Exploratory and confirmatory factor analyses of the Brief Symptom Inventory among substance abusers

Change in parent and child psychopathology following obesity treatment and maintenance: A secondary data analysis

BACKGROUND

General and eating disorder (ED) psychopathology are common among children and adults with overweight/obesity; few studies have examined their course of change throughout family-based behavioural obesity treatment (FBT) and maintenance.

OBJECTIVES

Examine: (1) the changes in the parent and child general and ED psychopathology during FBT and maintenance interventions; (2) the associations between change in psychopathology and change in weight among children or parents; (3) the associations between change in psychopathology within parent-child dyads.

METHODS

172 parent-child dyads participated in 4-month FBT and were subsequently randomized to one of three 8-month maintenance interventions. General psychopathology (child anxiety/depressive symptoms, parent severity of global psychological distress), ED psychopathology (shape/weight concern), and percent overweight were assessed at baseline, post-FBT, and post-maintenance. Separate linear mixed-effects models evaluated change in general and ED psychopathology, including an interaction between maintenance condition and time. Partial correlations examined associations between change in psychopathology and percent overweight among children or parents, and associations between change in psychopathology within parent-child dyads.

RESULTS

Among children, significant reductions were observed from baseline to post-FBT in all forms of psychopathology and from post-FBT to post-maintenance in general psychopathology. Among parents, significant reductions were observed from baseline to post-FBT in all forms of psychopathology; reductions were maintained from post-FBT to post-maintenance. There was no significant interaction between maintenance condition and time. Correlations between change in most forms of parent or child psychopathology and percent overweight were observed.

CONCLUSIONS

Participation in FBT and maintenance was associated with improvements in general and ED psychopathology in both parents and children.

Psychological Symptoms and Outcomes in Adults Receiving Community-based Treatment for Substance Use Disorders

BACKGROUND

Mental health issues in individuals with substance use disorders are common and can affect treatment outcomes.

OBJECTIVES

Secondary analysis of a multi-center trial of an internet-delivered psychosocial SUD treatment intervention (Therapeutic Education System; TES) to: 1) describe psychological symptoms over time, 2) explore whether treatment assignment was associated with psychological symptoms 3) explore whether psychological symptoms at baseline moderated the effect of TES on abstinence or retention at the end of treatment.

METHODS

Psychological symptoms were measured using the Global Severity Index (GSI) from the Brief Symptom Inventory (BSI-18), PHQ-9, and MINI SPIN (social anxiety). Zero-inflated-negative-binomial models given high numbers of "0" GSI scores and multivariate logistic regression models were run to estimate the effect of the interaction between treatment and baseline psychological symptoms.

RESULTS

The mean age was 35, 37.9% were female, 56.0% were white. Fifty-four percent had a negative urine drug or breath alcohol screen at baseline. Mean GSI score at baseline was 13.5 (SD = 12.6). GSI scores significantly improved (p<.0001) over time. Treatment was not significantly associated with GSI scores (aIRR = 0.97, 95%CI = 0.85-1.11). Those with social anxiety at baseline had a higher likelihood of achieving abstinence when receiving TES compared to TAU (b = 1.2071, SE = 0.6109, p = 0.0482).

CONCLUSIONS

Psychological symptoms may improve over time in individuals seeking treatment for SUD, and for those with social anxiety, technology-based treatments may result in a better response. Examining the effect of SUD treatment on broader psychological outcomes in addition to abstinence may help clinicians provide more individualized care for those with co-occurring conditions.

