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Marlowe NI, Nicholson Perry K, Lee J. Ontological insecurity II: Relationship to attachment, childhood trauma, and subclinical psychotic-like experiences. J Clin Psychol 2019; 76:440-460. [PMID: 31800105 DOI: 10.1002/jclp.22905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine ontological insecurity as a predictor of positive psychotic-like experiences (PLEs) relative to concepts of childhood trauma, parental bonding, and adult attachment style. METHODS A nonclinical sample (N = 298) completed the Ontological Insecurity Scale (OIS-34), a new measure of ontological insecurity, along with measures of the above concepts. RESULTS The OIS-34 accounted for a significantly greater proportion of unique variance in positive PLEs than any other theoretical variable. Anxious and avoidant adult attachment were also strongly associated with positive PLEs, but these relationships were mediated by the OIS-34, ceasing to be significant once this latter variable entered the hierarchical regression equation. CONCLUSIONS The results are consistent with R. D. Laing's theory that ontological insecurity plays a significant role in psychosis. Moreover, the results suggest that this concept may mediate the established relationship between anxious/avoidant adult attachment and positive PLEs. Implications for psychological approaches to clinical psychosis are discussed.
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Affiliation(s)
| | - Kathryn Nicholson Perry
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, New South Wales, Australia
| | - Jacob Lee
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, New South Wales, Australia
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Andrews NCZ, Motz M, Bondi BC, Leslie M, Pepler DJ. Using a Developmental-Relational Approach to Understand the Impact of Interpersonal Violence in Women Who Struggle with Substance Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234861. [PMID: 31816837 PMCID: PMC6926949 DOI: 10.3390/ijerph16234861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/16/2019] [Accepted: 11/28/2019] [Indexed: 01/02/2023]
Abstract
Substance use among women is a major public health concern. This review article takes a developmental-relational approach to examine processes through which early relational trauma and violence in relationships may lead to substance use. We examine how early exposure to violence in relationships can impact neurological development, specifically through interference with physiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis), brain structure and functioning (e.g., the hippocampus and prefrontal cortex), and neuropsychological development (e.g., executive functioning and emotion regulation) across the lifespan. Further, we discuss the impact of exposure to violence on the development of relational capacity, including attachment, internal working models, and subsequent interpersonal relationships across the lifespan, and how these developmental pathways can lead to continued problematic substance use in women.
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Affiliation(s)
- Naomi C. Z. Andrews
- Department of Child and Youth Studies, Brock University,1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1, Canada
- Correspondence: ; Tel.: +1-905-688-5550 (ext. 4654)
| | - Mary Motz
- Mothercraft, Early Intervention Department, 860 Richmond Street West, Toronto, ON M6J 1C9, Canada; (M.M.); (M.L.)
| | - Bianca C. Bondi
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; (B.C.B.); (D.J.P.)
| | - Margaret Leslie
- Mothercraft, Early Intervention Department, 860 Richmond Street West, Toronto, ON M6J 1C9, Canada; (M.M.); (M.L.)
| | - Debra J. Pepler
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; (B.C.B.); (D.J.P.)
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Social Impairments in Mental Disorders: Recent Developments in Studying the Mechanisms of Interactive Behavior. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i2.33143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Most mental disorders are associated with impairments in social functioning. Paradigms developed to study social functioning in laboratory settings mostly put participants in a detached observer point of view. However, some phenomena are inherently interactive and studying full-blown reciprocal interactions may be indispensable to understand social deficits in psychopathology.
We conducted a narrative review on recent developments in the field of experimental clinical psychology and clinical social neuroscience that employs a second-person approach to studying social impairments in Autism Spectrum Disorder (ASD), Personality Disorder, Social Anxiety Disorder (SAD), and Schizophrenia.
Recent developments in methodological, analytical, and technical approaches, such as dual eye-tracking, mobile eye-tracking, live video-feed, hyperscanning, or motion capture allow for a more ecologically valid assessment of social functioning. In individuals with ASD, these methods revealed reduced sensitivity to the presence of a real interaction partner as well as diminished behavioral and neural synchronicity with interaction partners. Initial evidence suggests that interactive paradigms might be a powerful tool to reveal reduced interpersonal sensitivity in Personality Disorders and increased interpersonal sensitivity in individuals with SAD.
A shift towards adapting a second-person account has clearly benefitted research on social interaction in psychopathology. Several studies showed profound differences in behavioral and neural measures during actual social interactions, as compared to engaging participants as mere observers. While research using truly interactive paradigms is still in its infancy, it holds great potential for clinical research on social interaction.
We review studies adopting a second-person account of social interaction in clinical psychology.
Studies show profound differences between actual social interactions and mere observations.
The full extent of impairments in social functioning unfolds only in complex social interactions.
New methodological developments hold great potential for research on social interaction deficits.
We review studies adopting a second-person account of social interaction in clinical psychology.
Studies show profound differences between actual social interactions and mere observations.
The full extent of impairments in social functioning unfolds only in complex social interactions.
New methodological developments hold great potential for research on social interaction deficits.
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Do TTH, Correa-Velez I, Dunne MP. Trauma Exposure and Mental Health Problems Among Adults in Central Vietnam: A Randomized Cross-Sectional Survey. Front Psychiatry 2019; 10:31. [PMID: 30853915 PMCID: PMC6395446 DOI: 10.3389/fpsyt.2019.00031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/18/2019] [Indexed: 11/13/2022] Open
Abstract
Background: There is relatively little evidence about the psychological and social impacts of trauma exposure in the general population in East Asian countries. Vietnam has a long history of war and poverty, is prone to natural disasters and has high mortality related to traffic accidents. The mental health systems may be inadequate to cope with the resultant trauma. Objectives: This research examines the lifetime prevalence of single and multiple traumas and the association between trauma exposure and depression, anxiety and post-traumatic stress disorder (PTSD) among a randomly selected sample of the adult population in Thua Thien-Hue province in central Vietnam. Methods: Six hundred and eight Vietnamese adults aged 18 years or older participated in the survey. The main tools in the face-to-face interview included the Life Event Checklist (LEC) to measure trauma exposure, the Hospital Anxiety and Depression Scale (HADS) and the PTSD Checklist for DSM-IV (PCL-IV). Hierarchical multiple logistic regression was used to examine associations between trauma exposure and mental health. Results: Forty seven percent of the participants experienced at least one traumatic event in their lifetime and about half of these people were exposed to multiple traumas. The prevalence of depression, anxiety, and PTSD symptoms among the total sample was 12.7, 15.5, and 6.9%, respectively. Prevalence of PTSD among those reporting trauma exposure was 14.8%. Exposure to a higher number of trauma types was associated with increased risk of having depression, anxiety, and PTSD symptoms. Interpersonal traumas were strongly associated with symptoms of all three mental disorders while non-interpersonal traumas were only associated with depressive symptoms. Conclusion: Our findings indicate high burden of lifetime trauma and mental ill health in the adult population of central Vietnam and show a cumulative effect of multiple traumas on symptoms of the three mental disorders. Interpersonal trauma appears to have a more harmful effect on mental health than non-interpersonal trauma. Efforts to improve mental health in Vietnam should focus on reducing risk of preventable interpersonal trauma in every stage of life, and more broadly, ensure greater availability of trauma-sensitive mental health programs and services.
