The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview

Competing Models of Personality Disorder: Relations With Psychosocial Functioning

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013), includes 10 categorical personality disorders (PD) in Section II (Section II PD) and a dimensional alternative model of PD (AMPD) in Section III. We compared the two models in explaining concurrent psychosocial functioning levels in psychiatric outpatients and community residents screened as at risk for PD pathology (N = 600). The AMPD's fully dimensional form showed stronger associations with psychosocial difficulties and explained more of their variance compared with the categorical Section II PD. AMPD Criterion A (personality functioning impairment) and Criterion B (pathological traits) incrementally predicted psychosocial functioning about equally with some unique predictions. Finally, AMPD's six categorical PD diagnoses did not show stronger associations with psychosocial functioning than the corresponding Section II PD diagnoses. Findings directly comparing the two models remain important and timely for informing future conceptualizations of PD in the diagnostic system.

Personality disorder coverage, prevalence, and convergence: do the DSM-5's two models of personality disorder identify the same patients?

BACKGROUND

Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness - that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage.

METHOD

Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., ). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs.

RESULTS

Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for 'any PD.'

CONCLUSIONS

Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.

Associations of antidepressant medication consumption with changes in personality pathology and quality of life among community-dwelling adults

BACKGROUND

Although antidepressant medication (ADM) has produced small advantages over pill placebo in randomized controlled trials, consuming ADM has predicted prospectively increasing depressive symptom severity in samples of community-dwelling adults.

OBJECTIVE

We extended the community literature by testing ADM's relations to changes in personality and quality of life that may underpin depression.

METHOD

In this longitudinal, observational study, community-dwelling adults (N = 601) were assessed twice, 8 months apart on average. Assessments included depressive symptoms, personality, life satisfaction and quality, and prescription medication consumption.

RESULTS

Consuming ADM at time 1 predicted relative increases in depressive symptoms (dysphoria), maladaptive traits (negative affect, negative temperament, disinhibition, low conscientiousness), personality dysfunction (non-coping, self-pathology), and decreases in life satisfaction and quality from time 1 to 2, before and after adjustment for age, gender, race, income, education, physical health problems, and use of other psychotropics. In no analysis did ADM use predict better outcomes.

CONCLUSION

Among community-dwelling adults, ADM use is a risk factor for psychosocial deterioration in domains including depressive symptoms, personality pathology, and quality of life. Until mechanisms connecting ADM to poor outcomes in community samples are understood, additional caution in use of ADM and consideration of empirically supported non-pharmacologic treatments is prudent.

Disinhibition domain and facets uniquely predict changes in depressive symptoms and psychosocial functioning

This study aimed to understand the role of disinhibition (low conscientiousness)-in conjunction with the other major personality traits of negative affectivity, detachment, antagonism, and psychoticism-in predicting changes in depressive symptoms and psychosocial functioning. Both the disinhibition trait domain and its primary facets (i.e., irresponsibility, impulsivity, and distractibility) were examined. In a large sample (Time 1 N = 605, Time 2 N = 497) of psychiatric outpatients and high-risk community residents, personality traits, depressive symptoms (both self-reported and interviewer-rated), and psychosocial functioning levels (i.e., daily functioning, interpersonal functioning, health-related quality of life, and global quality of life) were collected across two time points. Results showed that the disinhibition domain was the strongest predictor of changes in depressive symptoms and general quality of life levels. Disinhibition facets also predicted changes in depressive symptoms but showed a less consistent pattern compared to the broader trait domain. Finally, the irresponsibility and distractibility facets significantly and uniquely explained changes in interpersonal functioning. The study highlights the importance of assessing the disinhibition trait rather than only negative and positive affectivity (which are well-known correlates of depression), for understanding changes in depressive symptoms and psychosocial functioning. The findings identify potential targets in psychotherapy for individuals with disinhibition traits and depressive disorders.

Is Personality Pathology Ego-Syntonic? Self- and Meta-Perception of Maladaptive Personality Traits

Research has challenged the assumption that personality pathology is "ego-syntonic" or perceived favorably and consistent with one's self-image. The present study employed a community sample (n = 401) to examine relations between self-rated maladaptive personality and liking of maladaptive traits in self and others as well as meta-perception of personality pathology (i.e., how likable participants believe others find maladaptive traits). In general, individuals with higher self-rated maladaptive traits provided higher ratings of the likability of these traits in themselves and others. However, as hypothesized, comparison of liking ratings for high scorers and the rest of the sample revealed that individuals who score high on most pathological personality traits do not "like" these traits (or rate others as "liking" them) but simply dislike them less. Results support a dimensional view of ego-syntonicity.

Diagnosing attention-deficit hyperactivity disorder (ADHD) using artificial intelligence: a clinical study in the UK

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting a large percentage of the adult population. A series of ongoing efforts has led to the development of a hybrid AI algorithm (a combination of a machine learning model and a knowledge-based model) for assisting adult ADHD diagnosis, and its clinical trial currently operating in the largest National Health Service (NHS) for adults with ADHD in the UK. Most recently, more data was made available that has lead to a total collection of 501 anonymized records as of 2022 July. This prompted the ongoing research to carefully examine the model by retraining and optimizing the machine learning algorithm in order to update the model with better generalization capability. Based on the large data collection so far, this paper also pilots a study to examine the effectiveness of variables other than the Diagnostic Interview for ADHD in adults (DIVA) assessment, which adds considerable cost in the screenining process as it relies on specially trained senior clinicians. Results reported in this paper demonstrate that the newly trained machine learning model reaches an accuracy of 75.03% when all features are used; the hybrid model obtains an accuracy of 93.61%. Exceeding what clinical experts expected in the absence of DIVA, achieving an accuracy of 65.27% using a rule-based machine learning model alone encourages the development of a cost effective model in the future.

Evaluating a Comprehensive Model of Euthymia

INTRODUCTION

In research and treatment of mood disorders, "euthymia" traditionally denotes the absence of clinically significant mood disturbance. A newer, expanded definition of euthymia also includes positive affect and psychological well-being.

OBJECTIVE

We aimed to test this comprehensive model of euthymia and estimate the coherence and predictive power of each factor in the model.

