Predictors of Participation in Community Outpatient Psychosocial Rehabilitation in Schizophrenia

This study investigated demographic, clinical and neurocognitive factors predicting drop-out from an intensive, community outpatient psychosocial rehabilitation program for people with schizophrenia or schizoaffective disorder. One-hundred and twenty-seven outpatients with DSM-IV schizophrenia or schizoaffective disorder participated. Demographic variables of age, sex, education and race/ethnicity were recorded and formal symptom measures and a neurocognitive assessment consisting of measures of crystallized verbal ability, sustained visual vigilance, verbal learning, verbal fluency and problem-solving were administered at study entry. Thirty-seven percent of the sample dropped-out of the program. In a final multivariate model, younger age, and lower verbal fluency scores in clients with a history of a high number of hospitalizations predicted a greater likelihood of drop-out. The implications of these findings are discussed.     

Predictors of Barriers to Treatment and Therapeutic Change in Outpatient Therapy for Antisocial Children and Their Families

This study examined the role of parent psychopathology and quality of life in predicting barriers to participation in outpatient treatment and therapeutic change among clinically referred children. Children (N = 169) referred for oppositional, aggressive, and antisocial behavior and their families participated. The major findings were that (1) higher levels of parent psychopathology and lower levels of quality of life predicted the subsequent emergence of perceived barriers to treatment in the parents and therapeutic changes among the children, (2) these effects were not explained by socioeconomic disadvantage or severity of child dysfunction, (3) perceived barriers and therapeutic changes were related and this relation was not explained by other family and child predictors, (4) as the level of perceived barriers increased among families, the amount of therapeutic change and the proportion of children who made a marked change decreased, and (5) parent perception of the relevance and demandingness of treatment were salient dimensions contributing to the relation between perceived barriers and therapeutic change. The conceptual and applied implications of relating barriers to treatment and therapeutic change are discussed.     

Comparing Psychosocial Predictors of Physical Activity Adoption and Maintenance

Background   Most health behavior models do not distinguish between determinants of behavior adoption and maintenance. Purpose   This study compared psychosocial predictors of physical activity (PA) adoption and predictors of PA maintenance among 205 initially sedentary adults enrolled in a home-based PA promotion trial. Methods   Psychosocial variables were measured at 6 months (at which point 107 participants remained inactive and 98 participants adopted regular PA) and used to predict 12-month PA status (an indicator of PA adoption among those inactive at 6 months and an indicator of PA maintenance among those active at 6 months). Results   Six-month PA status moderated the relationships between 6-month measures of home access to PA equipment (p = .049), self-efficacy (p = .086), and perceived satisfaction (p = .062) and 12-month PA status. Simple effects analyses revealed that home access to PA equipment was predictive of PA adoption (OR = 1.73; 95% CI: 1.05, 2.85), but not PA maintenance (OR = 0.88; 95% CI: 0.58, 1.35), whereas self-efficacy and perceived satisfaction were predictive of PA maintenance (OR = 2.65; 95% CI: 1.55, 4.52; OR = 1.95; 95% CI: 0.93, 4.06), but not PA adoption (OR = 1.50; 95% CI: 0.87, 2.57; OR = 0.82, CI: 0.44, 1.52). Conclusion   Results suggest that these psychosocial variables may operate differently in predicting PA adoption versus maintenance.     

Predictors of Treatment Attrition Among an Outpatient Clinic Sample of Youths With Clinically Significant Anxiety

Predictors of treatment attrition were examined in a sample of 197 youths (ages 5–18) with clinically-significant symptoms of anxiety seeking psychotherapy services at a community-based outpatient mental health clinic (OMHC). Two related definitions of attrition were considered: (a) clinician-rated dropout (CR), and (b) CR dropout qualified by phase of treatment (pre, early, or late phases) (PT). Across both definitions, rates of attrition in the OMHC sample were higher than those for anxious youths treated in randomized controlled trials, and comorbid depression symptoms predicted dropout, with a higher rate of depressed youths dropping out later in treatment (after 6 sessions). Using the PT definition, minority status also predicted attrition, with more African-American youths lost pre-treatment. Other demographic (age, gender, single parent status) and clinical (externalizing symptoms, anxiety severity) characteristics were not significantly associated with attrition using either definition. Implications for services for anxious youths in public service settings are discussed. Results highlight the important role of comorbid depression in the treatment of anxious youth and the potential value of targeted retention efforts for ethnic minority families early in the treatment process.     

