Gender differences in peer reviewed grant applications, awards, and amounts: a systematic review and meta-analysis

BACKGROUND

Differential participation and success in grant applications may contribute to women's lesser representation in the sciences. This study's objective was to conduct a systematic review and meta-analysis to address the question of gender differences in grant award acceptance rates and reapplication award acceptance rates (potential bias in peer review outcomes) and other grant outcomes.

METHODS

The review was registered on PROSPERO (CRD42021232153) and conducted in accordance with PRISMA 2020 standards. We searched Academic Search Complete, PubMed, and Web of Science for the timeframe 1 January 2005 to 31 December 2020, and forward and backward citations. Studies were included that reported data, by gender, on any of the following: grant applications or reapplications, awards, award amounts, award acceptance rates, or reapplication award acceptance rates. Studies that duplicated data reported in another study were excluded. Gender differences were investigated by meta-analyses and generalized linear mixed models. Doi plots and LFK indices were used to assess reporting bias.

RESULTS

The searches identified 199 records, of which 13 were eligible. An additional 42 sources from forward and backward searches were eligible, for a total of 55 sources with data on one or more outcomes. The data from these studies ranged from 1975 to 2020: 49 sources were published papers and six were funders' reports (the latter were identified by forwards and backwards searches). Twenty-nine studies reported person-level data, 25 reported application-level data, and one study reported both: person-level data were used in analyses. Award acceptance rates were 1% higher for men, which was not significantly different from women (95% CI 3% more for men to 1% more for women, k = 36, n = 303,795 awards and 1,277,442 applications, I² = 84%). Reapplication award acceptance rates were significantly higher for men (9%, 95% CI 18% to 1%, k = 7, n = 7319 applications and 3324 awards, I² = 63%). Women received smaller award amounts (g = -2.28, 95% CI -4.92 to 0.36, k = 13, n = 212,935, I² = 100%).

CONCLUSIONS

The proportions of women that applied for grants, re-applied, accepted awards, and accepted awards after reapplication were less than the proportion of eligible women. However, the award acceptance rate was similar for women and men, implying no gender bias in this peer reviewed grant outcome. Women received smaller awards and fewer awards after re-applying, which may negatively affect continued scientific productivity. Greater transparency is needed to monitor and verify these data globally.

Depression trial results: A cross-sectional study of ClinicalTrials.gov

Published clinical trials represent a subsample of the objective information needed to appraise treatments for depression. We characterize the extent of selective and delayed reporting in a systematic review (PROSPERO #CRD42020173606) of depression trial results registered on ClinicalTrials.gov. Inclusion criteria were studies registered on ClinicalTrials.gov with depression as the condition, had enrolled ages 18 and over, were completed between January 1, 2008 and May 1, 2019, and had posted results by February 1, 2022. Cox regression analyses of time to result posting from registration and from study completion included enrollment as a covariate. Among 442 protocols, median result posting occurred over two years after study completion and five years after registration. Among protocols with incomplete results, effect sizes (d or W) were calculated for 134 protocols. Median effect sizes for protocols with incomplete results were small (0.16, 95% CI 0.08, 0.21). For 28% of protocols, observed effects were contrary to the expected direction. Between-group effect size calculations were based on post-treatment data as pre-treatment data were inconsistently provided. Although drug and device trials in the U.S. are required to register on ClinicalTrials.gov, compliance is imperfect, and submissions are not peer reviewed. For depression treatment trials, long intervals between study completion and posting of results are common. Further, investigators often fail to report the results of statistical tests. Failure to post trial results in a timely manner and omission of statistical test reporting may lead to overestimates of treatment effects in systematic literature reviews.

Peer review: Risk and risk tolerance

Peer review, commonly used in grant funding decisions, relies on scientists’ ability to evaluate research proposals’ quality. Such judgments are sometimes beyond reviewers’ discriminatory power and could lead to a reliance on subjective biases, including preferences for lower risk, incremental projects. However, peer reviewers’ risk tolerance has not been well studied. We conducted a cross-sectional experiment of peer reviewers’ evaluations of mock primary reviewers’ comments in which the level and sources of risks and weaknesses were manipulated. Here we show that proposal risks more strongly predicted reviewers’ scores than proposal strengths based on mock proposal evaluations. Risk tolerance was not predictive of scores but reviewer scoring leniency was predictive of overall and criteria scores. The evaluation of risks dominates reviewers’ evaluation of research proposals and is a source of inter-reviewer variability. These results suggest that reviewer scoring variability may be attributed to the interpretation of proposal risks, and could benefit from intervention to improve the reliability of reviews. Additionally, the valuation of risk drives proposal evaluations and may reduce the chances that risky, but highly impactful science, is supported.

Transparency of results reporting for depression treatment studies in ClinicalTrials.gov: a cross-sectional study

OBJECTIVES

Depression affects an estimated 7% of the adult population at an estimated cost of over US$200 billion/year in the USA. Complete, transparent reporting of clinical trial data facilitates valid estimates of treatment efficacy. In the USA, ClinicalTrials.gov increases transparency through mandatory prospective trial registration and outcome reporting. We examined characteristics of the transparent reporting of depression treatment studies registered in ClinicalTrials.gov.

