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Altmann HM, Gebara MA, Albert SM, Morse JQ, Reynolds CF, Thomas SB, Stahl ST. Interpersonal Support Domains Associated With Symptoms of Posttraumatic Stress Among Older Black and White Adults. J Clin Psychiatry 2023; 84. [PMID: 37256634 DOI: 10.4088/jcp.22m14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Objective: Older adults experience numerous changes in their social networks and social environment that may worsen preexisting posttraumatic stress disorder (PTSD) symptoms. This study tested whether tangible support, appraisal support, belonging support, and self-esteem were associated with trauma symptom burden among community-dwelling older Black and White adults at baseline and over 12 months of follow-up. Methods: This study used data collected from a randomized controlled trial for depression prevention in adults 50 years of age or older who had subsyndromal depression (2006-2011). Two hundred forty-four participants (including 90 older Black adults) were randomly assigned to a problem-solving therapy arm or an active control arm. The Interpersonal Support Evaluation List (ISEL) was administered at baseline and 12 months later. Linear regression analysis was used to examine associations of each of the ISEL dimensions with DSM-IV-defined PTSD symptoms at baseline and over time, with control for well-established correlates of PTSD including depression, anxiety, and sleep quality. Results: Participants were a mean (SD) of 65.6 (11.0) years of age, and 71% percent were female. Belongingness support was the only dimension of interpersonal support significantly associated with PTSD symptoms at baseline (β = -0.192, t = -3.582, P < .001) and 12 months later (β = -0.183, t = -2.735, P < .01). Regression models accounted for a large proportion of variance in PTSD symptoms. The association between belongingness support and PTSD symptoms did not vary by participant race. Conclusions: A strong perception of belongingness to family and/or friends was associated with fewer PTSD symptoms at baseline and over 12 months. This observation generates the hypothesis that behavioral interventions which directly target and modify interpersonal support may benefit both older Black and older White adults who have experienced trauma. Trial Registration: ClinicalTrials.gov identifier: NCT00326677.
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Affiliation(s)
- Helene M Altmann
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marie Anne Gebara
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer Q Morse
- Graduate Psychology Programs, Chatham University, Pittsburgh, Pennsylvania
| | - Charles F Reynolds
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen B Thomas
- Department of Health Policy & Management, University of Maryland, College Park, Maryland
| | - Sarah T Stahl
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Corresponding author: Sarah T. Stahl, PhD, Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA 15213
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Raina KD, Morse JQ, Chisholm D, Whyte EM, Terhorst L. An Internet-Based Self-Management Intervention to Reduce Fatigue Among People With Traumatic Brain Injury: A Pilot Randomized Controlled Trial. Am J Occup Ther 2022; 76:23313. [PMID: 35749267 DOI: 10.5014/ajot.2022.048587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Fatigue is a chronic and distressing sequela of traumatic brain injury (TBI). Little evidence exists for the efficacy of interventions that address post-TBI fatigue. OBJECTIVE To evaluate the preliminary efficacy of a self-management intervention (Maximizing Energy; MAX) for reducing the impact (primary outcome) and severity of fatigue on daily life, improving fatigue experience, and increasing participation compared with a health education (HE) intervention. DESIGN Pilot randomized controlled trial (RCT). SETTING Community. PARTICIPANTS Forty-one participants randomly assigned to the MAX (n = 20) or HE (n = 21) intervention. INTERVENTIONS The MAX intervention included problem-solving therapy with energy conservation education to teach participants fatigue management. The HE intervention included diet, exercise, and energy conservation education. Both interventions (30 min/day, 2 days/wk for 8 wk) were delivered online by occupational therapists. OUTCOME AND MEASURES The primary outcome was the modified Fatigue Impact Scale (mFIS). Outcome measures were collected at baseline, postintervention, and 4- and 8-wk postintervention. RESULTS At 8 wk postintervention, participants in the MAX group reported significantly lower levels of fatigue impact (mFIS) than those in the HE group, F(1, 107) = 29.54, p = .01; Cohen's d = 0.87; 95% confidence interval [0.18, 1.55]. CONCLUSIONS AND RELEVANCE These findings provide preliminary evidence that the MAX intervention may decrease the impact of fatigue on daily life among people with post-TBI fatigue. What This Article Adds: An internet-based, self-management intervention combining occupational therapy- delivered energy conservation education with cognitive-behavioral therapy seems to reduce fatigue impact and severity among people with post-TBI fatigue. Future appropriately powered RCTs could positively contribute to the evidence available to occupational therapy practitioners for this chronic, debilitating, and often overlooked symptom.
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Affiliation(s)
- Ketki D Raina
- Ketki D. Raina, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA;
| | - Jennifer Q Morse
- Jennifer Q. Morse, PhD, is Professor, Department of Counseling Psychology, School of Health Sciences, Chatham University, Pittsburgh, PA
| | - Denise Chisholm
- Denise Chisholm, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ellen M Whyte
- Ellen M. Whyte, MD, is Assistant Professor, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Terhorst
- Lauren Terhorst, PhD, is Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, and Codirector, School of Health and Rehabilitation Sciences Data Center, University of Pittsburgh, Pittsburgh, PA
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Azariah F, Sequeira M, Cohen A, Dias A, Morse JQ, Anderson SJ, Cuijpers P, Patel V, Reynolds CF. Problem-Solving Therapy for Older Adults at Risk for Depression: A Qualitative Analysis of the Depression in Later Life Trial. Am J Psychother 2019; 72:88-94. [PMID: 31813228 DOI: 10.1176/appi.psychotherapy.20190009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE As a sequel to the Depression in Later Life trial of lay counselor-delivered problem-solving therapy for depression prevention among older adults in Goa, India, this qualitative study aimed to explore participant experiences to illuminate the reasons for the trial's positive findings and implications for further efforts at depression prevention in low-resource settings. METHODS In-depth interviews were conducted with 19 participants (21% of those randomly assigned to the original intervention). Two independent raters coded the data and organized narratives according to broad themes. RESULTS Most participants valued their relationship with the lay counselor, learned self-care strategies to cope with illnesses, and increased engagement in pleasurable social and physical activities. Some participants reported needing assistance with managing financial strain and family conflicts. CONCLUSIONS The lay-counselor-delivered intervention was well received. The relationship with the counselor and behavioral activation toward better self-care and more-pleasurable activities may have been keys to the intervention's success.
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Affiliation(s)
- Fredric Azariah
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
| | - Miriam Sequeira
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
| | - Alex Cohen
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
| | - Amit Dias
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
| | - Jennifer Q Morse
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
| | - Stewart J Anderson
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
| | - Pim Cuijpers
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
| | - Vikram Patel
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
| | - Charles F Reynolds
- Sangath, Goa, India (Azariah, Sequeira, Dias, Patel); Department of Public Health, London School of Hygiene and Tropical Medicine, London (Cohen); Department of Preventive and Social Medicine, Goa Medical College, Goa, India (Dias); School of Health Sciences, Chatham University, Pittsburgh (Morse); Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Anderson); Department of Developmental, Neuro-, and Clinical Psychology, Free University of Amsterdam, Amsterdam (Cuijpers); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Patel); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Reynolds)
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Dias A, Azariah F, Sequeira M, Krishna R, Morse JQ, Cohen A, Cuijpers P, Anderson S, Patel V, Reynolds CF. Adaptation of problem-solving therapy for primary care to prevent late-life depression in Goa, India: the 'DIL' intervention. Glob Health Action 2019; 12:1420300. [PMID: 31104614 PMCID: PMC6534247 DOI: 10.1080/16549716.2017.1420300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Depression in late life is a major, yet unrecognized public health problem in low- and middle-income countries (LMICs). The dearth of specialist resources, together with the limited ability of current depression treatments to avert years lived with disability, underscores the need for preventive interventions that can be delivered by lay health workers in primary care settings. We describe the development of an intervention for the indicated prevention of depression in older adults at risk due to subsyndromal symptoms, attending rural and urban public primary care clinics in Goa, India. Objectives: (1) to describe a mixed-methods approach (qualitative and quantitative)to the development of ‘DIL,’ an intervention for preventing the onset of major depression in older adults living with subsyndromal symptoms in Goa, India; (2) to describe resulting components of the ‘DIL’ intervention; and (3) to present data on the feasibility, acceptability, and benefit of DIL to participants. Methods: We followed a mixed-methods design, including in-depth interviews, focus group discussions, a theory of change workshop to develop a logic model, and an open-case series. Results: The mixed-method approach led to the development and adaptation of the DIL (Depression in Later Life) intervention for the indicated prevention of depression in older adults. The intervention was delivered by lay health counselors (LHCs). ‘DIL’ is a hybrid model of simple behavioral strategies grounded in Problem-solving Therapy for Primary Care, improved self-management of common, co-occurring medical disorders such as diabetes mellitus, and pragmatic assistance in navigating to needed social services. The use of ‘DIL’ in an open-case series with 19 participants led to a moderate reduction in symptoms of depression and anxiety on the General Health Questionnaire. A pictorial flipchart was developed to assist in delivering the intervention to participants with low levels of literacy. High rates of participant retention and satisfaction were achieved. Conclusion: The DIL intervention was adapted to the local context for delivery by lay health counselors and was found to be acceptable and feasible among the elderly participants in the study.