METHODS

Community-dwelling adults (N = 601), including both mental health outpatients and non-patients at high risk for personality pathology, completed a battery of interviews and questionnaires at time 1. Most (n = 497) were reassessed on average 8 months later (time 2). We modeled euthymia using standard mood, personality, and psychosocial functioning assessments rather than measures designed specifically for euthymia.

RESULTS

The hypothesized model of euthymia was supported by confirmatory factor analysis: specific measures loaded on three lower order factors (mood disturbance, positive affect, and psychological well-being) that reflected general euthymia at time 1. Each factor (general euthymia plus lower order factors) demonstrated moderately strong concurrent (time 1) and predictive (time 1-2) correlations with outcomes, including employment status, income, mental health treatment consumption, and disability. Compared to positive affect and psychological well-being, mood disturbance had stronger incremental (i.e., nonoverlapping) relations with these outcomes.

CONCLUSIONS

Support for a comprehensive model of euthymia reinforces efforts to improve assessment and treatment of mood and other disorders. Beyond dampening of psychological distress, euthymia-informed treatment goals encompass full recovery, including enjoyment and meaning in life.

COVID-Dynamic: A large-scale longitudinal study of socioemotional and behavioral change across the pandemic

The COVID-19 pandemic has caused enormous societal upheaval globally. In the US, beyond the devastating toll on life and health, it triggered an economic shock unseen since the great depression and laid bare preexisting societal inequities. The full impacts of these personal, social, economic, and public-health challenges will not be known for years. To minimize societal costs and ensure future preparedness, it is critical to record the psychological and social experiences of individuals during such periods of high societal volatility. Here, we introduce, describe, and assess the COVID-Dynamic dataset, a within-participant longitudinal study conducted from April 2020 through January 2021, that captures the COVID-19 pandemic experiences of >1000 US residents. Each of 16 timepoints combines standard psychological assessments with novel surveys of emotion, social/political/moral attitudes, COVID-19-related behaviors, tasks assessing implicit attitudes and social decision-making, and external data to contextualize participants' responses. This dataset is a resource for researchers interested in COVID-19-specific questions and basic psychological phenomena, as well as clinicians and policy-makers looking to mitigate the effects of future calamities.

How can the DSM-5 alternative model of personality disorders advance understanding of depression?

BACKGROUND

The DSM-5 introduced an alternative model of personality disorder (AMPD) that includes personality dysfunction plus maladaptive-range traits. This study clarifies relations of depression diagnoses and symptoms with AMPD personality pathology.

METHOD

Two samples (Ns 402 and 601) of outpatients and community-dwelling adults completed four depression (criteria met for major depressive disorder and dysthymia; dysphoria and low well-being scales), ten trait (two scales for each of five domains-negative affectivity, detachment, disinhibition, antagonism, psychoticism), and eight dysfunction (four scales for each of two domains-self- and interpersonal pathology) measures. Diagnoses were made using a semi-structured interview; other measures were self-reports. We quantified cross-sectional relations between depression and personality pathology with correlation and multiple regression analyses.

RESULTS

Collectively (median R²; ps < 0.0001), the trait (0.46) and dysfunction (0.50) scales predicted the depression measures strongly, with most predictive power shared (0.41) between traits and dysfunction. However, trait and dysfunction scales altogether predicted depression (median R² = 0.54) more strongly than either domain alone, ps < 0.0001. Participants with depression diagnoses showed elevations on all nonadaptive trait and personality dysfunction measures, particularly negative temperament/affectivity and self-pathology measures.

LIMITATIONS

Generalization of findings to other populations (e.g., adolescents), settings (e.g., primary care), and measures (e.g., traditional personality disorder diagnoses) is uncertain. Cross-sectional analyses did not test changes over time or establish causality.

CONCLUSIONS

The AMPD is highly relevant to depression. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, stands to advance understanding of depression in adults.

The Incremental Utility of Criteria A and B of the DSM-5 Alternative Model for Personality Disorders for Predicting DSM-IV/DSM-5 Section II Personality Disorders

The DSM-5 Alternative Model for Personality Disorders (AMPD) includes two main criteria: moderate or greater impairment in personality functioning (Criterion A) and the presence of one or more pathological personality traits (Criterion B). The aim of the study was to investigate the incremental utility of Criteria A and B for predicting DSM-5 Section II personality disorders (PD). The sample (N = 317) consisted of three well-defined groups: non-clinical participants (n = 35), psychiatric patients with PD (n = 193), and without PD (n = 83). All were assessed using the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I): Level of Personality Functioning Scale (LPFS), and the Personality Inventory for DSM-5 (PID-5). Logistic regression analyses showed that the SCID-5-AMPD-I could predict the presence of PDs in general, and the three specific PDs that were investigated (i.e., Antisocial, Borderline, and Avoidant PDs). The PID-5 domains enhanced prediction of the specific PDs, but not the presence of PDs in general, when entered in the second step. Our results support the AMPD model: Criterion A predicted the presence of DSM-5 Section II PDs in general, whereas measures of Criterion B incremented prediction of Antisocial, Borderline, and Avoidant PDs.

The Appalachia Mind Health Initiative (AMHI): a pragmatic randomized clinical trial of adjunctive internet-based cognitive behavior therapy for treating major depressive disorder among primary care patients

BACKGROUND

Major depressive disorder (MDD) is a leading cause of disease morbidity. Combined treatment with antidepressant medication (ADM) plus psychotherapy yields a much higher MDD remission rate than ADM only. But 77% of US MDD patients are nonetheless treated with ADM only despite strong patient preferences for psychotherapy. This mismatch is due at least in part to a combination of cost considerations and limited availability of psychotherapists, although stigma and reluctance of PCPs to refer patients for psychotherapy are also involved. Internet-based cognitive behaviorial therapy (i-CBT) addresses all of these problems.

