Brief report: Development of the family perceptions scale; a novel instrument for evaluating subjective functioning in the families of adolescents

A pool of 75 items relating to family functioning was created and piloted in a sample of 12-18 year olds (N = 673). The responses were subjected to an exploratory factor analysis which indicated the presence of three significant latent traits. The results were then used to inform the development of a rating instrument with five subscales labelled Nurture, Problem Solving, Expressed Emotion, Behavioural Boundaries and Responsibility. These demonstrated high levels of internal consistency (Cronbach’s alphas .70-.81), high test-retest reliability (rho = .70-.82), varying degrees of intercorrelation (rho = .18-.75) and significant associations with family functioning as defined by the McMaster Family Assessment Device (p < 0.0001 in all cases). This novel instrument is a promising tool for use in both clinical practice and research.     

The impact of PTSD symptoms on physical and mental health functioning in returning veterans

This study aimed to determine the unique impact of PTSD symptoms, beyond other frequently examined factors on physical and mental health functioning in a sample of returning veterans. Assessments of 168 returning OEF/OIF veterans conducted an average of six months following return from deployment included measures of emotional disorders and the Short Form (36) Health Survey. Hierarchical multiple regressions revealed significant, unique contribution of Clinician-Administered PTSD Scale (CAPS) score above all other predictors in the model (demographics, severity of trauma exposure, physical injury, substance abuse and depressive symptoms), for both the physical (8%) and mental (6%) health aggregate scores, along with significant prediction of physical health (4–10%) and mental health (3–7%) subscale scores. The only other significant predictors were age for physical health scores, and depressive symptoms for mental health scores. PTSD criterion B (re-experiencing) symptoms uniquely predicted reduced physical health functioning and higher experience of bodily pain, while criterion D (hyperarousal) symptoms uniquely predicted lower feelings of energy/vitality and poorer perceptions of emotional health.     

Prevalence of sleep disorders by sex and ethnicity among older adolescents and emerging adults: Relations to daytime functioning,working memory and mental health

The study determined the prevalence of sleep disorders by ethnicity and sex, and related daytime functioning, working memory, and mental health among older adolescent to emerging adult college students. Participants were U.S.A. undergraduates (N = 1684), aged 17–25, recruited from 2010 to 2011. Participants completed online questionnaires for all variables. Overall, 36.0% of the sample screened positive for sleep disorders with insomnia, restless legs syndrome, and periodic limb movement disorder being the most prevalent. Women reported more insomnia and daytime impairment. African–Americans reported more early morning awakenings and less daytime impairment. Students with insomnia symptoms or restless legs syndrome tended to have lower working memory capacities. Students with nightmares or parasomnias had greater odds for mental disorders. In an older adolescent to emerging adult college student sample, sleep disorders may be a common source of sleep disturbance and impairment. Certain sleep disorders may be associated with lower working memory capacity and poor mental health.     

Exploring the differential associations between components of executive functioning and reactive and proactive aggression

Objective: A large body of literature confirms the importance of executive functioning (EF) in the explanation of aggressive and antisocial behaviors. However, the common and specific associations between subtypes of aggression, such as reactive (RA), proactive aggression (PA), and EF are unclear. The current study explored the nuanced associations between components of EF and subtypes of aggression, using a latent variable approach. Method: Participants were 384 racially diverse undergraduate students (ages 18–52 years) who completed a self-report measure of RA and PA, and traditional neuropsychological tasks of EF. The appropriateness of using a nested bifactor model of EF was confirmed, and this bifactor model of EF was then used to examine the specific associations between components of EF and RA and PA. Results: Results revealed that components of EF are differentially associated with RA and PA. Specifically, impulsive, provoked aggression (i.e., RA) was associated with lower levels of goal-oriented inhibition and higher levels of flexibility, whereas planned, goal-oriented aggression (i.e., PA) was associated with higher levels of working memory. Conclusions: Findings from the current study underscore the importance of considering the multidimensional nature of EF, as well as the heterogeneity within aggression, rather than considering either construct as a single monolithic construct. The current study suggests that potentially unique brain-based pathways from aspects of EF to subtypes of aggression may exist, and points toward potential avenues through which to intervene.     