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Affiliation(s)
- Amit Dias
- a Goa Medical College , Goa , India.,b Sangath , Goa , India
| | - Fredric Azariah
- a Goa Medical College , Goa , India.,b Sangath , Goa , India
| | - Miriam Sequeira
- a Goa Medical College , Goa , India.,b Sangath , Goa , India
| | - Revathi Krishna
- a Goa Medical College , Goa , India.,b Sangath , Goa , India
| | - Jennifer Q Morse
- c Graduate Psychology Program, School of Health Sciences , Chatham University , Pittsburgh , PA , USA
| | - Alex Cohen
- d Department of Population Health , London School of Hygiene and Tropical Medicine , London , UK
| | - Pim Cuijpers
- e Department of Developmental, Neuro-, and Clinical Psychology , Free University of Amsterdam , Amsterdam , Netherlands
| | - Stewart Anderson
- f Department of Biostatistics, Graduate School of Public Health , University of Pittsburgh , Pittsburgh , USA , PA
| | - Vikram Patel
- g Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
| | - Charles F Reynolds
- h Department of Psychiatry , The University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
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Garand L, Morse JQ, Chia L(R, Barnes J, Dadebo V, Lopez OL, Dew MA. Problem-solving therapy reduces subjective burden levels in caregivers of family members with mild cognitive impairment or early-stage dementia: Secondary analysis of a randomized clinical trial. Int J Geriatr Psychiatry 2019; 34:957-965. [PMID: 30868641 PMCID: PMC6579659 DOI: 10.1002/gps.5095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/05/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Interventions addressing burden have limited impact among long-term family caregivers. We examined whether problem-solving therapy (PST) would reduce burden levels of caregivers of individuals diagnosed with mild cognitive impairment (MCI) or early-stage dementia (AD). METHODS Caregivers (N = 73) randomly received PST or nutritional training (NT). Burden measures were assessed over 1-year post-intervention. RESULTS Relative to NT, caregivers receiving PST endorsed improved perceived burden levels over time, regardless of the type of caregiver. Distress over the care recipient's dementia-related behaviors remained low over time among MCI caregivers receiving PST, while these burden levels among MCI caregivers receiving NT rose over time. AD caregivers receiving PST endorsed reductions in these burden levels over time, while AD caregivers in the NT group endorsed higher burden levels over time. CONCLUSION PST, taught early in the caregiving trajectory, improves subjective burden levels among caregivers of family members with relatively mild cognitive deficits.
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Affiliation(s)
- Linda Garand
- Duquesne University School of Nursing, Pittsburgh, PA
| | | | | | | | | | - Oscar L. Lopez
- University of Pittsburgh School of Medicine, Departments of Neurology and Psychiatry. Director, Alzheimer Disease Research Center, Pittsburgh, PA, USA
| | - Mary Amanda Dew
- University of Pittsburgh Schools of Medicine and Public Health, Departments of Psychiatry, Biostatistics, Epidemiology, Psychology and Clinical and Translational Science, Pittsburgh, PA, USA
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Dias A, Azariah F, Anderson SJ, Sequeira M, Cohen A, Morse JQ, Cuijpers P, Patel V, Reynolds CF. Effect of a Lay Counselor Intervention on Prevention of Major Depression in Older Adults Living in Low- and Middle-Income Countries: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:13-20. [PMID: 30422259 PMCID: PMC6583466 DOI: 10.1001/jamapsychiatry.2018.3048] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Preventing depression in older adults living in low- and middle-income countries is important because of the scarcity of treatment resources and the risk of disability, suicide, and dementia. OBJECTIVE To assess whether an intervention for depression prevention provided by lay counselors is effective in older adults from low- and middle-income countries. DESIGN, SETTING, AND PARTICIPANTS This parallel-group randomized clinical trial with masked outcome assessment was performed in 181 older adults (≥60 years) with subsyndromal depressive symptoms at rural and urban primary care clinics in Goa, India. The first participant entered the trial on March 31, 2015, and the last exited on June 2, 2017. Data analysis used the intention-to-treat approach. INTERVENTIONS Lay counselors provided problem-solving therapy, brief behavioral treatment for insomnia, education in self-care of common medical disorders such as diabetes, and assistance in accessing medical and social programs. MAIN OUTCOMES AND MEASURES The main outcome was incidence of major depressive episodes. The study also assessed symptom change during 12 months (12-item General Health Questionnaire [GHQ-12]; score range of 0 to 12, with higher scores indicating greater symptoms of depression and anxiety), functional status (World Health Organization Disability Assessment Schedule 2.0; score range of 12 to 60, with higher scores indicating greater disability), cognition (Hindi Mini-Mental State Examination; score range of 0 to 30, with higher scores indicating better cognitive functioning), blood pressure, and body mass index to provide further clinical context. RESULTS The study enrolled 181 participants (mean [SD] age, 69.6 [7.2] years; 114 [63.0%] female): 91 to the intervention arm (depression in later life [DIL] intervention) and 90 to care as usual (CAU). Incident episodes of major depression were lower in the DIL intervention than in the CAU group (4.40% vs 14.44%; log-rank P = .04; number needed to treat, 9.95; 95% CI, 5.12-182.43). The 12-month Kaplan-Meier estimates of percentage of depression-free participants were 95.1% (95% CI, 90.5%-99.9%) in the DIL group vs 87.4% (95% CI, 80.4%-95.1%) in the CAU group. The incidence of depressive symptoms (GHQ-12) was also less (12-month mean difference, -1.18; 95% CI, -2.03 to -0.31; group × time interaction P < .001). There were no changes in measures of disability or cognition. The DIL intervention was associated with a significantly greater lowering of systolic blood pressure (12-month mean difference, -6.98; 95% CI, -11.96 to -2.01; group × time interaction P < .001) and change in body mass index (12-month mean difference, 0.23; 95% CI, -0.97 to 1.43; P = .04). CONCLUSIONS AND RELEVANCE The DIL intervention is effective for preventing episodes of major depression in older persons with subsyndromal symptoms. If replicated, the DIL intervention may be effective in older adults living in low- and middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02145429.
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Affiliation(s)
- Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Bambolim, Goa, India,Sangath, Goa, India
| | | | - Stewart J. Anderson
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Alex Cohen
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer Q. Morse
- Graduate Psychology Programs, School of Health Sciences, Chatham University, Pittsburgh, Pennsylvania
| | - Pim Cuijpers
- Department of Developmental, Neuro-, and Clinical Psychology, Amsterdam Public Health Research Institute, Free University of Amsterdam, Amsterdam, the Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Seaman JB, Arnold RM, Buddadhumaruk P, Shields AM, Gustafson RM, Felman K, Newdick W, SanPedro R, Mackenzie S, Morse JQ, Chang CCH, Happ MB, Song MK, Kahn JM, Reynolds CF, Angus DC, Landefeld S, White DB. Protocol and Fidelity Monitoring Plan for Four Supports. A Multicenter Trial of an Intervention to Support Surrogate Decision Makers in Intensive Care Units. Ann Am Thorac Soc 2018; 15:1083-1091. [PMID: 30088971 PMCID: PMC6322040 DOI: 10.1513/annalsats.201803-157sd] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Individuals acting as surrogate decision makers for critically ill patients frequently struggle in this role and experience high levels of long-term psychological distress. Prior interventions designed to improve the sharing of information by the clinical team with surrogate decision makers have demonstrated little effect on surrogates' outcomes or clinical decisions. In this report, we describe the study protocol and corresponding intervention fidelity monitoring plan for a multicenter randomized clinical trial testing the impact of a multifaceted surrogate support intervention (Four Supports) on surrogates' psychological distress, the quality of decisions about goals of care, and healthcare use. We will randomize the surrogates of 300 incapacitated critically ill patients at high risk of death and/or severe long-term functional impairment to receive the Four Supports intervention or an education control. The Four Supports intervention adds to the intensive care unit (ICU) team a trained interventionist (family support specialist) who delivers four types of protocolized support-emotional support; communication support; decisional support; and, if indicated, anticipatory grief support-to surrogates through daily interactions during the ICU stay. The primary outcome is surrogates' symptoms of anxiety and depression at 6-month follow-up, measured with the Hospital Anxiety and Depression Scale. Prespecified secondary outcome measures are the Patient Perception of Patient Centeredness Scale (modified for use with surrogates) and Impact of Event Scale scores at 3- and 6-month follow-up, respectively, together with ICU and hospital lengths of stay and total hospital cost among decedents. The fidelity monitoring plan entails establishing and measuring adherence to the intervention using multiple measurement methods, including daily checklists and coding of audiorecorded encounters. This approach to intervention fidelity may benefit others designing and testing behavioral interventions in the ICU setting. Clinical trial registered with www.clinicaltrials.gov (NCT01982877).