METHODS

Enrolled patients (n = 3360) will be those who are beginning ADM-only treatment of MDD in primary care facilities throughout West Virginia, one of the poorest and most rural states in the country. Participating treatment providers and study staff at West Virginia University School of Medicine (WVU) will recruit patients and, after obtaining informed consent, administer a baseline self-report questionnaire (SRQ) and then randomize patients to 1 of 3 treatment arms with equal allocation: ADM only, ADM + self-guided i-CBT, and ADM + guided i-CBT. Follow-up SRQs will be administered 2, 4, 8, 13, 16, 26, 39, and 52 weeks after randomization. The trial has two primary objectives: to evaluate aggregate comparative treatment effects across the 3 arms and to estimate heterogeneity of treatment effects (HTE). The primary outcome will be episode remission based on a modified version of the patient-centered Remission from Depression Questionnaire (RDQ). The sample was powered to detect predictors of HTE that would increase the proportional remission rate by 20% by optimally assigning individuals as opposed to randomly assigning them into three treatment groups of equal size. Aggregate comparative treatment effects will be estimated using intent-to-treat analysis methods. Cumulative inverse probability weights will be used to deal with loss to follow-up. A wide range of self-report predictors of MDD heterogeneity of treatment effects based on previous studies will be included in the baseline SRQ. A state-of-the-art ensemble machine learning method will be used to estimate HTE.

DISCUSSION

The study is innovative in using a rich baseline assessment and in having a sample large enough to carry out a well-powered analysis of heterogeneity of treatment effects. We anticipate finding that self-guided and guided i-CBT will both improve outcomes compared to ADM only. We also anticipate finding that the comparative advantages of adding i-CBT to ADM will vary significantly across patients. We hope to develop a stable individualized treatment rule that will allow patients and treatment providers to improve aggregate treatment outcomes by deciding collaboratively when ADM treatment should be augmented with i-CBT.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04120285 . Registered on October 19, 2019.

Is social function a good proxy measure of personality disorder?

BACKGROUND

Personality assessment may be helped by proxy measures.

AIMS

To examine the assessment of social functioning in relationship to personality disorder.

METHOD

Secondary analysis of data from three clinical studies, following deliberate self-harm (n = 460), cognitive behaviour therapy for health anxiety (n = 444) and a 30-year follow-up of 200 anxious/depressed patients. Social function and personality were assessed using the Social Functioning Questionnaire (SFQ) and the Personality Assessment Schedule, with its ICD-11 modification. A 5-item short version of the SFQ, the Short Social Functioning Questionnaire (SSFQ), was also developed. The SFQ score in the first two studies (area under curve [AUC] 0.64 and 0.65) partly predicted personality status; in the third study, this achieved close agreement (AUC SFQ 0.85 [95% CI 0.8-0.9]; AUC SSFQ 0.84 [95% CI 0.78-0.89]). In all studies, social function deteriorated linearly with increasing personality pathology. Cut-off points of 4 on the SSFQ and 7 on the SFQ had high sensitivity (SSFQ 82%-90%; SFQ 82%-83%) and acceptable specificity (SSFQ 66%-75%; SFQ 69%-75%) in identifying personality disorder in the third study.

CONCLUSIONS

Social functioning recorded in either a 5-item or 8-item self-rating is a useful proxy measure of personality disturbance and may be the core of disorder.

Arousability, Personality, and Decision-Making Ability in Dissociative Disorder

BACKGROUND

There is a gap in understanding the pathogenesis of dissociative conversion disorder (DCD), despite the disorder having a strong historical root. The role of personality and neurocognitive factors are now highlighted; however, inconsistencies are reported. This study explores the personality disposition, arousability, and decision-making ability of patients with DCD, in reference to a healthy control group (HCG).

METHODS

In this cross-sectional study, the sample comprised ten adult psychiatric patients with DCD. Ten participants of the HCG were matched according to age, gender, education, economic status, domicile, religious background, and handedness. The study assessed personality disposition with Temperament and Character Inventory, arousability with reaction time task, and decision-making ability with the Iowa Gambling Task (IGT PEBL version).

RESULTS

The DCD group differed significantly on personality disposition related to both temperament and character. There was also evidence of easy arousability and frustration along with deficit in executive function related to decision-making ability.

CONCLUSION

This study highlights the presence of both temperamental and characterological factors associated with DCD. Moreover, this study identifies the role of cognitive arousability and decision-making or feedback utilization ability in the psychopathology of DCD.

Validation of the Three-Item Screener for Personality Disorders From the Inventory of Interpersonal Problems (IIP-3)

We previously developed a three-item screener for identifying respondents with any personality disorder (PD) using the Inventory of Interpersonal Problems (IIP). The current goal was to examine the convergent validity of the IIP-3 with other PD screeners and diagnostic tools and to investigate its relationship to measures of adult attachment and emotion regulation. The sample consisted of participants from five studies (total N = 852), with data from collateral informants available for a subsample (N = 353). Despite its brevity, the IIP-3 showed moderate to strong relationships with other longer PD screeners, with PD symptom scores from the Structured Interview for DSM-IV Personality (SIDP-IV), and with a global rating of PD severity. It was most sensitive to the stylistic aspects of PD typical of the traditional DSM cluster B (dramatic, expressive) PDs. These results emerged with data from both participants and informants, although correlations using informant data were generally smaller.

Anxiety and Depression: A Key to Understanding the Complete Expression of Personality Disorders

ABSTRACT

Anxiety and depressive disorders affect one fourth of the population. Personality disorders often present comorbid with anxiety and depressive disorders during the lifetime course of the illness. To fully explore the interplay between personality disorders and anxiety or depression, 179 patients, consecutively admitted to the Anxiety and Depression Outpatient Department, were clinically evaluated and tested with the Mini-International Neuropsychiatric Interview and the Iowa Personality Disorder Screening. Twenty-six percent of the total sample was affected only by personality disorders (PDs), and 21% had a comorbidity between a personality, anxiety, and/or depressive disorder (Comorbidity). Compared with PDs, Comorbidity used more antipsychotics and benzodiazepines (4.3% vs. 9.6%, χ2 = 0.267; 43.4 vs. 72.6, p = 0.004), showing a worse clinical picture, and expressed more personality traits even without statistical significance (6.863 ± 2.328 vs. 7.609 ± 1.674, p = 0.105). The different impact of personality disorders compared with anxiety and/or depression has to be further analyzed in terms of economic load and resource allocation.