Mental-health disparities between heterosexual and sexual-minority adolescents: Examining the role of informant discrepancies

IntroductionAn emerging literature documents substantial mental-health disparities by sexual orientation amongst adolescents, with sexual-minority youth exhibiting poorer mental health than heterosexual youth. This brief report provides the first empirical account of how the association between sexual-minority status and adolescent mental health differs depending on who assesses adolescents' mental health (child/mother/father/teacher), and how informant discrepancies in assessments of adolescent mental health differ by adolescents’ sexual orientation.MethodsData come from an Australian national sample of 14-/15-year-old adolescents (Longitudinal Study of Australian Children; n~3,000). Adolescent mental health is measured using multiple measures from the Strengths and Difficulties Questionnaire, and modelled using multivariable linear regression models.ResultsMental-health disparities between sexual-minority and heterosexual adolescents emerged irrespective of who assessed the child's mental health. However, their magnitude varied substantially by informant, being largest when mental-health was reported by adolescents (~0.7 standard deviations) and smallest when reported by teachers (~0.2 standard deviations). Discrepancies between mental-health scores collected from the child and other informants were largest for internalising than externalising behaviours, and in child-father than child-mother comparisons.ConclusionsUnderstanding informant discrepancies and their meaning is pivotal to designing surveys that generate robust insights into the health of sexual-minority adolescents, as well as appropriate policy interventions.     

Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results

OBJECTIVES: Elevated homocysteine (Hcy) levels have been demonstrated to have a negative impact on cognitive functioning in healthy elderly people. Further studies suggest that they are an independent risk factor for dementia, in particular for Alzheimer's disease. Bipolar disorder is also associated with cognitive impairment. However, the pathophysiological mechanisms of these deficits have not been elucidated yet. This study examines the role of Hcy on cognition and its impact on psychosocial functioning in euthymic bipolar patients. METHODS: A total of 55 euthymic bipolar patients and 17 healthy controls were enrolled in the study. Neuropsychological assessments consisted of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Trail Making Test (TMT), the Weschler Adult Intelligence Scale, 3(rd) edition (WAIS-III) subtest Letter-Number Sequencing Test (LNST) and the HAWIE-R (German version of the WAIS-R) subtest Information. Psychosocial functioning was assessed using the Social Adjustment Scale (SAS). To obtain plasma levels of Hcy, blood samples were collected in EDTA tubes, immediately put on ice, centrifuged within 15 min and stored at -80 degrees C. Total Hcy concentration was measured using high-performance liquid chromatography. RESULTS: In the neuropsychological tests, patients differed significantly from healthy controls on the TMT B and the RBANS composite indices Language, Attention and Total Score. No differences were found on the HAWIE-R subtest Information, the TMT A, LNST or the RBANS composite indices Immediate Memory, Visuospatial/Constructional Abilities and Delayed Memory. Mean Hcy levels were 9.8 +/- 3.2 microm/L in the patient group and 7.8 +/- 2.1 microm/L in the control group, respectively (p = 0.012). In the patient group Hcy levels significantly correlated with gender, diagnosis and RBANS index scores for Immediate Memory, Language, Attention and Total Score. Linear regression analyses revealed a significant and independent association of Hcy levels with Immediate Memory and TMT B scores in the patient group. Homocysteine levels did not correlate with any measure in the control group. Spearman's correlations indicated that psychosocial functioning in bipolar patients is not associated with clinical variables apart from time in remission. However, it correlated significantly with working memory measures (LNST). No relationship could be determined between psychosocial functioning and Hcy plasma levels. CONCLUSIONS: Elevated Hcy levels seem to be associated with cognitive impairment in euthymic bipolar patients, but not with psychosocial functioning. More studies are needed to clarify the role of Hcy in cognition in bipolar disorder.     