Modest, yet progressive: Effective therapists tend to rate therapeutic change less positively than their patients

Objective: Empirical findings on self-serving biases amongst psychotherapists are inconsistent. We tested in a large naturalistic data set, if therapists are prone to illusory superiority when estimating their patients' outcome and whether this effect is buffered by therapists' effectiveness. Method: A post-hoc analysis with N = 69 therapists, who treated N = 1080 patients, was conducted. Therapists' and patients' mean ratings for therapeutic improvement in the Clinical Global Impression Scale (CGI) were compared. Using a multilevel modelling approach, we further investigated the relation between the patient-therapist divergence in the CGI and actual therapeutic change in the Global Severity Index (GSI) of the Brief Symptom Inventory and in the Satisfaction With Life Scale (SWLS). Results: Ratings in the CGI did not show significant differences between patients' and therapists' assessment of therapeutic change. Lower estimations by therapists, compared to patients' self-report, were associated with greater therapeutic change in GSI and SWLS. Conclusions: Therapists, on a whole, did not seem to be prone to illusory superiority when assessing therapeutic outcome. Contrary, the more modest the therapists' estimation of therapeutic outcome was, the greater the actual therapeutic change.

Male Perpetrators of Intimate Partner Violence: A Comparison Between Incarcerated and Community Offenders

The literature considers intimate partner violence (IPV) perpetrators to be a heterogeneous group. In Portugal, IPV perpetrators may be sentenced to either of two types of sentences: deprivation of freedom or alternatives to prison (in the community). In the present study, we performed a comparative analysis between 76 male individuals sentenced to prison and 76 male individuals sentenced to community measures for crimes against their current or former partners, using a set of psychological measures. The results indicate that although incarcerated and nonincarcerated IPV perpetrators demonstrate considerable differences, some similarities may also be observed. Incarcerated IPV perpetrators present the lowest socioeconomic status and education, perpetrate more severe IPV, and have more criminal convictions. A hierarchical regression analysis revealed that the use of weapons and objects increased the probability of IPV perpetrators belonging to the prison group above and beyond sociodemographic variables. Based on these results, implications for IPV perpetrators' treatment are discussed.

Housing Status, Psychiatric Symptoms, and Substance Abuse Outcomes Among Sober Living House Residents over 18 Months

Studies show individuals entering sober living recovery houses (SLHs) make significant, sustained improvement on measures of substance abuse problems, employment, and arrests. The current study assessed changes in housing status among SLH residents over 18 months and the relative influences of housing status and psychiatric distress on substance abuse outcomes. Two hundred forty one men and 58 women, all age 18 and older, were interviewed within their first week of entering 20 SLHs and again at 6-, 12-, and 18-month follow-up. Between entry into the SLHs and 18-month follow-up homelessness declined from 16% to 4%, marginal housing declined from 66% to 46%, and stable housing increased from 13% to 27%. Psychiatric severity was generally mild to moderate in severity, but nevertheless showed improvement over the 18-month study period. Multivariate models showed worse substance abuse outcomes for residents with higher psychiatric distress and unstable housing. Relative to persons with stable housing, those who were homeless or marginally housed had worse outcomes and those in SLHs had better outcomes. Overall, we conclude that individuals entering SLHs show improvement in housing status and psychiatric distress, both of which are associated with better substance abuse outcomes.

Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study

Objectives: The primary purpose of the current study was to assess the effects of a mindfulness-based stress reduction (MBSR) program, facilitated by non-psychologist clinicians, for improving psychosocial well-being. A secondary purpose of the current study was to explore the role of self-compassion as a potential underlying factor for improvements in emotional distress. Application of these findings to a physical therapy setting is provided. Methods: One hundred and thirty participants with a variety of medical complaints completed an eight-week MBSR program at Vanderbilt University's Osher Center for Integrative Medicine. Prior to the intervention and at the eight-week time point, participants completed measures for emotional distress (Brief Symptom Inventory), stress (Perceived Stress Scale-10), mindfulness (Mindfulness Attention and Awareness Scale), and self-compassion (Self-Compassion Scale). Wilcoxon signed-rank test was used to evaluate changes in outcomes after MBSR. Linear model estimation using ordinary least squares was used to evaluate the association between changes in self-compassion with changes in emotional distress. Results: Following MBSR, participants reported significant reductions in emotional distress (p < 0.001). Additionally, participants reported improvements in mindfulness and self-compassion (p < 0.001). Linear regression model revealed that changes in self-compassion were significantly associated with changes in emotional distress (p < 0.001). Discussion: An MBSR program conducted by non-psychologist clinicians was associated with improvements in emotional distress, stress, and self-compassion. MBSR is a promising adjunct intervention in which principles can be integrated within a physical therapy approach for chronic conditions. Level of Evidence: 3B.