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Affiliation(s)
- Trang Thi Hanh Do
- Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ignacio Correa-Velez
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michael P Dunne
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Community Health Research, Hue University, Hue, Vietnam
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Adams GC, Wrath AJ, Mondal P, Asmundson GJG. Depression with or without comorbid social anxiety: Is attachment the culprit? Psychiatry Res 2018; 269:86-92. [PMID: 30145307 DOI: 10.1016/j.psychres.2018.08.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 12/27/2022]
Abstract
Major depressive disorder (MDD) frequently co-occurs with social anxiety disorder (SAD), and their comorbidity (MDD-SAD) increases clinical severity and functional impairment. Still, the specific psychological vulnerabilities of individuals with MDD-SAD are poorly understood. Individual attachment characteristics develop early in life through interactions with primary caregivers, and tend to persist throughout life. Early trauma can worsen attachment insecurity, increasing the risk for future anxiety and depression. The purpose of this study is to examine differences in individual attachment and history of trauma in depressed individuals with or without comorbid SAD and controls. One hundred sixty-two participants were categorized into three groups based on SCID-I interview: healthy controls (HC), individuals with current MDD without SAD (MDD), and individuals with current MDD comorbid with SAD (MDD-SAD). MDD-SAD group had significantly greater attachment anxiety and attachment avoidance compared to the MDD and HC groups. MDD-SAD group had greater clinician-rated depression severity and dysfunction compared to MDD group. In summary, the study further supports the clinical risks associated with MDD-SAD and suggests that insecure attachment might represent an associated vulnerability and a possible pathway which warrants further research and clinical attention.
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Affiliation(s)
- G Camelia Adams
- Department of Psychiatry, University of Saskatchewan, Ellis Hall Room 124 Royal University Hospital 103 Hospital Drive Saskatoon, Saskatoon, Saskatchewan, S7N 0W8, Canada.
| | - Andrew J Wrath
- Department of Psychiatry, University of Saskatchewan, Ellis Hall Room 124 Royal University Hospital 103 Hospital Drive Saskatoon, Saskatoon, Saskatchewan, S7N 0W8, Canada
| | - Prosanta Mondal
- Department of Psychiatry, University of Saskatchewan, Ellis Hall Room 124 Royal University Hospital 103 Hospital Drive Saskatoon, Saskatoon, Saskatchewan, S7N 0W8, Canada
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Liu D, Liu S, Liu X, Zhang C, Li A, Jin C, Chen Y, Wang H, Zhang X. Interactive Brain Activity: Review and Progress on EEG-Based Hyperscanning in Social Interactions. Front Psychol 2018; 9:1862. [PMID: 30349495 PMCID: PMC6186988 DOI: 10.3389/fpsyg.2018.01862] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/12/2018] [Indexed: 01/25/2023] Open
Abstract
When individuals interact with others, perceived information is transmitted among their brains. The EEG-based hyperscanning technique, which provides an approach to explore dynamic brain activities between two or more interactive individuals and their underlying neural mechanisms, has been applied to study different aspects of social interactions since 2010. Recently there has been an increase in research on EEG-based hyperscanning of social interactions. This paper summarizes the application of EEG-based hyperscanning on the dynamic brain activities during social interactions according to the experimental designs and contents, discusses the possibility of applying inter-brain synchrony to social communication systems and analyzes the contributions and the limitations of these investigations. Furthermore, this paper sheds light on some new challenges to future EEG-based hyperscanning studies and the emerging field of EEG-based hyperscanning for pursuing the broader research field of social interactions.
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Affiliation(s)
- Difei Liu
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, China.,Department of Education, Hefei University, Hefei, China
| | - Shen Liu
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, China
| | - Xiaoming Liu
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, China.,School of Foreign Languages, Anhui Jianzhu University, Hefei, China
| | - Chong Zhang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Aosika Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Chenggong Jin
- CAS Key Laboratory of Brain Function and Disease, and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Yijun Chen
- School of Chemistry and Materials Science, University of Science and Technology of China, Hefei, China
| | - Hangwei Wang
- CAS Key Laboratory of Brain Function and Disease, and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Xiaochu Zhang
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, China.,CAS Key Laboratory of Brain Function and Disease, and School of Life Sciences, University of Science and Technology of China, Hefei, China.,Hefei Medical Research Center on Alcohol Addiction, Anhui Mental Health Center, Hefei, China.,Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
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57
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Ward KP, Shaw SA, Chang M, El-Bassel N. Social Support Moderates the Association Between Traumatic Life Events and Depression Among Migrant and Nonmigrant Men in Almaty, Kazakhstan. J Trauma Stress 2018; 31:698-707. [PMID: 30338586 DOI: 10.1002/jts.22324] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 04/20/2018] [Accepted: 05/21/2018] [Indexed: 11/08/2022]
Abstract
Across cultures, experiencing traumatic life events, particularly violence, is a salient predictor of depression. Some previous findings have shown that social support can serve as a buffer in the association between traumatic life events and depression (i.e., the buffering hypothesis) in that individuals with a high level of social support have a decreased or nonexistent association between traumatic life events and depression. The purpose of this study was to test the buffering hypothesis among a sample of 1,342 male migrant and nonmigrant market vendors in Almaty, Kazakhstan. Using multiple-group structural equation modeling (SEM), we identified the following results: (a) higher levels of traumatic life events were associated with higher depression scores, (b) higher social support scores were associated with decreased depression scores, and (c) social support buffered the association between traumatic life events and depression among migrants and nonmigrants. The final model accounted for 45.0% and 38.4% of the variance in depression for migrants and nonmigrants, respectively. Findings suggest that social support may be an important protective factor for men in Kazakhstan who have experienced trauma and call for an incorporation of social support interventions for migrant and nonmigrant men experiencing depression.
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Affiliation(s)
- Kaitlin P Ward
- Brigham Young University School of Social Work, Provo, Utah, USA
| | - Stacey A Shaw
- Brigham Young University School of Social Work, Provo, Utah, USA
| | - Mingway Chang
- Columbia University School of Social Work, New York, New York, USA
| | - Nabila El-Bassel
- Columbia University School of Social Work, New York, New York, USA
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Emotional rigidity negatively impacts remission from anxiety and recovery of well-being. J Affect Disord 2018; 236:69-74. [PMID: 29723764 DOI: 10.1016/j.jad.2018.04.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Emotional rigidity is described in clinical literature as a significant barrier to recovery; however, few there are few empirical measures of the construct. The current study had two aims: Study 1 aimed to identify latent factors that may bear on the construct of emotional rigidity while Study 2 assessed the potential impact of the latent factor(s) on anxiety remission rates and well-being. METHOD This study utilized data from 2472 adult inpatients (1176 females and 1296 males) with severe psychopathology. Study 1 utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to identify latent factors of emotional rigidity. Study 2 utilized hierarchical logistic regression analyses to assess the relationships among emotional rigidity factors and anxiety remission and well-being recovery at discharge. RESULTS Study 1 yielded a two-factor solution identified in EFA was confirmed with CFA. Factor 1 consisted of neuroticism, experiential avoidance, non-acceptance of emotions, impaired goal-directed behavior, impulse control difficulties and limited access to emotion regulation strategies when experiencing negative emotions. Factor 2 consisted of lack of emotional awareness and lack of emotional clarity when experiencing negative emotions. Results of Study 2 indicated higher scores on Factor 1 was associated with lower remission rates from anxiety and poorer well-being upon discharge. Factor 2 was not predictive of outcome. CONCLUSIONS Emotional rigidity appears to be a latent construct that negatively impacts remission rates from anxiety. Limitations of the present study include its retrospective design, and inefficient methods of assessing emotional rigidity.
