended cut-off on the instrument was used. CONCLUSIONS: The PCL-C had diagnostic utility in screening mothers of childhood cancer survivors. The presence of comorbid diagnoses such as anxiety and depression should be examined.     

Drugs and the college athlete: an analysis of the attitudes of student athletes at risk

This study examines the degree to which untreated anxiety disorders and major depressive disorder, occurring either singly or in combination, reduce functioning and well-being among primary care patients. Adult patients were screened using the SCL-52 to identify those with clinically significant anxiety symptoms. They also completed the Rand Short-Form (SF-36) to measure self-reported patient functioning and well-being. Patients with untreated disorders were identified using the Q-DIS-III-R to diagnose six DIS-anxiety disorders (generalized anxiety disorder, post-traumatic stress disorder (PTSD), simple phobia, social phobia, panic/agoraphobia, obsessive/compulsive disorder) and major depression. Of 319 patients identified, 137 (43%) had a single disorder and 182 (57%) had multiple disorders. Regression models estimated the relative effects of these disorders on health status (SF-36) by comparing patients with the disorders to patients screened as being not-anxious. Estimates of these effects were consistent with available national norms. The estimated effect of each single disorder on all subscales for physical, social and emotional functioning was negative, often as much as a 20-30 point reduction on this 100-point scale. Major depression had the greatest negative impact, followed by PTSD and panic/ agoraphobia. For patients with multiple disorders, the presence of major depression was associated with the greatest reduction in functioning status. The impact of untreated anxiety disorders and major depressive disorder on functioning was comparable to, or greater than, the effects of medical conditions such as low back pain, arthritis, diabetes and heart disease.     

Predisaster trait anxiety and negative affect predict posttraumatic stress in youths after Hurricane Katrina.

On the basis of theory and previous research, it was hypothesized that predisaster child trait anxiety would predict disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms, even after controlling for the number of hurricane exposure events. Results support this hypothesis and further indicate that predisaster negative affect predicted disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms. Also, Katrina-related posttraumatic stress disorder symptoms were predicted by the number of hurricane exposure events and sex (being female). Predisaster generalized anxiety disorder symptoms predicted postdisaster generalized anxiety disorder symptoms, and predisaster trait anxiety predicted postdisaster depressive symptoms. Findings are discussed in terms of their relevance for developing interventions to mitigate the impact of disasters in youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of distress following trauma: Posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder.

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures. The results of construct level analyses suggested that PTSD, MDD, and GAD are distinguishable but highly correlated disorders following a traumatic event. Symptom level analyses supported a model where the Reexperiencing, Avoidance, and Hypervigilance factors were subsumed under the PTSD construct. However, in this model the Dysphoria factor was a higher order construct correlated with the PTSD, MDD, and GAD factors, suggesting that the Dysphoria cluster may not be unique to PTSD. Diagnostic and theoretical implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of self-reported distress to depressive disorders and other psychopathology.

The relationship between self-reported depression and a clinical diagnosis of depression was investigated. Within 2 wks of completing the Center for Epidemiologic Studies Depression Scale (CES-D), a stratified sample of 425 primary medical care patients received the structured interview for the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). In the weighted data set, the CES-D was significantly related to a diagnosis of depression but also to other Axis I disorders. Most distressed subjects were not depressed, a fifth of the patients with major depressive disorder (MDD) had low distress, and the CES-D performed as well in detecting anxiety as in detecting depression. MDD, other depression diagnoses, and anxiety and substance use disorders were all significant predictors of CES-D score. Differences in demographic variables, treatment history, and impairment highlight the nonequivalence of the self-report scale and diagnosable depression. The use of a self-report in place of an interview-based diagnostic measure in the study of depression, as well as the use of such a report as a screening device, is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Standardization Committee for Haematology. External Quality Assurance Program for General Hematology. Evaluation of the 1994 results