Measurement Invariance of the Brief Symptom Inventory in Survivors of Torture and Trauma

The United States accepts more refugees than any other industrialized nation. As refugee populations grow, mental health professionals must implement culturally and ethnically appropriate strategies to assess and treat individuals from diverse backgrounds. Culture can exert a powerful and often misunderstood influence on psychological assessment, and few structured measures have been demonstrated to have adequate cross-cultural validity for use with diverse and vulnerable populations such as survivors of torture. This study examined the factor structure and equivalency of underlying construct(s) of psychological distress as measured by the Brief Symptom Inventory (BSI) in three samples who had survived torture and other severe trauma from Tibet, West Africa and the Punjab region of India. Confirmatory factor analyses provided support for configural invariance of a two-factor model across the three samples, suggesting that the two latent factors of Complex Dysphoria and Somatic Distress were present in each subgroup. The data provide additional support for the strict invariance model in the West African-Tibetan dyad suggesting that scores are comparable across those two groups. Implications for research and treatment are discussed.

Child-Adult Relationship Enhancement in Primary Care (PriCARE): A Randomized Trial of a Parent Training for Child Behavior Problems

OBJECTIVE

Child-Adult Relationship Enhancement in Primary Care (PriCARE) is a 6-session group parent training designed to teach positive parenting skills. Our objective was to measure PriCARE's impact on child behavior and parenting attitudes.

METHODS

Parents of children 2 to 6 years old with behavior concerns were randomized to PriCARE (n = 80) or control (n = 40). Child behavior and parenting attitudes were measured at baseline (0 weeks), program completion (9 weeks), and 7 weeks after program completion (16 weeks) using the Eyberg Child Behavior Inventory (ECBI) and the Adult Adolescent Parenting Inventory 2 (AAPI2). Linear regression models compared mean ECBI and AAPI2 change scores from 0 to 16 weeks in the PriCARE and control groups, adjusted for baseline scores.

RESULTS

Of those randomized to PriCARE, 43% attended 3 or more sessions. Decreases in mean ECBI intensity and problem scores between 0 and 16 weeks were greater in the PriCARE group, reflecting a larger improvement in behavior problems [intensity: -22 (-29, -16) vs -7 (-17, 2), P = .012; problem: -5 (-7, -4) vs -2 (-4, 0), P = .014]. Scores on 3 of the 5 AAPI2 subscales reflected greater improvements in parenting attitudes in the PriCARE group compared to control in the following areas: empathy toward children's needs [0.82 (0.51, 1.14) vs 0.25 (-0.19, 0.70), P = .04], corporal punishment [0.22 (0.00, 0.45) vs -0.30 (-0.61, 0.02), P = .009], and power and independence [0.37 (-0.02, 0.76) vs -0.64 (-1.19, -0.09), P = .003].

CONCLUSIONS

PriCARE shows promise in improving parent-reported child-behavior problems in preschool-aged children and increasing positive parenting attitudes.

Prevalence and Trajectories of Psychiatric Symptoms Among Sober Living House Residents

OBJECTIVE

Sober living houses are alcohol- and drug-free recovery residences that help individuals with substance use disorders maintain long-term abstinence. Given the prevalence of co-occurring mental disorders among individuals entering substance use treatment, it is likely that many such residents are also contending with psychiatric symptoms, and it is unclear how these symptoms may affect their sobriety. This study sought to describe the prevalence and trajectories of different types of symptoms among sober living house residents and examine how these symptoms affect substance use outcomes.