DESIGN

Cross sectional.

SETTING AND PARTICIPANTS

US-based studies identified in a search of ClinicalTrials.gov with depression as the condition, enrolling ages 18 and older, and completed between 1 January 2008 and 1 May 2019.

INTERVENTIONS

All interventions were included.

MAIN OUTCOMES AND MEASURES

The main outcome was whether any results were reported prior to 1 May 2020. Data were extracted regarding inclusion and exclusion criteria, publications related to the study and specification of hypotheses.

RESULTS

725 studies involving 156 634 patients met inclusion criteria. 416 (57.4%) of the studies posted some results. However, statistical test results were not included in 230 studies (55.3%). Most studies had data that could have been analysed and reported. Compared with studies without results, studies with any results were more likely to have hypotheses, include drug treatment conditions, and to have publications related to the study.

CONCLUSIONS

Required study registration does not always result in transparent outcome reporting. Better compliance with mandated reporting and improved reporting standards would facilitate a more comprehensive representation of depression treatment research.

Treatment for Borderline Personality Disorder and Secondary Effects on Somatization

Borderline personality disorder (BPD) is often accompanied by other diagnoses. Some comorbidities have received a good deal of attention, but others, including somatization, have not. As effective treatments for BPD are identified, the secondary effects of these treatments on BPD comorbidities are of clinical relevance. Secondary data were used from a randomized clinical trial of dialectical behavior therapy (DBT) and community treatment by experts among 101 women with BPD in order to characterize change in somatization with treatment for BPD, and to examine emotional avoidance as a mediator. Somatization decreased significantly over time, which did not differ by treatment condition. DBT had an indirect effect on somatization through less emotional avoidance. These results suggest that the comorbid presence of significant somatization should be evaluated among those with BPD, especially in the context of emotional avoidance; treatments could be enhanced by addressing emotion regulation skills.

Grant Review Feedback: Appropriateness and Usefulness

The primary goal of the peer review of research grant proposals is to evaluate their quality for the funding agency. An important secondary goal is to provide constructive feedback to applicants for their resubmissions. However, little is known about whether review feedback achieves this goal. In this paper, we present a multi-methods analysis of responses from grant applicants regarding their perceptions of the effectiveness and appropriateness of peer review feedback they received from grant submissions. Overall, 56-60% of applicants determined the feedback to be appropriate (fair, well-written, and well-informed), although their judgments were more favorable if their recent application was funded. Importantly, independent of funding success, women found the feedback better written than men, and more white applicants found the feedback to be fair than non-white applicants. Also, perceptions of a variety of biases were specifically reported in respondents' feedback. Less than 40% of applicants found the feedback to be very useful in informing their research and improving grantsmanship and future submissions. Further, negative perceptions of the appropriateness of review feedback were positively correlated with more negative perceptions of feedback usefulness. Importantly, respondents suggested that highly competitive funding pay-lines and poor inter-panel reliability limited the usefulness of review feedback. Overall, these results suggest that more effort is needed to ensure that appropriate and useful feedback is provided to all applicants, bolstering the equity of the review process and likely improving the quality of resubmitted proposals.

Grant reviewer perceptions of the quality, effectiveness, and influence of panel discussion

Background

Funding agencies have long used panel discussion in the peer review of research grant proposals as a way to utilize a set of expertise and perspectives in making funding decisions. Little research has examined the quality of panel discussions and how effectively they are facilitated.

Methods

Here, we present a mixed-method analysis of data from a survey of reviewers focused on their perceptions of the quality, effectiveness, and influence of panel discussion from their last peer review experience.

Results

Reviewers indicated that panel discussions were viewed favorably in terms of participation, clarifying differing opinions, informing unassigned reviewers, and chair facilitation. However, some reviewers mentioned issues with panel discussions, including an uneven focus, limited participation from unassigned reviewers, and short discussion times. Most reviewers felt the discussions affected the review outcome, helped in choosing the best science, and were generally fair and balanced. However, those who felt the discussion did not affect the outcome were also more likely to evaluate panel communication negatively, and several reviewers mentioned potential sources of bias related to the discussion. While respondents strongly acknowledged the importance of the chair in ensuring appropriate facilitation of the discussion to influence scoring and to limit the influence of potential sources of bias from the discussion on scoring, nearly a third of respondents did not find the chair of their most recent panel to have performed these roles effectively.

Conclusions

It is likely that improving chair training in the management of discussion as well as creating review procedures that are informed by the science of leadership and team communication would improve review processes and proposal review reliability.