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Affiliation(s)
| | - Robert M. Arnold
- Department of General Internal Medicine, Section of Palliative Care and Medical Ethics, School of Medicine
- UPMC Palliative and Supportive Institute, Pittsburgh, Pennsylvania
| | | | | | | | - Kristyn Felman
- CRISMA Center, Department of Critical Care Medicine, School of Medicine
| | - Wendy Newdick
- CRISMA Center, Department of Critical Care Medicine, School of Medicine
| | - Rachel SanPedro
- CRISMA Center, Department of Critical Care Medicine, School of Medicine
| | | | - Jennifer Q. Morse
- School of the Health Sciences, Chatham University, Pittsburgh, Pennsylvania
| | - Chung-Chou H. Chang
- CRISMA Center, Department of Critical Care Medicine, School of Medicine
- Department of General Internal Medicine and
| | | | - Mi-Kyung Song
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia and
| | - Jeremy M. Kahn
- CRISMA Center, Department of Critical Care Medicine, School of Medicine
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek C. Angus
- CRISMA Center, Department of Critical Care Medicine, School of Medicine
| | - Seth Landefeld
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Douglas B. White
- CRISMA Center, Department of Critical Care Medicine, School of Medicine
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Cohen A, Dias A, Azariah F, Krishna RN, Sequeira M, Abraham S, Cuijpers P, Morse JQ, Reynolds CF, Patel V. Aging and well-being in Goa, India: a qualitative study. Aging Ment Health 2018; 22:168-174. [PMID: 27689842 PMCID: PMC5374050 DOI: 10.1080/13607863.2016.1236239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The population of India is aging rapidly. This demographic shift brings with it a host of challenges to the health and well-being of older adults, including the increased prevalence of non-communicable diseases, among them depressive disorders. In this paper, we report on qualitative research intended to inform the development of a locally acceptable and appropriate intervention to improve the well-being of older adults in Goa, India and, specifically, to prevent late-life depression. METHOD Semi-structured interviews with 20 individuals, aged 60 years and older, attending two primary care clinics in Goa, India. Transcripts were reviewed to identify emerging themes, a coding scheme was developed and thematic analyses were conducted. RESULTS Analyses of the interview transcripts revealed the following key themes: (1) notions of old age tended to be negative and there were widespread fears of becoming widowed or incapacitated; (2) the most frequently reported health conditions were joint pain, diabetes and heart disease; (3) emotional distress was described using the terms 'tension', 'stress', 'worry' and 'thinking'; (4) family issues often involved financial matters, difficult relationships with daughters-in-law and conflicted feelings about living with the family or independently; (5) other than a pension scheme, participants did not know of community resources available to older adults. CONCLUSIONS Our findings are in general agreement with those of previous research, and with our experiences of working with older adults in Pittsburgh and the Netherlands. This research will inform the development of an intervention to prevent depression in older adults in Goa.
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Affiliation(s)
- Alex Cohen
- London School of Hygiene & Tropical Medicine, Faculty of Epidemiology & Population Health, Department of Population Health, London, United Kingdom
| | - Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Goa, India
- Sangath, Goa, INDIA
| | | | | | | | | | - Pim Cuijpers
- Department of Clinical Psychology, VU-University Amsterdam, Amsterdam, the Netherlands
| | - Jennifer Q. Morse
- Graduate Psychology Programs, Chatham University, Pittsburgh, PA 15232, USA
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine; and Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Vikram Patel
- London School of Hygiene & Tropical Medicine, Faculty of Epidemiology & Population Health, Department of Population Health, London, United Kingdom
- Sangath, Goa, INDIA
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Stahl ST, Rodakowski J, Gildengers AG, Reynolds CF, Morse JQ, Rico K, Butters MA. Treatment Considerations for Depression Research in Older Married Couples: A Dyadic Case Study. Am J Geriatr Psychiatry 2017; 25:388-395. [PMID: 28237826 PMCID: PMC5724521 DOI: 10.1016/j.jagp.2016.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Critical gaps remain in understanding optimal approaches to intervening with older couples. The focus of this report is to describe the pros and cons of incorporating spousal dyads into depression-prevention research. METHODS In an intervention development study, the authors administered problem-solving therapy (PST) dyadically to participants with mild cognitive impairment (MCI) and their caregivers. Dyads worked with the same interventionist in the same therapy session. The dyadic PST (highlighted in a case example of a husband with MCI and his wife/support person) and the potential feasibility of the program are described. RESULTS The authors found that the wife of the individual with MCI could be trained as a PST coach to help her husband learn and use problem-solving skills. A decrease in depressive symptom severity was observed for the individual with MCI, which was sustained over 12 months of follow-up. Neither the husband nor wife experienced an incident episode of major depression over the course of the study. CONCLUSION Dyadic interventions need to be further developed in geriatric psychiatry; proven methods such as PST can be modified to include patients' support persons. Recommendations are offered for developing randomized controlled trials that aim to recruit dyads and prevent depression in at-risk older married couples.
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Affiliation(s)
- Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer Q Morse
- Department of Counseling Psychology, Chatham University, Pittsburgh, PA
| | - Kevin Rico
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Foltz C, Morse JQ, Calvo N, Barber JP. Self- and Observer Ratings on the NEO-FFI in Couples: Initial Evidence of the Psychometric Properties of an Observer Form. Assessment 2016; 4:287-95. [DOI: 10.1177/107319119700400308] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study investigated the psychometric properties of the NEO Five-Factor Inventory (NEO-FFI) Observer form of the five-factor model of personality by examining agreement between self- and observer ratings. Both partners of 49 young, adult couples rated themselves and their partners on the NEO-FFI. The results provide preliminary evidence of the measurement utility of the NEO-FFI Observer form. Specifically, (a) each personality scale possessed acceptable levels of internal reliability, (b) five factors consistent with the five-factor model of personality emerged in both ratings forms, and (c) there was significant self-observer agreement for all five personality scales. Self-observer agreement was assessed by correlations as well as analyses that test a more stringent definition of agreement. Overall, there is consensus across analyses that points to a substantial amount of concordance between partners' self- and observer ratings.
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Karp JF, Dew MA, Wahed AS, Fitzgerald K, Bolon CA, Weiner DK, Morse JQ, Albert S, Butters M, Gildengers A, Reynolds CF. Challenges and Solutions for Depression Prevention Research: Methodology for a Depression Prevention Trial for Older Adults with Knee Arthritis and Emotional Distress. Am J Geriatr Psychiatry 2016; 24:433-43. [PMID: 26809601 PMCID: PMC4870147 DOI: 10.1016/j.jagp.2015.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 10/19/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the methodology, challenges, and baseline characteristics of a prevention development trial entitled "Reducing Pain, Preventing Depression." METHODS A sequential multiple assignment randomized trial (SMART) compared sequences of cognitive behavioral therapy (CBT) and physical therapy for knee pain and prevention of depression and anxiety. Participants were randomized to CBT, physical therapy, or enhanced usual care and followed for 12 months for new-episode depression or anxiety. Participants were age ≥ 60 with knee osteoarthritis and subsyndromal depression, defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥1 (which included the endorsement of one of the cardinal symptoms of depression [low mood or anhedonia]) and no diagnosis of major depressive disorder per the Structured Clinical Interview for DSM-IV. Depression and anxiety severity and characterization of new episodes were assessed with the PHQ-9, Generalized Anxiety Disorder-7, and the PRIME-MD. Knee pain was characterized with the Western Ontario McMaster Arthritis Index. Response was defined as at least "Very Much Better" on a Patient Global Impression of Change. RESULTS At baseline there were 99 patients with an average age of 71; 61.62% were women and 81.8% white. The average PHQ-9 was 5.6 and average Generalized Anxiety Disorder-7, was 3.2. Most were satisfied with the interventions and study procedures. The challenges and solutions described here will also be used in a confirmatory clinical trial of efficacy. CONCLUSION A SMART design for depression and anxiety prevention, using both CBT and physical therapy, appears to be feasible and acceptable to participants. The methodologic innovations of this project may advance the field of late-life depression and anxiety prevention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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12
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van Londen GJ, Donovan HS, Beckjord EB, Cardy AL, Bovbjerg DH, Davidson NE, Morse JQ, Switzer GE, Verdonck-de Leeuw IM, Dew MA. Perspectives of postmenopausal breast cancer survivors on adjuvant endocrine therapy-related symptoms. Oncol Nurs Forum 2015; 41:660-8. [PMID: 25355021 DOI: 10.1188/14.onf.660-668] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE/OBJECTIVES To conduct an investigation of women's experiences related to adjuvant endocrine therapy (AET) and managing AET-related symptoms. RESEARCH APPROACH Qualitative, focus group design. SETTING Main campus of the University of Pittsburgh in Pennsylvania. PARTICIPANTS 14 breast cancer survivors, aged 50 years or older, with AET-related symptoms. METHODOLOGIC APPROACH Semistructured discussion guides were used to elicit recollections of conversations with healthcare providers about starting AET, symptom experiences, symptom management, and suggestions for improving management. Audiotaped discussions were transcribed and analyzed to identify themes. FINDINGS Women reported that, initially, AET was not viewed as a choice, but rather as the necessary next step to save their lives. After starting AET, women experienced difficulties making sense of, communicating about, and managing unanticipated AET-related symptoms. Women who experienced persistently bothersome symptoms began weighing the pros and cons of AET to decide whether to continue treatment. CONCLUSIONS Focus group findings suggest multiple opportunities to better prepare patients for AET and to improve assessment and management of AET-related symptoms. INTERPRETATION By exploring AET-related symptom experiences, nurses may be able to promote AET adherence in breast cancer survivors.