A hybrid AI approach for supporting clinical diagnosis of attention deficit hyperactivity disorder (ADHD) in adults

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness. It is considered as an important public health issue and prevalence of, as well as demand for diagnosis, has increased as awareness of the disease grew over the past years. Supply of specialist medical experts has not kept pace with the increasing demand for assessment, both due to financial pressures on health systems and the difficulty to train new experts, resulting in growing waiting lists. Patients are not being treated quickly enough causing problems in other areas of health systems (e.g. increased GP visits, increased risk of self-harm and accidents) and more broadly (e.g. time off work, relationship problems). Advances in AI make it possible to support the clinical diagnosis of ADHD based on the analysis of relevant data. This paper reports on findings related to the mental health services of a specialist Trust within the UK’s National Health Service (NHS). The analysis studied data of adult patients who underwent diagnosis over the past few years, and developed a hybrid approach, consisting of two different models: a machine learning model obtained by training on data of past cases; and a knowledge model capturing the expertise of medical experts through knowledge engineering. The resulting algorithm has an accuracy of 95% on data currently available, and is currently being tested in a clinical environment.

Current mental health in women with childhood sexual abuse who had outpatient psychotherapy

Purpose

This study from Norway examines mental health status of women with child sexual abuse (CSA) who formerly had outpatient psychotherapy for anxiety disorders and/or depression. The relative contributions of CSA and other family background risk factors (FBRF) to aspects of mental health status are also explored.

Subjects

At a mean of 5.1 years after outpatient psychotherapy, 56 female outpatients with CSA and 56 without CSA were personally examined by an independent female psychiatrist. Systematic information about current mental health and functioning was collected by structured interview and questionnaires.

Results

Among women with CSA 95% had a mental disorder, 50% had PTSD, and mean global assessment of functioning (GAF) score was 61.8 ± 10.6. In contrast, 70% of women without CSA had a mental disorder, 14% had PTSD, and mean GAF 71.2 + 8.5. GAF and trauma scale scores were mainly determined by CSA, while FBRF mainly influenced the global psychopathology and dissociation scores.

Discussion

We have little knowledge on the mental health status at long-term in women with CSA who had psychotherapy. This study found their mental status to be rather poor, and worse than that of women without CSA who had psychotherapy for the same disorders. From the broad spectrum of mental disorders associated with CSA, this study concerns only women treated as outpatients for anxiety disorders and/or non-psychotic depressions.

Conclusion

Women with CSA showed poor mental health at long-term follow-up after treatment. The fitness of the psychodynamic individual psychotherapy given, or to what extent treatment can remedy the consequences of such childhood adversities, is discussed.

Problems in developing an instrument for the rapid assessment of personality status

Purpose

To assess the validity of a quick assessment instrument (10 minutes) for assessing personality status, the Rapid Personality Assessment Schedule (PAS-R).

Subjects and methods

The PAS-R was evaluated in psychotic patients recruited in one of the centres involved in a multicentre randomised controlled trial of intensive vs standard case management (the UK700 case management trial). Patients were assessed using both a full version of the PAS (PAS-I – ICD version) and the PAS-R. The weighted kappa statistic was used to gauge the (criterion-related) validity of the PAS-R using the PAS-I as the gold standard. Both measure code personality status using a four-point rating of severity in addition to recording individual categories of personality disorder.

Results

One hundred fifty-five (77%) of 201 patients recruited were assessed with both instruments. The weighted kappa statistic was 0.31, suggesting only moderate agreement between the PAS-I and PAS-R instruments under the four-point rating format, and 0.39 for the dichotomous personality disorder/no disorder separation. The sensitivity (64%) and specificity (82%) of the PAS-R in predicting PAS-I personality disorder were as satisfactory as for other screening instruments but still somewhat disappointing, and the PAS-R had an overall diagnostic accuracy of 78%.

Conclusion

The PAS-R is a quick and rough method of detecting personality abnormality but is not a substitute for a fuller assessment.

Personality profiles as potential targets for intervention: Identification and replication

The alternative dimensional model of personality disorder (PD) diagnosis, based on personality-functioning impairment and pathological traits, opens the door for tailoring treatments to individuals with more homogeneous personality profiles than diagnostic categories. Such a transdiagnostic PD treatment approach requires robust, replicable, personality-relevant dimensions, which we found using a large battery of self-report measures: Self-pathology and negative affectivity (NA) traits, interpersonal pathology and detachment traits, and interpersonal pathology and antagonism traits. Using these dimensions, we identified three groups that had, respectively, elevations on (1) all three dimensions, (2) self-pathology/NA (with/without interpersonal-pathology elevation(s)) and (3) either or both interpersonal-pathology dimensions, without elevated self-pathology/NA. Using the same personality-functioning measures and a half-overlapping trait set, we replicated these profiles in an additional sample. Interview-based measures of functioning and personality pathology provided external validity evidence for the method, suggesting it represents a critical first step towards treatment research targeting transdiagnostic processes rather than diagnoses. For example, two groups might benefit from treatments focused, respectively, on emotional dysregulation and interpersonal relations, whereas the multiple-problem group may need a sequenced treatment approach. Research is needed to test these hypotheses and to expand the method to include a wider range of pathological personality traits. © 2019 John Wiley & Sons, Ltd.

Screening for Personality Disorders: A Three-Item Screener From the Inventory of Interpersonal Problems (IIP-3)

To encourage screening for personality disorders (PDs), we developed (in previous work) self-report scales for PDs using the Inventory of Interpersonal Problems (IIP). The combined score from three of the scales-inter-personal sensitivity, interpersonal ambivalence, and aggression-requiring 15 items (IIP-15) did the best job of distinguishing between respondents with any versus no PD. The goals for the present work were (a) to cross-validate the IIP-15 by examining its performance using receiver operating characteristics (ROC) analyses in a new sample (N = 410), and (b) to investigate the utility of a brief three-item variant (IIP-3). The present results again documented the good operating characteristics of the IIP-15. Sensitivity, specificity, and positive and negative predictive values were all above. 70. The operating characteristics of the IIP-3 were nearly as good despite its brevity and support its use as an initial screen for PDs.

Role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders: a protocol for a systematic review and meta-analysis

INTRODUCTION

Remission rates for mood disorders, including depressive and bipolar disorders, remain relatively low despite available treatments, and many patients fail to respond adequately to these interventions. Evidence suggests that personality disorder may play a role in poor outcomes. Although personality disorders are common in patients with mood disorders, it remains unknown whether personality disorder affects treatment outcomes in mood disorders. We aim to review currently available evidence regarding the role of personality disorder on pharmacological interventions in randomised controlled trials for adults with mood disorders.