The interactive effect of social pain and executive functioning on aggression: an fMRI experiment

Social rejection often increases aggression, but the neural mechanisms underlying this effect remain unclear. This experiment tested whether neural activity in the dorsal anterior cingulate cortex (dACC) and anterior insula in response to social rejection predicted greater subsequent aggression. Additionally, it tested whether executive functioning moderated this relationship. Participants completed a behavioral measure of executive functioning, experienced social rejection while undergoing functional magnetic resonance imaging and then completed a task in which they could aggress against a person who rejected them using noise blasts . We found that dACC activation and executive functioning interacted to predict aggression. Specifically, participants with low executive functioning showed a positive association between dACC activation and aggression, whereas individuals with high executive functioning showed a negative association. Similar results were found for the left anterior insula. These findings suggest that social pain can increase or decrease aggression, depending on an individual’s regulatory capability.     

The long-term impact of combat exposure on health,interpersonal, and economic domains of functioning

Purpose: Wartime combat exposure is linked to a broad array of negative outcomes. The current study identified potential differences between middle-to-older aged men exposed to combat and those not exposed for physical health, interpersonal, and economic functioning over 10 years. Post-traumatic stress disorder (PTSD) and social support were examined as moderators between combat exposure and outcomes.

Methods: Data from the National Comorbidity Survey, baseline and 10-year follow-up, were utilized. Only men aged 50–65 at follow-up (N = 727) were included. Group differences between combat and non-combat men were examined. Regression analyses were performed to examine relationships between earlier combat and health, interpersonal, and economic outcomes over time, while controlling for important covariates.

Results: Combat-exposed men were at increased risk for asthma, arthritis/rheumatism, lung diseases, headaches, and pain; they also had greater marital instability. However, combat-exposed men reported economic advantages, including higher personal earnings at follow-up. For combat-exposed men, PTSD did not increase risk for headaches; however, PTSD in non-combat men was associated with increased risk for headaches at follow-up. Whereas combat-exposed men with higher levels of social support were less likely to report chronic pain at follow-up, there were no group differences in pain at lower levels of social support.

Implications: Individuals who experience combat may be susceptible to later health and marital problems; however, as combat-exposed men age, they demonstrate some resilience, including in economic domains of life. Given that consequences of combat may manifest years after initial exposure, knowledge of combat exposure is necessary to inform treatments and the delivery of disability benefits.     

Psychological impact of verbal abuse and violence by patients on nurses working in psychiatric departments

The aim of this study was to assess the psychological impact of verbal abuse or violence by patients on nurses working in psychiatry departments and to identify factors related to their impact. Survey sheets were distributed to a total of 266 nurses working at two hospitals, and replies were obtained from 232 of them. Because three of them had less than 1 month of experience working in the psychiatry department and four of them failed to answer all the questions, valid replies were obtained from 225 nurses. Among the 225 whose replies were valid, 141 nurses who replied that they had experienced verbal abuse or violence that left an impression on them remained as the subjects of the final analysis. The Impact of Event Scale-Revised (IES-R) was used to evaluate psychological impact. Of the nurses who had been exposed to verbal abuse or violence that left an impression, 21% had scores that exceeded the IES-R cut-off point (24/25), and low satisfaction with family support, and neuroticism on the Eysenck Personality Questionnaire-Revised were shown to have contributed to the psychological impact. Nurses working in psychiatry departments were shown to experience a severe psychological impact when exposed to verbal abuse or violence. These results suggest the need for mental care approaches for nurses working in psychiatry departments.     

The antecedents of violence and aggression within psychiatric in-patient settings

Papadopoulos C, Ross J, Stewart D, Dack C, James K, Bowers L. The antecedents of violence and aggression within psychiatric in‐patient settings. Objective: To systematically review the types and proportions of antecedents of violence and aggression within psychiatric in‐patient settings. Method: Empirical articles and reports with primary data pertaining to violence and aggression within adult psychiatric in‐patient settings were retrieved. For each study, prospective antecedent data were extracted. The extracted antecedent data were thematically analysed, and all higher‐level themes were meta‐analysed using rate data. Results: Seventy‐one studies met the inclusion criteria, from which 59 distinct antecedent themes were identified and organised into nine higher‐level themes. The higher‐level antecedent theme ‘staff–patient interaction’ was the most frequent type of antecedent overall, precipitating an estimated 39% of all violent/aggressive incidents. An examination of the staff–patient interaction themes revealed that limiting patients freedoms, by either placing some sort of restriction or denying a patient request, was the most frequent precursor of incidents, accounting for an estimated 25% of all antecedents. The higher‐level themes ‘patient behavioural cues’ and ‘no clear cause’ also produced other large estimates and were attributed to 38% and 33% of incidents overall. Conclusion: This review underscores the influence that staff have in making in‐patient psychiatric wards safe and efficacious environments.     