METHODS

Data for this study were collected as part of a larger study on outcomes among sober living house residents in Northern California. The current study examined data from 300 residents in two housing groups; residents were interviewed upon entry and re-interviewed at 6-, 12-, and 18-month follow-ups. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI). General estimating equations tested changes in BSI global psychological distress and clinical symptom scales over time and examined the relationship between scale scores and substance use in longitudinal models controlling for demographics, length of stay, and psychiatric service utilization.

RESULTS

The average age of residents was 38.5 years (SD = 10.1) and they were mostly male (80%) and Caucasian (65%). Retention rates were high, with 90% (n = 269) participating in at least one follow-up interview. Overall psychological distress (Wald χ(2) = 7.99, df = 3, p = .046), symptoms of depression (Wald χ(2) = 13.57, df = 3, p = .004), and phobic anxiety (Wald χ(2) = 7.89, df = 3, p = .048) significantly improved over time. In all models examining the relationship between BSI scale scores and substance use, rates of abstinence and days of use among those who reported using substances also improved over time. Overall distress (OR = 0.48, p < .001) as well as higher scores on the somatization (OR = 0.56, p < .001), depression (OR = 0.53, p < .001), hostility (OR = 0.71, p = .006), and phobic anxiety (OR = 0.74, p = .012) subscales were significantly associated with a decreased likelihood of abstinence. Symptoms of somatization (B = 0.092, SE = 0.029, p = .002) were associated with an increase in the number of days substances were used among those who reported use.

CONCLUSIONS

Psychological symptoms among sober living house residents improve over time, but they are risk factors for relapse, suggesting that additional support provided to residents with psychiatric symptoms could improve substance use outcomes.

Patients with Gilles de la Tourette syndrome have widespread personality differences

Only little is known about pathological personality traits in patients with Gilles de la Tourette syndrome (GTS). The aim of this study was to further investigate the prevalence of personality traits in adults with GTS. We used a variety of rating scales to assess not only personality traits, but also severity of tics, quality of life, and comorbidities (obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), depression), in a large group (n=50) of patients. Our major finding was that pathological personality traits are very common in patients with GTS encompassing a wide range of different personality traits, but most typically personality traits related to cluster C. Demand-anxious was the most common personality trait, while histrionic personality trait was absent. Patients' quality of life was more impaired by personality traits than comorbidities. Personality traits were more common in patients with comorbid OCD and depression, while comorbid ADHD had no influence. Our findings, therefore, corroborate the hypothesis that GTS plus OCD represents a more severe subtype of GTS, and support the assumption that OCD and depression, but not ADHD, are part of the GTS spectrum.

Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment

Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment.

The relationship between effortful control, current psychopathology and interpersonal difficulties in adulthood

This study examined whether the relationship between low effortful control (EC), general psychopathology and interpersonal maladjustment previously reported among children extends to adulthood. Two hundred and forty undergraduate students were assessed using the EC scale of the Adult Temperament Questionnaire, the General Severity Index of the Brief Symptom Inventory (BSI-GSI) and the interpersonal distress index of the Inventory of Interpersonal Problems-Short Circumplex (IIP-distress). Both the BSI-GSI and the IIP-distress scores were related to low levels of EC. Furthermore, interpersonal distress mediated the association between low EC and greater psychopathology severity. These results suggest that deficits in regulatory temperament among adults may be associated with experiencing greater psychopathology distress, and that this relationship may be explained by an impairment in interpersonal adjustment. Such preliminary findings may constitute a useful starting point for investigating this hypothesis among clinical populations.

Comparative psychometric analyses of the SCL-90-R and its short versions in patients with affective disorders

BACKGROUND

Despite the widespread application of Symptom Checklist 90-R (SCL-90-R), its psychometric weaknesses have repeatedly been noted. This study aimed to comparatively assess the psychometric properties of the SCL-90-R scales and the scales of its short versions Brief Symptom Inventory (BSI), Symptom Checklist-27 (SCL-27), Brief Symptom Inventory-18 (BSI-18), Symptom Checklist-14 (SCL-14), and Symptom Checklist short version-9 (SCL-K-9) in patients with affective disorders.

