Social support among veterans with serious mental illness

Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT) for US Veterans With Serious Mental Illness: Community Engagement Approach

BACKGROUND

Peer specialists are hired, trained, and accredited to share their lived experience of psychiatric illness to support other similar individuals through the recovery process. There are limited data on the role of peer specialists in suicide prevention, including their role in intervention development.

OBJECTIVE

To better understand peer specialists within the Veterans Health Administration (VHA), we followed partnership community engagement and a formative research approach to intervention development to (1) identify barriers, facilitators, and perceptions of VHA peer specialists delivering a suicide prevention service and (2) develop and refine an intervention curriculum based on an evidence-informed preliminary intervention framework for veterans with serious mental illness (SMI).

METHODS

Following the community engagement approach, VHA local and national peer support and mental health leaders, veterans with SMI, and veteran peer specialists met to develop a preliminary intervention framework. Next, VHA peer specialist advisors (n=5) and scientific advisors (n=6) participated in respective advisory boards and met every 2-4 months for more than 18 months via videoconferencing to address study objectives. The process used was a reflexive thematic analysis after each advisory board meeting.

RESULTS

The themes discussed included (1) the desire for suicide prevention training for peer specialists, (2) determining the role of VHA peer specialists in suicide prevention, (3) integration of recovery themes in suicide prevention, and (4) difficulties using safety plans during a crisis. There were no discrepancies in thematic content between advisory boards. Advisor input led to the development of Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT). SUPPORT includes training in general suicide prevention and a peer specialist-delivered intervention for veterans with SMI at an increased suicide risk. This training aims to increase the competence and confidence of peer specialists in suicide prevention and the intervention supports veterans with SMI at an increased suicide risk through their recovery process.

CONCLUSIONS

This paper intends to document the procedures taken in suicide prevention intervention development, specifically those led by peer specialists, and to be a source for future research developing and evaluating similar interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05537376; https://classic.clinicaltrials.gov/ct2/show/NCT05537376.

A call to action: informing research and practice in suicide prevention among individuals with psychosis

Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.

Changes in Patient-Reported Outcomes Associated with Receiving Whole Health in the Veteran Health Administration (VHA)'s National Demonstration Project

BACKGROUND

Whole Health (WH) is a patient-centered model of care being implemented by the Veterans Health Administration. Little is known about how use of WH services impacts patients' health and well-being.

OBJECTIVE

We sought to assess the association of WH utilization with pain and other patient-reported outcomes (PRO) over 6 months.

DESIGN

A longitudinal observational cohort evaluation, comparing changes in PRO surveys for WH users and Conventional Care (CC) users. Inverse probability of treatment weighting was used to balance the two groups on observed demographic and clinical characteristics.

PARTICIPANTS

A total of 9689 veterans receiving outpatient care at 18 VA medical centers piloting WH.

INTERVENTIONS

WH services included goal-setting clinical encounters, Whole Health coaching, personal health planning, and well-being services.

MAIN OUTCOME MEASURES

The primary outcome was change in pain intensity and interference at 6 months using the 3-item PEG. Secondary outcomes included satisfaction, experiences of care, patient engagement in healthcare, and well-being.

KEY RESULTS

By 6 months,1053 veterans had utilized WH and 3139 utilized only CC. Baseline pain PEG scores were 6.2 (2.5) for WH users and 6.4 (2.3) for CC users (difference p = 0.028), improving by - 2.4% (p = 0.006) and - 2.3% (p < 0.001), respectively. In adjusted analyses, WH use was unassociated with greater improvement in PEG scores compared to CC - 1.0% (- 2.9%, 1.2%). Positive trends were observed for 8 of 15 exploratory outcomes for WH compared to CC. WH use was associated with greater improvements at 6 months in likelihood to recommend VA 2.0% (0.9%, 3.3%); discussions of goals 11.8% (8.2%, 15.5%); perceptions of healthcare interactions 2.5% (0.4%, 4.6%); and engagement in health behaviors 2.2% (0.3%, 3.9%).

CONCLUSION

This study provides early evidence supporting the delivery of WH patient-centered care services to improve veterans' experiences of and engagement in care. These are important first-line impacts towards the goals of better overall health and well-being outcomes for Veterans.