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Affiliation(s)
- G J van Londen
- Division of Hematology-Oncology and Geriatric Medicine in the Department of Medicine, University of Pittsburgh
| | - Heidi S Donovan
- Department of Acute and Tertiary Care, Office of Community Partnerships, University of Pittsburgh
| | | | - Alexandra L Cardy
- Biobehavioral Oncology Program, University of Pittsburgh Cancer Institute
| | - Dana H Bovbjerg
- Department of Psychiatry, Psychology, Clinical and Translational Science Institute, Behavioral and Community Health Services, University of Pittsburgh
| | | | | | - Galen E Switzer
- Department of Medicine, Psychiatry, and Clinical and Translational Science, University of Pittsburgh
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, Vrije Universiteit (VU) Medical Center, Amsterdam, Netherlands
| | - Mary Amanda Dew
- Department of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh
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Siegle GJ, D'Andrea W, Jones N, Hallquist MN, Stepp SD, Fortunato A, Morse JQ, Pilkonis PA. Prolonged physiological reactivity and loss: Association of pupillary reactivity with negative thinking and feelings. Int J Psychophysiol 2015; 98:310-320. [PMID: 26143740 DOI: 10.1016/j.ijpsycho.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
Prolonged psychophysiological reactions to negative information have long been associated with negative thinking and feeling. This association is operationalized in the RDoC negative affect construct of loss, which is nominally indexed by prolonged physiological reactivity, cognitive loss-related constructs such as rumination and guilt, and more feeling-related constructs such as sadness, crying, and anhedonia. These associations have not been tested explicitly. If thinking and feeling aspects of loss reflect different physiological mechanisms, as might be suggested by their putative neurobiology, different intervention pathways might be suggested. Here we examined the extent to which self-reported negative thinking and feeling constructs were associated with prolonged pupillary reactivity following negative words and a subsequent cognitive distractor in a diverse heterogeneously diagnosed sample of N=84 participants. We also considered indices of abuse and variables associated with borderline personality disorder as possible moderators. Consistently, feeling-related negative affect constructs were related to prolonged pupillary reactivity during the distractor after a negative stimulus whereas thinking-related constructs were not. These data suggest that people who have sustained physiological reactions to emotional stimuli may be more strongly characterized by non-linguistic negative feelings than explicit cognitions related to loss. Sustained physiological reactions could reflect efforts to regulate feeling states. In contrast to cognitive and affective variables, abuse was associated with decreased physiological reactivity, consistent with decreased neural engagement. Interventions that target mechanisms underlying feelings and their regulation may be more mechanistically specific to sustained reactivity than those which directly address cognitions.
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Affiliation(s)
- Greg J Siegle
- University of Pittsburgh School of Medicine, United States.
| | | | - Neil Jones
- University of Pittsburgh School of Medicine, United States
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Reynolds CF, Thomas SB, Morse JQ, Anderson SJ, Albert S, Dew MA, Begley A, Karp JF, Gildengers A, Butters MA, Stack JA, Kasckow J, Miller MD, Quinn SC. Early intervention to preempt major depression among older black and white adults. Psychiatr Serv 2014; 65:765-73. [PMID: 24632760 PMCID: PMC4050338 DOI: 10.1176/appi.ps.201300216] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study objective was to assess the efficacy of problem-solving therapy for primary care (PST-PC) for preventing episodes of major depression and mitigating depressive symptoms of older black and white adults. The comparison group received dietary coaching. METHODS A total of 247 participants (90 blacks, 154 whites, and three Asians) with subsyndromal depressive symptoms were recruited into a randomized depression prevention trial that compared effects of individually delivered PST-PC and dietary coaching on time to major depressive episode and level of depressive symptoms (Beck Depression Inventory) over two years. Cumulative intervention time averaged 5.5-6.0 hours in each study arm. RESULTS The two groups did not differ significantly in time to major depressive episodes, and incidence of such episodes was low (blacks, N=8, 9%; whites, N=13, 8%), compared with published rates of 20%-25% over one year among persons with subsyndromal symptoms and receiving care as usual. Participants also showed a mean decrease of 4 points in depressive symptoms, sustained over two years. Despite greater burden of depression risk factors among blacks, no significant differences from whites were found in the primary outcome. CONCLUSIONS Both PST-PC and dietary coaching are potentially effective in protecting older black and white adults with subsyndromal depressive symptoms from developing episodes of major depression over two years. Absent a control for concurrent usual care, this conclusion is preliminary. If confirmed, both interventions hold promise as scalable, safe, nonstigmatizing interventions for delaying or preventing episodes of major depression in the nation's increasingly diverse older population.
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Affiliation(s)
- Charles F. Reynolds
- University of Pittsburgh, School of Medicine, Psychiatry, 3811 O’Hara Street, BT 758, Pittsburgh, Pennsylvania, 15213
| | | | - Jennifer Q. Morse
- Western Psychiatric Institute & Clinic - Psychiatry, 3811 O’Hara St. Personality Studies, Pittsburgh, Pennsylvania 15213
| | - Stewart J. Anderson
- University of Pittsburgh Graduate School of Public Health - Department of Biostatistics, Pittsburgh, Pennsylvania
| | - Steven Albert
- University of Pittsburgh - Behavioral & Community Health Science, Pittsburgh, Pennsylvania 15261
| | - Mary Amanda Dew
- University of Pittsburgh - Psychiatry, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
| | - Amy Begley
- Western Psychiatric Institute & Clinic - Psychiatry, 3811 O’Hara St. Personality Studies, Pittsburgh, Pennsylvania 15213
| | - Jordan F. Karp
- University of Pittsburgh School of Medicine - Psychiatry, Western Psychiatric Institute and Clinic 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
| | - Ariel Gildengers
- University of Pittsburgh School of Medicine - Dept of Psychiatry, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213
| | - Meryl A. Butters
- University of Pittsburgh Medical Center - Geriatric Psychiatry, 3811 O’Hara St. Rm. E-462 WPIC, Pittsburgh 15213
| | | | - John Kasckow
- VA Pittsburgh Health Care System - Behavioral Health, 7180 Highland Dr, Pittsburgh, Pennsylvania 15206. University of Pittsburgh Medical Center - Western Psychiatric Institute and Clinics, 3811 O’Hara St, Pittsburgh, Pennsylvania 15213
| | - Mark D. Miller
- University of Pittsburgh, Shcool of Medicine - Psychiatry, Pittsburgh, Pennsylvania
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Stepp SD, Scott LN, Morse JQ, Nolf KA, Hallquist MN, Pilkonis PA. Emotion dysregulation as a maintenance factor of borderline personality disorder features. Compr Psychiatry 2014; 55:657-66. [PMID: 24342056 PMCID: PMC3965595 DOI: 10.1016/j.comppsych.2013.11.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 11/05/2013] [Accepted: 11/09/2013] [Indexed: 10/26/2022] Open
Abstract
We examined within-individual changes in emotion dysregulation over the course of one year as a maintenance factor of borderline personality disorder (BPD) features. We evaluated the extent to which (1) BPD symptom severity at baseline predicted within-individual changes in emotion dysregulation and (2) within-individual changes in emotion dysregulation predicted four BPD features at 12-month follow-up: affective instability, identity disturbances, negative relationships, and impulsivity. The specificity of emotion dysregulation as a maintaining mechanism of BPD features was examined by controlling for a competing intervening variable, interpersonal conflict. BPD symptoms at baseline predicted overall level and increasing emotion dysregulation. Additionally, increasing emotion dysregulation predicted all four BPD features at 12-month follow-up after controlling for BPD symptoms at baseline. Further, overall level of emotion dysregulation mediated the association between BPD symptom severity at baseline and both affective instability and identity disturbance at 12-month follow-up, consistent with the notion of emotion dysregulation as a maintenance factor. Future research on the malleability of emotion dysregulation in laboratory paradigms and its effects on short-term changes in BPD features is needed to inform interventions.
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Abstract
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.
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Affiliation(s)
- Paul A. Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Yookyung Kim
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Lan Yu
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Department of Medicine, University of Pittsburgh School of Medicine
| | - Jennifer Q. Morse
- Department of Psychiatry, University of Pittsburgh School of Medicine
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Scott LN, Kim Y, Nolf KA, Hallquist MN, Wright AGC, Stepp SD, Morse JQ, Pilkonis PA. Preoccupied attachment and emotional dysregulation: specific aspects of borderline personality disorder or general dimensions of personality pathology? J Pers Disord 2013; 27:473-95. [PMID: 23586934 PMCID: PMC3723709 DOI: 10.1521/pedi_2013_27_099] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Emotional dysregulation and impaired attachment are seen by many clinical researchers as central aspects of borderline personality disorder (BPD). Alternatively, these constructs may represent general impairments in personality that are nonspecific to BPD. Using multitraitmultimethod models, the authors examined the strength of associations among preoccupied attachment, difficulties with emotion regulation, BPD features, and features of two other personality disorders (i.e., antisocial and avoidant) in a combined psychiatric outpatient and community sample of adults. Results suggested that preoccupied attachment and difficulties with emotion regulation shared strong positive associations with each other and with each of the selected personality disorders. However, preoccupied attachment and emotional dysregulation were more strongly related to BPD features than to features of other personality disorders. Findings suggest that although impairments in relational and emotional domains may underlie personality pathology in general, preoccupied attachment and emotional dysregulation also have specificity for understanding core difficulties in those with BPD.
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Affiliation(s)
- Lori N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA 15213, USA.
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Wright AGC, Hallquist MN, Morse JQ, Scott LN, Stepp SD, Nolf KA, Pilkonis PA. Clarifying interpersonal heterogeneity in borderline personality disorder using latent mixture modeling. J Pers Disord 2013; 27:125-43. [PMID: 23514179 PMCID: PMC3607958 DOI: 10.1521/pedi.2013.27.2.125] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Significant interpersonal impairment is a cardinal feature of borderline personality disorder (BPD). However, past research has demonstrated that the interpersonal profile associated with BPD varies across samples, which is evidence for considerable interpersonal heterogeneity. The current study used inventory of interpersonal problems-circumplex (IIP-C; Alden, Wiggins, & Pincus, 1990) scale scores to investigate interpersonal inhibitions and excesses in a large sample (N = 255) selected for significant borderline pathology. Results indicated that BPD symptom counts were unrelated to the primary dimensions of the IIPC, but were related to generalized interpersonal distress. A latent class analysis clarified this finding by revealing six homogeneous interpersonal classes with prototypical profiles associated with Intrusive, Vindictive, Avoidant, Nonassertive, and moderate and severe Exploitable interpersonal problems. These classes differed in clinically relevant features (e.g., antisocial behaviors, self-injury, past suicide attempts). Findings are discussed in terms of the incremental clinical utility of the interpersonal circumplex model and the implications for developmental and nosological models of BPD.