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Interpersonal trauma and hoarding: The mediating role of aggression. J Affect Disord 2018; 227:512-516. [PMID: 29161672 DOI: 10.1016/j.jad.2017.11.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/06/2017] [Accepted: 11/12/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND A growing body of literature indicates that exposure to interpersonal trauma contributes to the onset or exacerbation of hoarding symptoms. However, little research has explored psychosocial factors that may help to explain the relationship between interpersonal trauma and hoarding symptoms. One outcome of trauma exposure that may be associated with hoarding symptoms is aggression, defined as the tendency to experience and express hostility and anger, and to engage in aggressive behavior. Therefore, the current study examined the relationship between hoarding and aggression, as well as the mediating role of aggression in the relationship between exposure to interpersonal trauma and hoarding symptoms. METHODS Community participants (n = 258) completed a battery of questionnaires assessing trauma exposure, hoarding symptoms, aggression, and negative affect. RESULTS Results revealed that when accounting for negative affect, hoarding symptoms were associated with greater aggression, and the relationship between exposure to interpersonal trauma and hoarding symptoms was mediated by aggression. Specificity analyses indicated that depression symptoms and emotion dysregulation did not mediate the relationship between interpersonal trauma exposure and hoarding, providing further support for the importance of aggression. LIMITATIONS Findings should be interpreted in light of limitations, including the use of cross-sectional and self-report data, and a general community sample. CONCLUSIONS Taken together, our findings suggest that interpersonal processes, such as aggression toward others, may be associated with increased hoarding symptoms.
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60
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Interpersonal trauma moderates the relationship between personality factors and suicidality of individuals with posttraumatic stress disorder. PLoS One 2018; 13:e0191198. [PMID: 29329352 PMCID: PMC5766138 DOI: 10.1371/journal.pone.0191198] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/30/2017] [Indexed: 11/25/2022] Open
Abstract
Individuals with posttraumatic stress disorder (PTSD) are more prone to suicidal ideation and behavior. While those who have experienced interpersonal trauma exhibit more suicidality than those who have experienced non-interpersonal trauma, it is unclear how the traumatic effects are related to an individual’s personality characteristics. This study examined the association between interpersonal trauma and personality factors with suicidality, and elucidated the moderating role of interpersonal trauma in individuals with PTSD. The study included 6,022 participants from the Korean Epidemiologic Catchment Area Study 2011. The Korean Version of Composite International Diagnostic Interview was used for the survey, including the participants’ history of suicidality, the traumas they have experienced, and their PTSD symptoms. The 11-item version of the Big Five Inventory (BFI-11) was used to assess the participants’ personality factors. 76 individuals were diagnosed with PTSD, while 810 had been exposed to trauma but were not diagnosed with any DSM-IV mental disorder. Among the individuals with PTSD, those who had experienced interpersonal trauma were more likely to have suicidal ideation than those who had experienced non-interpersonal trauma (p = .020; odds ratio [OR] = 3.643; 95% confidence interval of OR = [1.226, 10.825]). High agreeableness and conscientiousness predicted less suicidality in those exposed to non-interpersonal trauma, while predicting more suicidality in those exposed to interpersonal trauma. Clinicians examining individuals with PTSD should pay closer attention to the trauma that they have experienced, as well as their personality factors, to provide appropriate treatment.
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61
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Miu AC, Bîlc MI, Bunea I, Szentágotai-Tătar A. Childhood trauma and sensitivity to reward and punishment: Implications for depressive and anxiety symptoms. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Nowakowski-Sims E, Rowe A. The relationship between childhood adversity, attachment, and internalizing behaviors in a diversion program for child-to-mother violence. CHILD ABUSE & NEGLECT 2017; 72:266-275. [PMID: 28865397 DOI: 10.1016/j.chiabu.2017.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/06/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
Very little research has been conducted on the role of childhood adversity in child-to-parent violence. Childhood adversity places youth at risk for internalizing behaviors (i.e. anxiety and depression) and externalizing behaviors (i.e. aggression). The purpose of this study was to explore the relationships between childhood adversity, child-mother attachment, and internalizing behaviors among a sample of 80 youth who have been arrested for domestic battery against a mother. This study reported high prevalence rates of childhood adversity (mean score of 10 out of 17 events). Multiple regression analysis indicated that insecure attachment predicted depression among females (F(6, 73)=4.87, p<0.001), and previous experience with child maltreatment and/or witness to parental violence predicted anxiety among females (F(6, 73)=3.08, p<0.01). This study is the first study to explore childhood adversity among a sample of perpetrators of child-to-mother violence and notably adds to our understanding of the multiple pathways connecting childhood adversity, child-mother attachment, and depression and anxiety among a difficult to treat youth population.
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63
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Patient-reported Outcomes in Practice: Clinicians' Perspectives From an Inpatient Psychiatric Setting. J Psychiatr Pract 2017; 23:312-319. [PMID: 28961660 DOI: 10.1097/pra.0000000000000250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of patient-reported outcomes (PROs) has become increasingly common. They have been used to assess quality of care and to support policy decisions, but the evidence concerning their utility to improve patient outcomes is inconsistent. A better understanding of clinicians' experience with PROs has the potential to improve their effectiveness. This exploratory, quantitative, and qualitative study investigated the perspectives of clinicians (N=70) from multiple disciplines (psychiatrists, psychologists, social workers, and psychiatric nurses) on the utility of PROs in an inpatient psychiatric setting. During scheduled, monthly, discipline-specific administrative meetings, clinicians in attendance completed a 1-time, 5-item survey. The highest rated item related to the frequency of reviewing outcomes reports; this item was rated higher than all other items (mean±SD, 4.5±1.5), which 37.5% of the participants in the overall sample stated they "always" did. The lowest rated item related to the frequency of conveying the results of the outcomes reports to patients (3.3±1.9), which 20% of participants reported "always" doing; this item was rated lower than all other items (P<0.03). Qualitative analyses were based on 30 comments from 22 clinicians, which resulted in the emergence of 6 themes. The 2 themes that received the highest number of comments related to: (1) the sensitivity and specificity of measures across the PROs platform and (2) the value of the reports in directly influencing treatment decisions. Clinicians' relatively favorable perspective of PROs in practice in this study may be related to the assessment-oriented culture at the study institution. Nonetheless, many barriers to the routine use of PROs exist. Addressing clinician concerns has the potential to improve utilization of this facet of good clinical care.