METHODS AND ANALYSIS

A systematic search of Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com, PubMed via PubMed, EMBASE via embase.com, PsycINFO via Ebsco and CINAHL Complete via Ebsco databases will be conducted to identify randomised controlled trials that have investigated pharmacological interventions in participants aged 18 years or older for mood disorders (ie, depressive disorders and bipolar spectrum disorders) and have also included assessment of personality disorder. One reviewer will screen studies against the predetermined eligibility criteria, and a second reviewer will confirm eligible studies. Data will be extracted by two independent reviewers. Methodological quality and risk of bias will be assessed using the Cochrane Risk of Bias tool. A systematic review, and if sufficient evidence is identified, a meta-analysis will be completed. Meta-analysis will be conducted using the standardised mean difference approach and reported with 95% CIs. A random effects model will be employed and statistical heterogeneity will be evaluated using the I² statistic. Prespecified subgroup analyses will be completed.

ETHICS AND DISSEMINATION

As this systematic review will use published data, ethics permission will not be required. The outcomes of this systematic review will be published in a relevant scientific journal and presented at a research conference.

TRIAL REGISTRATION NUMBER

CRD42018089279.

The Iowa Personality Disorder Screen: A validation study in a psychiatric population that receives long-term group psychotherapy for personality related problems

Personality disorder (PD) is common among psychiatric patients, and diagnosing such disorders is of great importance for the choice of treatment. Diagnosing PD is a demanding and time-consuming process. The utilities of several PD screening instruments have been studied in different populations, but not in a population who receives long-term group psychotherapy. In the current study, we investigate the predictive properties of the Iowa Personality Disorder Screen (IPDS) in a sample of 694 psychiatric outpatients with and without PD who were admitted for psychodynamic long-term group therapy from 2012 to 2014. The definitive, reference diagnoses were defined according to the SCID-II, by which 484 patients (68%) warranted a PD diagnosis. The IPDS correctly classified 67.4 percent of all participants. Sensitivity (0.75) and specificity (0.51) were lower than in previous validation studies of IPDS. We discuss possible explanations related to the general concept of PD and, more specifically, to our study sample. Because of the weaker predictive properties of IPDS, we advise caution in use of the IPDS in similar clinical settings. Copyright © 2018 John Wiley & Sons, Ltd.

The ELPAT living organ donor Psychosocial Assessment Tool (EPAT): from 'what' to 'how' of psychosocial screening - a pilot study

Thorough psychosocial screening of donor candidates is required in order to minimize potential negative consequences and to strive for optimal safety within living donation programmes. We aimed to develop an evidence-based tool to standardize the psychosocial screening process. Key concepts of psychosocial screening were used to structure our tool: motivation and decision-making, personal resources, psychopathology, social resources, ethical and legal factors and information and risk processing. We (i) discussed how each item per concept could be measured, (ii) reviewed and rated available validated tools, (iii) where necessary developed new items, (iv) assessed content validity and (v) pilot-tested the new items. The resulting ELPAT living organ donor Psychosocial Assessment Tool (EPAT) consists of a selection of validated questionnaires (28 items in total), a semi-structured interview (43 questions) and a Red Flag Checklist. We outline optimal procedures and conditions for implementing this tool. The EPAT and user manual are available from the authors. Use of this tool will standardize the psychosocial screening procedure ensuring that no psychosocial issues are overlooked and ensure that comparable selection criteria are used and facilitate generation of comparable psychosocial data on living donor candidates.

The concurrent validity of a new eDiagnostic system for mental disorders in primary care

BACKGROUND

An eDiagnostic system was implemented to classify mental disorders, to support general practitioners.

OBJECTIVE

Assessing the validity of the system, compared to the psychologists' judgment.

METHODS

Concurrent validity, using routinely collected data of 675 primary care patients with a suspicion of a mental disorder in the Netherlands. Four psychologists classified the patients according to the DSM-IV. Hundred records were randomly selected to investigate the inter-rater reliability among psychologists. To investigate the concurrent validity of the system the sensitivity, specificity, positive predictive values (PPVs), negative predictive values (NPVs) and Cohen's κ-values (κ-values) were calculated.

RESULTS

Inter-rater agreement between psychologists were fair to good or excellent. The system could correctly estimate the echelon (sensitivity range: 0.85-0.95, specificity range: 0.88-0.98) and correctly identify most Axis I classifications (sensitivity: 0.46-1.00, specificity: 0.75-0.99), except for Asperger's, sexual and adjustment disorders (sensitivity: 0.10-0.24, specificity: 0.97-0.99). It could determine the absence of a personality disorder (sensitivity: 0.81, specificity: 0.84, PPV: 0.77, NPV: 0.87 and κ-value: 0.65). The sensitivities and specificities for most specific personality disorders were good, but the PPVs for several specific Axis II classifications were low (PPV range: 0.06-0.77). The system was inaccurate in identifying the global assessment of functioning of patients (e.g. κ-values varied from 0.17-0.46).

CONCLUSIONS

Generally, the system can be seen as a valid instrument for most DSM-IV classifications in primary care patients. It could assist healthcare professionals in the assessment and classification of mental disorders. Future research should include comparison to an independently administered structured clinical interview.

Development and Validation of a Brief Mental Health Screening Instrument for Newly Incarcerated Adults

The authors report the development and initial psychometric evaluation of gender-specific brief screening instruments to identify undetected psychiatric impairment on incarceration. Women and men completed the Correctional Mental Health Screen (CMHS), a 56-item screen derived from validated measures. Representative subsamples completed structured diagnostic interviews within 5 days. An 8-item screen for women and a 12-item screen for men identified inmates with current Axis I psychiatric disorders with 83% to 100% accuracy on the basis of cut points chosen to maximize negative predictive power. The CMHS showed evidence of incremental predictive utility compared with two previously validated correctional mental health screening measures with White and Black men and White women. Incremental validity was not supported with Black women, for whom the CMHS performed well in identifying true cases but not in ruling out noncases. Analyses of internal consistency, interrater, and retest reliability and convergent, discriminant, and criterion validity supported the psychometric status of the CMHS.