Association between perceived social support and suicide ideation distress among psychiatric inpatients: The role of thwarted interpersonal needs

INTRODUCTION

The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) are proximal risk factors for suicide ideation; however, there are mixed results regarding this hypothesis among psychiatric inpatients.

OBJECTIVE

The current study examined the mediating role of TB and PB in the relationship between perceived social support (i.e., support from family, friends, a significant other, and total) and suicide ideation distress among psychiatric inpatients.

METHODS

Participants (short-term psychiatric inpatients; N = 139) were administered self-report assessments cross-sectionally.

RESULTS

Nonparametric mediation results indicated that the total (additive) indirect effects of TB and PB, in parallel, were significant in all models, yet there were only significant specific (unique) indirect effects of PB.

CONCLUSION

TB and PB, in combination, may be proximal risk factors for suicide ideation distress among psychiatric inpatients with lower perceived social support from family, friends, a significant other, and in total. These findings are congruent with the interpersonal theory of suicide's propositions that the combination of TB and PB increases the risk for suicide ideation. Clinicians may consider using interventions that target increasing perceived social support and decreasing TB and PB (i.e., cognitive behavioral therapy and social skills training) for this population.

Serious Mental Illness Exacerbation Post-Bereavement: A Population-Based Study of Partners and Adult Children

Purpose

The death of a close family member is commonly accompanied by intense grief, stress, and loss of social support. We hypothesized that recent bereavement would be associated with an increase in symptom exacerbations among adults with serious mental illness (SMI) whose partners or parents had died.

Patients and Methods

Adults whose partners and parents had died in Denmark between January 1, 2010, and June 30, 2016, were identified using linked population-based registries. History of SMI was defined as having a diagnosis of schizophrenia and schizoaffective disorders, major depression, and bipolar disorder in the five years preceding their family member's death in the Danish Psychiatric Central Research Register using International Classification of Diseases-10 codes. The odds of SMI exacerbation (ie, attempt or completion of suicide or psychiatric hospitalization) among partners and children in the first two years after death in 3-month intervals were estimated with generalized estimating equations.

Results

12.8% of partners and 15.0% of adult children with a history of SMI experienced any SMI exacerbation two years after bereavement. Among bereaved partners, older age (80+ years) was associated with a lower risk of experiencing an SMI exacerbation compared with partners aged 18-49 years (ORadj=0.29, [0.18-0.45]). Partners with a history of SMI had significantly increased odds of SMI exacerbations three months after their partners' death compared to prior to their partners' death (ORadj = 1.43, [1.13-1.81]). There was no evidence that adult children with SMI experience increased SMI exacerbations after the death of their parents compared to prior to death.

Conclusion

Adults with a history of SMI whose partners had died are at increased risk for an SMI exacerbation post bereavement. Additional bereavement resources and support should be provided to those with a history of SMI, especially in the period immediately after death.

Behavioral Activation and Therapeutic Exposure vs. Cognitive Therapy for Grief Among Combat Veterans: A Randomized Clinical Trial of Bereavement Interventions

Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence of Persistent Complex Bereavement Disorder (PCBD) is high in these groups. Importantly, PCBD impact appears to be independent of both Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (Bonnano, 2007), 2 disorders that are also highly prevalent in these groups, thus tailored treatments for grief are indicated. The Department of Veterans Affairs suggests Cognitive Therapy for Grief as a first line psychotherapy, however treatments relatively more focused on behavior change and exposure to grief cues also may be useful for this population. To address this question, the present study used a randomized controlled trial to compare a 7-session program of Behavioral Activation and Therapeutic Exposure for Grief vs. Cognitive Therapy for Grief among 155 OIF/OEF/OND veterans. Both treatments produced significant treatment gains over baseline, and these improvements were maintained over 6-month followup; however no differences were observed between groups. Given equal efficacy, implications for matching treatment to patient characteristics are discussed.

Peer Support Groups for Weight Loss

Purpose of Review

Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses upon peer support weight loss interventions with the objective of identifying common elements of successful programs.