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Huang YL, Chen SH, Su YJ, Kung YW. Attachment Dimensions and Post-traumatic Symptoms Following Interpersonal Traumas versus Impersonal Traumas in Young Adults in Taiwan. Stress Health 2017; 33:233-243. [PMID: 27509839 DOI: 10.1002/smi.2702] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 11/09/2022]
Abstract
Greater risk of post-traumatic stress disorder (PTSD) is seen in individuals exposed to interpersonal traumatic events. Based on an attachment perspective, interpersonal trauma exposure may activate one's attachment insecurity system and disrupt affect, behaviour and interpersonal function, which may in turn create more difficulties to cope with interpersonal traumas and exacerbate PTSD symptomatology. The present study examined whether attachment anxiety relative to attachment avoidance would be a stronger predictor of greater PTSD symptoms following interpersonal traumas versus impersonal traumas in a Taiwanese sample. One hundred and sixty-two trauma-exposed Taiwanese young adults completed the measures of symptoms of depression, anxiety and PTSD, and attachment anxiety and attachment avoidance. In this Taiwanese study, higher attachment anxiety was observed in individuals who were exposed to interpersonal traumas. The interpersonal trauma group reported greater PTSD symptoms than did the impersonal trauma group. Specifically, after controlling for age, occurrence of trauma and distress of trauma, attachment anxiety, but not attachment avoidance, predicted more PTSD total severity and avoidance symptoms in the interpersonal trauma group. The findings may be pertinent to attachment anxiety-related hyperactivating strategies, as well as specific cultural values and a forbearance strategy applied to regulate traumatic distress in a collectivist society. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yu-Lien Huang
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Sue-Huei Chen
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Yi-Jen Su
- Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Wen Kung
- Department of Psychology, Fo Guang University, Yilan, Taiwan
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Abstract
Few studies examine the effect of interpersonal, regulatory or legal coercion on the treatment of depressive symptoms. This retrospective case-control study compared the recovery rates of 574 adults whose level of coercion was scored on a 0-3 scale from fully voluntary to severe coercion when admitted to the Menninger Clinic between 2009 and 2014. The change in Patient Health Questionnaire-9 (PHQ-9) scores (measuring depression severity) from admission to discharge served as the primary outcome measure. Level of coercion was not associated with a difference in rate of improvement in PHQ-9 score. Greater improvement in PHQ-9 scores was associated with (a) older age, (b) lack of a psychotic spectrum disorder diagnosis, (c) stronger working alliance with treatment team, and (d) less difficulty with emotional regulation [lower Difficulties in Emotion Regulation Scale (DERS) scores]. DERS scores were the most impactful factor. This study suggests that licensure boards can continue to mandate treatment despite concerns that coercion may decrease treatment effectiveness.
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Allen JG, Fowler JC, Madan A, Ellis TE, Oldham JM, Frueh BC. Discovering the impact of psychotherapeutic hospital treatment for adults with serious mental illness. Bull Menninger Clin 2017; 81:1-38. [DOI: 10.1521/bumc.2017.81.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jon G. Allen
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | | | - Alok Madan
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Thomas E. Ellis
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - John M. Oldham
- The Menninger Clinic, Houston, Texas
- Baylor College of Medicine, Houston, Texas
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Treatment outcomes for inpatients with obsessive-compulsive personality disorder: An open comparison trial. J Affect Disord 2017; 209:273-278. [PMID: 27988411 DOI: 10.1016/j.jad.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/22/2016] [Accepted: 12/04/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current case-control study compared rates of clinically significant and reliable change in psychopathology and global functioning, prevalence of clinical deterioration, and rates of symptom remission among adult patients with obsessive compulsive personality disorder OCPD (n=52) and well-matched inpatients with any other personality disorder (n=56) and no personality disorder (n=53). METHODS Propensity score matching (PSM) was utilized to select patients matched on specific criteria present in the OCPD group. Multivariate analysis of variance models measured differences in admission functioning and RCI change across depression and anxiety severity, emotion dysregulation and suicidal ideation. RESULTS Patients diagnosed with OCPD admit to treatment with higher rates of depression, anxiety, difficulty with emotion regulation and non-acceptance of emotional experience than inpatient controls. Furthermore, OCPD patients respond to treatment at a similar rate to inpatient controls, but experience lower rates of anxiety remission upon discharge. Post-hoc analyses indicate individuals meeting stubbornness and rigidity (OCPD Criteria 8) were nine times more likely to report moderate to severe anxiety at point of discharge. LIMITATIONS Limitations include a predominantly Caucasian, inpatient sample, use of self-report measures and a non-manualized treatment approach. CONCLUSIONS Overall, OCPD inpatients benefit from an intensive multimodal psychiatric treatment, but experience more anxiety than non-PD patients upon discharge.
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Fowler JC, Clapp JD, Madan A, Allen JG, Frueh BC, Oldham JM. An Open Effectiveness Trial of a Multimodal Inpatient Treatment for Depression and Anxiety Among Adults With Serious Mental Illness. Psychiatry 2017; 80:42-54. [PMID: 28409715 DOI: 10.1080/00332747.2016.1196072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This prospective open effectiveness trial examined symptom change trajectories and rates of remission from depression and anxiety in an intensive multimodal inpatient treatment for adults with serious mental illness (SMI). Patient baseline characteristics were examined as mediators/moderators of treatment response. METHODS Adult inpatients with SMI (N = 994) completed an average of 39 days of inpatient treatment. Latent growth curve (LGC) methods were used to model symptom trajectories, estimating expected remission based on individual patterns of change observed across the sample. RESULTS Absolute reductions in symptoms were substantial, with large effect size improvements for both depression (d = 1.21, 95% CI [1.13, 1.29]) and anxiety (d = 1.13, 95% CI [1.05, 1.21]). For those presenting with elevated depressive symptoms (Patient Health Questionnaire-Depression ≥ 5.0; 87.5% of the sample), 46.9% evidenced remission from admission to discharge. Among patients presenting with significant anxiety (Patient Health Questionnaire-Generalized Anxiety Disorder Screener ≥ 5.0; 84.5% of the sample), 50.0% evidenced remission from admission to discharge. Mediation analyses revealed that depression and anxiety severity decreased more rapidly with increasing age and initial levels of experiential avoidance. CONCLUSIONS Rates of remission of depression and anxiety were greater than anticipated in this large cohort of adult SMI inpatients and may be related to intensity and length of hospitalization.
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Emotion dysregulation as a cross-cutting target for inpatient psychiatric intervention. J Affect Disord 2016; 206:224-231. [PMID: 27479535 DOI: 10.1016/j.jad.2016.07.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/20/2016] [Accepted: 07/09/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND This prospective, open effectiveness trial examined trajectories of change in a cross-cutting measure of emotion dysregulation in an intensive multimodal inpatient treatment for adults experiencing serious mental illness (SMI). METHODS Adult inpatients with SMI (N=994) completed an average of 38.6 days of inpatient treatment. Latent growth curve (LGC) methods were used to model emotion dysregulation trajectories, estimating expected remission based on individual patterns of change. RESULTS Absolute reductions in experiential avoidance (d=1.03, CI95% [.94, 1.10]) and emotional dysregulation were substantial with large effect size improvements (d=.98, CI95% [.90, 1.05]). Initial scores for experiential avoidance and emotion dysregulation were higher for patients with diagnoses of bipolar, depressive, anxiety, and personality disorders; whereas, male gender was associated with lower initial scores. Substance use diagnoses were associated with rapid improvement in experiential avoidance and specific emotion dysregulation involving goal-directed behavior and impulse control. Presence of a personality disorder predicted rapid improvement in overall emotion dysregulation and clarity of emotional experiences. CONCLUSIONS Adults with SMI demonstrated substantial improvement in experiential avoidance and emotion dysregulation over the course of intensive inpatient treatment, with significant variability in patterns of change. Substance use and personality disorders were associated with rapid improvements in specific aspects of emotion dysregulation.