A Head-to-Head Comparison of the Personality Inventory for DSM-5 (PID-5) With the Personality Diagnostic Questionnaire-4 (PDQ-4) in Predicting the General Level of Personality Pathology Among Community Dwelling Subjects

In order to evaluate if measures of DSM-5 Alternative PD Model domains predicted interview-based scores of general personality pathology when compared to self-report measures of DSM-IV Axis II/DSM-5 Section II PD criteria, 300 Italian community adults were administered the Iowa Personality Disorder Screen (IPDS) interview, the Personality Inventory for DSM-5 (PID-5), and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Multiple regression analyses showed that the five PID-5 domain scales collectively explained an adequate rate of the variance of the IPDS interview total score. This result was slightly lower than the amount of variance in the IPDS total score explained by the 10 PDQ-4+ scales. The PID-5 traits scales performed better than the PDQ-4+, although the difference was marginal. Hierarchical regression analyses revealed that the PID-5 domain and trait scales provided a moderate, but significant increase in the prediction of the general level of personality pathology above and beyond the PDQ-4+ scales.

Is there an association between the level of grandiose narcissism severity of psychopathology?

BACKGROUND

Narcissism is a personality trait associated with both psychological health and resilience as well as with aggression and interpersonal problems.

AIM

This study compares levels of total narcissism and subscale scores in inpatients, outpatients and a community sample.

METHODS

Inpatients (N = 186) were recruited from consecutively admitted patients to two closed units, and the outpatient group (N = 144) consisted of patients attending a psychiatric outpatient clinic. The patients and a normative community sample (N = 437) all filled in the Narcissistic Personality Inventory questionnaire (NPI-29).

RESULTS

The NPI total and subscales scores showed considerable gender differences. Among men only the Uniqueness/Entitlement subscale showed significant group differences, with inpatients showing higher mean score than the two other groups. Among women three factors, Leadership/Power, Superiority/Arrogance, and Uniqueness/ Entitlement, showed significant differences between the different levels of psychopathology. The outpatient female group regularly had the lowest group mean scores. The NPI-29 scores of the normative group showed weak internal consistencies.

CONCLUSION

Our hypothesis of a significant association between mean levels of total narcissism and subscale scores and severity of psychopathology was not supported.

Denial of risk: The effects of positive impression management on risk assessments for psychopathic and nonpsychopathic offenders

Risk assessments for offenders often combine past records with current clinical findings from observations, interviews, and test data. Conclusions based on these risk assessments are highly consequential, sometimes resulting in increased criminal sentences or prolonged hospitalization. Therefore, many offenders are motivated to intentionally minimize risk factors and their negative consequences. Positive impression management (PIM) is especially likely to occur in offenders with high psychopathic traits because goal-directed deception is reflected in several of psychopathy's core traits of the disorder, such as manipulativeness, glibness, and superficial charm. However, this connection appears to be based on the conceptual understanding of psychopathy, and has rarely been examined empirically for either frequency of or success at deception. The current study examined the ability of a jail sample to intentionally minimize risk factors and related criminal attributes using a repeated measures, simulation design. In general, offenders were able to effectively use PIM to lower scores on the HCR-20 and the Self-Appraisal Questionnaire (SAQ), while the Psychological Inventory of Criminal Thinking Styles (PICTS), as a measure of cognitive styles, was more resistant to such minimization. Psychopathic traits, especially high Factor 1 scores (i.e., affective/interpersonal), were associated with greater PIM. Important differences in the willingness and ability to use deception were found based on the (a) mode of administration (i.e., interview vs. self-report) and (b) level of psychopathy as measured by the Psychopathy Checklist - Revised (PCL-R). The important implications of this research are discussed for risk assessment procedures regarding likely areas of deception and its detection. The current research also informs the growing literature on the connection between psychopathic traits and deception.

Classification, assessment, prevalence, and effect of personality disorder

Personality disorders are common and ubiquitous in all medical settings, so every medical practitioner will encounter them frequently. People with personality disorder have problems in interpersonal relationships but often attribute them wrongly to others. No clear threshold exists between types and degrees of personality dysfunction and its pathology is best classified by a single dimension, ranging from normal personality at one extreme through to severe personality disorder at the other. The description of personality disorders has been complicated over the years by undue adherence to overlapping and unvalidated categories that represent specific characteristics rather than the core components of personality disorder. Many people with personality disorder remain undetected in clinical practice and might be given treatments that are ineffective or harmful as a result. Comorbidity with other mental disorders is common, and the presence of personality disorder often has a negative effect on course and treatment outcome. Personality disorder is also associated with premature mortality and suicide, and needs to be identified more often in clinical practice than it is at present.

The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity

The alternative dimensional model for personality disorder (PD) in DSM-5, Section III (DSM-5-III) includes two main criteria: (A) personality-functioning impairment, and (B) personality-trait pathology; provides specific functioning-and-trait criteria for six PD-type diagnoses; and introduces PD-trait specified (PD-TS), which requires meeting the general PD criteria and not meeting criteria for any specific PD type. We termed this Simple PD-TS and developed two additional definitions: Mixed PD-TS, meeting criteria for one or two PD types and having five or more additional pathological traits; and Complex PD-TS, meeting criteria for three or more PD types. In a mixed sample of 165 outpatients and 215 community adults screened to be at high-risk for PD, we investigated the effect of these additional definitions on prevalence, coverage, comorbidity, and within-diagnosis heterogeneity, and conclude that eliminating the PD-type diagnoses and thus having PD-TS as the only PD diagnosis would be both more parsimonious and more useful clinically.

The psychometric properties of the iowa personality disorder screen in methadone-maintained patients: an initial investigation

The psychometric properties of the Iowa Personality Disorder Screen (IPDS) were examined in 150 methadone-maintained patients who completed measures of demographic, psychopathology, substance use, pain, and methadone maintenance treatment (MMT) characteristics. An exploratory factor analysis revealed a two-factor solution that explained 45% of the scale variance. The first factor captured internalizing tendencies, such as inhibition and hypersensitivity to others. The second factor comprised externalizing tendencies, such as impulsivity and insensitivity to others. The IPDS item subsets, derived factors, and the total score were significantly related to race/ethnicity but not sex. The effects of race/ethnicity were controlled statistically when the IPDS was compared to other measures of psychopathology, self-reported substance use, pain variables, and MMT characteristics. In general, the IPDS appears to be reliable and valid for use with methadone-maintained patients. The two-factor structure found in this study may have clinical utility and merits further investigation in other MMT samples.