Recent Findings

Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepresented in weight loss programs and often perceive “dieting” as feminine. However, several peer programs for male sports fans have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to professionally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities allow participants to share peer support similar to in-person formats.

Summary

Many peer support interventions show significant short-term weight loss. Group members frequently report that peer support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups, and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.

Association Between Technology Use and Social Integration Among Veterans With Disabilities

Social connectedness has positive effects on physical and mental health. Many aspects of life, including social networks, are increasingly technology-based, influenced by access to computers. Individuals with psychiatric disabilities may experience unique barriers to computer use. The current study evaluated computer use among 199 veterans in Connecticut and Houston, Texas, with psychiatric and/or physical disabilities, and its association with social integration. Two-thirds had used a computer within the past month, most commonly for information seeking, but also for social interaction. However, computer use and social integration were not significantly associated. The study suggests a greater rate of computer use than anticipated, encouraging given society's increasing reliance on technology. Future research into experience with other modalities is needed, as is research into veterans' willingness and desire to use technology for various purposes.

Perception of social support and psychotic symptoms among persons with schizophrenia: A strategy to lessen caregiver burden

BACKGROUND

Improving patients' perception of social support is significant not only for their re-adaptation to life but also for alleviating caregivers' burden.

AIM

This study aims to examine an integrated model regarding social support, psychotic symptoms and caregiver burden.

METHODS

Persons with schizophrenia (N₁ = 300) and their family caregivers (N₂ = 300) in Xinjin County, Chengdu, China, completed the survey to report their demographics, patients' perception of social support (Duke Social Support Index), psychotic symptoms (Positive and Negative Syndrome Scale) and caregiver burden (Burden Scale for Family Caregivers, Short Version). Structural equation modelling was utilised to test the proposed model.

RESULTS

The degree of caregiver burden differed significantly within subgroups of patients' gender and education, as well as caregivers' gender, education and employment. Caregiver burden was negatively related to patients' age and household income. Social interaction partially mediated the relationship between instrumental and subjective social support (total effect = 0.451, p < .01). Subjective social support fully mediated the impact of social interaction on psychotic symptoms (total effect = -0.099, p < .05). In the final model, instrumental social support was positively associated with social interaction (p < .001) and increased subjective social support (p < .05). Increased subjective social support showed correlation with a lower degree of psychotic symptoms (p < .01), which was related to a lower level of caregiver burden (p < .001).

CONCLUSION

This study shows the associations of patients' social support with psychotic symptoms and caregiver burden. Culture-specific psychosocial interventions should be provided for both patients and caregivers to enrich external support and reduce psychotic symptoms and caregivers' burden within the health care environment.

An Examination of Social Support and PTSD Treatment Response During Prolonged Exposure

OBJECTIVE

Posttraumatic stress disorder (PTSD) results from exposure to traumatic events. Social support is negatively related to PTSD symptoms in cross-sectional and longitudinal studies. It is unclear, however, if social support is associated with treatment response for PTSD. The current study evaluated the extent to which social support was associated with PTSD treatment response among treatment-seeking veterans receiving prolonged exposure (PE). It was hypothesized that social support would improve PTSD treatment response and that PTSD symptom reduction would improve social support.

METHOD

A total of 123 veterans were recruited from a Veterans Affairs Medical Center and evaluated for PTSD, diagnostic-related symptoms, and social support. All participants received PE. Data were analyzed using mixed-effects models.

RESULTS

Findings suggested that elevated social support during treatment was associated with greater reductions in PTSD symptoms during treatment. Social support also increased during treatment. Increases in social support were not moderated by PTSD symptoms during treatment.

CONCLUSIONS

These findings suggest that social support and PTSD symptoms are related throughout treatment. Social support moderated the change in PTSD symptoms, whereas PTSD symptoms did not moderate changes in social support.