METHODS

The data of 2,727 patients within the main treatment group of affective disorders were assessed according to the DSM-IV. Patients completed the SCL-90-R and Beck Depression Inventory (BDI).

RESULTS

There were no significant differences regarding the internal consistency of the SCL-90-R scales and the scales of the short versions. The dimensional structure was only supported for the short versions BSI-18, SCL-14 and SCL-K-9. The assessment of convergent validity revealed high correlations. With regard to the discriminant validity, there were medium correlations. With regard to the sensitivity of change, no significant differences between the scales were found.

CONCLUSIONS

In summary, the scales of the short versions show mostly satisfactory psychometric properties in comparison to the scales of the SCL-90-R. The results support the application of the short versions as screening instruments, especially the BSI-18, and more economic variants of the SCL-90-R covering a wide range of psychopathological symptoms.

Exploratory study on domain-specific determinants of opiate-dependent individuals' quality of life

BACKGROUND/AIMS

Studies on determinants of quality of life (QoL) among opiate-dependent individuals are scarce. Moreover, findings concerning the role of severity of drug use are inconsistent. This exploratory study investigates the association between domain-specific QoL and demographic, social, person, health and drug-related variables, and potential indirect effects of current heroin use on opiate-dependent individuals' QoL.

METHODS

A cohort of opiate-dependent individuals who started outpatient methadone treatment at least 5 years previously (n = 159) were interviewed about their current QoL, psychological distress, satisfaction with methadone treatment and the severity of drug-related problems using the Lancashire Quality of Life Profile, the Brief Symptom Inventory, the Verona Service Satisfaction Scale for Methadone Treatment and the EuropASI.

RESULTS

None of the QoL domains were defined by the same compilation of determinants. No direct effect of current heroin use on QoL was retained, but path analyses demonstrated its indirect effects on the domains of 'living situation', 'finances' and 'leisure and social participation'.

CONCLUSION

These findings illustrate the particularity of each QoL domain and the need for a multidimensional approach to the concept. The relationship between current heroin use and various domains of opiate-dependent individuals' QoL is complex, indirect and mediated by psychosocial and treatment-related variables.

Correlates of functional impairment in treatment-seeking survivors of mass terrorism

This study sought to identify variables associated with functional impairment in persons exposed to terrorism. A sample of adults who sought treatment for psychological distress related to the 2001 World Trade Center attack completed standardized self-report measures of PTSD symptoms, expectancies of ability to regulate negative moods, interpersonal problems, and social-occupational impairment. A multiple regression analysis found that PTSD numbing symptoms, beliefs about the ability to regulate negative moods, feelings of social discomfort and expectations of being disliked, income level, and relationship status significantly predicted 58% of the variance in social-occupational impairment. The results suggest that treatments targeting PTSD numbing symptoms as well as maladaptive expectations about social interactions and one's ability to manage negative affect may have utility for persons adversely affected by mass violence.

Ego development, psychopathology, and parenting problems in substance-abusing mothers

The authors examined maternal ego development in relation to psychopathology and parenting problems in a sample of substance abusing mothers. Given predilections at higher levels of ego development for introspection and guilt, the authors expected mothers at higher levels to report more psychopathology. Given predilections at lower levels of ego development for dichotomous perceptions and limited conceptions of causation, the authors expected mothers at low levels to report more problematic parenting behaviors. Intelligence was expected to correlate but not overlap with ego development. Subjects were 182 mothers who expressed interest in a randomized clinical trial for a new parenting intervention. Measures included the Washington University Sentence Completion Task--Short Form, the Parental Acceptance-Rejection Questionnaire, the Brief Symptom Inventory and the Kaufman Brief Intelligence Test. Results of correlation and multivariate analyses of variance confirmed predictions. Implications for future development of interventions for substance abusing mothers are discussed.