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70
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Haldane J, Nickerson A. The Impact of Interpersonal and Noninterpersonal Trauma on Psychological Symptoms in Refugees: The Moderating Role of Gender and Trauma Type. J Trauma Stress 2016; 29:457-465. [PMID: 27603167 DOI: 10.1002/jts.22132] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/17/2016] [Accepted: 07/12/2016] [Indexed: 12/12/2022]
Abstract
Research findings have documented a relationship between the number of types of traumatic events to which refugees were exposed and psychological disorders. It is unclear, however, if gender moderates the impact of trauma on refugee mental health. The participants in this study were 60 male and 31 female refugees and asylum-seekers resettled in Australia. Participants had a mean age of 34.54 years (SD = 9.70), and were from a variety of countries including Iraq, Iran, and Sri Lanka. We conducted a multigroup path analysis to test if the relationship between psychological outcomes of exposure to trauma (posttraumatic stress disorder [PTSD] symptoms, symptoms of anxiety, and symptoms of depression) was different as a function of the type of traumatic exposure (interpersonal vs. noninterpersonal) or as a function of gender. We found a significant relationship between interpersonal trauma exposure and PTSD symptoms (β = .77) and anxiety symptoms (β = .32) in women, and a significant association between noninterpersonal trauma exposure and PTSD symptoms (β = .59), anxiety (β =.49), and depression symptoms (β = .32) in men. For men, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = 0.14 to 1.01; for exposure to interpersonal trauma, they ranged from d = -0.53 to 0.43. For women, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = -0.79 to 0.67; for exposure to interpersonal trauma, they ranged from d = -0.09 to 1.46. These results suggested supporting refugees in their efforts to overcome the psychological impact of trauma, including the allocation of resources in clinical services to support the psychological recovery of refugees.
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Affiliation(s)
- Joanne Haldane
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Angela Nickerson
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia.
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Abstract
Psychiatric disorders can affect our ability to successfully and enjoyably interact with others. Conversely, having difficulties in social relations is known to increase the risk of developing a psychiatric disorder. In this article, the assumption that psychiatric disorders can be construed as disorders of social interaction is reviewed from a clinical point of view. Furthermore, it is argued that a psychiatrically motivated focus on the dynamics of social interaction may help to provide new perspectives for the field of social neuroscience. Such progress may be crucial to realize social neuroscience's translational potential and to advance the transdiagnostic investigation of the neurobiology of psychiatric disorders.
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Affiliation(s)
- Leonhard Schilbach
- Independent Max Planck Research Group for Social Neuroscience, Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, München-Schwabing 80804, Germany Department of Psychiatry, University Hospital Cologne, Kerpener Strasse 62, Cologne 50924, Germany
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72
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Özcan NK, Boyacioğlu NE, Enginkaya S, Bilgin H, Tomruk NB. The relationship between attachment styles and childhood trauma: a transgenerational perspective - a controlled study of patients with psychiatric disorders. J Clin Nurs 2016; 25:2357-66. [DOI: 10.1111/jocn.13274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Neslihan K Özcan
- Midwife Department; Istanbul University Health Sciences Faculty; Istanbul Turkey
| | - Nur E Boyacioğlu
- Midwife Department; Istanbul University Health Sciences Faculty; Istanbul Turkey
| | - Semra Enginkaya
- Bakırköy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery; Istanbul Turkey
| | - Hülya Bilgin
- Mental Health and Psychiatric Nursing Department; Florence Nightingale Nursing Faculty; Istanbul University; Istanbul Turkey
| | - Nesrin B Tomruk
- Bakırköy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery; Istanbul Turkey
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Zare L, Refahi Z. The Prediction of Depression by the Early Trauma and Maladaptive Schema in 11 - 13 Year-Old Students. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2016. [DOI: 10.17795/intjsh-29074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Park SC, Kim D, Jang EY. Prevalence and symptomatic correlates of interpersonal trauma in South Korean outpatients with major depressive disorder. Compr Psychiatry 2016; 66:46-52. [PMID: 26995235 DOI: 10.1016/j.comppsych.2015.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is growing evidence that exposure to severe interpersonal trauma (IPT) has a pivotal role in the development and manifestation of depression. However, it is not clearly understood whether patients with major depressive disorder (MDD) have specifically increased prevalence of IPT than other non-interpersonal traumatic events and whether those with IPT have unique symptom profile within depressed groups. In this study, we investigated the prevalence of past traumatic events and symptomatic features of treatment-seeking outpatients with MDD. METHODS A consecutive sample of 111 South Korean outpatients with MDD was recruited on their first visit to a psychiatric department of a university-affiliated hospital. Participants completed the Life Events Checklist (LEC), the Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Dissociative Experience Scale (DES) and Impact of Event Scale-Revised (IES-R). The prevalence of past traumatic events on LEC was compared to medical outpatients. RESULTS Compared to medical outpatients, MDD patients had significantly higher rates of IPT (physical and sexual) but not other traumatic events of non-interpersonal origin such as accidents or disaster. Compared to MDD patients without IPT (n=44, 40%), those with IPT (n=67, 60%) had higher subscale scores on hostility in SCL-90-R, as well as greater depressive and post-traumatic symptoms. However, multivariate analysis revealed that the best model to discriminate those with IPT was interaction of depressive and posttraumatic symptoms. LIMITATIONS Limitations include sample characteristics (treatment-seeking outpatients) and possible effects of comorbid conditions, which were not investigated. CONCLUSIONS Clinicians managing individuals with depressive disorder need to include the assessment of lifetime IPT and its impact on presenting symptoms.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Republic of Korea; Institute of Mental Health, Hanyang University, Seoul, Republic of Korea
| | - Daeho Kim
- Department of Psychiatry, Hanyang University Medical School, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea.
| | - Eun Young Jang
- Department of Psychiatry, Hanyang University Medical School, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
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75
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Improvements in Somatic Complaints Among Individuals With Serious Mental Illness Receiving Treatment in a Psychiatric Hospital. Psychosom Med 2016; 78:271-80. [PMID: 26867074 DOI: 10.1097/psy.0000000000000298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) experience significant comorbid somatic complaints. Little is known about response to integrated inpatient care that addresses psychiatric and general medical needs among individuals with SMI. METHODS Latent growth curve analyses were used to model somatic symptom trajectories across adult inpatients with SMI (n = 989). The Patient Health Questionnaire-15 (PHQ-15) was administered at admission, every 14 days, and at discharge. RESULTS Patients evidenced substantial reduction in somatization from admission (mean [standard deviation] = 9.0 [5.2]) to discharge (mean [standard deviation] = 5.2 [4.4]), with large effects (d = 0.83, 95% confidence interval = 0.76-0.90). Results indicate nonlinear improvement in somatic symptoms for 8 weeks of treatment, with greatest symptom reduction occurring during the first weeks of treatment with continued, albeit slowed, improvement until discharge. Initial PHQ-15 scores were lower among men and those who reported regular exercise in the 30 days preceding this hospitalization. In addition, presence of an anxiety disorder or personality disorder at admission; history of trauma, a gastrointestinal disorder, or major medical illness (within the past 3 months); and significant sleep disturbance independently contribute to higher PHQ-15 scores at admission. A substance use disorder and sleep disturbance were associated with greater immediate symptom reduction. CONCLUSIONS Somatic complaints can be managed in the context of inpatient psychiatric care integrated with 24-hour nursing and internal medicine specialists. Addressing psychiatric impairments, improving sleep, and ensuring abstinence from drugs and alcohol are associated with significant improvement in somatic complaints.
