Overcoming Barriers to Collaboration Between Basic Behavioral Scientists and Public Health Scientists in Research on Mental Disorders

The behavioral and public health sciences both have a long and rich history supporting basic, translational, and applied research aimed at improving human lives and reducing human suffering. Through the complementary expertise of these disciplines, investigators have contributed to significant, worldwide improvements in mental and physical health. Further gains can be achieved through collaborative research among scientists in these 2 fields. Unfortunately, there are a number of barriers to such collaboration originating in different intellectual traditions, research methods, and the structure and values of academia. We identify these barriers and potential strategies for overcoming them. Several areas for future collaborative research appear promising, especially comorbid mental and physical disorders, adherence to interventions, stigma, and emotional processes. Theory-guided preventive interventions may represent especially fertile areas of collaborative effort.     

论精神障碍患者的社会保障及发展思路

目前精神障碍群体的生存状况不容乐观,群体人数众多,社会保障严重缺失,而导致其发生的原因,除了传统的家庭责任观念外,社会保障制度设计缺乏总体规划、资金投入不足、运用低效等也是重要的因素。鉴于此,提出了精神障碍群体社会保障发展的思路,一是树立家庭、国家、社会责任共担的理念;二是坚持一般性制度安排与专项制度安排相结合的原则;三是加大投入并充分利用社会资源;四是加强保障制度的立法工作,完善社会保障相关政策法规,以期加强和完善这一特殊群体的社会保障制度。     

Vicarious Improvement Among Parents Participating in Child-Focused Cognitive-Behavioral Therapy for Anxiety

Parental variables likely have important and bidirectional influences on the etiology of child anxiety. Although some child-focused cognitive-behavioral therapy (CCBT) anxiety trials have found vicarious improvements among parents who participated in their children’s treatment, this is an understudied area. We hypothesized that parental variables (psychopathology, stress, and burden) will significantly decrease from pre- to post-CCBT and will be associated with child treatment response. We explored whether intervention delivery method—in-person CCBT versus parent-mediated bibliotherapy—influenced vicarious parental improvements. Parental variables decreased from pre- to post-CCBT and were associated with child treatment response. Effects did not interact with delivery method. Parent participation in anxiety CCBT may result in vicarious improvements for parents.     

精神障碍诊疗实行自愿原则的伦理辩护

精神病患者的自主权应当得到相应的尊重和保护,作为社会的弱势群体,精神病患者的认知和行为能力存有缺陷,无法完全对自身的健康与合法权益予以保护,“自愿原则”将精神病患者从历史“异端”拉进社会关爱中,并用法律予以规范,是法制与人权的进步。通过对维护患者利益原则、尊重自主权原则、知情同意权原则、维护公共利益原则和公正原则进行伦理精神分析,论述《精神卫生法》对精神障碍诊疗实行自愿原则的相关规定,提出“自愿原则”实施的伦理正当性,为衡平正义提供价值考量。     

国内外严重精神障碍康复服务模式的比较研究

以文献回顾和对比归纳的方法,对国内外典型的严重精神障碍康复服务模式进行探讨和比较分析,揭示了国内严重精神障碍康复服务模式存在的问题与不足：精神卫生服务资源匮乏、专业型人才短缺、资源整合协调效率低、对复元理念理解不透彻等。提出加强精神卫生服务体系建设,打造高质高量的精神卫生康复服务人才队伍、设立负责协调各方资源的专职部门,优化精神障碍社区康复服务体系布局和建设本土化复元导向的康复服务模式的建议,以期为我国严重精神障碍康复服务模式的发展提供参考。

     

国家承担精神障碍患者监护责任的伦理性

近年精神障碍患者伤人案件频发,由此提出精神障碍患者监护主体范围问题,特别是家庭成员无力履行监护职责情形,为兼顾患者权益及社会公众权利,作为独立伦理实体与法律主体的国家有道义承担该职责。国家承担监护精神障碍患者责任的伦理根源在于:既有家庭伦理难以适应社会发展现实性,又有国家职责伦理必要性、个体人权伦理合理性以及社会生产方式之可能性。精神障碍患者保护主体从家庭成员转为国家,有利于保护患者权益,确保个体权利发展,促进社会进步繁荣。     