Different impulsivity profiles in borderline personality disorder and bipolar II disorder

INTRODUCTION

Borderline personality disorder (BPD) and bipolar II disorder (BP II) share clinical characteristics including impulsivity. Their relationship is disputed. In this study, we investigated self-reported impulsivity in these patient groups and in a healthy control group. Effects of current mood state and of traumatic childhood experiences were explored.

METHODS

Twenty-five patients with BPD without comorbid bipolar disorder; 20 patients with BP II without comorbid BPD; and 44 healthy control subjects completed the UPPS questionnaire which yields assessments of four components of impulsivity: Urgency, Lack of Premeditation, Lack of Perseverance, and Sensation Seeking. Current mood state was rated using the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Traumatic childhood experiences were assessed using the Childhood Trauma Questionnaire (CTQ). Group differences in UPPS levels; and effects of mood state and CTQ score on UPPS scores in patients were investigated.

RESULTS

BPD patients showed significantly higher levels of Urgency and Lack of Perseverance than BP II patients and controls, and a significantly higher level of Lack of Premeditation than controls. BP II patients showed higher levels of Urgency and Lack of Perseverance than controls. In BP II, higher MADRS scores were associated with higher impulsivity scores. Also, higher CTQ scores were associated with higher Urgency scores in BP II.

LIMITATIONS

Relatively small sample size; cross-sectional assessment of influence of mood state.

CONCLUSIONS

BPD patients exhibited markedly elevated UPPS impulsivity scores compared with healthy controls and BP II patients, and the elevations were not related to current mood state. BP II patients showed moderately elevated impulsivity scores which were associated with a depressed mood state and to some extent with a history of childhood trauma. The findings suggest that BPD and BP II have different impulsivity profiles.

Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD): an open-label prospective study of time in treatment, dose, side-effects and comorbidity

How to generalize from randomized placebo controlled trials of ADHD drug treatment in adults to 'real-world' clinical practice is intriguing. This open-labeled prospective observational study examined the effectiveness of long-term stimulant and non-stimulant medication in adult ADHD including dose, side-effects and comorbidity in a clinical setting. A specialized ADHD outpatient clinic gave previously non-medicated adults (n=250) with ADHD methylphenidate as first-line drug according to current guidelines. Patients who were non-tolerant or experiencing low efficacy were switched to amphetamine or atomoxetine. Primary outcomes were changes of ADHD-symptoms evaluated with the Adult ADHD Self-Report Scale (ASRS) and overall severity by the Global Assessment of Functioning (GAF). Secondary outcomes were measures of mental distress, and response on the Clinical-Global-Impressions-Improvement Scale. Data at baseline and follow-ups were compared in longitudinal mixed model analyses for time on-medication, dosage, comorbidity, and side-effects. As results, 232 patients (93%) completed examination at the 12 month endpoint, and 163 (70%) remained on medication. Compared with the patients who discontinued medication, those still on medication had greater percentage reduction in ASRS-scores (median 39%, versus 13%, P<0.001) and greater improvement of GAF (median 20% versus 4%, P<0.001) and secondary outcomes. Continued medication and higher cumulated doses showed significant associations to sustained improvement. Conversely, psychiatric comorbidity and side-effects were related to lower effectiveness and more frequent termination of medication. Taken together, one-year treatment with stimulants or atomoxetine was associated with a clinically significant reduction in ADHD symptoms and mental distress, and improvement of measured function. No serious adverse events were observed.

Stalking experiences and associated factors--a controlled population-based study from Norway

BACKGROUND

Stalking is a considerable health problem. In order to develop interventions for victims, more knowledge is needed concerning prevalence, stress and coping related to stalking as well as associated symptomatology in the victims. This is the first population-based study of stalking in Norway.

AIMS

To examine the prevalence of stalking in relation to gender and time, and the association with indicators of socio-demographic status and mental health.

METHODS

A cross-sectional case-control questionnaire design. The sample, 5000 Norwegians aged 20-59 years, was nationally representative according to gender, 10-year age groups and county of living. A total of 248 (5%) of the mailed envelops were returned due to wrong address, leaving 4752 individuals as possible respondents. Among them 1520 (32%) returned the questionnaire, but 98 of them had to be discarded due to lack of completion, giving a sample of 1422 valid questionnaires (30%).

RESULTS

The total weighted lifetime prevalence of stalking was 8.1% (95% CI 6.6-9.4%), for females 11.8% (95% CI 10.2-13.5%) and for males 4.3% (95% CI 3.2-5.3%) [corrected]. The point prevalence of current stalking was 2.8% (95% CI 2.0-3.7%). The stalked individuals had a significantly poorer social situation and mental health than the controls. Few significant group differences were observed between males and females exposed to stalking.

CONCLUSIONS

The prevalence of stalking was within the range observed by questionnaire studies in other cultures.

Screening for personality disorder in drug and alcohol dependence

Comorbidity of personality disorders in addiction is common, and there is a need for efficient detection methods. This study describes the use of two quick screening instruments: the self-reported versions of the Iowa Personality Disorder Screen (IPDS-SR) and the Standardised Assessment of Personality Abbreviated Scale (SAPAS-SR). The sample included 53 inpatients dependent on alcohol and/or drugs, with a 42% prevalence of any DSM-IV personality disorder. The Personality Assessment Schedule (PAS) was used as gold standard. Receiver-Operant-Characteristic (ROC) was used for analysis. The Area Under the Curve for the IPDS-SR was 0.84 (95% CI 0.72-0.93) and for the SAPAS-SR was 0.82 (95% CI 0.70-0.93). An IPDS-SR score of 5 or more correctly classified 77.4% of patients, with a sensitivity of 86.4% and a specificity of 71%. A SAPAS-SR score of 4 or more correctly classified 73.6% of patients, with a sensitivity of 81.8% and a specificity of 67.7%. Both instruments were quick, easy to administer, and acceptable to use by this population. They can be implemented in routine clinical practice in busy substance misuse departments. However further research into the implications of positive screenings is required.