The Participation and Motivations of Grant Peer Reviewers: A Comprehensive Survey

Scientific peer reviewers play an integral role in the grant selection process, yet very little has been reported on the levels of participation or the motivations of scientists to take part in peer review. The American Institute of Biological Sciences (AIBS) developed a comprehensive peer review survey that examined the motivations and levels of participation of grant reviewers. The survey was disseminated to 13,091 scientists in AIBS's proprietary database. Of the 874 respondents, 76% indicated they had reviewed grant applications in the last 3 years; however, the number of reviews was unevenly distributed across this sample. Higher review loads were associated with respondents who had submitted more grant proposals over this time period, some of whom were likely to be study section members for large funding agencies. The most prevalent reason to participate in a review was to give back to the scientific community (especially among frequent grant submitters) and the most common reason to decline an invitation to review was lack of time. Interestingly, few suggested that expectation from the funding agency was a motivation to review. Most felt that review participation positively influenced their careers through improving grantsmanship and exposure to new scientific ideas. Of those who reviewed, respondents reported dedicating 2-5% of their total annual work time to grant review and, based on their self-reported maximum review loads, it is estimated they are participating at 56-87% of their capacity, which may have important implications regarding the sustainability of the system. Overall, it is clear that participation in peer review is uneven and in some cases near capacity, and more needs to be done to create new motivations and incentives to increase the future pool of reviewers.

Moderators of Outcome in Problem-Solving Therapy for Depression in Primary Care

OBJECTIVE

The purpose of this study was to conduct a secondary analysis of data from trials of problem-solving therapy in primary care (PST-PC) to examine differential outcomes by gender or race-ethnicity.

METHODS

The participants were 352 patients with depression treated with PST-PC in multiple primary care sites in the United States.

RESULTS

Women's depressive symptoms improved more over time than men's. Hopkins Symptom Checklist depression scale scores decreased significantly (t=-10.12, df=692, p<0.001) (estimate=-0.02, 95% confidence interval=-0.03, -0.02). Although patients from racial-ethnic minority groups had more depressive symptoms over time than patients from nonminority groups, there was no evidence of differential change by racial-ethnic group.

CONCLUSIONS

These data add to the literature supporting the usefulness of PST-PC without evidence of differential effects for patients from racial-ethnic minority or nonminority groups.

The association of major life events with chronic fatigue

OBJECTIVE

Major life events have been associated with the onset of unexplained chronic fatigue (CF) and with variability in illness course. The purpose of this study was to characterize the associations of major life events with illness status over time.

METHOD

Sentinel measures of clinical status were collected four times over 18 months in a cohort of 99 persons with CF; participants also were interviewed regarding major life events, which were independently rated by observers.

RESULTS

Over time, more major life events attributed to CF predicted a worse clinical course, suggesting that illness-related major life events rather than stressful life events in general are associated with worse clinical status for persons with CF.

CONCLUSION

This study adds to the literature regarding specific types of life events' relationship to illness course, which has implications for the management of CF.

Negative life events and incident alcohol use disorders among ethnic minorities

The association of negative life events (NLEs) with incident alcohol use disorders (AUDs) was examined among Blacks, Hispanics, and Whites in the second wave of the National Comorbidity Survey (NCS) among 3,679 participants without AUDs at the first wave. The number of past-year NLEs at NCS-2 was higher for Black than White participants, but the rates of incident AUDs did not differ by racial/ethnic group (14.2% among all participants). Past-year NLEs were associated with increased odds of incident AUDs for Whites and Hispanics but not Blacks. The implications of racial/ethnic differences in life events and AUDs are discussed.

Incident Chronic Spinal Pain and Depressive Disorders: Data From the National Comorbidity Survey

This study examined pre-existing depression as a risk factor for the development of chronic spinal pain, and pre-existing chronic spinal pain as a risk factor for the development of depression. Data from the National Comorbidity Survey, a stratified sample of 5,001 participants evaluated in 1990 to 1992 (NCS-1) and again in 2000 to 2001 (NCS-2) were used to address these associations. Cox regression was used to estimate hazard ratios and time-to-incidence after NCS-1. Participants with antecedent acute or chronic depressive disorders at NCS-1 were more likely to develop chronic spinal pain in the ensuing 10 years compared with participants without depressive disorders. Those with antecedent chronic spinal pain at NCS-1 were more likely to develop dysthymic disorder than subjects without chronic spinal pain at NCS-1; however, antecedent chronic spinal pain was not associated the subsequent development of major depressive disorder. These results suggest that both pain and depression are associated with the development of the other condition. In particular, chronic depression is more strongly linked to chronic spinal pain than is acute depression. The results are discussed in terms of the need to assess the presence of both disorders given the presence of one. PERSPECTIVE: Chronic spinal pain and depressive disorders, especially chronic depression, increase the likelihood for the subsequent development of the other condition. The results underscore the need to routinely assess for the presence of both disorders given the presence of one to mitigate the effects of developing comorbid conditions.

Longitudinal associations of lymphocyte subsets with clinical outcomes in chronic fatigue syndrome

Background

Chronic fatigue syndrome (CFS) is characterized by prolonged fatigue and other physical and neurocognitive symptoms. Some studies suggest that CFS is accompanied by disruptions in the number and function of various lymphocytes. However, it is not clear which lymphocytes might influence CFS symptoms.