Using a Behavioral Treatment Package for Sleep Problems in Children With Autism Spectrum Disorders

This study investigated the effectiveness of a behavioral treatment package for sleep problems in children diagnosed with Autism Spectrum Disorders. Treatment consisted of four behaviorally based components: circadian rhythm management, positive bedtime routines, white noise, and graduated extinction. A multiple-baseline design across three participants was used. Families completed a baseline of various lengths followed by 1 month of intervention. Results indicated the treatment package was effective in decreasing sleep onset latency and the frequency of night awakenings. A week of follow-up data showed continued improvement. Parents reported their children slept better and satisfaction with the four intervention components.     

Meta-analysis of the effects of cognitive-behavioral therapy on the core eating disorder maintaining mechanisms: implications for mechanisms of therapeutic change

The original and enhanced cognitive model of eating disorders proposes that cognitive-behavioral therapy (CBT) "works" through modifying dietary restraint and dysfunctional attitudes towards shape and weight. However, evidence supporting the validity of this model is limited. This meta-analysis examined whether CBT can effectively modify these proposed maintaining mechanisms. Randomized controlled trials that compared CBT to control conditions or non-CBT interventions, and reported dietary restraint and shape and weight concern outcomes were searched. Twenty-nine trials were included. CBT was superior to control conditions in reducing shape (g=0.53) and weight (g=0.63) concerns, and dietary restraint (g=0.36). These effects occurred across all diagnoses and treatment formats. Improvements in shape and weight concerns and restraint were also greater in CBT than non-CBT interventions (g's=0.25, 0.24, 0.31, respectively) at post-treatment and follow-up. The magnitude of improvement in binge/purge symptoms was related to the magnitude of improvement in these maintaining mechanisms. Findings demonstrate that CBT has a specific effect in targeting the eating disorder maintaining mechanisms, and offers support to the underlying cognitive model. If changes in these variables during treatment are shown to be causal mechanisms, then these findings show that CBT, relative to non-CBT interventions, is better able to modify these mechanisms.     

Homework Compliance and Quality in Cognitive Behavioral Therapies for Anxiety Disorders and Obsessive-Compulsive Disorder

Homework assignments are an integral part of cognitive behavioral therapy, providing patients with opportunities to practice skills between sessions. Generally, greater homework compliance is associated with better treatment outcomes. However, fewer studies have examined the effect of homework quality on treatment outcomes. This study examined homework compliance and quality as predictors of outcome and attrition across five CBT protocols. A sample of 179 individuals with principal diagnoses of generalized anxiety disorder, panic disorder, social anxiety disorder, or obsessive-compulsive disorder were randomized to receive a transdiagnostic CBT protocol (the Unified Protocol) or a single-diagnosis CBT protocol corresponding to their principal diagnosis. The Unified Protocol had a lower homework burden than the majority of the single-diagnosis protocols, which varied in degree of assigned homework. Despite this, there were no differences in average homework compliance or quality across principal diagnosis, treatment condition, or their interaction. Homework quality was significantly related to all symptom outcomes (self-reported and clinician-rated anxiety and depressive symptoms, clinician-rated clinical severity). Homework compliance was significantly related to clinician-rated anxiety symptom outcomes. Additionally, greater homework quality and compliance were both significantly associated with increased odds of completing treatment, suggesting homework variables can be useful and easily obtainable predictors of treatment retention.     