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Shaw AM, Witcraft SM, Timpano KR. The Relationship between Traumatic Life Events and Hoarding Symptoms: A Multi-Method Approach. Cogn Behav Ther 2016; 45:49-59. [PMID: 26895444 DOI: 10.1080/16506073.2015.1101150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hoarding Disorder is characterized by difficulties with discarding and frequently excessively acquiring possessions, resulting in substantial clutter. Previous research has implicated trauma in the development of hoarding, but no study to date has examined the relationship between trauma and hoarding using hypothetical hoarding paradigms. This study investigated the association between traumatic events and both self-report and hypothetical indices of hoarding symptoms. We predicted that frequency of trauma would be associated with greater hoarding symptoms (across self-report and hypothetical indices). Undergraduate students (N = 80) completed self-report measures of hoarding symptoms and trauma, and hypothetical measures of acquiring and saving tendencies. As expected, more frequent trauma, and physical/sexual trauma in particular, was associated with greater acquiring tendencies. However, frequency of trauma was not significantly correlated with saving tendencies or self-reported hoarding symptoms. Future research should replicate these findings using longitudinal designs to confirm whether trauma actually serves as a risk factor for hoarding. Replication in a clinical sample is needed to better understand the implications of these results for intervention.
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Affiliation(s)
- Ashley M Shaw
- a Department of Psychology , University of Miami 5665 Ponce de Leon Blvd. , Coral Gables , USA
| | - Sara M Witcraft
- b Department of Psychology , University of Texas at Austin , Austin , USA
| | - Kiara R Timpano
- a Department of Psychology , University of Miami 5665 Ponce de Leon Blvd. , Coral Gables , USA
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77
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Wiltgen A, Arbona C, Frankel L, Frueh BC. Interpersonal trauma, attachment insecurity and anxiety in an inpatient psychiatric population. J Anxiety Disord 2015; 35:82-7. [PMID: 26398370 DOI: 10.1016/j.janxdis.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/01/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
Current research suggests that interpersonal trauma has an impact on insecure attachment and anxiety. Some research further suggests that attachment may play a mediating role between traumatic events and psychopathology. The purpose of this study was to examine the relationship between the experience of interpersonal trauma, attachment anxiety, attachment avoidance and clinical anxiety severity among adult psychiatric inpatients who reported having experienced interpersonal trauma after the age of 16. It was hypothesized that attachment anxiety and attachment avoidance would mediate the relationship between interpersonal trauma and clinical anxiety level. This study used archival data on 414 adult psychiatric inpatients in a large city in the Southwest U.S. Results suggest that interpersonal trauma was correlated to attachment avoidance but not to attachment anxiety and that attachment avoidance partially mediated the relation of interpersonal trauma to anxiety. The attachment framework appositely explains how a negative model of other contributes to the relation between experiences of interpersonal trauma and anxiety in adulthood.
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Affiliation(s)
- Anika Wiltgen
- The Menninger Clinic, 12301 S. Main Street, Houston, TX 77035, USA.
| | - Consuelo Arbona
- The University of Houston, 4800 Calhoun Road, Houston, TX 77004, USA
| | - Leslie Frankel
- The University of Houston, 4800 Calhoun Road, Houston, TX 77004, USA
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78
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Allen JG, Madan A, Fowler JC. Reliability and validity of the Stressful Life Events Screening Questionnaire among inpatients with severe neuropsychiatric illness. Bull Menninger Clin 2015; 79:187-202. [DOI: 10.1521/bumc.2015.79.3.187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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79
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Fowler JC, Patriquin M, Madan A, Allen JG, Frueh BC, Oldham JM. Early identification of treatment non-response utilizing the Patient Health Questionnaire (PHQ-9). J Psychiatr Res 2015; 68:114-9. [PMID: 26228409 DOI: 10.1016/j.jpsychires.2015.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment non-response among high-risk, psychiatric patients exposes those suffering to suicidal risk as well as persistent social and occupational difficulties. Strategies for identification of treatment non-response are limited. AIMS Diagnostic efficiency of a self-report, cross-cutting symptom measure was assessed as a marker of treatment non-response. METHOD 835 inpatients at a specialist psychiatric hospital completed the Patient Health Questionnaire - Depression (PHQ-9) at admission and every two weeks during hospitalization. RESULTS For patients admitted with severe depression (PHQ-9 ≥ 20), results indicated good accuracy of 2-week PHQ-9 change score in identifying treatment non-response (AUC = 0.80, SE = 0.04, p < .0001; sensitivity = 85%; specificity = 73%; OR = 14.91). CONCLUSIONS The search for predictors of non-response to psychiatric treatment has a long and generally unfulfilled history. The PHQ-9 change score holds promise as a cost-effective test with comparable diagnostic characteristics to other medical tests.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Michelle Patriquin
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Alok Madan
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Jon G Allen
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - B Christopher Frueh
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; University of Hawaii, Department of Psychology, 200 West Kawili St., Hilo, HI 96720, USA
| | - John M Oldham
- The Menninger Clinic, 12301 Main Street Houston, TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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80
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Bizzi F, Cavanna D, Castellano R, Pace CS. Children's mental representations with respect to caregivers and post-traumatic symptomatology in Somatic Symptom Disorders and Disruptive Behavior Disorders. Front Psychol 2015; 6:1125. [PMID: 26284022 PMCID: PMC4522510 DOI: 10.3389/fpsyg.2015.01125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022] Open
Abstract
Introduction: In line with literature, the quality of adult–infant interactions and mental representations of the caregivers play an essential role in influencing the children’s well-being. Many studies focused the attention on the role of attachment for a better evaluation of child psychopathological outcomes. The flexibility of the child’s attachment model gives the opportunity to parents to be helped in modifying their own caregiving quality, encouraging the reflection on the children’s state of mind with respect to attachment. The aims of this study were to evaluate: (1) the attachment models in young patients diagnosed with Disruptive Behavior Disorders (DBDs) and Somatic Symptoms Disorders (SSDs); (2) the levels of post-traumatic symptomatology; (3) the association between the attachment models and post-traumatic symptomatology. Methods: Forty Italian patients, aged from 8 to 15, recruited at Gaslini Paediatric Hospital of Genoa, previously diagnosed with SSD (N = 20) and DBD (N = 20) were assessed using the Child Attachment Interview (CAI), the Separation Anxiety Test (SAT), the Trauma Symptom Checklist for Children (TSCC-A). Socio-demographic data were collected. Results: In both the clinical samples, the findings on the distribution of attachment models showed a significant presence of insecure attachment with respect to both parents in more than a half of the patients and high levels of disorganized attachment. No significant differences between DBD and SSD samples were found on post-traumatic symptomatology (Post-Traumatic Stress and Dissociation). Significant differences were found on Depression, Anxiety, and Fantasy subscales. Discussion: This study can provide a detection of dysfunctional aspects in clinical populations. The findings suggest that the quality of the attachment to parents may be a fundamental element to better assess SSD and DBD in children and adolescents. Clinical implications of this study aimed at improving parental caregiving are highlighted.
