Using Geospatial Research Methods to Examine Resource Accessibility and Availability as it Relates to Community Participation of Individuals with Serious Mental Illnesses

Greater community participation among individuals with serious mental illnesses is associated with better psychosocial and health outcomes. Typically, studies examining community participation have utilized self‐report measures and been conducted in limited settings. The introduction of methodological advances to examining community participation of individuals with serious mental illnesses has the potential to advance the science of community mental health research and invigorate the work of community psychologists in this area. This study employed an innovative geospatial approach to examine the relationship between community participation and resource accessibility (i.e., proximity) and availability (i.e., concentration) among 294 individuals utilizing community mental health services throughout the United States. Findings suggest small but significant associations between community participation and the accessibility and availability of resources needed for participation. Furthermore, findings demonstrate the importance of car access for individuals residing in both urban and non‐urban settings. The methods and results presented in this study have implications for community mental health research and services and provide an illustration of ways that geospatial methodologies can be used to investigate environmental factors that impact community inclusion and participation of individuals with serious mental illnesses.     

Mental Health Research in Correctional Settings: Perceptions of Risk and Vulnerabilities

With more than half of individuals incarcerated having serious mental health concerns, correctional settings offer excellent opportunities for epidemiological, prevention, and intervention research. However, due to unique ethical and structural challenges, these settings create risks and vulnerabilities for participants not typically encountered in research populations. We surveyed 1,224 researchers, Institutional Review Board (IRB) members, and IRB prisoner representatives to assess their perceptions of risks and vulnerabilities associated with mental health research conducted in correctional settings. Highest ranked risks were related to privacy, stigma, and confidentiality; lowest ranked risks were related to prisoners’ loss of privileges or becoming targets of violence due to having participated in research. Cognitive impairment, mental illness, lack of autonomy, and limited access to services emerged as the greatest sources of vulnerability; being male, being female, being older than age 60, being a minority, and being pregnant were the lowest ranked sources of vulnerability. Researchers with corrections experience perceived lower risks and vulnerabilities than all other groups, raising the question whether these researchers accurately appraise risk and vulnerability based on experience, or if their lower risk and vulnerability perceptions reflect potential bias due to their vested interests. By identifying areas of particular risk and vulnerability, this study provides important information for researchers and research reviewers alike.     

Genetics in eating disorders: state of the science

Eating disorders have been viewed as psychiatric illnesses that are strongly influenced by societal pressures towards thinness and attractiveness. Although the environmental context of these disorders must not be neglected, recent research in the area of genetic epidemiology suggests a substantial influence of genetic factors on liability to eating disorders. This review presents a synthesis of current knowledge about genetic factors implicated in the etiology of eating disorders.     

Do Negative Cognitive Styles Confer Vulnerability to Depression?

According to the cognitive-vulnerability hypothesis of depression, negative cognitive styles confer vulnerability to depression when people confront negative life events. In this article, we present evidence that negative cognitive styles do indeed confer vulnerability to clinically significant depressive disorders and suicidality and discuss possible developmental antecedents of cognitive vulnerability to depression. We consider the issue of stability versus change in cognitive vulnerability to depression and discuss the broader implications of the cognitive-vulnerability findings for mental and physical health.     

Infectious and immune factors in the pathogenesis of neurodevelopmental disorders: epidemiology, hypotheses, and animal models

Both genetic and environmental factors contribute to the pathogenesis of a wide variety of neurodevelopmental disorders, including autism, mental retardation, and schizophrenia. Some heritable disorders approach 100% penetrance; nonetheless, even in these disorders, subtle aspects of clinical disease expression may be influenced by the environment. In other disorders with genetic influences, exogenous factors, and the timepoint(s) during nervous system development at which they are introduced, modulate expression of disease. Elucidation of the mechanisms guiding this intricate interplay between host response genes, environmental agents, and the neurodevelopmental context within which these interactions occur, is necessary to understand the continuum of clinical outcomes. This chapter will review the evidence that infectious and immune factors may contribute to the pathogenesis of neurodevelopmental disorders, describe an animal model of neurodevelopmental disorders based upon viral infection, identify processes by which neural circuitry may be compromised, and outline areas for future research.     