Purpose

To determine if patient reported fatigue symptoms and physical functioning scores significantly changed across time with lymphocyte counts as evidence of a relation among chronic fatigue symptoms and the immune response.

Methods

The current longitudinal, naturalistic study assessed the cellular expression of three lymphocyte subtypes -- natural killer (NK) cells (CD3-CD16+ and CD3-CD56+) and naïve T cells (CD4+CD45RA+) -- to determine whether changes in lymphocytes at 4 time points across 18 months were associated with clinical outcomes, including CFS symptoms, physical functioning, and vitality, among patients with chronic fatigue.. Latent growth curve models were used to examine the longitudinal relationship between lymphocytes and clinical outcomes.

Results

Ninety-three patients with Fukuda-based CFS and seven with non-CFS fatigue provided study data. Results indicated that higher proportions of naïve T cells and lower proportions of NK cells were associated with worse physical functioning, whereas higher proportions of NK cells (CD3-CD16+) and lower proportions of naïve T cells were associated with fewer CFS symptoms.

Conclusion

These findings suggest that lymphocytes are modestly related to clinical outcomes over time.

Longitudinal outcomes associated with significant other responses to chronic fatigue and pain

This study investigated significant others' behavior associated with fatigue, pain, and mental health outcomes among 68 individuals with chronic fatigue (43% also had fibromyalgia) over 18 months. More negative significant others' responses were associated with more pain, poorer physical and mental health, and more fatigue-related symptoms over time. More fibromyalgia tender points covaried with more solicitous significant others' responses over time. Better mental health covaried with more distracting significant others' responses over time. The results are discussed in terms of theoretical models of the role of perceived significant others' responses on patient outcomes and recommendations for future research.

Psychologists in Academic Administration: A Call to Action and Service

Academic psychologists' backgrounds may prepare them for many aspects of academic administration such as: understanding and working with people; prioritizing others' needs and institutional needs; and managing projects and budgets, e.g., for research grants or training programs. Contemporary academic health centers also may provide opportunities for psychologists to serve in academic health administration. This article encourages psychologists to consider preparing for and seeking administrative and higher-level leadership roles. Six psychologists serving diverse administrative roles-from vice chairs in medical school departments to presidents of universities with academic health centers-reflected on: their paths to administration; their preparation for administrative roles; and the commonalities and differences between the work and skills sets of psychologist health service providers and the work and skill sets required for higher level administrative and leadership roles.

The privilege and burden of peer review

OBJECTIVES

Peer review is a core value and method of quality control in psychological research, academic psychology, and other disciplines, but little is known about the peer-reviewing behavior of ethnic minority reviewers in particular. The purpose of this study was to examine the self-identified ethnicity of those invited to peer review articles for 76 journals that utilized the American Psychological Association's Journals Back Office (JBO) system from 2003 to 2012. It was hypothesized that a modest increase in the ratio of requests for reviews from self-identified ethnic minority reviewers would be observed over time, that self-identified ethnic minority reviewers would be less likely to refuse a review request than those who do not self-identify as an ethnic minority, and finally that increases in reviewer burden would be evident in significant increases in declines to requests by all reviewers.

METHOD

Reviewer requests and responses were examined among the 76 journals that used the JBO system over a 10-year period.

RESULTS

Using hierarchical linear models, the percentage of review invitations extended to ethnic minorities was found to significantly increase over time: Initially, an estimated 8.34% of review requests were made to ethnic minority reviewers, and that percentage increased an average of 0.41% per year.

CONCLUSIONS

Ethnic minority reviewers were significantly less likely to refuse a review request than ethnic majority reviewers. Results are discussed in terms of perceived pressure to demonstrate scholastic impact and the disproportionate service burden often borne by ethnic minority psychologists.

Neurocognitive complaints and functional status among patients with chronic fatigue syndrome and fibromyalgia

PURPOSE

The purpose of this study was to conduct a longitudinal examination of cognitive complaints and functional status in patients with chronic fatigue syndrome (CFS) alone and those who also had fibromyalgia (CFS/FM).

METHODS

A total of 93 patients from a tertiary care fatigue clinic were evaluated on four occasions, each 6 months apart. Each evaluation included a tender point assessment, and self-reported functional status and cognitive complaints.

RESULTS

Patients with CFS/FM reported significantly worse physical functioning, more bodily pain, and more cognitive difficulties (visuo-perceptual ability and verbal memory) than patients with CFS alone. Over time, bodily pain decreased only for participants with CFS alone. Verbal memory problems were associated with more bodily pain for both patient groups, whereas visuo-perceptual problems were associated with worse functional status for patients with CFS alone.