Psychiatric Diagnoses and Psychosocial Needs of Outpatient Deaf Children and Adolescents

Deaf youth may be more vulnerable to psychiatric disorders but very little research data is available. The current study identified prevalence rates of psychiatric disorders and examined the psychosocial needs and strengths of deaf youth aged 4–17 receiving specialized outpatient mental health services for the deaf. Compared to hearing peers, deaf youth had greater rates of attention deficit hyperactivity disorder, conduct, autism-spectrum and bipolar disorders and spent three times longer in treatment than their hearing peers. In the deaf subsample, moderate-severe risk was found in social functioning (33.3 %) and suicidal behavior (14 %). Deaf youth had moderate to severe impairment in social relationships (54.8 %), school functioning (42.9 %). Over one-third of deaf youth had impaired family relationships, living situation, communication, judgment and physical health. Deaf youth present with higher rates of certain clinical disorders and have deficits in multiple life domains that may impact functioning and create a longer treatment course.     

Cognitive and Psychosocial Predictors of Subjective Well-Being in Urban Older Adults

Prior research indicates that physical health and social support have substantial influences on subjective well-being among older adults. However, little research has examined the influences of coping style and cognitive functioning on subjective well-being among older adults. This study investigated cognitive and psychosocial predictors of subjective well-being among 129 adults, ages 65-89 years. Canonical correlation indicated that subjective well-being was characterized by two dimensions: life satisfaction and affective balance (happiness). The use of emotion-focused coping strategies and poor perceived health were associated with diminished perceptions of life satisfaction, whereas task-oriented and avoidance-oriented coping were positively related to happiness. Cognitive functioning was positively related to life satisfaction and pleasant emotions independent of education and income.     

Verbal Abilities as Predictors of Retention Among Adolescents in a Therapeutic Community

The relationship between verbal skills and retention among adolescents in substance abuse treatment is understudied. In order to assess verbal predictors of retention, twenty-eight 16–19 year old adolescents in a therapeutic community for substance abuse were evaluated between 30 and 90 days after admission. These adolescents were then followed prospectively for 1 year. Verbal and non-verbal cognitive screens, audio taped narrative responses, and self-reports of socio-emotional function and psychiatric symptoms were completed. Verbal scores were associated with self-restraint and counselor reports of therapeutic engagement and comprehension. General verbal scores predicted attrition, while therapeutic expressiveness (verbal expressiveness in a therapeutic context) predicted retention. Remediation of verbal communication skills may be an overlooked aspect of the therapeutic process in treating adolescent substance abusers.     

Counselor Incentives to Improve Client Retention in an Outpatient Substance Abuse Aftercare Program

Pay for performance, the provision of financial incentives for favorable performance, is increasingly under study as an evidence-based practice. This study estimated the improvement in client retention from offering incentives to 11 substance abuse counselors providing outpatient aftercare treatment. During the incentive period, a counselor could earn a bonus of $100, in addition to his regular compensation, for each client who completed at least five aftercare sessions (the “milestone” which we considered the minimum adequate dose of the aftercare curriculum). We evaluated this and a similar, 12-session incentive using a logistic regression in which the retention “milestone” was the dependent variable and the proportion of time in the incentive condition was the independent variable. Among the 123 clients offered this aftercare program, their probability of completing at least 5 sessions was 59% with the incentive compared to 33% beforehand (odds ratio 4.1, P<.01). These findings suggest that counselor incentives are an effective strategy to improve client retention in substance abuse treatment.The authors acknowledge ongoing support of the Massachusetts Department of Public Health Bureau of Substance Abuse Services financial assistance from grant R01 DA08739 from the National Institute on Drug Abuse.     