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Affiliation(s)
- Aidan G C Wright
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
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Abstract
Even though interpersonal functioning is of great clinical importance for patients with borderline personality disorder (BPD), the comparative validity of different assessment methods for interpersonal dysfunction has not yet been tested. This study examined multiple methods of assessing interpersonal functioning, including self- and other- reports, clinical ratings, electronic diaries, and social cognitions in three groups of psychiatric patients (N = 138): patients with (1) BPD, (2) another personality disorder, and (3) Axis I psychopathology only. Using dominance analysis, we examined the predictive validity of each method in detecting changes in symptom distress and social functioning 6 months later. Across multiple methods, the BPD group often reported higher interpersonal dysfunction scores compared with other groups. Predictive validity results demonstrated that self-report and electronic diary ratings were the most important predictors of distress and social functioning. Our findings suggest that self-report scores and electronic diary ratings have high clinical utility, because these methods appear most sensitive to change.
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Affiliation(s)
| | | | - Jennifer Q Morse
- Department of Psychiatry, Western Psychiatric Institute and Clinic
| | - Paul A Pilkonis
- Department of Psychiatry, Western Psychiatric Institute and Clinic
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Miller JD, Morse JQ, Nolf K, Stepp SD, Pilkonis PA. Can DSM-IV borderline personality disorder be diagnosed via dimensional personality traits? Implications for the DSM-5 personality disorder proposal. J Abnorm Psychol 2012; 121:944-950. [PMID: 22428791 DOI: 10.1037/a0027410] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The proposal for the diagnosis of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5;American Psychiatric Association, in preparation) involves, in part, the use of elevated scores on dimensional personality traits. For instance, the diagnosis of borderline personality disorder (BPD) in the DSM-5 will require evidence of self- and interpersonal impairment as well as elevated scores on traits of emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk taking, and hostility. Using a sample of individuals from the community (N = 134), half of whom were receiving psychiatric treatment, we tested whether the summation of relevant personality trait scores, using data derived from a measure of the Five-Factor Model of personality (FFM), would result in a construct that corresponds to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV, American Psychiatric Association, 2000) BPD construct as scored by expert consensus ratings. The DSM-IV and FFM BPD scores were significantly correlated (r = .60) and generated highly similar patterns of relations (ricc = .84) with key constructs from BPD's nomological network. These data should serve to allay concerns that the DSM-5's new diagnostic approach will be detrimental to the identification of BPD.
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Affiliation(s)
| | - Jennifer Q Morse
- Department of Psychiatry, University of Pittsburgh Medical Center
| | - Kimberly Nolf
- Department of Psychiatry, University of Pittsburgh Medical Center
| | | | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh Medical Center
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Karp JF, Rollman BL, Reynolds CF, Morse JQ, Lotrich F, Mazumdar S, Morone N, Weiner DK. Addressing both depression and pain in late life: the methodology of the ADAPT study. Pain Med 2012; 13:405-18. [PMID: 22313547 DOI: 10.1111/j.1526-4637.2011.01322.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the methodology of the first NIH-funded clinical trial for seniors with comorbid depression and chronic low back pain. METHODS Randomized controlled effectiveness trial using stepped care methodology. Participants are ≥60 years old. Phase 1 (6 weeks) is open treatment with venlafaxine xr 150 mg/day and supportive management (SM). Response is 2 weeks of PHQ-9 ≤5 and at least 30% improvement in the average numeric rating scale for pain. Nonresponders progress to phase 2 (14 weeks) in which they are randomized to high-dose venlafaxine xr (up to 300 mg/day) with problem solving therapy for depression and pain (PST-DP) or high-dose venlafaxine xr and continued SM. Primary outcomes are the univariate pain and depression response and both observed and self-reported disability. Survival analytic techniques will be used, and the clinical effect size will be estimated with the number needed to treat. We hypothesize that self-efficacy for pain management will mediate response for subjects randomized to venlafaxine xr and PST-DP. RESULTS Not applicable. CONCLUSIONS The results of this trial will inform the care of these complex patients and further understanding of comorbid pain and depression in late life.
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Affiliation(s)
- Jordan F Karp
- Departments of Psychiatry, University of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Wallace ML, Dombrovski AY, Morse JQ, Houck PR, Frank E, Alexopoulos GS, Reynolds CF, Schulz R. Coping with health stresses and remission from late-life depression in primary care: a two-year prospective study. Int J Geriatr Psychiatry 2012; 27:178-86. [PMID: 21452177 PMCID: PMC3184468 DOI: 10.1002/gps.2706] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 02/08/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Identifying the predictors of late-life depression that are amenable to change may lead to interventions that result in better and faster remission. Thus, the authors investigated the impact of two different strategies for coping with physical illness on depression in older, primary care patients. Health-oriented goal engagement strategies involve the investment of cognitive and behavioral resources to achieve health goals. Conversely, disengagement strategies involve the withdrawal of these resources from obsolete or unattainable health goals, combined with goal restructuring. METHODS The participants were 271 adults aged >59 years who took part in a two-year randomized clinical trial for treating depression in older adults (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). The use of engagement and disengagement strategies, along with other risk factors for depression, were included in a tree-structured survival analysis to identify subgroups of individuals at risk for not achieving depression remission. RESULTS The use of disengagement strategies predicted earlier remission of depression, particularly among more severely depressed older patients. The use of engagement strategies did not predict earlier remission. CONCLUSION Interventions that encourage disengagement from unattainable health goals may promote remission from depression in older, primary care patients.
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Affiliation(s)
- Meredith L. Wallace
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alexandre Y. Dombrovski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer Q. Morse
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Patricia R. Houck
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ellen Frank
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - George S. Alexopoulos
- Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY
| | - Charles F. Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Richard Schulz
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Stepp SD, Smith TD, Morse JQ, Hallquist MN, Pilkonis PA. Prospective associations among borderline personality disorder symptoms, interpersonal problems, and aggressive behaviors. J Interpers Violence 2012; 27:103-24. [PMID: 21859760 PMCID: PMC3575083 DOI: 10.1177/0886260511416468] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study examined the prospective relationships among borderline personality disorder (BPD) symptoms, interpersonal problems, and types of aggressive behaviors (i.e., experiencing psychological and physical victimization and perpetrating psychological and physical aggression) in a psychiatric sample (N = 139) over the course of 2 years. We controlled for other PD symptoms and demographic variables. BPD symptoms at baseline were associated with interpersonal sensitivity, interpersonal ambivalence, interpersonal aggression, need for social approval, and lack of sociability 6 months later. In turn, interpersonal sensitivity predicted not experiencing physical aggression, interpersonal aggression predicted experiencing physical aggression and perpetrating both psychological and physical aggression, need for social approval predicted experiencing both psychological and physical aggression, and lack of sociability predicted perpetrating physical aggression 2 years later. Results demonstrated that interpersonal problems mediated the relationship between BPD and later violent behaviors. Our findings suggest the importance of distinguishing between these groups of aggressive behaviors in terms of etiological pathways, maintenance processes, and treatment interventions.
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Abstract
Previous studies have implicated attachment and disturbances in romantic relationships as important indicators for Borderline Personality Disorder (BPD). The current research extends our current knowledge by examining the specific associations among attachment, romantic relationship dysfunction, and BPD, above and beyond the contribution of emotional distress and nonromantic interpersonal functioning in two distinct samples. Study 1 comprised a community sample of women (N = 58) aged 25-36. Study 2 consisted of a psychiatric sample (N = 138) aged 21-60. Results from both Study 1 and Study 2 demonstrated that (1) attachment was specifically related to BPD symptoms and romantic dysfunction, (2) BPD symptoms were specifically associated with romantic dysfunction, and (3) the association between attachment and romantic dysfunction was statistically mediated by BPD symptoms. The findings support specific associations among attachment, BPD symptoms, and romantic dysfunction.
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Morse JQ, Shaffer DR, Williamson GM, Dooley WK, Schulz R. Models of self and others and their relation to positive and negative caregiving responses. Psychol Aging 2011; 27:211-8. [PMID: 21604890 DOI: 10.1037/a0023960] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The burden of providing informal care to a family member can lead to caregiver depression and potentially harmful caregiving behavior. Given the interpersonal nature of caregiving, the relationship between caregivers and care recipients may impact caregiver responses. We applied attachment theory to understanding caregiver depression, and both potentially harmful and exemplary caregiving responses. We present data from 430 caregivers in the Family Relationships in Late Life (FRILL 2) Project, a multisite, longitudinal study of caregiving. Age, gender, and model of self were related to caregiving responses, suggesting that model of self may help identify caregivers at risk for poor responses.
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Affiliation(s)
- Jennifer Q Morse
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Kasckow J, Ingram E, Brown C, Tew JD, Conner KO, Morse JQ, Haas GL, Reynolds CF, Oslin DW. Differences in treatment attitudes between depressed African-American and Caucasian veterans in primary care. Psychiatr Serv 2011; 62:426-9. [PMID: 21459996 PMCID: PMC3089655 DOI: 10.1176/ps.62.4.pss6204_0426] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Depressive disorders are common, and it is important to understand the factors that contribute to racial disparities in depression treatment. This primary care study of veterans with subsyndromal depression examined two hypotheses: that African Americans would be less likely than Caucasians to believe that medication is beneficial in depression treatment and would be more likely to believe that counseling or psychotherapy is beneficial. METHODS Primary care patients with subsyndromal depression were referred to the Philadelphia Department of Veterans Affairs Behavioral Health Laboratory and asked about past experiences and attitudes toward depression treatment. RESULTS Among 111 African-American and 95 Caucasian participants, logistic regression analyses determined that African Americans were less likely to view medication as beneficial (odds ratio=.44). No racial differences were found in participants' attitude toward counseling or psychotherapy. CONCLUSIONS The findings support the premise that clinicians treating patients with subsyndromal depressive syndromes should take into account racial differences in attitudes toward treatment.