Emotion Regulation as a Moderator of Outcomes of Transdiagnostic Group Cognitive-Behavioral Therapy for Emotional Disorders

The aim of this study was to examine the potential moderating effect of baseline emotion regulation skills—cognitive reappraisal and expressive suppression—on the relationship between treatment allocation and treatment outcomes in primary care patients with emotional symptoms. A total of 631 participants completed scales to evaluate emotion regulation, anxiety, depression, functioning, and quality of life (QOL). The moderation analysis was carried out using the SPSS PROCESS macro, version 3.5. Expressive suppression was a significant moderator in the relationship between treatment allocation and treatment outcomes in terms of symptoms of anxiety (b = −0.530, p = .026), depression (b = −0.812, p = .004), and QOL (b = 0.156, p = .048). Cognitive reappraisal acted as a moderator only in terms of QOL (b = 0.217, p = .028). The findings of this study show that participants with higher scores of expressive suppression benefited more from the addition of transdiagnostic cognitive-behavioral therapy to treatment as usual (TAU) in terms of anxiety and depressive symptoms, and QOL. Individuals with higher levels of cognitive reappraisal obtained a greater benefit in terms of QOL from the addition of psychological treatment to TAU. These results underscore the relevant role that emotion regulation skills play in the outcomes of psychological therapy for emotional symptoms.     

Invariance Properties for General Diagnostic Classification Models

In item response theory (IRT), the invariance property states that item parameter estimates are independent of the examinee sample, and examinee ability estimates are independent of the test items. While this property has long been established and understood by the measurement community for IRT models, the same cannot be said for diagnostic classification models (DCMs). DCMs are a newer class of psychometric models that are designed to classify examinees according to levels of categorical latent traits. We examined the invariance property for general DCMs using the log-linear cognitive diagnosis model (LCDM) framework. We conducted a simulation study to examine the degree to which theoretical invariance of LCDM classifications and item parameter estimates can be observed under various sample and test characteristics. Results illustrated that LCDM classifications and item parameter estimates show clear invariance when adequate model data fit is present. To demonstrate the implications of this important property, we conducted additional analyses to show that using pre-calibrated tests to classify examinees provided consistent classifications across calibration samples with varying mastery profile distributions and across tests with varying difficulties.     

Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Analogue Mental Transformations in 3‐Year‐Olds: Introducing a New Mental Rotation Paradigm Suitable for Young Children

Until now, a successful application of the mental rotation paradigm was restricted to children 5 years or older. By contrast, recent findings suggest that even infants can perform mental rotation. Unlike the methods used in infant studies (looking time), our new research paradigm allows for the measurement and interpretation of reaction times. Kindergartners (aged 3–6 years) were presented with a stimulus configuration on a touchscreen and asked to bring a rotated stimulus into an upright position using the shortest path. Mean reaction time (RT) increased linearly with angular disparity. The ensuing linear trend was significant not only for the entire sample but also for the youngest age group analysed separately. To exclude the possibility that linearity was due to movement planning, 3‐year‐olds had to manually rotate a stimulus about the same trajectory without the need for a corresponding mental transformation in a second experiment. Here, no linear trend was observed. These results are interpreted as evidence for an analogue mental transformation in 3‐year‐olds, equal to the transformation processes in older children's and adults' mental rotation. Copyright © 2013 John Wiley & Sons, Ltd.     

Toward a Public Mental Health Approach for Survivors of Terrorism

Abstract

Although most people exposed to bioterrorism or mass casualties will be extremely distressed during the immediate aftermath, only a minority (approximately 30%) will develop clinically significant psychiatric disorders. From a public mental health perspective, the challenge is to provide both preventive programs for the entire population and early detection and intervention for those at greatest risk for PTSD or other post-traumatic psychiatric disorders. Both individual and soci-etal preventive and early intervention approaches are reviewed. Utilization of the media, especially television, is presented as an example of one of many potential community/societal public mental health approaches.     