Concerns about the cultural competence of child mental health services has led to the examination of racial/ethnic and gender differences in the prevalence of psychiatric symptoms. This study examines racial and gender differences in depressive and substance abuse symptomatology in a high-risk population of adolescents living in five residential group homes in South Carolina. We surveyed 299 youth ages 12 to 17, including 101 African American and 198 Whites. They completed the Centers for Epidemiological Studies-Depression scale (CES-D) and questions on substance abuse, demographics, and psychosocial functioning. No significant differences were found in the percentages of Whites and African Americans scoring above 16+ and 23+ cutoff scores on the CES-D, but significant gender differences were identified. Neither race nor race by age group interactions were found to be significantly correlated in regression analyses with CES-D score nor multiple substance use, whereas gender (p < .001) and school performance were significantly correlated with CES-D score, and poverty was correlated with multiple substance use. Our results indicate that levels of depressive symptomatology as measured by the CES-D are much more sensitive to gender than to race in high-risk populations. Different gender cutoffs are indicated when using systematic instruments in the measurement of depressive symptoms.     

The phenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma

This study analyses and categorises the subjective experiences and psychological symptoms of those involved in a major disaster but not themselves physically injured. It examines the concept of post-traumatic stress disorder (PTSD) and relates it to other psychiatric diagnoses and also to the particular nature of the disaster. 70 police officers are the subjects of this study, 59 men and 11 women, all of them involved in the Hills-borough Football Stadium Disaster. Assessment included detailed psychiatric history and examination with an account of the events experienced by the informants and their psychological reaction to this at the time and subsequently. Psychiatric diagnosis was made and quantified measurements were also recorded, including a rating scale for the criteria of PTSD, the General Health Questionnaire and rating scales for depression and anxiety. Severity of PTSD symptoms was associated with higher scores on rating scales for both depressive and anxiety symptomatology. Subjective depressive symptoms and depersonalisation were associated with severity of PTSD. Frustrated helplessness was a recurring theme in the psychopathology. Alcohol consumption of those who were already drinkers increased. Social functioning at work and in marriage deteriorated with increased severity of PTSD. Although PTSD has features that distinguish it from other conditions, the degree of distress and long-term disability is more related to depressive symptomatology than to the severity of PTSD itself.     

Measuring exposure to racism: Development and validation of a Race-Related Stressor Scale (RRSS) for Asian American Vietnam veterans.

This article describes the development and validation of the Race-Related Stressor Scale (RRSS), a questionnaire that assesses exposure to race-related stressors in the military and war zone. Validated on a sample of 300 Asian American Vietnam veterans, the RRSS has high internal consistency and adequate temporal stability. Hierarchical regression analyses revealed that exposure to race-related stressors accounted for a significant proportion of the variance in posttraumatic stress disorder (PTSD) symptoms and general psychiatric symptoms, over and above (by 20% and 19%, respectively) that accounted for by combat exposure and military rank. The RRSS appears to be a psychometrically sound measure of exposure to race-related stressors for this population. Race-related stressors as measured by the RRSS appear to contribute uniquely and substantially to PTSD symptoms and generalized psychiatric distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining scale discriminability in the BDI and CES-D as a function of depressive severity.

Scale discriminability is the ability of a measure to discriminate among individuals ordered along some continuum, such as depressive severity. We used a nonparametric item-response model to examine scale discriminability in the Beck Depression Inventory (BDI) and Center for Epidemiologic Studies Depression Scale (CES-D) in both college and depressed outpatient samples. In the college sample, the CES-D was more discriminating than the BDI, but a standard CES-D cutoff score of 16 overestimated the likely prevalence of depression (45%). The CES-D may be more effective than the BDI in detecting differences in depressive severity in college students but may be less specific. In the depressed outpatient sample, the CES-D was again more discriminating than the BDI. The superior scale discriminability of the CES-D offers one explanation for its poorer specificity in college samples. Endorsing many items that discriminate at low levels of depressive severity can result in scores that exceed a cutoff criterion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents.