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Affiliation(s)
- John Kasckow
- Behavioral Health Division, Department of Veterans Affairs (VA) Pittsburgh Health Care System, Pittsburgh, PA 15206, USA.
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Kelly MAR, Morse JQ, Stover A, Hofkens T, Huisman E, Shulman S, Eisen SV, Becker SJ, Weinfurt K, Boland E, Pilkonis PA. Describing depression: congruence between patient experiences and clinical assessments. Br J Clin Psychol 2011; 50:46-66. [PMID: 21332520 PMCID: PMC3136556 DOI: 10.1348/014466510x493926] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Efforts to describe depression have relied on top-down methods in which theory and clinical experience define depression but may not reflect the individuals' experiences with depression. We assessed the degree of overlap between academic descriptions of depression and patient-reported symptoms as conceptualized in the Patient-Reported Outcomes Measurement Information System(®) (PROMIS(®)). By extension, this work assesses the degree of overlap between current clinical descriptions of depression and patient-reported symptoms. DESIGN In this content analysis study, four focus groups were conducted across two sites to elicit symptoms and the experience of depression from depressed and medically ill patients. METHODS Depressed and medically ill patients were asked to describe symptoms that characterize depression. Data were transcribed and then coded using an a priori list of 43 facets of depression derived from extant depression measures. RESULTS Participants described 93% of the symptoms from the a priori list, supporting the validity of current depression measures. Interpersonal difficulties were underscored as was anger. In general, results from the focus groups did not require the generation of new items for depression and supported the content validity of the PROMIS hierarchical framework and item pool created originally. CONCLUSIONS This work supports the validity of current depression assessment, but suggests further investigation of interpersonal functioning and anger may add to the depth and breadth of depression assessment.
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Affiliation(s)
- Morgen A R Kelly
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pennsylvania, USA.
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Pilkonis PA, Hallquist MN, Morse JQ, Stepp SD. Striking the (Im)Proper Balance between Scientific Advances and Clinical Utility: Commentary on the DSM-5 Proposal for Personality Disorders. Personal Disord 2011; 2:68-82. [PMID: 21804929 PMCID: PMC3143499 DOI: 10.1037/a0022226] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We review briefly the contributions of Skodol, Pincus, and Widiger (this issue) describing and critiquing the proposed changes in the assessment of personality and personality disorders for the DSM-5. Despite the hard work of the DSM-5 Work Group to date, there are shortcomings and areas of controversy in the current proposal that demand further attention and change. We discuss the controversy in the broader context of the DSM over the past 30 years. In addressing specific problems, we focus on the limitations of the proposed system for assessing traits (even as we endorse the movement toward dimensional assessment of personality) and the difficulties posed by the current "hybrid" model that attempts to include both traits and types. In moving forward, we suggest greater emphasis on decision-making regarding the presence and severity of any personality disorder (understood on the basis of generalized failures in adaptation) and greater flexibility in identifying the variants of personality disorders in order to accommodate both traits and types more inclusively during this transition toward dimensional approaches to assessment.
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Affiliation(s)
- Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh Medical Center
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Reynolds CF, Dew MA, Martire LM, Miller MD, Cyranowski JM, Lenze E, Whyte EM, Mulsant BH, Pollock BG, Karp JF, Gildengers A, Szanto K, Dombrovski AY, Andreescu C, Butters MA, Morse JQ, Houck PR, Bensasi S, Mazumdar S, Stack JA, Frank E. Treating depression to remission in older adults: a controlled evaluation of combined escitalopram with interpersonal psychotherapy versus escitalopram with depression care management. Int J Geriatr Psychiatry 2010; 25:1134-41. [PMID: 20957693 PMCID: PMC3004217 DOI: 10.1002/gps.2443] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE More than half of the older adults respond only partially to first-line antidepressant pharmacotherapy. Our objective was to test the hypothesis that a depression-specific psychotherapy, Interpersonal Psychotherapy (IPT), when used adjunctively with escitalopram, would lead to a higher rate of remission and faster resolution of symptoms in partial responders than escitalopram with depression care management (DCM). METHOD We conducted a 16-week randomized clinical trial of IPT and DCM in partial responders to escitalopram, enrolling 124 outpatients aged 60 and older. The primary outcome, remission, was defined as three consecutive weekly scores of 7 or less on the Hamilton rating scale for depression (17-item). We conducted Cox regression analyses of time to remission and logistic modeling for rates of remission. We tested group differences in Hamilton depression ratings over time via mixed-effects modeling. RESULTS Remission rates for escitalopram with IPT and with DCM were similar in intention-to-treat (IPT vs. DCM: 58 [95% CI: 46, 71] vs. 45% [33,58]; p = 0.14) and completer analyses (IPT vs. DCM: 58% [95% CI: 44,72] vs. 43% [30,57]; p = 0.20). Rapidity of symptom improvement did not differ in the two treatments. CONCLUSION No added advantage of IPT over DCM was shown. DCM is a clinically useful strategy to achieve full remission in about 50% of partial responders.
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Affiliation(s)
- Charles F. Reynolds
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Mary Amanda Dew
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Lynn M. Martire
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Mark D. Miller
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Jill M. Cyranowski
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Eric Lenze
- Washington University in St. Louis, Department of Psychiatry
| | - Ellen M. Whyte
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Bruce G. Pollock
- University of Toronto School of Medicine, Centre for Addiction and Mental Health; University of Toronto, The Rotman Research Institute, Baycrest Centre for Geriatric Care
| | - Jordan F. Karp
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Ariel Gildengers
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Katalin Szanto
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Alexandre Y. Dombrovski
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Carmen Andreescu
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Meryl A. Butters
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Jennifer Q. Morse
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Patricia R. Houck
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Salem Bensasi
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Sati Mazumdar
- University of Pittsburgh Graduate School of Public Health
| | - Jacqueline A. Stack
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Ellen Frank
- Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, Department of Psychiatry, University of Pittsburgh School of Medicine
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Rosen D, Morse JQ, Reynolds CF. Adapting problem-solving therapy for depressed older adults in methadone maintenance treatment. J Subst Abuse Treat 2010; 40:132-41. [PMID: 21036509 DOI: 10.1016/j.jsat.2010.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 09/02/2010] [Accepted: 09/15/2010] [Indexed: 11/18/2022]
Abstract
Late-life depression is prevalent in older adults who are dependent on opiates. Depressive disorders among opiate abusers have detrimental effects on their well-being and ability to refrain from illegal drugs. There are numerous barriers to the provision of appropriate mental health care to older adults receiving methadone maintenance treatment. This article focuses on problem-solving therapy (PST) and presents evidence that PST may be a promising nonpharmacological treatment for older methadone clients with comorbid depressive disorders that can be applied within the staffing and resource limits of methadone maintenance treatment facilities. The advantages of PST relative to other behavioral therapies for this population are based on evidence that PST is less cognitively demanding for an older adult population with mood and substance use disorders. A properly modified PST for an older adult substance-dependent population with subsyndromal or diagnosed depression may be a viable option for methadone maintenance programs with limited resources.
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Affiliation(s)
- Daniel Rosen
- University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Miller JD, Maples J, Few LR, Morse JQ, Yaggi KE, Pilkonis PA. Using clinician-rated five-factor model data to score the DSM-IV personality disorders. J Pers Assess 2010; 92:296-305. [PMID: 20552504 DOI: 10.1080/00223891.2010.481984] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Proposals suggest that many or all of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders (PDs) may be omitted from the DSM (5th ed.; DSM-V) and replaced with a dimensional trait model of personality pathology (Krueger, Skodol, Livesley, Shrout, & Huang, 2007; Skodol, 2009). Several authors have expressed concerns that this may be difficult for clinicians and researchers who are more comfortable with the extant PD diagnoses. In this study, we tested whether clinician ratings of traits from the Five-factor model (FFM; Costa & McCrae, 1990) can be used to recreate DSM-IV PDs. Using a sample of 130 clinical outpatients, we tested the convergent and discriminant validity of the FFM PD counts in relation to consensus ratings of the DSM-IV PDs. We then examined whether the FFM and DSM-IV PD scores correlate in similar ways with self-reported personality traits from the Schedule for Nonadaptive and Adaptive Personality (Clark, 1993). Finally, we tested the clinical utility of the FFM PD counts in relation to functional impairment. Overall, the FFM PD counts, scored using clinician ratings of the FFM traits, appeared to function like the DSM-IV PDs, thus suggesting that the use of a dimensional trait model of personality in the DSM-V may still allow for an assessment of the DSM-IV PD constructs.
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Affiliation(s)
- Joshua D Miller
- Department of Psychology, University of Georgia, Athens, GA 30602-3013, USA.
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Kasckow J, Brown C, Morse JQ, Karpov I, Bensasi S, Thomas SB, Ford A, Reynolds C. Racial preferences for participation in a depression prevention trial involving problem-solving therapy. Psychiatr Serv 2010; 61:722-4. [PMID: 20592009 PMCID: PMC3044189 DOI: 10.1176/ps.2010.61.7.722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study compared African Americans' and Caucasians' willingness to participate in an indicated intervention to prevent depression with problem-solving therapy. It also examined participants' problem-solving skills. Hypotheses stated that there would be no racial differences in consent rates and that social problem-solving coping skills would be lower among African Americans than Caucasians. METHODS Proportions of African Americans and Caucasians who consented were compared, as were Social Problem Solving Inventory scores between the groups. RESULTS Of 2,788 individuals approached, 82 (4%) of 1,970 Caucasians and 46 (6%) of 818 African Americans signed consent, and the difference was not significant (p=.09). Racial differences were observed in neither Social Problem Solving Inventory scores nor in the relationship between problem-solving skills and depressive symptoms. CONCLUSIONS African Americans with depression demonstrated a willingness to participate in an indicated trial of depression prevention. Furthermore, both groups would appear to benefit from the problem-solving process.