CONCLUSIONS

This study adds to the literature on functional status, longitudinal course, and cognitive difficulties among patients with CFS and those with CFS and FM. The results suggest that patients with CFS/FM are more disabled, have more cognitive complaints, and improve more slowly over time than patients with CFS alone. Specific cognitive difficulties are related to worse functional status, which supports the addition of cognitive difficulties to the FM case criteria.

Salivary cortisol responses to household tasks among couples with unexplained chronic fatigue

This study examined salivary cortisol levels in couples in which one member had unexplained chronic fatigue (CF). The couples completed questionnaires and seven household activities in a laboratory setting and provided salivary cortisol samples prior to and immediately after the activities, as well as again after completing additional questionnaires and debriefing. The couples rated their interactions as similar to those at home, suggesting ecological validity, and patients with CF experienced the activities as involving more exertion than did their partners. The multilevel model results indicated that patients with CF had overall lower cortisol levels and flatter slopes across repeated measurements than did their significant others. Patients' and significant others' cortisol concentrations were significantly associated with each other over time. Furthermore, significant others' cortisol was associated with greater relationship satisfaction and greater observed rates of patients' illness/pain behaviors per minute, but patients' levels of cortisol were not associated with relationship variables. This study is the first to examine cortisol in couples with CF; the results are discussed in terms of implications for future research.

Interaction of asthmatics and their spouses: A preliminary study of individual differences

Some asthmatics show evidence of airways reactivity triggered by strong emotions. Six case studies of married patients with severe asthma are reported. The videotaped interactions of the asthmatic and his/her spouse were coded for affect and behavior. Repeated measures of pulmonary function and affective state were recorded before and after two interaction tasks. Over the course of the experimental period, two patients' pulmonary function improved and four patients' deteriorated. In general, decreased pulmonary function was associated with more self-rated hostility and depression. The results are discussed in terms of their implications for the intra- and interpersonal factors that are important in asthma management.

Descriptors of breathlessness in children with persistent asthma

BACKGROUND

In adult patients, the consistent use of language to describe dyspnea enhances patient-provider communication and contributes to diagnostic and therapeutic decisions. The objective of this research was to determine whether pediatric patients similarly display consistency in the language used to describe "uncomfortable awareness of breathing."

METHODS

One hundred children between the ages of 8 and 15 years with moderate to severe persistent asthma enrolled in an asthma education research program completed questionnaires regarding descriptors of asthma on each of two occasions. In addition to the breathlessness questionnaires, demographic information, self-reported asthma severity, ED visits, missed school days, anthropometrics, and spirometry were obtained for each participant.

RESULTS

Children were reliable in their choice of the descriptors that they applied to their breathing discomfort across two occasions, and they selected the same descriptors that were used by adults with asthma in previous studies. Children with greater self-reported asthma severity endorsed more descriptors to characterize breathing discomfort than did children with less severe asthma, but no differences were found among children based on demographic or anthropometric variables.

CONCLUSIONS

Children with moderate to severe persistent asthma are reliable in their choice of descriptors of breathlessness. Knowledge of their experience of symptoms may be helpful clinically in the assessment and management of asthma.

Stress and alcohol use among soldiers assessed at mobilization and demobilization

Excessive alcohol use may have negative consequences, including less force readiness among military personnel. The identification of variables associated with alcohol use may inform early intervention efforts to decrease negative consequences. This longitudinal prospective study examined the associations of demographic and stress variables with alcohol use among 876 soldiers that were mobilized and demobilized through an Army installation during a 9-month period in 2003. Participants reported a moderate level of general stress at mobilization and demobilization, and a minority reported significant combat stress. Alcohol use in the 2 weeks before the demobilization evaluation was associated with younger age, nonactive duty status before mobilization, and more general stress. Male gender was associated with more drinks per drinking day. The results suggest that younger, nonactive duty male personnel experiencing stress may be a group at risk for increased drinking after deployment and for whom intervention may be helpful.

Ethics instruction increases graduate students' responsible conduct of research knowledge but not moral reasoning

The purpose of this study was to assess the short-term effectiveness of ethics courses in enhancing responsible conduct of research (RCR) knowledge and moral judgment among graduate students in health-related disciplines. Forty-eight graduate students completed a questionnaire about research experience, knowledge and judgments about appropriate research practices, and a standardized test of moral judgment at the beginning and end of a semester-long ethics course. Knowledge about RCR but not moral judgment increased significantly in some areas. The results are discussed in terms of implications for RCR instruction and of future research designed to improve RCR instruction.

An investigation of victimization and the clinical course of chronic fatigue syndrome

Medically unexplained syndromes, including chronic fatigue syndrome (CFS), have been associated with victimization in childhood and adulthood. The purpose of this study was to examine the associations of victimization experiences in childhood and adulthood with functional status and illness severity in a sample of patients with CFS using longitudinal data. In the sample of 93 patients with CFS, childhood abuse and neglect had greater impact than adulthood victimization. Overall, victimization experiences in childhood demonstrated modest associations with clinical outcomes in CFS, although several victimization experiences were in the opposite direction of expectations. Victimization predicted worse outcomes, but not worsening outcomes over time.