An Exploratory Analysis of Unhealthy and Abusive Relationships for Adults with Serious Mental Illnesses Living in Supportive Housing

Individuals living with serious mental illness are at high risk of chronic homelessness, victimization, and intimate partner violence. In recent years, supportive housing programs have emerged as one way to prevent homelessness and victimization for this population, while also expanding social interactions and social networks. In concert with a focal supportive housing program, this research conducted two focus groups with 18 individuals who have a serious mental illness diagnosis. The authors sought to answer the research question, "What are perceptions of healthy and unhealthy relationships among formerly homeless people with serious mental illness?" To this end, the eight-item questionnaire was created around dimensions of power and control, as well as relationship equality. Findings from an inductive thematic analysis reveal three broad families of themes (relationship ideals, lived experiences, and risk/resources in supportive housing), around which smaller themes and subthemes are organized. Implications for policy, practice, and future research are also discussed.

The front line of social capital creation--a natural experiment in symbolic interaction

This paper offers theoretical and empirical contributions to understanding the micro-sociological processes behind the creation of social capital. Theoretically, we argue that the emotional and shared experience of participating in symbolic interaction rituals may affect social capital in four different ways, via: (i) a 'citizenship' effect, connecting participants symbolically to the broader, civic society; (ii) a 'supportive' effect, bonding participants with each other; (iii) an exclusive 'tribal' effect, which crowds-out connections with other groups and the wider society; and (iv) an 'atomising' effect, whereby intense experiences create mental health problems that damage social capital. We illustrate this with a case study of Australian veterans of the Vietnam War. The randomness of the National Service conscription lotteries of that era translates into a high-quality natural experiment. We formulate several hypotheses about which of the four effects dominates for veterans who participated in the 'symbolic interaction' of training and deployment. We test these hypotheses using data from the 2006 Australian Census of Population and Housing, and the NSW 45 & Up Study. We found that war service reduced 'bonding' social capital, but increased 'bridging' social capital, and this is not explained completely by mental health problems. This suggests that while the combined 'tribal' and 'atomizing' effects of service outweigh the 'supportive' effects, the 'citizenship' effect is surprisingly robust. Although they feel unsupported and isolated, veterans are committed to their community and country. These paradoxical findings suggest that social capital is formed through symbolic interaction. The emotional and symbolic qualities of interaction rituals may formulate non-strategic (perhaps irrational) connections with society regardless of the status of one's personal support networks.

Declining social support in adolescents prior to first episode psychosis: associations with negative and affective symptoms

Social support for individuals with psychosis is associated with decreased symptom severity, improved outcomes, and recovery. In adolescents, declining social support prior to the first hospitalization has been shown to predict time to relapse, which may have implications for early intervention. Data were collected on adolescents (n=84) following a first hospitalization for a psychotic episode in order to examine how change in social support relates to the duration and type of untreated symptoms. Most adolescents experienced a decline in social support (n=46) prior to index hospitalization. Chi-square analyses showed that declining social support was related to negative symptoms and longer duration of untreated psychosis, whereas stable social support was associated with manic symptoms and diagnosis of Bipolar disorder. When entered together into a logistic regression model, the decline in social support was primarily explained by the type of symptoms, rather than by the duration of untreated symptoms. These findings are relevant for targeting psychosocial treatments toward adolescents who may have particular deficits in social support during the prodromal phase and first episode of psychosis.

Validation of the modified DUKE-UNC Functional Social Support Questionnaire in patients with schizophrenia

PURPOSE

The modified DUKE-UNC Functional Social Support Questionnaire (FSSQ) is considered a psychometric instrument to assess the social support in patients with schizophrenia. However, it has not been validated in this patient population. This issue is addressed here by examining the tool's psychometric properties in a clinical sample of patients with schizophrenia.

METHODS

Two hundred and forty-one patients from ten Adult Mental Health Centres (AMHC) meeting the following inclusion criteria were included: (1) International Classification of Diseases-10 (ICD-10) diagnosis of schizophrenia; (2) Global Assessment of Functioning (GAF) scores ≤50; (3) Illness duration of more than 2 years; and (4) Clinical stability. Patients were evaluated at baseline and at 1-year follow-up for clinical and psychosocial variables.