The relationship of gambling to intimate partner violence and child maltreatment in a nationally representative sample

It has been suggested that family violence is associated with gambling problems. However, to date, this relationship has not been thoroughly investigated using representative data. The purpose of the current study was to analyze the relationship between gambling problems and the perpetration and victimization of intimate partner violence (including dating and marital violence) and child maltreatment (including minor child assault and severe child abuse) using nationally representative data. Data were drawn from the US National Comorbidity Survey Replication (n = 3334; 18 years and older). Multiple logistic and multinomial logistic regression models were used to examine the relationships between gambling and the perpetration and victimization of dating violence, marital violence, and child maltreatment. The results indicated that problem gambling was associated with increased odds of the perpetration of dating violence (Adjusted Odds Ratios (AORs) ranged from 2.2 to 4.2), while pathological gambling was associated with increased odds of the perpetration of dating violence (AORs ranged from 5.7 to 11.9), severe marital violence (AOR = 20.4), and severe child abuse (AOR = 13.2). Additionally, dating violence, marital violence, and severe child abuse victimization were associated with increased odds of gambling problems. The results were attenuated when adjusted for lifetime mental disorders. These findings can be used as evidence-based research to inform healthy public gambling polices and inform prevention and intervention efforts.     

Impact of ADHD on the neurocognitive functioning of adolescents with bipolar disorder.

BACKGROUND: Pediatric Bipolar Disorder (BD) has been associated with a number of neurocognitive deficits not dissimilar to ADHD. This study compared neuropsychological profiles of 4 groups of adolescents (14-17 years): 41 Normal Controls (NC), 30 ADHD, 12 BD and 12 combined (BD+ADHD). METHODS: Participants were identified according to a standardized protocol (WASHU-KSADS mood section, K-SADS-PL and Conners Scales) and completed tests of processing speed, memory, executive functioning, set shifting, and inhibition. ADHD adolescents on stimulant medication did not take it on the day. RESULTS: After controlling for covariates, the ADHD-only and combined groups were most impaired, including processing and naming speed, working memory, and response inhibition. The ADHD-only group showed specific impairment in naming objects, numbers and letters than the NC and showed greater deficits than the BD-only group on tests of naming speed. The combined group showed greatest deficits in verbal memory and inhibitory control. Other than working memory, there were no differences between the BD-only and NC groups. Removal of BD-NOS did not impact on the results. CONCLUSIONS: This study failed to find broad neurocognitive deficits in BD-only adolescents. Only those with comorbid ADHD showed cognitive deficits, highlighting the impact ADHD may have on neurocognitive functioning of BD.     

Non-right-handedness and mental health problems among adolescents from the general population: The Trails Study

To determine whether the association between non-right-handedness and mental problems among adolescents is specific for psychotic symptoms, we included a group of 2096 adolescents with a mean age of 14 years from the general population. Mental health problems were assessed using the parent, self-report, and teacher versions of the Child Behavior Checklist. Internalising problems comprised anxious and depressed, withdrawn and depressed, and somatic complaints. Externalising problems consisted of delinquent behaviour and aggressive behaviour. The remaining problems consisted of social problems, attention problems, and thought problems. The latter were divided into psychotic and non-psychotic items. A total of 14.3% of the adolescents were non-right-handed. We observed positive associations of non-right-handedness with thought problems, social problems, and being withdrawn and depressed. Externalising problems showed no associations with handedness. Within the thought problems subscale, the effect sizes associated with non-right-handedness for psychotic and non-psychotic items were 0.18 (p=.005) and 0.04 (p=.459), respectively. In conclusion, non-right-handedness is predominantly associated with psychosis-related mental problems as early as in adolescence. Handedness could be taken into account when identifying adolescents at risk for psychosis.