Predictors of Client Satisfaction with Outpatient Mental Health Clinic Services in Italy and New York

The aim of this cross-sectional study was to assess factors associated with client satisfaction in two mental health outpatient settings in Italy and the US. Sociodemographic and clinical variables, hope, and personality characteristics were evaluated in 18–65-year-old patients who had been receiving services for at least 2 months in one of two outpatient clinics, in Italy and the US. Patients were administered: the Healthy Days Core Module, the Kessler Screening Scale for Psychological Distress, the Verona Service Satisfaction Survey, the Client Satisfaction Inventory, the Health Service OutPatient Experience questionnaire, the Herth Hope Index, and the NEO Five-Factor Inventory-3. Bivariate tests for differences between the two samples were conducted, a Satisfaction Composite z-score was computed, and a stepwise, backward elimination, multiple linear regression model—including the variables that were significantly associated with Satisfaction Composite Score in bivariate tests—was built. From July 1, 2015 to April 30, 2016, 184 patients (121 in Foligno, 63 in New York City) were enrolled in the study. Predictors of client satisfaction included: receiving services in New York City, being older, having lower educational attainment, having inner positive readiness and expectancy as well as interconnectedness with self and others, and high scores on the agreeableness personality domain. Interestingly, diagnosis and treatment characteristics did not influence satisfaction. Client satisfaction with outpatient mental health services is mainly influenced by sociodemographic characteristics and personality factors more than clinical variables or patterns of care. These findings could have implications regarding trends toward value-based payment models.     

The Efficacy of Involuntary Outpatient Treatment in Massachusetts

One means to address some of the unintended consequences of the shift of treatment for individuals with serious mental illness from hospitals to communities has been involuntary outpatient treatment (IOT). Using Massachusetts data, 19 patients with court orders for IOT were matched to all and to best fits on demographic and clinical variables, and then to individuals with the closest fit on utilization before the IOT date. Outcomes indicated the IOT group had significantly fewer admissions and hospital days after the court order. The full impact of IOT requires more study, particularly directed toward IOT's effects on insight and quality of life.     

Medicaid and African American Outpatient Mental Health Treatment

The present study tested the hypothesis that Medicaid-financed African Americans would be more likely to receive outpatient mental health treatment than African Americans whose treatment was financed by private insurance. The hypothesis was confirmed: when compared with privately insured persons eligible for care under either fee-for-service or managed care, the Black–White gap in outpatient service use was significantly smaller under Medicaid. There was no racial difference in outpatient treatment rates among the uninsured. The often-noted difference between Blacks and Whites in the likelihood of receiving outpatient mental health treatment is confined largely to the privately insured.     

Mortality in Schizophrenia: Clinical and Serological Predictors

Persons with schizophrenia have a reduced life expectancy largely due to death from natural causes. Factors that have been previously associated with excess mortality include cigarette smoking and antipsychotic medication. The role of other environmental factors such as exposure to infectious agents has been the subject of only limited investigation. We prospectively assessed a cohort of persons with schizophrenia with a clinical evaluation and a blood sample from which antibodies to human herpes viruses and Toxoplasma gondii were measured. Mortality was determined with data from the National Death Index following a period of up to 11 years. We examined the role of demographic, serological, and clinical factors on mortality. A total of 25 (5%) of 517 persons died of natural causes. The standardized mortality ratio was 2.80 (95% CI 0.89, 6.38). After adjusting for age and gender, mortality from natural causes was predicted in separate models by cigarette smoking (relative risk [RR] = 4.66, P = .0029); lower cognitive score (RR = 0.96, P = .013); level of antibodies to Epstein–Barr virus (RR = 1.22, P = .0041) and to Herpes Simplex virus type 1 (RR = 1.19, P = .030); immunologic disease (RR = 3.14, P = .044); and genitourinary disease (RR = 2.70; P = .035). Because cigarette smoking confers an almost 5-fold risk of mortality, smoking cessation is an urgent priority. Having an elevated level of antibodies to Epstein–Barr virus and to Herpes Simplex virus type 1 are also significant predictors of death from natural causes.Key words: premature death, cigarette smoking, Epstein–Barr virus     

Clinical Features and Predictors of Postictal Excitement

In a retrospective case control study, clinical features of postictal excitement following electroconvulsive therapy (ECT) were examined in 24 patients and 24 matched controls. The two groups did not differ in clinical outcome, degree of pretreatment agitation, anesthetic or succinylcholine dose, number of ECTs received, mean seizure duration, number of titrated treatments with subconvulsive stimulation, or type of EEG ending. Patients who became excited early in the treatment course rarely manifested this phenomenon at all subsequent treatments. Within the "excited" group, a minority of patients became excited following the first ECT, and only 34.3% of their treatments resulted in postictal excitement. It may not be necessary to routinely use postseizure benzodiazepines in patients who have once exhibited a postictal excitement.