Training needs among nonmental health professionals working with service members: A qualitative investigation

Though many service members will not directly seek mental health care due to stigma and other factors, they may interact with the healthcare system in other ways including contact with first responders, nurses, and allied health care professionals. However, little attention has been spent in this regard on the educational needs of these professionals whose contact with service members and Veterans may provide the opportunity to assist Veterans in need with overcoming barriers to accessing mental health care. This qualitative study investigates the educational training needs of first responders and health care professionals in contact with military families and trauma survivors to determine whether, and what type, of additional training is needed. A sample of 42 first responders and health care professionals including emergency medical technicians, police officers, fire fighters, speech language pathologists, occupational therapists, physical therapists, and nurses were recruited to participate in 1 of 6 focus groups. Sessions were audiotaped and transcribed verbatim. Data analysis was guided by a thematic analysis approach. Thematic analyses suggest there is a significant knowledge gap with unmet educational needs of these professionals such as information on the invisible wounds of war, military culture, and screening and referring patients who present symptoms falling outside professionals’ scope of practice. Findings point to a need and desire for more robust education for first responders and health care providers around mental health concerns of military populations, including topics such as trauma, military culture, and screening tools. Efforts to develop curricula addressing these concerns are warranted.     

Psychometric Assessment of the Comprehensive Effects of Alcohol Questionnaire: Comparing a Brief Version to the Original Full Scale

The current set of studies compared the psychometric properties of the original Comprehensive Effects of Alcohol Questionnaire (CEOA) to a 15-item version (B-CEOA) in a nonclinical undergraduate sample (N = 581), and attempted to replicate and extend the B-CEOA findings in an undergraduate sample referred to an alcohol intervention (N = 734). Psychometric assessment included construct validity, internal consistency, and concurrent validity, using both positive and negative expectancy items in all analyses. Results provided further support for the empirical validity of the original CEOA, and provided support for the use of the B-CEOA despite the reduction in the number of items. The B-CEOA factor structures obtained using exploratory and confirmatory techniques provided support for a 4-factor structure of expectancies and 3-factor structure of valuations. Findings reveal potential problems with positive and negative expectancy items. Trade-offs regarding factor structure, internal consistency, and administration time should be considered in using the B-CEOA vs. the CEOA.     

Developing a family-based depression prevention program in urban community mental health clinics: a qualitative investigation

Extensive research documents that children of depressed mothers are at a significantly higher risk for developing a variety of socioemotional difficulties than children of nondepressed mothers. Yet, little prevention research has been conducted for this population, and low-income, minority, and urban families are rarely included. To address this deficit, we are developing the Protecting Families Program (PFP), a family-based multicomponent depression prevention program for mothers in treatment at urban community mental health agencies and their school-aged children. To inform intervention development and begin relationship building with the agencies, patient and staff focus groups were conducted in the participating agencies. Eighteen mothers with depression participated, and eight major themes were identified: (1) depression symptoms, (2) generational legacy, (3) parenting difficulties, (4) child problems, (5) social support, (6) stressful life events, (7) therapy and other helpful activities, and (8) desired treatment. In the focus groups with 10 mental health providers, the five major themes identified were parenting difficulties, lack of social support, life stress, current mental health practices, and intervention development. The findings support the multicomponent design of PFP, which focuses on increasing knowledge of depression, enhancing social support, and improving parenting skills. The study helped clarify many of the challenges of conducting research in a community mental health system.     

Behavioral and cognitive correlates of exercise self-schemata

The purpose of this study was to examine the relationship of exercise self-schemata to both cognitive and behavioral concomitants including exercise self-efficacy, attitudes toward fitness, self-perceptions of fitness, and self-report of exercise behavior. Participants were 161 undergraduate students who subsequently were categorized into groups defined by the authors as "exercise schematics," "nonexercise schematics," "aschematics," and unclassified. Results indicated that exercise schematics reported greater total caloric expenditure, higher frequency of exercise behavior in the past as well as future expectations to exercise, greater self-perceptions of physical fitness, and more favorable attitudes toward fitness than either nonexercise schematics or aschematics. Furthermore, exercise schematics expressed higher levels of exercise self-efficacy than did nonexercise schematics. The results clearly support earlier findings concerning exercise self-schemata and exercise behavior and further indicate that schematics also differ from others in important cognitive-motivational determinants of exercise such as self-efficacy and perceptions of physical fitness. Future research should define the role of exercise self-schemata both theoretically and practically in order to enrich our understanding of and facilitate the enhancement of exercise adherence.     