Psychopathology and pain correlates of dispositional optimism in methadone-maintained patients

BACKGROUND AND OBJECTIVES

Although higher levels of dispositional optimism are associated with decreased levels of psychopathology and pain, and higher levels of mental health functioning-important outcomes in opioid treatment programs-a paucity of studies has examined dispositional optimism among individuals with opioid use disorders. The aim of this study was to examine the clinical correlates (i.e., psychopathology, pain status) of dispositional optimism in opioid dependent patients enrolled in methadone maintenance treatment (MMT).

METHODS

A survey targeting demographics, pain, psychopathology, and dispositional optimism was administered to 150 MMT patients.

RESULTS

In multivariable analyses, higher levels of dispositional optimism were significantly associated with lower levels of: depression, screened personality disorder criteria, screened symptoms of posttraumatic stress disorder, and pain-related emotional strain. In comparison to those without a history of chronic pain (ie, noncancer related physical pain lasting at least 3 months), MMT patients who reported either lifetime or current chronic pain exhibited significantly lower levels of dispositional optimism.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

The associations among higher levels of dispositional optimism, lower levels of psychopathology, and lower pain-related emotional strain suggest that research focusing on the efficacy of specific interventions to promote dispositional optimism in MMT patients is warranted.

Mixture modeling methods for the assessment of normal and abnormal personality, part I: cross-sectional models

Over the past 75 years, the study of personality and personality disorders has been informed considerably by an impressive array of psychometric instruments. Many of these tests draw on the perspective that personality features can be conceptualized in terms of latent traits that vary dimensionally across the population. A purely trait-oriented approach to personality, however, might overlook heterogeneity that is related to similarities among subgroups of people. This article describes how factor mixture modeling (FMM), which incorporates both categories and dimensions, can be used to represent person-oriented and trait-oriented variability in the latent structure of personality. We provide an overview of different forms of FMM that vary in the degree to which they emphasize trait- versus person-oriented variability. We also provide practical guidelines for applying FMM to personality data, and we illustrate model fitting and interpretation using an empirical analysis of general personality dysfunction.

Adult Attachment Ratings (AAR): an item response theory analysis

The Adult Attachment Ratings (AAR) include 3 scales for anxious, ambivalent attachment (excessive dependency, interpersonal ambivalence, and compulsive care-giving), 3 for avoidant attachment (rigid self-control, defensive separation, and emotional detachment), and 1 for secure attachment. The scales include items (ranging from 6-16 in their original form) scored by raters using a 3-point format (0 = absent, 1 = present, and 2 = strongly present) and summed to produce a total score. Item response theory (IRT) analyses were conducted with data from 414 participants recruited from psychiatric outpatient, medical, and community settings to identify the most informative items from each scale. The IRT results allowed us to shorten the scales to 5-item versions that are more precise and easier to rate because of their brevity. In general, the effective range of measurement for the scales was 0 to +2 SDs for each of the attachment constructs; that is, from average to high levels of attachment problems. Evidence for convergent and discriminant validity of the scales was investigated by comparing them with the Experiences of Close Relationships-Revised (ECR-R) scale and the Kobak Attachment Q-sort. The best consensus among self-reports on the ECR-R, informant ratings on the ECR-R, and expert judgments on the Q-sort and the AAR emerged for anxious, ambivalent attachment. Given the good psychometric characteristics of the scale for secure attachment, however, this measure alone might provide a simple alternative to more elaborate procedures for some measurement purposes. Conversion tables are provided for the 7 scales to facilitate transformation from raw scores to IRT-calibrated (theta) scores.

Anxiety as a risk factor for school absenteeism: what differentiates anxious school attenders from non-attenders?

BACKGROUND

Anxiety is a major risk factor for problematic school absenteeism. However, most anxious students attend school. What differentiates anxious attenders from non-attenders?

METHOD

High school students (N = 865) were assigned to groups based on anxiety and absenteeism scores. These groups were then tested for differences in risk factor profiles using discriminant analysis.

RESULTS

Anxious school attenders were less affected by negative personality traits, total number of risk factors, social anxiety, panic, and behavioural and family problems. They also displayed greater resilience.

CONCLUSIONS

This study indicates that the risk for problematic school absenteeism increases as the number of risk factors aggregate and that treatment for anxious school refusal should be based on a profile of the individual's risk factors.

Unfavorable health conditions associated with high social anxiety in the elderly: a community-based study

BACKGROUND

There is little knowledge concerning unfavorable health conditions (UHC) associated with high level of social phobia/anxiety symptoms (SPAS) in the elderly.

AIMS

This cross-sectional community-based study examines five categories of UHC related to high SPAS in individuals aged 75/76 years compared with controls with lower SPAS.

METHODS

The study was based on data from the Oslo Health Study. Based on self-rating of the MINI-SPIN screening instrument, 246 individuals (9%) had high SPAS (cases) and 2464 (91%) had lower SPAS (controls). The socio-demographic, somatic, lifestyle, social and mental categories of UHC were compared between cases and controls.

RESULTS

A significantly higher proportion of cases were in non-paired relationships, had low level of education and low income compared with controls. Among cases, a significantly higher proportion had poor self-rated health, more somatic morbidity, regular use of analgesics and frequent drinking. All indicators of social UHC, except low community activism, were significantly more common among cases compared with controls. Except for use of hypnotics, the same was true for the indicators of mental UHC. Stepwise multivariate logistic regression analysis showed that the socio-demographic, somatic, social and mental UHC steps were significantly associated with high SPAS.

CONCLUSIONS

Individuals aged 75/76 years with high level of SPAS showed multiple UHC within several areas. Identification and interventions like exposure and though modification geared at such anxiety should be considered.

Comparing the validity of the K6 when assessing depression, anxiety, and PTSD among male and female jail detainees

A lack of a consistent and valid approach to screening within the jail often hinders identification and treatment. Furthermore, screening instruments developed for jail populations are often inadequate in detecting serious depression and anxiety disorders in women. While the remedy thus far has been the use of separate screening instruments for men and women, others have suggested that the K6, a six-item measure validated in large epidemiologic studies, may hold promise. Building on prior research, this study assesses the validity of the K6 in detecting depression, posttraumatic stress disorder, and anxiety disorders among 494 male and 515 female jail detainees. The authors found that 15% of males and 36% of females meet criteria for serious mental illness on the K6, with receiver operating characteristics--area under the curve scores of .84 and .93, respectively. This study not only establishes the validity and efficiency of using the K6 for screening within jails but also suggests a need for adjusting scale cut points.