Illness behaviors in patients with unexplained chronic fatigue are associated with significant other responses

Chronic fatigue syndrome (CFS) and unexplained chronic fatigue (CF) are characterized by compromised functional status and physical disability. Prior research on chronic pain has suggested that social factors may contribute to disability. This study examined the relationship between significant other responses and patient outcomes in patients with unexplained CF. Questionnaire data were collected from 117 patients on physical function, fatigue, pain, illness behaviors and responses of significant others to them, and depression. Ninety-four SOs reported their perceptions of patient illness behavior and their responses. Thirty-seven of these dyads also completed a series of household activities while being videotaped. Dyadic interactions were coded and analyzed. Both reported and observed solicitous responses by the significant other were associated with reported and observed patient illness behavior. Negative responses to patient illness behavior by significant others were associated with higher levels of patient depressive symptoms. The findings provide support for the role of operant behavioral factors in the context of chronic fatigue. They also suggest that further research on the relationship between dysfunction and significant other responses in patients with CFS or CF appears warranted and may have implications for treatment development.

Change in airflow among patients with asthma discussing relationship problems with their partners

This study examined the covariation of negative emotions with airflow among 48 persons with asthma and their partners as they discussed relationship problems. Measures included self-reported questionnaires, airflow and behavior coded from videotaped discussions. Significantly increased self-reported hostility and statistically but not clinically significant declines in airflow were found post- versus pre-discussion. Self-reported responses to asthma symptoms of more anger and less loneliness predicted lower post-discussion airflow after accounting for pre-discussion airflow. The use of effort-independent measures of airflow and autonomic nervous system monitoring may inform future research regarding the physiological mechanisms through which mood and behavior affect airflow.

The content of behavior therapy for depression demonstrates few associations with treatment outcome among low-income, medically ill older adults

We reported previously the results of a randomized controlled trial of a home-based behavioral treatment for dysthymia or minor depression that emphasized problem solving and activity scheduling among low-income, medically ill older adults. This report focuses on the content of treatment sessions as predictors of depressive symptoms, social activity, and physical activity outcomes among 64 participants who completed 2 or more sessions and evaluations at 6 and 12 months after the baseline evaluation. Worksheets from the treatment sessions were coded for focus on 4 types of problems (functional, social, health/physical, emotional); the number of activities planned was counted. More activity scheduling was associated with increased physical activity at the 12-month evaluation relative to baseline. The limited findings suggest either that the study methodology did not reveal extant associations between treatment variables and outcomes or that the session content variables tested in this study are not the active ingredients of treatment.

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression

This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior psychotherapy was also superior to medication withdrawal in the prevention of recurrence across the 2nd year of follow-up. Specific comparisons indicated that patients previously exposed to cognitive therapy were significantly less likely to relapse following treatment termination than patients withdrawn from medication, and patients previously exposed to behavioral activation did almost as well relative to patients withdrawn from medication, although the difference was not significantly different. Differences between behavioral activation and cognitive therapy were small in magnitude and not significantly different across the full 2-year follow-up, and each therapy was at least as efficacious as the continuation of medication. These findings suggest that behavioral activation may be nearly as enduring as cognitive therapy and that both psychotherapies are less expensive and longer lasting alternatives to medication in the treatment of depression.

Problem-solving treatment for depression among Mexican Americans in primary care

The need to identify and improve access to evidence-based treatments for depressive disorders and other mental health problems is a public health priority, particularly in relation to racial/ethnic minorities and other underserved groups. One hundred forty-six Mexican American primary care patients who met diagnostic criteria for major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified (NOS) were offered eight sessions of an evidence-based behavioral treatment, problem-solving treatment for primary care (PST-PC). Among participants who agreed to treatment (N=117), depressive symptom scores decreased over time; a minority of participants completed four or more sessions of PST-PC (N=55), and those participants had greater decreases in depressive symptom severity than participants who completed three or fewer PST-PC sessions (N=62) (Hopkins Symptom Checklist-20 scores declined on average 0.86+/-0.97 and 0.40+/-0.66 points for these groups, respectively, p<.05). More work is needed to enhance the engagement in treatments for depression, especially among Latinos in primary care.

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Predictors of Aversive Alcohol Consequences in a Military Sample

The purpose of this study was to identify predictors of risky alcohol use and alcohol-related consequences among postdeployment soldiers. Demobilizing soldiers completed an assessment packet that included questions about demographic factors, relationships, stress, and alcohol-related consequences. Significant predictors of greater alcohol-related consequences, as assessed with the CAGE questionnaire, included fewer years of formal education, male gender, not being in an intimate relationship, racial/ethnic minority status, enlisted rank, having been deployed to the continental United States, and greater stress, whereas significant predictors of drinking and driving included male gender, not being in an intimate relationship, and greater stress. Identifying the predictors of alcohol consequences that occur upon demobilization may aid in determining which soldiers are at risk for such consequences before deployment and may help to maintain military readiness.