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Affiliation(s)
- Fabiola Bizzi
- Department of Educational Science, University of Genoa Genoa, Italy
| | | | | | - Cecilia S Pace
- Department of Educational Science, University of Genoa Genoa, Italy
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81
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Wickham S, Sitko K, Bentall RP. Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: the mediating role of negative self-esteem. Psychol Med 2015; 45:1495-1507. [PMID: 25388512 DOI: 10.1017/s0033291714002633] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A growing body of research has investigated associations between insecure attachment styles and psychosis. However, despite good theoretical and epidemiological reasons for hypothesising that insecure attachment may be specifically implicated in paranoid delusions, few studies have considered the role it plays in specific symptoms. METHOD We examined the relationship between attachment style, paranoid beliefs and hallucinatory experiences in a sample of 176 people with a diagnosis of schizophrenia spectrum disorders and 113 healthy controls. We also investigated the possible role of negative self-esteem in mediating this association. RESULTS Insecure attachment predicted paranoia but not hallucinations after co-morbidity between the symptoms was controlled for. Negative self-esteem partially mediated the association between attachment anxiety and clinical paranoia, and fully mediated the relationship between attachment avoidance and clinical paranoia. CONCLUSIONS It may be fruitful to explore attachment representations in psychological treatments for paranoid patients. If future research confirms the importance of disrupted attachment as a risk factor for persecutory delusions, consideration might be given to how to protect vulnerable young people, for example those raised in children's homes.
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Affiliation(s)
- S Wickham
- Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK
| | - K Sitko
- Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK
| | - R P Bentall
- Department of Psychological Sciences,University of Liverpool,Waterhouse Building Block B,Liverpool L69 3GL,UK
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Wiltgen A, Adler H, Smith R, Rufino K, Frazier C, Shepard C, Booker K, Simmons D, Richardson L, Allen JG, Fowler JC. Attachment insecurity and obsessive-compulsive personality disorder among inpatients with serious mental illness. J Affect Disord 2015; 174:411-5. [PMID: 25553401 DOI: 10.1016/j.jad.2014.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obsessive-compulsive personality disorder (OCPD) is characterized by traits such as extreme rigidity, perfectionism, and controlling behavior, all of which have a negative impact on interpersonal functioning. Attachment theory provides a useful framework to elucidate the interpersonal dysfunction characteristic of OCPD; yet, there is a dearth of attachment research on OCPD in the context of severe mental illness. METHODS Attachment security and personality disorders were assessed in adult inpatients with severe mental illness. Propensity Score Matching (PSM) was used to match OCPD and control subjects on age, gender, number of psychiatric disorders, and number of criteria endorsed for borderline personality disorder. RESULTS Consistent with hypotheses, the OCPD group (n=61) showed greater attachment avoidance than controls (n=61), and the avoidance was manifested in a predominance of the most insecure attachment style, fearful attachment. Correlations between attachment anxiety/avoidance with specific OCPD diagnostic criteria revealed that attachment avoidance was correlated with four of eight OCPD criteria across the full sample. Within the subset of OCPD patients, attachment avoidance was significantly correlated with OCPD criterion 3 (is excessively devoted to work and productivity to the exclusion of leisure activities and friendships). LIMITATIONS The use of self-report measure of attachment and the high burden of illness in the SMI population may not generalize to interview based assessment or outpatients, respectively. CONCLUSIONS Findings attest to the severity of impairment in interpersonal functioning and attachment avoidance, in particular, is characteristic of OCPD patients. These results suggest that viable treatment targets include interpersonal functioning along with more classical features of OCPD such as perfectionism and obsessiveness in task performance.
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Affiliation(s)
- Anika Wiltgen
- Menninger Clinic 12301 Main St Houston TX 77035, USA
| | - Herman Adler
- Menninger Clinic 12301 Main St Houston TX 77035, USA
| | - Ryan Smith
- Menninger Clinic 12301 Main St Houston TX 77035, USA
| | - Katrina Rufino
- Menninger Clinic 12301 Main St Houston TX 77035, USA; University of Houston, Downtown 1 Main St, Houston, TX 77002, USA
| | | | | | - Kirk Booker
- Menninger Clinic 12301 Main St Houston TX 77035, USA
| | | | | | - Jon G Allen
- Menninger Clinic 12301 Main St Houston TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - J Christopher Fowler
- Menninger Clinic 12301 Main St Houston TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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83
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Winham KM, Engstrom M, Golder S, Renn T, Higgins GE, Logan TK. Childhood victimization, attachment, psychological distress, and substance use among women on probation and parole. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2015; 85:145-158. [PMID: 25822606 DOI: 10.1037/ort0000038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The present analysis was guided by a gendered pathways-based theoretical model and examined relationships between childhood victimization and current attachment, psychological distress, and substance use among 406 women with histories of victimization who were on probation and parole in an urban Kentucky county. Structural equation modeling examined relationships among childhood victimization, attachment, psychological distress, and substance use. Additionally, we examined the mediational role that attachment plays in relationships between childhood victimization and both psychological distress and substance use. The data fit the models properly. Psychological distress was significantly predicted by childhood victimization, and adult attachment partially mediated this relationship. Childhood victimization did not significantly predict substance use; however, attachment did. The findings suggest that attachment may be an important factor to further understand and address in relation to psychological distress and substance use among women with histories of victimization who are involved in the criminal justice system.