Objective: Our objective in the present study was to examine the temporal sequencing of posttraumatic and depressive symptoms during prolonged exposure therapy for posttraumatic stress disorder (PTSD) among children and adolescents. Method: Participants were 73 children and adolescents (56.2% female) between the ages of 8 and 18. Participants completed self-report measures of posttraumatic stress and depression prior to every session. Measures included the Child PTSD Symptom Scale, Beck Depression Inventory, and Children's Depression Inventory. Results: Multilevel mediational analyses indicated reciprocal relations during treatment: Changes in posttraumatic symptoms led to changes in depressive symptoms and vice versa. Posttraumatic symptoms accounted for 64.1% of the changes in depression, whereas depressive symptoms accounted for 11.0% of the changes in posttraumatic stress. Conclusions: Prolonged exposure therapy may work primarily by reducing posttraumatic stress, which in turn reduces depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Guidelines for differential diagnoses in a population with posttraumatic stress disorder.

In a large posttraumatic stress disorder (PTSD) and depression treatment outcome study, thorough diagnostic assessments of veterans at pretreatment, posttreatment, and 3 follow-up times were completed. The research team that reviewed these assessments encountered several challenges in the differential diagnosis of PTSD because of high comorbidity and symptoms shared with or resembling other disorders. For example, how do mental health professionals distinguish symptoms of agoraphobia from avoidance and hypervigilance symptoms of PTSD? When are hallucinations symptomatic of PTSD (e.g., flashbacks) versus a nonpsychotic near-death experience or an independent psychotic disorder? How do mental health professionals differentiate overlapping symptoms of PTSD and depressive disorders? To help make reliable diagnoses, the team developed clarifying questions and diagnostic guidelines, which may prove useful to other clinicians and researchers working with PTSD populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder

Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.     

Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.

Objective: Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumatic stress disorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up. Method: Sixty-three youngsters (ages 8–17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982). Results: Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p     

Lower precombat intelligence is a risk factor for posttraumatic stress disorder.

The authors examined the relation between intelligence and posttraumatic stress disorder (PTSD) by studying the association among precombat intelligence, current intelligence, and self-reported PTSD symptoms. Military aptitude test results were obtained in 59 PTSD and 31 non-PTSD Vietnam combat veterans who had undergone a psychodiagnostic interview and current intelligence testing. People with lower precombat intelligence were more likely to develop PTSD symptoms as assessed by the Clinician-Administered PTSD Scale even after adjustment for extent of combat exposure. The association between current intelligence and PTSD was no longer significant after adjusting for precombat intelligence. These results suggest that lower pretrauma intelligence increases risk for developing PTSD symptoms, not that PTSD lowers performance on intelligence tests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Electroconvulsive shocks exacerbate the heightened acoustic startle response in stressed rats.

Electroconvulsive therapy (ECT) has been successfully used in the treatment of depression, particularly when the illness is refractory to pharmacological therapy. A recent study has shown that ECT is also effective in reducing both depressive and posttraumatic stress disorder (PTSD) symptoms in patients with major depression (MDD) and co-occurring PTSD. This raises the possibility that ECT might be effective in the treatment of PTSD, a disease whose prevalence has increased substantially in recent years. A characteristic symptom of PTSD is an exaggerated reactivity to startling sounds (acoustic startle response; ASR). In the present study, we investigated the effects of electroconvulsive shocks (ECS) on the ASR, in a rat model of traumatic stress. The animals were subjected to a restraint/tailshock paradigm and then administered ECS. ASR measurements were obtained at several time points following ECS administration. Although ECS had no effect in control rats, it significantly exacerbated the already potentiated ASR in the stressed group. While ECT may prove to be an effective treatment for certain symptoms of co-occurring MDD/PTSD or PTSD alone, it may exacerbate heightened arousal associated with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)