RESULTS

The factor analysis revealed two factors that explained 54.15 % of the variance. Internal consistency was excellent for the total FSSQ (0.87 at baseline and 0.88 at 1 year follow-up) and ranged between adequate and excellent for FSSQ domains. Correlations between FSSQ scores and those of global functioning, psychiatric symptoms, disability and quality of life ranged between small and large. There were significant differences between groups of patients with schizophrenia in FSSQ scores. Patients with higher levels of somatic complaints and patients who were disabled scored significantly lower in some or all FSSQ scores. After 1-year follow-up, patients improved in overall functioning and there was a decrease in psychiatric symptoms. There were mainly small significant associations between changes in FSSQ scores from baseline to 1-year follow-up and changes in the rest of the test scores, and AMHC visits between baseline and 1-year follow-up.

CONCLUSIONS

The FSSQ scores are reliable and valid, which suggests that the instrument is appropriate for the assessment of perceived social support in patients with schizophrenia.

The Role of Social Support in Exposure Therapy for Operation Iraqi Freedom/Operation Enduring Freedom Veterans: A Preliminary Investigation

The lack of social support has consistently been identified as a relevant factor in the development, maintenance, and treatment of posttraumatic stress disorder (PTSD). Prospective studies with combat veterans have supported the erosion model of social support in the development of PTSD. This model posits that increased PTSD symptoms lead to diminished social support over time. Additional epidemiological work that has investigated mental health and functional impairment in recently returning Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) veterans has suggested that interpersonal problems coincide with the onset of PTSD. Despite research that suggests OIF/OEF veterans experience high rates of PTSD and associated interpersonal problems, no studies have examined social support in relation to treatment response in this group. The current study examined the role of four theorized functional aspects of social support- emotional/informational support, positive social interactions, affectionate support, and tangible support- on pretreatment PTSD symptom severity and treatment response in a sample of OIF/OEF veterans receiving exposure-based psychotherapy. Findings showed that positive social interactions were negatively correlated with pretreatment symptom severity, and emotional/informational support was positively related to increased treatment response. Together, these findings suggest that specific types of social support may have an important influence on the course of exposure treatment.

Social value of supported employment for psychosocial program participants

Members of a psychiatric psychosocial program designed to provide both supported employment and peer support were surveyed about their current social activities, sources of social support, and social life improvement since joining the program. Survey respondents who worked a mainstream job (n=17) reported greater peer contact in community locations, and correspondingly greater social life improvement, than those who remained unemployed or worked volunteer jobs (n=45). Results of a hierarchical regression analysis (N=62) that explored this positive correlation between mainstream work, community-based peer contact, and social life satisfaction suggest that working a job in an integrated setting that paid at least minimum wage encouraged program participants to meet and interact in community locations, thereby strengthening peer mutual support while furthering social integration. This unique pattern of findings requires replication, and we recommend that other psychosocial programs conduct similar quality improvement studies to provide further insights into the relationship between peer support and community integration.

A place to be: the role of clubhouses in facilitating social support

OBJECTIVE

Intentional recovery communities, such as clubhouse programs, aim to foster social connections among individuals at risk for isolation as a result of living with a serious mental illness to engage and become active participants in the community. The objective of the study was to gather information on the nature of clubhouse support as it pertains to social network support and social relationships.

METHODS

The personal story/narrative approach was utilized and involved a naturalistic inquiry approach that allowed stories of clubhouse experiences to come forth with little interference or interjection as possible.

RESULTS

Personal narratives revealed that staff, members and the overall clubhouse structure emerged as the center of social interaction and comfort for participants and a central sustaining means of social support.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

It appears that the clubhouse provides an intentional environment that creates a sense of community and a place to belong. The clubhouse as a place to be where one can meet individuals in like situations has been identified as very helpful in achieving recovery by providing the opportunity to rebuild one's shattered social network and offering contact with others in similar contexts.

Are cervical cancer screening rates different for women with schizophrenia? A Manitoba population-based study

CONTEXT

Barriers to cervical cancer screening (Pap tests) may exist for women experiencing schizophrenia.

DESIGN

This study analyzed healthcare records of all women in the province of Manitoba, Canada to: (a) compare cervical cancer screening rates of women with and without schizophrenia; and (b) determine factors associated with screening uptake.