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Affiliation(s)
| | - Malitta Engstrom
- School of Social Policy and Practice, University of Pennsylvania
| | - Seana Golder
- Kent School of Social Work, University of Louisville
| | - Tanya Renn
- Kent School of Social Work, University of Louisville
| | | | - T K Logan
- Department of Behavioral Science, University of Kentucky
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Myers B, Jones HE, Doherty IA, Kline TL, Key ME, Johnson K, Wechsberg WM. Correlates of lifetime trauma exposure among pregnant women from Cape Town, South Africa. Int J Ment Health Addict 2015; 13:307-321. [PMID: 27087804 DOI: 10.1007/s11469-015-9544-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A cross-sectional survey of 298 pregnant women from Cape Town, South Africa was conducted to examine socio-demographic, reproductive health, mental health, and relationship correlates of lifetime trauma exposure and whether these correlates vary as a function of age. Overall, 19.8% of participants reported trauma exposure. We found similarities and differences in correlates of trauma exposure among women in emerging adulthood and older women. Prior termination of pregnancy was associated with trauma exposure in both age groups. Difficulties in resolving arguments, lifetime substance use, and a prior sexually transmitted infection were associated with trauma exposure among women in emerging adulthood. In contrast, depression and awareness of substance abuse treatment programmes were associated with trauma exposure among older women. These findings highlight the need for interventions that prevent and treat trauma exposure among vulnerable women. Such interventions should be tailored to address the correlates of trauma exposure in each age group.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hendrée E Jones
- UNC Horizons Program, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, USA; Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Irene A Doherty
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Tracy L Kline
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Mary E Key
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA; Gillings Global School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Psychology in the Public Interest, North Carolina State University, North Carolina, USA; Psychiatry and Behavioral Sciences, Duke University School of Medicine, North Carolina, USA
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85
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Fowler JC, Charak R, Elhai JD, Allen JG, Frueh BC, Oldham JM. Construct validity and factor structure of the difficulties in Emotion Regulation Scale among adults with severe mental illness. J Psychiatr Res 2014; 58:175-80. [PMID: 25171941 DOI: 10.1016/j.jpsychires.2014.07.029] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Difficulties in Emotion Regulation Scale (DERS: Gratz and Roemer, 2004) is a measure of emotion-regulation capacities with good construct validity, test-retest reliability and internal consistency. Factor analytic studies have produced mixed results, with the majority of studies supporting the original 6-factor model while several studies advance alternative 5-factor models, each of which raises questions about the psychometric validity of the Lack of Emotional Awareness factor. A limitation of prior psychometric studies on the DERS is the reliance on healthy subjects with minimal impairment in emotion regulation. The current study assesses the construct validity and latent factor structure of the DERS in a large sample of adult psychiatric inpatients with serious mental illness (SMI). METHODS Inpatients with SMI (N = 592) completed the DERS, Acceptance and Action Questionnaire (AAQ-2), Patient Health Questionnaire (PHQ-SADS), and research diagnostic interviews (SCID I/II) at admission. RESULTS DERS total scores were correlated with AAQ-2 (r = .70), PHQ-Depression (r = .45), PHQ-Anxiety (r = .44) and moderately correlated with PHQ-Somatization (r = .28). Confirmatory factor analysis indicated that five and six-factor model produced equivalent fit indices. All factors demonstrated positive correlations with the exception of difficulty engaging in goal-directed behavior and lack of emotional awareness. CONCLUSIONS The DERS is a strong measure with excellent internal consistency and good construct validity. Caution is warranted in discarding the six-factor model given the equivalence with the five-factor model, particularly in light of the body of clinical research evidence utilizing the full scale.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, Houston, TX 77035, USA; Baylor College of Medicine, Houston, TX 77030, USA.
| | - Ruby Charak
- University of Toledo, Toledo, OH 43606, USA; VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Jon G Allen
- The Menninger Clinic, Houston, TX 77035, USA; Baylor College of Medicine, Houston, TX 77030, USA
| | - B Christopher Frueh
- The Menninger Clinic, Houston, TX 77035, USA; Baylor College of Medicine, Houston, TX 77030, USA; University of Hawaii, Hilo, HI 96720, USA
| | - John M Oldham
- The Menninger Clinic, Houston, TX 77035, USA; Baylor College of Medicine, Houston, TX 77030, USA
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86
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Ciocca G, Limoncin E, Di Tommaso S, Mollaioli D, Gravina GL, Marcozzi A, Tullii A, Carosa E, Di Sante S, Gianfrilli D, Lenzi A, Jannini EA. Attachment styles and sexual dysfunctions: a case–control study of female and male sexuality. Int J Impot Res 2014; 27:81-5. [DOI: 10.1038/ijir.2014.33] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 07/07/2014] [Accepted: 07/12/2014] [Indexed: 11/09/2022]
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87
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Okello J, Nakimuli-Mpungu E, Musisi S, Broekaert E, Derluyn I. The association between attachment and mental health symptoms among school-going adolescents in northern Uganda: the moderating role of war-related trauma. PLoS One 2014; 9:e88494. [PMID: 24614005 PMCID: PMC3948618 DOI: 10.1371/journal.pone.0088494] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented. METHODS We investigated the relationship between parent and peer attachment and posttraumatic stress, depression and anxiety symptoms in a sample of 551 adolescents aged 13-21 years old. Attachment quality was assessed using the Inventory of Parent and Peer Attachment (IPPA). Post-traumatic stress, depression and anxiety symptoms were assessed using the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Gender differences in attachment relationships were determined using independent t-tests. Multivariate logistic regression was used to assess whether attachment relationships were independently associated with posttraumatic stress, depression and anxiety symptoms. Hierarchical linear regression analyses were conducted to explore the moderating role of war-related trauma. RESULTS Our analyses revealed gender differences in attachment to parents, with males reporting stronger attachment than females. Parental attachment was protective against depression and anxiety symptoms but not posttraumatic stress symptoms after adjusting for potential confounders. Alienation by parents was independently associated with an increase in these mental health symptoms while peer attachment was not associated with any of these symptoms. However, in situations of severe trauma, our analyses showed that peer attachment was significantly protective against post-traumatic stress symptoms. CONCLUSIONS Secure parental attachment is associated with better psychosocial adjustment in adolescents affected by war. Further, adolescents with secure peer attachment relationships in situations of severe war trauma may be less likely to develop posttraumatic stress symptoms. Interventions to enhance peer support in this post conflict setting would benefit this vulnerable population.
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Affiliation(s)
- James Okello
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Psychiatry, Gulu University, Gulu, Uganda
- Department of Social Welfare Studies and Centre for Children in Vulnerable Situations, Ghent University, Ghent, Belgium
- * E-mail:
| | | | - Seggane Musisi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eric Broekaert
- Department of Orthopedagogics, Ghent University, Ghent, Belgium
| | - Ilse Derluyn
- Department of Social Welfare Studies and Centre for Children in Vulnerable Situations, Ghent University, Ghent, Belgium
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88
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Price M, Higa-McMillan C, Kim S, Frueh BC. Trauma experience in children and adolescents: an assessment of the effects of trauma type and role of interpersonal proximity. J Anxiety Disord 2013; 27:652-60. [PMID: 24064334 DOI: 10.1016/j.janxdis.2013.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 07/11/2013] [Accepted: 07/31/2013] [Indexed: 11/15/2022]
Abstract
The psychiatric sequelae associated with childhood experience(s) of trauma is complex and distinguishable from that of adult trauma exposure. Categories of impairment associated with experiences of early trauma include internalizing and externalizing emotional and behavioral problems, posttraumatic stress symptomatology, and dissociation. The present study assessed the relationship between the type of trauma experience (i.e., non-interpersonal or interpersonal) and the manifestation of a wide range of psychiatric symptomatology using prospective longitudinal data from a community sample of ethnically diverse children and adolescents (N=1676; ages 4-18). The study also examined the relationship between different types of trauma experiences (e.g., direct, vicarious, interpersonal) and levels of various symptom domains (e.g., anxiety, posttraumatic stress, conduct problems). A number of factors relevant to the relationship between early trauma experience and subsequent impairment including temperament, socioeconomic status, sex, and age were included in the analyses. Results indicated that interpersonal traumas involving significant interpersonal proximity were associated with externalizing problems (i.e., oppositional defiant and conduct problems). Direct trauma experiences and emotionality were positively associated with almost all symptom domains. Implications for the relationship between trauma and developmental psychopathology are discussed.
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Affiliation(s)
- Maggi Price
- Department of Psychology, University of Hawaii, 200W. Kawili Street, Hilo, HI 96720, United States.
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