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Affiliation(s)
- John Kasckow
- Department of Behavioral Health, U.S. Department of Veterans Affairs Pittsburgh Health Care System, 7180 Highland Dr., Pittsburgh, PA 15206, USA.
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Few LR, Miller JD, Morse JQ, Yaggi KE, Reynolds SK, Pilkonis PA. Examining the reliability and validity of clinician ratings on the Five-Factor Model Score Sheet. Assessment 2010; 17:440-53. [PMID: 20519735 DOI: 10.1177/1073191110372210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite substantial research use, measures of the five-factor model (FFM) are infrequently used in clinical settings due, in part, to issues related to administration time and a reluctance to use self-report instruments. The current study examines the reliability and validity of the Five-Factor Model Score Sheet (FFMSS), which is a 30-item clinician rating form designed to assess the five domains and 30 facets of one conceptualization of the FFM. Studied in a sample of 130 outpatients, clinical raters demonstrated reasonably good interrater reliability across personality profiles and the domains manifested good internal consistency with the exception of Neuroticism. The FFMSS ratings also evinced expected relations with self-reported personality traits (e.g., FFMSS Extraversion and Schedule for Nonadaptive and Adaptive Personality Positive Temperament) and consensus-rated personality disorder symptoms (e.g., FFMSS Agreeableness and Narcissistic Personality Disorder). Finally, on average, the FFMSS domains were able to account for approximately 50% of the variance in domains of functioning (e.g., occupational, parental) and were even able to account for variance after controlling for Axis I and Axis II pathology. Given these findings, it is believed that the FFMSS holds promise for clinical use.
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Affiliation(s)
- Lauren R Few
- University of Georgia, Athens, GA 30602-3013, USA
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Martire LM, Hinrichsen GA, Morse JQ, Reynolds CF, Gildengers AG, Mulsant BH, Schulz R, Frank E, Kupfer DJ. The Mood Disorder Burden Index: a scale for assessing the burden of caregivers to adults with unipolar or bipolar disorder. Psychiatry Res 2009; 168:67-77. [PMID: 19427705 PMCID: PMC2727157 DOI: 10.1016/j.psychres.2008.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 03/17/2008] [Accepted: 04/10/2008] [Indexed: 02/05/2023]
Abstract
We present a brief measure of caregiver burden, the Mood Disorder Burden Index (MDBI), for use with family members and close friends of adults with major depressive disorder (MDD) or bipolar disorder (BD). The MDBI assesses burden in three core domains (patients' mood symptoms, caregivers' worry about the future, and caregivers' interpersonal difficulties with the patient) and includes an optional module that assesses caregiver burden associated with patients' pharmacotherapy or psychotherapy. The MDBI was administered to caregivers of older individuals (i.e., 58 years and older) with MDD (n=123) or BD (n=38) who were receiving treatment through a research study. Analyses indicated evidence of convergent and discriminant validity of the new measure well as internal consistency within both caregiver groups. It will be important for future research to administer the MDBI to caregivers of middle-aged and older patients as well as those receiving treatment through inpatient settings or community outpatient clinics.
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Affiliation(s)
- Lynn M. Martire
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA, University Center for Social and Urban Research, Pittsburgh, PA,contact information: 121 University Place, Room 508, University Center for Social & Urban Research, Pittsburgh PA 15260. Telephone: (412) 624-6172. FAX: (412) 624-4810. E-mail:
| | | | - Jennifer Q. Morse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Ariel G. Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA
| | - Benoit H. Mulsant
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Richard Schulz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh PA, University Center for Social and Urban Research, Pittsburgh, PA
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Morse JQ, Hill J, Pilkonis PA, Yaggi K, Broyden N, Stepp S, Reed LI, Feske U. Anger, preoccupied attachment, and domain disorganization in borderline personality disorder. J Pers Disord 2009; 23:240-57. [PMID: 19538080 PMCID: PMC2821703 DOI: 10.1521/pedi.2009.23.3.240] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Emotional dysregulation and attachment insecurity have been reported in borderline personality disorder (BPD). Domain disorganization, evidenced in poor regulation of emotions and behaviors in relation to the demands of different social domains, may be a distinguishing feature of BPD. Understanding the interplay between these factors may be critical for identifying interacting processes in BPD and potential subtypes of BPD. Therefore, we examined the joint and interactive effects of anger, preoccupied attachment, and domain disorganization on BPD traits in a clinical sample of 128 psychiatric patients. The results suggest that these factors contribute to BPD both independently and in interaction, even when controlling for other personality disorder traits and Axis I symptoms. In regression analyses, the interaction between anger and domain disorganization predicted BPD traits. In recursive partitioning analyses, two possible paths to BPD were identified: high anger combined with high domain disorganization and low anger combined with preoccupied attachment. These results may suggest possible subtypes of BPD or possible mechanisms by which BPD traits are established and maintained.
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Miller JD, Campbell WK, Pilkonis PA, Morse JQ. Assessment procedures for narcissistic personality disorder: a comparison of the personality diagnostic questionnaire-4 and best-estimate clinical judgments. Assessment 2008; 15:483-92. [PMID: 18550845 PMCID: PMC2841972 DOI: 10.1177/1073191108319022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the degree of correspondence between two assessments for narcissistic personality disorder (NPD) in a mixed clinical and community sample--one using a self-report measure (Personality Diagnostic Questionnaire-4) and the other using clinical judgments derived from an assessment based on the longitudinal, expert, all data (LEAD) methodology. NPD scores demonstrated moderate convergence for the total scores but weak convergence for the individual criteria. The authors also examined the correlates created by each set of NPD scores using Cloninger's Temperament and Character Inventory (TCI). The NPD scores demonstrated areas of convergence (e.g., Cooperativeness, Self-directedness) and divergence (i.e., Harm Avoidance, Novelty Seeking) with these personality scores. These divergences may be due to the wording of certain items on the Personality Diagnostic Questionnaire-4 NPD scale, which may require rewriting if it is to provide an assessment that is more highly convergent with the Diagnostic and Statistical Manual of Mental Disorders NPD construct.
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Affiliation(s)
- Joshua D Miller
- Department of Psychology, University of Georgia, Athens, GA 30602-3013, USA. jdmiller @uga.edu
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Carreira K, Miller MD, Frank E, Houck PR, Morse JQ, Dew MA, Butters MA, Reynolds CF. A controlled evaluation of monthly maintenance interpersonal psychotherapy in late-life depression with varying levels of cognitive function. Int J Geriatr Psychiatry 2008; 23:1110-3. [PMID: 18457338 PMCID: PMC2872074 DOI: 10.1002/gps.2031] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the effect of maintenance Interpersonal Psychotherapy (IPT) on recurrence rates and time to recurrence of major depression in elderly patients with varying levels of cognitive function. METHODS/DESIGN Two-year maintenance study of monthly maintenance IPT vs supportive clinical management (CM) in remitted depressed elderly who were participants in a previously reported placebo-controlled study of maintenance paroxetine and IPT (Reynolds et al., 2006). We used Cox regression analysis to test interactions between cognitive status (Dementia Rating Scale score) and treatment (IPT, CM) with respect to recurrence of major depression. RESULTS We observed a significant interaction between cognitive status and treatment: lower cognitive performance was associated with longer time to recurrence in IPT than in CM (58 weeks vs 17 weeks) (HR = 1.41 [95% CI = 1.04, 1.91], p = 0.03). Subjects with average cognitive performance showed no effect of maintenance IPT vs CM on time to recurrence (38 vs 32 weeks, respectively). CONCLUSION Monthly maintenance IPT confers protection against recurrence of major depression in elders with lower cognitive functioning.
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Affiliation(s)
- Kristen Carreira
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Mark D. Miller
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Interventions and Services Research in Late-Life Mood Disorders
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Interventions and Services Research in Late-Life Mood Disorders
| | - Patricia R. Houck
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Interventions and Services Research in Late-Life Mood Disorders
| | - Jennifer Q. Morse
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Interventions and Services Research in Late-Life Mood Disorders
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Interventions and Services Research in Late-Life Mood Disorders
| | - Meryl A. Butters
- Advanced Center for Interventions and Services Research in Late-Life Mood Disorders
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Interventions and Services Research in Late-Life Mood Disorders
- John A. Hartford Center of Excellence in Geriatric Psychiatry
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Martire LM, Schulz R, Reynolds CF, Morse JQ, Butters MA, Hinrichsen GA. Impact of close family members on older adults' early response to depression treatment. Psychol Aging 2008; 23:447-52. [PMID: 18573018 DOI: 10.1037/0882-7974.23.2.447] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study of 130 depressed older adults and their spouses or adult children examined the impact of caregiver burden specific to patients' depressive symptoms on patients' response to antidepressant treatment. Primary care patients completed medical, psychiatric, and neuropsychological assessments prior to treatment, and interviews were conducted with their identified family member. As hypothesized, caregivers' depression-specific burden predicted greater depression severity for the patient at the 6th week of treatment after accounting for patients' pretreatment characteristics, caregivers' depressive symptoms, and caregivers' relationship satisfaction. Future research may identify family attitudes and behaviors that stem from burden and compromise older adults' ability to recover from depression.
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Affiliation(s)
- Lynn M Martire
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA.