Psychosocial Impact of Predictive Testing for Illness on Children and Families: Challenges for a New Millennium

Predictive testing for adult- and child-onset diseases is becoming widely available. The identification of individuals prone to develop certain illnesses is often medically advantageous in that it may afford opportunities to engage in risk reduction behaviors to detect or delay disease onset. However, sometimes the knowledge gained from these tests can be ambiguous, generate distress, and potentially affect several generations of family members. Overall, these factors create a challenging set of circumstances for persons considering genetic and other forms of predictive testing, particularly parents and children. In this article, we (1) address conceptual issues involved in determining the impact of predictive testing on child and family well-being, (2) review empirical data on this topic, and (3) provide a case example to illustrate these findings. Recommendations are made for additional psychological research on child- and family-focused outcomes associated with participation in testing, highlighting their clinical implications.     

Complex Genetic Disorders: Evaluating When Genetic Research Findings Are Applicable for Genetic Counseling Practice

Traditional genetic counseling processes and principles will be extended to a new realm—complex disorders. Although it may seem like a daunting task, understanding the methodologies used to study complex genetic disorders will enable genetic counselors to critically analyze research studies involving complex disorders. In this article, we explain newly evolving methodologies for genetic research, including case-control studies and transmission disequilibrium testing (TDT). Additionally, a framework is provided for evaluating original research findings and replication studies.     

The impact of emotional stress early in life on adult voluntary ethanol intake-results of maternal separation in rats

The combination of genetic and environmental factors determines the individual vulnerability for excessive ethanol intake, possibly leading to dependence. The environmental influences early in life represent examples of determinant factors for adult behaviour and can be protective as well as risk factors. Maternal separation is one model to examine the long-term consequences of early environmental experiences on neurochemistry and behaviour, including drug-taking behaviour in experimental animals. In the present review, findings from studies using repeated short and prolonged periods of maternal separation, with emphasis on effects on voluntary ethanol intake in rats with or without a genetic predisposition for high voluntary ethanol intake, are summarized. Despite some contradictory results, the general picture emerging shows that short periods of maternal separation during the postnatal period result in a lower adult voluntary ethanol intake in male rats. Prolonged periods of maternal separation were found to induce a high voluntary ethanol intake in male rats, including rats with a genetic predisposition for high ethanol intake. Results from the literature also show that changes were not just related to time of separation but were also related to the degree of handling. Interestingly, in terms of voluntary ethanol intake, female rats were generally not affected by postnatal maternal separation. The reasons for these sex differences need further investigation. In terms of neurobiological consequences of maternal separation, conclusive data are sparse and one of the future challenges will, therefore, be to identify and characterize underlying neurobiological mechanisms, especially in the individual animal.     

Examining the State-Trait Anxiety Relationship: A Behavioural Genetic Approach

State and trait anxiety define different aspects of anxiety, and may represent environmentally and genetically mediated components of this phenotype. Furthermore their relationship, where trait anxiety is expressed through levels of state anxiety under threatening circumstances, may represent a process of interplay between a genetic vulnerability factor and an environmental stressor. To test these hypotheses, we explored genetic and environmental influences on measures of state and trait anxiety in a sample of 1058 twins (521 males and 537 females) aged 8–16. The results were consistent with these hypotheses. State anxiety is largely influenced by environmental factors in males and females whereas trait anxiety shows moderate genetic effects and substantial non-shared environment effects. Their association was accounted for by non-shared environmental effects, with modest genetic and shared environmental inputs. The implications of these results for vulnerability mechanisms involving stress reactivity on anxiety are discussed.     

Vulnerable Populations in Research: The Case of the Seriously Ill

This paper advances a new criterion of a vulnerable population in research. According to this criterion, there are consent-based and fairness-based reasons for calling a group vulnerable. The criterion is then applied to the case of people with serious illnesses. It is argued that people with serious illnesses meet this criterion for reasons related to consent. Seriously ill people have a susceptibility to “enticing offers” that hold out the prospect of removing or alleviating illness, and this susceptibility reduces their ability to safeguard their own interests. This explains the inclusion of people with serious illnesses in the Belmont Report’s list of populations needing special protections, and supports the claim that vulnerability is the rule, rather than the exception, in biomedical research.     