Emotion Regulation in Youth with Emotional Disorders: Implications for a Unified Treatment Approach

Given the relationship between internalizing disorders and deficits in emotion regulation in youth, the emotion science literature has suggested several avenues for increasing the efficacy of interventions for youth presenting with anxiety and depression. These possibilities include the identification and addition of emotion-regulation skills to existing treatment packages and broadening the scope of those emotions addressed in cognitive-behavioral treatments. Current emotion-focused interventions designed to meet one or both of these goals are discussed, and the developmental influences relevant to the selection of emotion-focused treatment goals are explored using the framework of a modal model of emotion regulation. These various lines of evidence are woven together to support the utility of a novel emotion-focused, cognitive-behavioral intervention, the Unified Protocol for the Treatment of Emotional Disorders in Youth, a transdiagnostic treatment protocol that aims to treat the range of emotional disorders (i.e., anxiety and depression) simultaneously. Avenues for future directions in treatment outcome and assessment of emotion regulation are also discussed.     

Outcomes in a System of Care for Youths with Emotional and Behavioral Disorders: An Examination of Differential Change Across Clinical Profiles

We assessed the utility of an empirically-derived classification system for youths with emotional and behavioral disorders in a system of care with a strong representation of juvenile delinquents. Eighty-seven youths served in a system of care were categorized by variables related to past history, current behavioral functioning, and current psychological functioning into four clinical clusters. We evaluated preliminary clinical outcomes after six months of interagency involvement for youths within each cluster and across the four clusters. Results indicated that youths in different clusters improved significantly in need-specific areas. Trends in our data indicated differential change in clinical outcomes across clusters. We discuss our findings within the context of emerging outcomes of youths involved in comprehensive community-based programs and consider implications for outcome research, treatment of juvenile delinquents, and mental health policy.     

Cultural Adaptation of a Cognitive Behavior Therapy Guided Self‐Help Program for Mexican American Women With Binge Eating Disorders

Data on the compatibility of evidence‐based treatment in ethnic minority groups are limited. This study utilized focus group interviews to elicit Mexican American women's (N= 12) feedback on a cognitive behavior therapy guided self‐help program for binge eating disorders. Findings revealed 6 themes to be considered during the cultural adaptation process and highlighted the importance of balancing the fidelity and cultural relevance of evidence‐based treatment when disseminating it across diverse racial/ethnic groups.     

Diagnostic Classification Models for a Mixture of Ordered and Non-ordered Response Options in Rating Scales

When developing ordinal rating scales, we may include potentially unordered response options such as “Neither Agree nor Disagree,” “Neutral,” “Don’t Know,” “No Opinion,” or “Hard to Say.” To handle responses to a mixture of ordered and unordered options, Huggins-Manley et al. (2018) proposed a class of semi-ordered models under the unidimensional item response theory framework. This study extends the concept of semi-ordered models into the area of diagnostic classification models. Specifically, we propose a flexible framework of semi-ordered DCMs that accommodates most earlier DCMs and allows for analyzing the relationship between those potentially unordered responses and the measured traits. Results from an operational study and two simulation studies show that the proposed framework can incorporate both ordered and non-ordered responses into the estimation of the latent traits and thus provide useful information about both the items and the respondents.     

The Relation of Exposure to Traumatic Events and Longitudinal Mental Health Outcomes for Children Enrolled in Systems of Care: Results from a National System of Care Evaluation

This study examined the relation between children's history of exposure to potentially traumatic events (PTEs) and clinical and functional mental health trajectories over a 18‐month period among a national sample of youth referred for services in children's behavioral health systems of care (SOCs). Using data from the national evaluation of the Comprehensive Community Mental Health Services program for communities funded from 1997 to 2000, the study sample included 9556 children and their families. Latent growth modeling was used to assess the effect of history of exposure to PTEs on trajectories in a number of behavioral health outcomes during the 3‐year period following referral to services, controlling for child demographic characteristics (gender, race, and age). Results revealed that, on average, children in SOCs exhibited significant improvements over time on all four outcome measures. Children with a history of exposure to PTEs had higher rates of internalizing and externalizing problem behaviors and functional impairments and fewer behavioral and emotional strengths at baseline, but experienced improvements in these outcomes at the same rates as children without exposure to a traumatic event. Finally, child race, gender, and age also were associated with differences in behavioral health trajectories among service recipients. Implications for SOCs, including approaches to make them more trauma‐informed, are discussed.