Variables Associated with Intimate Partner Violence in a Deploying Military Sample

Variables associated with intimate partner violence (IPV) were examined within a sample of military personnel preparing to deploy. Soldiers with intimate relationships processed for mobilization through Fort Bliss, Texas, completed a questionnaire that queried demographic information, relationship satisfaction, stress, risky alcohol use behaviors, and tactics used during intimate relationship conflict. Four hundred forty-nine deploying soldiers (15.8% of 2,841 with usable data) reported IPV in the past year. Younger age, less education, less relationship satisfaction, more stress, and risky alcohol use behaviors were significant individual predictors of engaging in IPV. The results of this study are discussed in terms of their implications for targeting efforts to reduce IPV among military personnel.

Recent drinking consequences, motivation to change, and changes in alcohol consumption over a three month period

Little is known about what type of drinking related consequences may enhance motivation to change or may hinder behavior change over time. In order to examine this research question, 120 adult participants abusing alcohol were administered the Drinker Inventory of Consequences-Recent (DrInC-R), the Brief Readiness to Change Questionnaire (BRTC), and the Steady Pattern Chart (SP). Subscale scores from the DrInC-R and the BRTC; and alcohol consumption as assessed by the SP at baseline and three month follow-up were retained for data analyses. Greater intrapersonal DrInC-R consequences scores significantly predicted greater contemplation stage scores (R2=.37, p<.001), and lower precontemplation stage scores (R2=.32, p<.001), and DrInC-R impulse control and interpersonal consequences scores significantly predicted alcohol consumption at three month follow-up after controlling for baseline consumption (R2=.50, p<.001). Increased awareness of intrapersonal drinking related consequences may motivate change, whereas numbers of impulse control and interpersonal consequences may predict changes in drinking behavior over the short-term.

Understanding and resolving adherence problems

The expert panel report version 2 (EPR-2) is a comprehensive set of recommendations for the evaluation and treatment of asthma. However, physicians demonstrate scant adoption of many of the key evaluation and treatment components of the EPR-2, with primary care physicians being less likely to adopt EPR-2 recommendations than specialist physicians. Patients also demonstrate very limited adoption of physician recommendations, such as the use of medications as prescribed. Predictors of physician and patient nonadherence are reviewed, as modifiable predictors may be targets for interventions to enhance adherence. Finally, areas for future efforts are identified.

A longitudinal study of physical activity and body mass index among persons with unexplained chronic fatigue

OBJECTIVE AND METHODS

A cohort of 100 patients with unexplained chronic fatigue (CF) was assessed longitudinally for 1.5 years to determine if physical activity (kcal expended), exercise capacity (VO(2)max), perceived exertion, and body mass index (BMI) changed over time and were associated with changes in CF-related clinical status.

RESULTS

BMI increased significantly over time but did not predict changes in clinical status. Increasing energy expenditure was associated with increasing vitality and decreasing CF symptom severity over time, and decreasing perceived exertion was associated with increasing physical functioning. However, increasing perceived exertion was also associated with increasing CF symptoms.

CONCLUSIONS

These data do not support models that posit associations between CF and deconditioning.

Memory, executive cognitive function, and readiness to change drinking behavior

The transtheoretical model of Prochaska and DiClemente [Psychother. Theory Res. Prac. 19 (1982) 276] postulates that cognitive skills are critical for drinking behavior change. Memory and executive cognitive function likely influence the execution of skills that are implicated for both motivating and sustaining drinking behavior change. Participants who met criteria for alcohol abuse or dependence (N=117) were administered a battery of standardized memory and executive cognitive function tests that included the Wechsler Memory Scale-Revised (WMS-R), Controlled Oral Word Association Test (COWAT), Ruff Figural Fluency Test (RFFT), and Wisconsin Card Sort Test (WCST). Lower verbal and higher delayed recall memory score at baseline significantly predicted precontemplation, higher verbal memory scores predicted contemplation, and better attention-concentration at baseline significantly predicted reduced drinking at 3-month follow-up, after controlling for baseline alcohol consumption. The study findings indicate that explicit memory processes may have utility for predicting readiness to change drinking behavior.

Detection of Depression among Low-income Mexican Americans In Primary Care

Between one and two thirds of depressive disorders go undetected in primary care settings. Four hundred ninety-six Mexican American primary care patients from high-poverty areas were screened for depressive symptoms, and 41% endorsed depressive symptoms. Eighty percent of screened patients with depressive symptoms agreed to structured diagnostic interviews and 90% of those interviewed met diagnostic criteria for one or more depressive disorders. Cases of depression detected through this systematic process were compared with evidence of depression detected by providers in medical charts. Provider and study evaluation agreement was poor (kappa= 0.13); providers noted depression in 21% of patients with depressive disorders based on the systematic evaluation. More work is needed to enhance detection of depression in primary care, especially in minority populations.