Effects of a Documentary Film on Public Stigma Related to Mental Illness Among Genetic Counselors

Many people, including genetic counselors, have been found to hold stigmatizing attitudes towards people with mental illnesses. We aimed to determine whether these attitudes could be changed by exposing genetic counselors and genetic counseling students to a documentary film about people with mental illness. We screened the documentary at the 2010 North American conferences for genetic counselors. Immediately before (T1), immediately after (T2), and one month after (T3) watching the documentary, participants self-rated their comfort with asking patients about mental illness, and they completed scales measuring two aspects of stigma: stereotype endorsement, and desire for social distance. A total of 87 T1 and T2 questionnaires, and 39 T3 questionnaires were returned. At T2 and T3, 34.5% and 48.7% respectively reported feeling more comfortable to ask patients about mental illness. Scores on the social distance and stereotype endorsement scales decreased significantly from T1 to T2, but returned to initial levels at T3. The findings suggest the documentary increased genetic counselors' and genetic counseling students' comfort with asking about mental illness and temporarily decreased their stigmatizing attitudes.     

The Nature and Significance of Behavioural Genetic Information

In light of the human genome project, establishing the genetic aetiology of complex human diseases has become a research priority within Western medicine. However, in addition to the identification of disease genes, numerous research projects are also being undertaken to identify genes contributing to the development of human behavioural characteristics, such as cognitive ability and criminal tendency. The permissibility of this research is obviously controversial: will society benefit from this research, or will it adversely affect our conceptions of ourselves and each other? When assessing the permissibility of this research, it is important to consider the nature and deterministic significance of behavioural genetic information. Whilst todate there has been much discussion and debate about the properties of genetic information per se and genetic determinism, this has not been applied to behavioural genetic research and its ethical implications. Therefore, this paper elucidates how behavioural genetic information can be distinguished from other types of genetic and non-genetic information and also synthesises the determinative significance of genetic factors for the development of human behavioural traits. Undertaking this analysis enables the ethical issues raised by this research to be debated in an appropriate context and indicates that separate policy considerations are warranted.

     

The Complexity and Challenges of Genetic Counseling and Testing for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an umbrella term referring to two chronic idiopathic intestinal diseases: ulcerative colitis (UC) and Crohn’s disease (CD). Both UC and CD are characterized by immune activation that leads to symptoms, but the location, severity and behavior of the inflammation varies among individuals and in characteristic ways between UC and CD. A majority of patients with IBD are diagnosed in young adulthood, but the response to therapy is variable and difficult to predict, with some patients demonstrating a prompt and effective remission while others have continuous symptoms that do not respond to existing medical options. Surgery remains a frequent and necessary occurrence among patients with IBD, but in UC it is considered curative, while in CD only temporizing. Clinical observations, epidemiological studies, and molecular genetics have provided strong evidence that both genetic and environmental factors are important determinants for disease susceptibility. In recent years, a number of genes have been identified that associate with CD and UC, although the clinical utility of these discoveries in patients or in susceptible family members has not been determined. Nonetheless, it is hoped that these fundamental advances in our understanding of IBD will lead to better therapies for patients and prevention strategies for those who are susceptible. Effective incorporation of clinical genetic testing for IBD into practice will require appropriate education and counseling.     

Stigma as a barrier to recovery from mental illness

Advances in neuroscience, technology and research sophistication have greatly increased understanding of mental illnesses and improved the treatment of these disorders. However, there are also important psychosocial aspects of mental illness that play a significant role in recovery from these conditions. One set of these factors involves the prejudice and discrimination, often referred to as 'stigma', faced by people when others learn that they have been diagnosed with, and/or treated for, a mental disorder.     

儿童抑郁认知易感性的发展特点

相对稳定的负性认知特征会使个体容易发生抑郁,被称为抑郁认知易感性.文章总结并对比当前关于抑郁认知易感性的稳定性与可变性的观点,提出从儿童发展早期开始研究认知易感性因素的必要性.接着回顾消极归因方式、功能失调态度和冗思这三种认知易感性因素在儿童期的表现及其前期心理特征,试图找到抑郁认知易感性在个体发展中的连续性.建议今后探讨认知易感性因素在不同年龄的发展特点,关注发展早期认知易感性因素的测量.     