Emotional Distress During Interferon-α-2B and Ribavirin Treatment of Chronic Hepatitis C

The aim of the study was to describe the use of the Brief Symptom Inventory in characterizing the type and severity of emotional distress in 26 patients with chronic hepatitis C who were receiving interferon-alpha-2B and ribavirin. The 6-month actuarial incidence of neuropsychiatric toxicity, determined by physician interview, was 58%. Significant differences in mean depression, anxiety, and somatization Brief Symptom Inventory T scores were noted in the 15 patients with clinically apparent neuropsychiatric toxicity compared to the 11 patients without neuropsychiatric toxicity. Because of its brevity and simplicity, the Brief Symptom Inventory may prove to be a useful adjunct to clinician assessment in detecting and monitoring emotional distress during interferon-alpha treatment of chronic hepatitis C.

Cross-validation of the SCL-27: a short psychometric screening instrument for chronic pain patients

We constructed a short multidimensional screening instrument for chronic pain patients based on the items contained in the Symptom Check List-90-Revised (SCL-90-R). The proposed dimensional structure of the SCL-90-R was recently shown to be irreproducible in chronic pain patients. As a consequence, the use of the Global Severity Index (GSI) was recommended, although it did not capture all information contained in the many items of the SCL-90-R. Based on an exploratory factor analysis, a six-dimensional structure using 27 items from the SCL-90-R was explored utilizing the data of 2780 chronic pain patients. A short form was prospectively tested on 581 patients in the same setting. Criteria for item selection were high convergent and low discriminant correlations. The assessment of the dimensions was kept short, but a minimum of four items were retained. A questionnaire yielding the dimensions (I) depressive symptoms, (II) dysthymic symptoms, (III) vegetative symptoms, (IV) agoraphobic symptoms, (V) symptoms of social phobia, and (VI) symptoms of mistrust was obtained. Additionally, the GSI of the SCL-90-R could be estimated precisely (r =0.96). The SCL-27 can be used for screening psychopathology in chronic pain patients. The scoring algorithm of the SCL-27 can be used for the 90-item form as well.

Psychometric Properties of the Spanish Version of the BSI

Summary: This study investigates in a nonclinical sample some aspects of the reliability and validity of the Spanish adaptation of the Brief Symptom Inventory (BSI) as well as the relationship of personality dimensions and psychopathological symptoms. Factor analysis showed a six-factor structure: depression, phobic anxiety, paranoid ideation, obsession-compulsion, somatization, and hostility/aggressivity. Alpha reliabilities for the six BSI scales showed optimal indices (between 0.70 and 0.91). Furthermore, the relationships among BSI-extracted factors and extraversion (E), neuroticism (N), and psychoticism (P) scales of the EPQ-R were also studied. Phobic anxiety and somatization were related to N and P; hostility/aggressivity was related to N, P and E; obsession-compulsion was related to N, P and inversely to E. In conclusion, the Spanish version of the BSI is a reliable, valid, and rapid tool for the assessment of symptoms of depression, phobic anxiety, paranoid ideation, obsession-compulsion, somatization, and hostility/aggressivity in the nonclinical population.

Six- and ten-item indexes of psychological distress based on the Symptom Checklist-90

Clinicians, provider organizations, and researchers need simple and valid measures to monitor mental health treatment outcomes. This article describes development of 6- and 10-item indexes of psychological distress based on the Symptom Checklist-90 (SCL-90). A review of eight factor-analytic studies identified SCL-90 items most indicative of overall distress. Convergent validity of two new indexes and the previously developed SCL-10 were compared in an archival sample of posttraumatic stress disorder patients (n = 323). One index, the SCL-6, was further validated with archival data on substance abuse patients (n = 3,014 and n = 316) and hospital staff (n = 542). The three brief indexes had similar convergent validity, correlating .87 to .97 with the SCL-90 and Brief Symptom Inventory, .49 to .76 with other symptom scales, and .46 to .73 with changes in other symptom measures over time. These results indicate the concise, easily administered indexes are valid indicators of psychological distress.