SETTING

This study took place in Manitoba, Canada, utilizing anonymized universal administrative data in the Population Health Research Data Repository at the Manitoba Centre for Health Policy.

PARTICIPANTS

All females aged 18-69 living in Manitoba December 31, 2002, excluding those diagnosed with invasive or in situ cervical cancer in the study period or previous 5 years.

MAIN OUTCOME

To determine factors associated with Papanicolaou (Pap) test uptake (1+ Pap test in 3 years, 2001/02-2003/04), logistic regression modeling included: diagnosis of schizophrenia, age, region, average household income, continuity of care (COC), presence of major physical comorbidity. Good COC was defined as at least 50% of ambulatory physician visits from the same general/family practitioner within two years.

RESULTS

Women with schizophrenia (n=3220) were less likely to have a Pap test (58.8% vs. 67.8%, p<.0001) compared to all other women (n=335 294). In the logistic regression, a diagnosis of schizophrenia (aOR=0.70, 95% CI 0.65-0.75); aged 50+, and living in a low-income area or the North decreased likelihood; good continuity of care (aOR 1.88, 95% CI 1.85-1.91) and greater physical comorbidity (1.21, 95% CI 1.04-1.41) increased likelihood.

CONCLUSION

Women with schizophrenia are less likely to receive appropriate cervical cancer screening. Since good continuity of care by primary care physicians may mitigate this, psychiatrists should consider assisting in ensuring screening uptake.

Perceived access to general medical and psychiatric care among veterans with bipolar disorder

OBJECTIVES

We examined associations between patient characteristics and self-reported difficulties in accessing mental health and general medical care services.

METHODS

Patients were recruited from the Continuous Improvement for Veterans in Care-Mood Disorders study. We used multivariable logistic regression analyses to assess whether predisposing (demographic characteristics), enabling (e.g., homelessness), or need (bipolar symptoms, substance abuse) factors were associated with difficulties in obtaining care, difficulties in locating specialty providers, and forgoing care because of cost.

RESULTS

Patients reported greater difficulty in accessing general medical services than in accessing psychiatric care. Individuals experiencing bipolar symptoms more frequently avoided psychiatric care because of cost (odds ratio [OR] = 2.43) and perceived greater difficulties in accessing medical specialists (OR = 2.06). Homeless individuals were more likely to report hospitalization barriers, whereas older and minority patients generally encountered fewer problems accessing treatment.

CONCLUSIONS

Need and enabling factors were most influential in predicting self-reported difficulties in accessing care, subsequently interfering with treatment dynamics and jeopardizing clinical outcomes. Efforts in the Department of Veterans Affairs to expand mental health care access should be coupled with efforts to ensure adequate access to general medical services among patients with chronic mental illnesses.

Remission of maternal depression and child symptoms among single mothers: a STAR*D-Child report

OBJECTIVE

Offspring of depressed parents are at increased risk for depressive and other disorders. We recently found that when depressed mothers reached full remission over 3 months of treatment, a significant improvement in the children's disorders occurred. Since only a third of the mothers remitted, factors related to maternal remission rates, and thereby child outcomes, were important. This report examined the relationship of the presence of a father in the household to maternal depression remission and child outcomes.

METHOD

Maternal depression was measured using the 17-item Hamilton Rating Scale for Depression (HRSD(17)); social functioning was assessed using the Social Adjustment Scale-Self Report (SAS-SR). Children (age 7-17) were assessed independently, blind to maternal outcome, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL) and the Child Global Assessment Scale (C-GAS).

RESULTS

Single mothers (n = 50), as compared to those in two-parent households (n = 61), were more likely to discontinue treatment (31% vs. 16%, P = 0.04), and less likely to remit if they remained in treatment (20% vs. 43%, P = 0.013). These differences remained significant after adjusting for socioeconomic status and potential confounders, but were partially explained by the mother's pre-treatment social functioning. The reduction in child diagnoses following maternal remission was greater in two-parent than in single-parent households, although a formal test of interaction between the odds ratios was not significant.

CONCLUSION

Single depressed mothers are more likely to drop out of treatment, and less likely to reach remission if they stay in treatment. This high-risk group requires vigorous treatment approaches.