Molecular mechanisms of stress-induced prefrontal cortical impairment: implications for mental illness

The symptoms of mental illness often involve weakened regulation of thought, emotion, and behavior by the prefrontal cortex. Exposure to stress exacerbates symptoms of mental illness and causes marked prefrontal cortical dysfunction. Studies in animals have revealed the intracellular signaling pathways activated by stress exposure that induce profound prefrontal cortical impairment: Excessive dopamine stimulation of D1 receptors impairs prefrontal function via cAMP intracellular signaling, leading to disconnection of prefrontal networks, while excessive norepinephrine stimulation of alpha1 receptors impairs prefrontal function via phosphatidylinositol-protein kinase C intracellular signaling. Genetic studies indicate that the genes disrupted in serious mental illness (bipolar disorder and schizophrenia) often encode for the intracellular proteins that serve as brakes on the intracellular stress pathways. For example, disrupted in schizophrenia 1 (DISC1) normally regulates cAMP levels, while regulator of G protein signaling 4 (RGS4) and diacylglycerol kinase (DGKH)-the molecule most associated with bipolar disorder- normally serve to inhibit phosphatidylinositol-protein kinase C intracellular signaling. Patients with mutations resulting in loss of adequate function of these genes likely have weaker endogenous regulation of these stress pathways. This may account for the vulnerability to stress and the severe loss of PFC regulation of behavior, thought, and affect in these illnesses. This review highlights the signaling pathways onto which genetic vulnerability and stress converge to impair PFC function and induce debilitating symptoms such as thought disorder, disinhibition, and impaired working memory.     

粗暴养育的内涵、影响因素及作用机制

因对儿童青少年身心发展的消极影响, 粗暴养育(harsh parenting)近年来成为养育研究领域的热点。粗暴养育的表现形式主要包括身体攻击、言语攻击、心理攻击以及强迫/控制行为等。影响因素包括个体影响因素和环境影响因素。前者主要包括父母的敌意人格、认知能力不足、消极的被养经历以及儿童的困难型气质和易损基因型等。后者主要包括家庭经济困难和社区处境不利等。粗暴养育引发儿童的内外化问题, 损害其人际功能, 造成生理/神经系统功能紊乱等。未来研究需进一步考察粗暴养育的影响因素(如特殊家庭环境)、表现形式及其负面影响, 加强本土化研究, 重视粗暴养育的预防和干预。     

无望抑郁认知易感操作化方法及其研究述评

合成分数、基于最弱联结假设提出的最大值以及基于解释方式差异性提出的个体内标准差是目前无望抑郁研究中应用较广的认知易感操作化方法.回顾无望抑郁研究所使用的认知易感操作化方法,梳理这些操作化方法对理解无望抑郁症状发展及其治疗的意义,可发现合成分数与最大值反映了无望抑郁认知易感因子之间关系的不同侧面,后续研究可继续对这两种操作化方法进行比较,以个体内标准差计算出的解释弹性可能是无望抑郁理论之外新的易感因素,可为治疗抑郁提供新的视角.     

A Review of Epigenetic Markers of Tobacco and Alcohol Consumption

Over the past two decades, advances in genetic technologies have posed unexpected challenges to the ethical and legal framework guiding the application of the most recent advances in healthcare technologies. By and large, these challenges have been successfully met by the introduction by statutes such as the Genetic Information Nondiscrimination Act (GINA). However, over the past several years, these advances in the ability to measure genetic (or heritable) contributions to medical illness have been joined by advances in epigenetic (or acquired) contributions to common medical illnesses. Unfortunately, the moral and legal framework for the use of these epigenetic technologies, which can objectively determine the presence of medical illnesses such as diabetes or the consumption of substances of abuse, is not as well developed. This communication provides an introduction to the fundamentals of epigenetics and then reviews how some of the latest advances in this technology can now be used to assess the consumption of alcohol and tobacco. Next, the possible mechanisms through which these tools could be employed clinically are discussed. Finally, the authors outline the potential for misuse of this technology and suggest that well-informed policy could play a critical role in shaping the optimal implementation of epigenetic technologies. Copyright © 2015 John Wiley & Sons, Ltd.