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Abstract
The relationships among adult attachment styles, interpersonal problems, and categories of suicide-related behaviors (i.e., self-harm, suicide attempts, and their co-occurrence) were examined in a predominantly psychiatric sample (N = 406). Both anxious and avoidant attachment styles were associated with interpersonal problems. In turn, specific interpersonal problems differentially mediated the relations between attachment style and type of suicide-related behaviors. These findings suggest the importance of distinguishing between these groups of behaviors in terms of etiological pathways, maintenance processes, and treatment interventions.
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Marshal MP, Friedman MS, Stall R, King KM, Miles J, Gold MA, Bukstein OG, Morse JQ. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction 2008; 103:546-56. [PMID: 18339100 PMCID: PMC2680081 DOI: 10.1111/j.1360-0443.2008.02149.x] [Citation(s) in RCA: 546] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature. METHODS Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software. RESULTS LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen's d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables. CONCLUSIONS The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.
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Affiliation(s)
- Michael P. Marshal
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark S. Friedman
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Kevin M. King
- Department of Psychology, University of Washington, WA, USA
| | | | - Melanie A. Gold
- Department of Pediatrics, Division of Adolescent Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Oscar G. Bukstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer Q. Morse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
A brief but valid self-report measure to screen for personality disorders (PDs) would be a valuable tool in making decisions about further assessment and in planning optimal treatments. In psychiatric and nonpsychiatric samples, we compared the validity of three screening measures: the PD scales from the Inventory of Interpersonal Problems, a self-report version of the Iowa Personality Disorder Screen, and the selfdirectedness scale of the Temperament and Character Inventory. Despite their different theoretical origins, the screeners were highly correlated in a range from .71 to .77. As a result, the use of multiple screeners was not a significant improvement over any individual screener, and no single screener stood out as clearly superior to the others. Each performed modestly in predicting the presence of any PD diagnosis in both the psychiatric and nonpsychiatric groups. Performance was best when predicting a more severe PD diagnosis in the psychiatric sample. The results also highlight the potential value of multiple assessments when relying on self-reports.
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Affiliation(s)
- Jennifer Q Morse
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Morse JQ, Pilkonis PA, Houck PR, Frank E, Reynolds CF. Impact of cluster C personality disorders on outcomes of acute and maintenance treatment in late-life depression. Am J Geriatr Psychiatry 2005; 13:808-14. [PMID: 16166411 DOI: 10.1176/appi.ajgp.13.9.808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Personality disorders (PDs) have been associated with poor treatment outcomes in acute treatments for late-life depression and with persistent functional impairment after recovery from an episode of depression. METHODS Using survival analysis and mixed-effects models, the authors examined the impact of Cluster C PDs on time-to-response and several aspects of functioning in acute and maintenance treatment of major depression in later life. RESULTS Cluster C PDs were associated with longer time-to-response during acute treatment and non-response in continuation or maintenance treatment. Although not statistically significant, there was evidence of a cumulative negative impact of Cluster C PDs and residual depressive symptoms on instrumental activities of daily living (IADLs) during maintenance treatment. CONCLUSIONS These findings suggest that screening for PD may be important for clinicians treating late-life depression and that the combination of Cluster C PDs and residual depressive symptoms may predict functional declines even after recovery from the index episode of depression.
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Affiliation(s)
- Jennifer Q Morse
- Personality Studies, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Abstract
BACKGROUND This study examined whether specific interactions of personality and life events predicted increases in depressive symptoms over time in a late-life sample. METHOD Participants (n=55) who were in remission from a recent episode of major depression completed a depression symptom interview and a questionnaire assessing the personality constructs sociotropy and autonomy. Six months later, they completed the same personality questionnaire and a checklist of life events experienced during the past 6 months. RESULTS As predicted, increases in depressive symptoms were significantly predicted by the congruent interaction of sociotropy with negative interpersonal events and by the congruent interaction of autonomy with negative autonomy events, but not by either of the non-congruent interactions. LIMITATIONS A small sample prevented examinations of important depressive subtypes based on age of depression onset and vascular status. CONCLUSIONS These findings strongly support the personality-life event congruence model of depression in a late-life sample. Clinical implications include attending to stressful events that match an older adult's personality style, to help the older adult cope with those events that are more likely to increase his or her depression.
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Affiliation(s)
- Jennifer Q Morse
- Department of Psychology, Social and Health Sciences, Duke University, USA.
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Lynch TR, Cheavens JS, Morse JQ, Rosenthal MZ. A model predicting suicidal ideation and hopelessness in depressed older adults: the impact of emotion inhibition and affect intensity. Aging Ment Health 2004; 8:486-97. [PMID: 15724830 DOI: 10.1080/13607860412331303775] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to begin a preliminary examination of constructs theorized to be related to suicidal behavior by testing a model of the influence of both temperament and emotion regulation on suicidal ideation and hopelessness in a sample of depressed older adults. The model was evaluated using structural equation modeling procedures in a sample of depressed, older adults. Findings supported a temporally predictive model in which negative affect intensity and reactivity lead to emotion inhibition, operationalized as ambivalence over emotional expression and thought suppression, which in turn lead to increased presence of suicidal predictors, operationalized as hopelessness and suicidal ideation. These results suggest that suicide prevention efforts in older adults may be improved by targeting emotion inhibition in treatment, especially among affectively intense and reactive older adults.
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Affiliation(s)
- T R Lynch
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27704, USA.
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Abstract
The current study examined the prototype-matching technique for using the five-factor model (FFM) of personality to assess personality disorders (PDs) and their correlates. The sample was composed of 69 psychiatric patients, most of whom suffered from affective or anxiety disorders. The participants were predominantly outpatients (78%), Caucasian (94%), and women (58%). NEO Personality Inventory (NEO-PI) data from these patients and informants were available for deriving PD prototype scores. The results supported four conclusions. First, the FFM prototype-matching method is useful for clinical samples. Second, agreement between self-reports and information from significant others (SOs) using this method is good compared to previous results. Third, this agreement varies systematically with the observability of the PD criteria. Fourth, the value of self- and other-reported personality information depends on the rating source of the outcome variables. Other-reported information provides incremental utility in predicting impairment and interpersonal distress rated by clinicians and significant others.
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Affiliation(s)
- Joshua D Miller
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
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Morse JQ, Lynch TR. A preliminary investigation of self-reported personality disorders in late life: prevalence, predictors of depressive severity, and clinical correlates. Aging Ment Health 2004; 8:307-15. [PMID: 15370047 DOI: 10.1080/13607860410001709674] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Previous research suggests that personality disorders, particularly in clusters A and C, persist into late life, are particularly prevalent in late-life depressed samples, and negatively impact treatment of late-life depression. The present study examined the self-reported personality disorder traits of a sample of 65 depressed elders using the Wisconsin Personality Disorder Inventory IV (WISPI IV). As expected, clusters A and C were most prevalent and the presence of a personality disorder predicted the maintenance or re-emergence of depressive symptoms, as did hopelessness and ambivalence regarding emotional expression. No specific personality disorder traits were associated with clinical features of late-life depression (age of onset, number of previous episodes) while some personality disorder traits were associated with psychological correlates of depression (hopelessness, ambivalence regarding emotional expression, thought suppression). A theoretical explanation for the cluster prevalence based on self-verification is discussed along with a profile of elderly patients who may have poor depression treatment course if they exhibit personality disorder traits, particularly interpersonal rigidity or avoidance, chronic hopelessness, and emotional inhibition.
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Affiliation(s)
- J Q Morse
- Department of Psychiatry, Western Psychiatric Institute and Clinic, North Carolina, USA
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Lynch TR, Morse JQ, Mendelson T, Robins CJ. Dialectical behavior therapy for depressed older adults: a randomized pilot study. Am J Geriatr Psychiatry 2003; 11:33-45. [PMID: 12527538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy. METHODS They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT). RESULTS Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. CONCLUSION Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults.
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Affiliation(s)
- Thomas R Lynch
- Duke University Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27704, USA.
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Abstract
Sociotropy and autonomy (Beck, 1983) are sets of beliefs, concerns, and behavioral tendencies that are proposed to create vulnerability to depression and other psychopathology and to influence its manifestation and treatment response. Other theoretical frameworks (Blatt, 1974) have made similar suggestions. We investigated the differential relations of sociotropy and autonomy to dimensional scores for each DSM-III-R personality disorder (PD) in a sample of 188 psychiatric patients, controlling for the other set of characteristics and for the other PDs. Histrionic and dependent PD traits were related specifically to sociotropy. Paranoid, schizoid, schizotypal, and passive-aggressive PD traits were related specifically to autonomy. Borderline, narcissistic, avoidant, and self-defeating PD traits were related significantly and about equally to both sociotropy and autonomy. Obsessive-compulsive PD traits were not related consistently to either. Results were mostly as predicted and suggest that sociotropy and autonomy may be useful constructs for understanding and treating PDs.
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Abstract
We evaluated the hypothesis that interpersonal relationships of depressed persons would vary as a function of the personality variables sociotropy and autonomy. Depressed psychiatric patients who reported being in a current intimate relationship for at least six months were administered measures of sociotropy, autonomy, and several aspects of relationship functioning. Results indicated that sociotropy was related significantly to patients' reporting their own behavior as demanding and their partners' behavior as withdrawing, whereas autonomy was related to patients' reporting their partners' behavior as demanding and their own behavior as withdrawing. Autonomy also was related to greater relationship dissatisfaction, and there was a trend for autonomy to be related to greater criticism of the partner. The results are consistent with a model in which sociotropy and autonomy increase vulnerability to depression, in part, through their effects on interpersonal relationships.
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Affiliation(s)
- T R Lynch
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
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