Beliefs about drinking behavior predict drinking consequences

Cognitions about drinking, such as positive expectancies and self-efficacy, have been found to profoundly influence drinking behavior. Although the relationship of self-efficacy and positive expectancies with drinking consumption has been established, the relationship of self-efficacy and alcohol expectancies with the number of reported drinking related consequences has not been examined. One hundred thirteen participants who met criteria for alcohol abuse or dependence were administered the Situational Confidence Questionnaire, the Alcohol Expectancies Questionnaire, the Drinker Inventory of Consequences-Recent, and the Losses of Significance Self-report Questionnaire-Revised. As predicted, lower self-efficacy and greater positive alcohol expectancies predicted greater recent drinking consequences beyond those accounted for by alcohol consumption alone. Greater numbers of positive alcohol expectancies also predicted greater numbers of recent important alcohol related losses. Correcting errant assumptions about alcohol expectancies and strategies designed to increase self-efficacy may reduce harmful drinking consequences even if a client is unwilling to reduce consumption.

Prospective study of the prognosis of unexplained chronic fatigue in a clinic-based cohort

OBJECTIVES

To determine prospective changes in clinical status related to chronic fatigue over an 18-month period, and to test demographic and clinical predictors of outcome.

METHODS

A cohort of 100 patients with unexplained chronic fatigue (UCF), which encompasses both chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF), completed questionnaire measures and medical and psychiatric evaluations on four occasions, each six months apart.

RESULTS

Approximately 21% of the sample did not meet criteria for either CFS or ICF at their last research appointment 1.5 years after their index visit. Vitality increased over time, and physical functioning tended to improve, but UCF symptoms did not decrease significantly. Less education, being unemployed, worse mental health, more use of sedating and antidepressant medications, and more somatic attributions for their symptoms were associated with worsening symptom severity over time. Older age, current depression, and more somatic attributions predicted worsening physical functioning. Better mental health, less use of sedating medications, and fewer somatic attributions for illness were significant predictors of increases in vitality.

CONCLUSIONS

Demographic and clinical variables predict outcomes over time among a cohort of patients with unexplained chronic fatigue.

Predictors of change in binge drinking over a 3-month period

Self-efficacy and positive and negative alcohol expectancies have been associated with drinking reduction for some groups, but the relationship of these constructs with changes in high-risk binge drinking behavior among young adults over time is poorly understood. Seventy-six young adults between the ages of 18-32 were recruited to examine this question. Lower self-efficacy and greater positive alcohol expectancies predicted greater numbers of follow-up binge drinking episodes, and greater positive alcohol expectancies predicted greater follow-up alcohol consumption. Young adults with lower self-efficacy, and greater numbers of positive alcohol expectancies may be at risk for experiencing a worsening binge pattern over time.

Single-photon emission computerized tomography and neurocognitive function in patients with chronic fatigue syndrome

OBJECTIVE

The purposes of this study were to compare functional imaging under control and experimental conditions among patients with chronic fatigue syndrome (CFS) and healthy persons and to examine perceived and objective performance on a test of attention and working memory previously found to be difficult for persons with CFS.

METHODS

Single-photon emission computerized tomography scans were completed on 15 subjects with CFS and 15 healthy persons twice: at rest and when performing the Paced Auditory Serial Addition Test (PASAT).

RESULTS

No group differences were found for performance on the PASAT despite CFS subjects' perceptions of exerting more mental effort to perform the task than healthy subjects. Inspection of the aggregate scans by group and task suggested a pattern of diffuse regional cerebral blood flow among subjects with CFS in comparison with the more focal pattern of regional cerebral blood flow seen among healthy subjects. Between-group region-of-interest analysis revealed that although CFS subjects showed less perfusion in the anterior cingulate region, the change in CFS subjects' activation of the left anterior cingulate region during the PASAT was greater than that observed for healthy subjects. The differences were not attributable to lesser effort by the subjects with CFS, confounding effects of mood perturbation, or to poorer performance on the experimental task.

CONCLUSIONS

Further research regarding CFS subjects' diffuse cerebral perfusion and its relationship to inefficient neuropsychological performance is warranted.

Relationship satisfaction moderates the association between catastrophic cognitions and asthma symptoms

The tendency to have catastrophic beliefs and interpretations when anxious has been associated with less optimal disease management among persons with asthma. The goal of the present study was to examine the mediating effect of relationship satisfaction on the association between catastrophic cognitions and asthma symptom reporting in a sample of couples in which one partner has asthma. The participants were 50 patients with mild-to-moderate asthma and their partners. The results indicated that catastrophic cognitions were significantly associated with greater asthma symptoms related to rapid breathing, irritability, and panic/fear, after controlling for asthma severity. Among participants with high relationship satisfaction, catastrophic cognitions were significantly associated with panic/fear, irritability, anger, and loneliness. Among participants with low relationship satisfaction, catastrophic cognitions were significantly associated with dyspnea, congestion, and rapid breathing. These results are discussed in terms of potentially reflecting patients' perceptions of the fit between their coping needs and the support available in their intimate relationships.