Prevalence of anxiety and depression in Australian adolescents: comparisons with worldwide data

Data from two Australian studies were combined so that the prevalence of anxiety and depression in a large, normative sample of Australian adolescents could be investigated. The combined sample comprised 1,299 adolescents randomly selected from metropolitan and country schools in Melbourne, a large Australian city. The data were examined in order to ascertain the percentages of adolescents who scored above the clinical cut-off on two self-report instruments--the Revised Children's Manifest Anxiety Scale (C. R. Reynolds & B. O. Richmond, 1985) and the Reynolds Adolescent Depression Scale (W. M. Reynolds, 1986). The results of these analyses were then compared with previously reported prevalence rates from studies worldwide. This comparison revealed striking differences in the prevalence of anxiety and depression across different countries and cultures. Limitations attributable to different self-report measures and imposed-etic approaches are discussed. Issues pertaining to social and political climate are also raised.     

Editorial: Challenging injustice: Understanding upstanding,civic action,and bystander intervention to promote justice

Throughout history, individuals and communities have come together to challenge injustice in the local community and across the globe. In recent years, we have seen communities rally together to advocate for changes in policy and practice to address injustices faced by marginalized and disenfranchised groups of people. For instance, communities have taken action through the Movement for Black Lives in the United States, the women's uprising in Iran following the death of Mahsa Amini, and the pro-democracy protests in Hong Kong. These challenges to social injustices are not only led by adults. Rather, youth engage in civic action to amplify the voices of those who are marginalized, isolated, or victimized and frequently organize to protest injustice and foster collective action through social media or other technology. These challenges to injustice often arise from community-led efforts, rooted in the unique contexts and histories of the local community. This special issue considers challenging injustice broadly to include bystander intervention in instances of bullying, harassment, or aggression, political and civic engagement, anti-racist or anti-oppression activism, and resistance to injustice in institutions and communities. Three overarching themes are featured in this special issue: (1) work examining bullying experiences and factors that motivate bystander intervention in response to bullying; (2) scholarship exploring identity, socialization, and critical action and (3) research focused on collective action and challenging inequalities.     

Public and private self-consciousness and social phobia

The relationship between public and private self-consciousness and self-report questionnaires, clinician ratings, and various measures derived from an individualized simulation of an anxiety-provoking situation was examined in a sample of men and women seeking treatment for social phobia. As predicted, public, not private, self-consciousness was generally related to self-report and naive observer ratings of anxiety and to behavioral disruption during the simulation. The predicted relationship between public self-consciousness and how accurately subjects evaluated their performance in the anxiety-provoking situation was marginally supported. Hypotheses regarding the relationship between private self-consciousness and self-reported anxiety during an anxiety-provoking situation, and between private self-consciousness and the correspondence between physiological assessment and self-report, were not supported. The discussion focuses on methodological issues and the theoretical implications of the relationship between self-consciousness and social anxiety.     

Androgyny as synthetic narcissism: Sex role measures and Kohut's psychology of the self

In Kohut's analysis of narcissism, the self emerges as a bipolar structure characterized by grandiosity at one pole and dependency at the other. Through appropriate developmental processes, grandiosity grows into a mature ambitiousness, and early dependencies are converted into a stable system of ideals. The present investigation predicted that sex role constructs essentially measure these two aspects of the self. Expected relationships between masculinity and grandiosity, and between femininity and dependency, were in fact obtained. Based in large part on Westin's (Self and Society, Cambridge: Cambridge University Press, 1985) analysis of Kohut's theory, synthetic, internal, external, and archaic narcissistic self styles were hypothesized to exist and to parallel the androgynous, masculine, feminine, and undifferentiated sex roles, respectively. Rough comparabilities were in fact evident between these two typologies. Factor analyses also demonstrated that narcissism and sex role measures load on factors in ways revealing the intimate ties between pathological narcissism and the failure to achieve desirable sex role characteristics.     

The Ethical Inclusion of Children With Psychotic Disorders in Research: Recommendations for an Educative,Multimodal Assent Process

This article addresses the issue of properly assenting children with psychotic disorders to participate in clinical research. Due to the protective concerns with such a vulnerable population, additional precautions are necessary to ensure that youth with psychotic disorders assent to research with an appropriate level of understanding regarding study procedures. Current literature suggests that positive/negative symptoms and minor cognitive deficits do not interfere with the ability to comprehend study-related information for adults with psychosis if the study information is presented through an educative process. Similarly, youth benefit from repeated presentation of procedures and periodic assessment of their comprehension. An integrated educative process is proposed that emphasizes the importance of an interactive consent through repetition and participant/investigator feedback.