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.     

Managing daily life with age-related sensory loss: cognitive resources gain in importance

This paper investigates the role of cognitive resources in everyday functioning, comparing visually impaired, hearing impaired, and sensory unimpaired older adults. According to arguments that cognitive resources are of increased importance and a greater awareness of cognitive restrictions exists among sensory impaired individuals, in particular among visually impaired individuals, we hypothesized differential relationships between resources and outcomes when comparing sensory impaired and sensory unimpaired older adults. Findings are based on samples of 121 visually impaired, 116 hearing impaired, and 150 sensory unimpaired older adults (M = 82 years). Results from a sample of 43 dual sensory impaired older adults are reported for comparison. Assessment relied on established instruments (e.g., WAIS-R, ADL/IADL). Structural equation modeling showed that cognitive resources and behavior-related everyday functioning were more strongly related in the sensory impaired groups as compared to the sensory unimpaired group. Cognitive resources and evaluation of everyday functioning were significantly linked only among the sensory impaired groups. When medical condition was controlled for, these effects persisted. It is concluded that both cognitive training as well as psychosocial support may serve as important additions to classic vision and hearing loss rehabilitation.     

Personalizing Behavioral Interventions Through Single‐Patient (N‐of‐1) Trials

Behavioral interventions are typically studied with the use of a conventional between‐subject randomized controlled trial (RCT) design. In this design, the effect of an intervention on one group of patients is compared with the effect of a control condition on another group of patients, such that a between‐subject change is tested. A between‐subject design has an underlying assumption that there is a homogenous treatment effect for a behavioral intervention, drug, or psychotherapy and that the way the intervention operates in the study will tend to operate in the same way in many other patients. We review some of the philosophical and practical problems with the use of this design when a clinician is attempting to decide on a course of behavioral treatment aimed at within‐subject change in patients who are likely to have heterogeneous or unique responses to behavioral treatment. We also review the biases inherent in our current clinical practice model, which does not use any empirical data collection or design for testing if a treatment is useful, and also in the conventional between‐subject personalized medicine RCT designs. We propose increased use of single‐patient (also known as N‐of‐1) trials that employ within‐subject designs, in cases where treatment response is heterogeneous – as is the case for most psychological and behavioral treatments. Limitations of such designs include that they can only be used when the treatment is potentially reversible, the patient can act as their own control, and the outcome can be measured repeatedly. Increased use of within‐subject trials may address in many more instances the more clinically relevant question of how a specific patient will respond to a specific treatment and could introduce a more harmonious scientific approach into the way we treat our patients. We have incorporated a case presentation that illustrates the complexities of applying evidence drawn from these different designs to selecting and evaluating treatments for the behavioral issues commonly faced by clinicians and patients.     

Changes in Specialists’ Perspectives on Cancer Genetic Testing,Prophylactic Surgery and Insurance Discrimination: Then and Now

We surveyed cancer genetics specialists in 1998 to learn what they would do if at 50 % risk to carry a BRCA or Lynch syndrome mutation. We chose to repeat our study 14 years later, to examine how perspectives have changed with the extensive data now available. In July 2012 we surveyed the National Society of Genetic Counselors (NSGC) Cancer Special Interest Group via an internet based survey. We found statistically significant increases in the percentage of specialists who: would undergo BRCA testing (p?=?0.0006), opt for prophylactic bilateral mastectomy (p =0.0001), opt for prophylactic removal of their uterus and ovaries for Lynch syndrome (p =0.0057 and P?=?0.0090, respectively), and bill testing to insurance (p >0.0001). There were also statistically significant decreases in the percentage of participants who would have their colon removed for Lynch syndrome (p?=?0.0002) and use an alias when pursuing testing (p?>?0.0001). Over the past 14 years there has been a major change in perspective amongst cancer genetic specialists regarding genetic testing, prophylactic surgery and insurance discrimination.     

Opening the black box: Presenting a model for evaluating organizational-level interventions

Organizational-level occupational health interventions are often recommended when improvements in working conditions, employee health, and well-being are sought within organizations. Research has revealed that these interventions result in inconsistent effects despite being based on theoretical frameworks. This inconsistency indicates that intervention studies need to be designed to examine directly how and why such interventions bring about change and why they sometimes fail. We argue that intervention studies should include a process evaluation that includes a close examination of the psychological and organizational mechanisms that hinder and facilitate desired intervention outcomes. By drawing on existing intervention literature we present an evidence-based model containing three levels of elements that appear to be crucial in process evaluation. We describe how this model may be applied and developed in future research to identify better the mechanisms that link intervention processes to intervention outcomes.     

Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents

This study aimed to describe the course of early onset eating disorders in a population-based sample followed from 14 to 20 years; identify variables that could account for the persistence of eating disorders from 14 to 20 years; and describe outcome of early onset eating disorders with reference to general and psychological functioning at age 20. Participants (N?=?1,383; 49 % male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to young adulthood. Eating disorder symptoms were assessed using an adapted version of the Eating Disorder Examination-Questionnaire, at ages 14, 17 and 20. At age 14, 70 participants met DSM-IV criteria for a binge eating or purging eating disorder. Nearly half (44 %) of these adolescents ceased to meet criteria for an eating disorders at ages 17 and 20, whilst one-quarter still met criteria for an eating disorder at age 20 and one-fifth met criteria for an eating disorder at all three time points. Purging at age 17 and externalising behaviour problems at age 14 were the strongest predictors of eating disorder persistence to age 20. Participants who experienced a persistent eating disorder were less likely to complete high school than other participants, and reported pronounced depressive and anxiety symptoms at age 20. This study provides new data the course and outcome of early onset eating disorders at a population level. Behavioural difficulties in early adolescence and purging in middle adolescence may predict persistent eating pathology to young adulthood.     

Reexamining Nonlinear Structural Equation Modeling Procedures: The Effect of Parallel and Congeneric Measures

The current study examines the performance of the extended unconstrained approach (EXUC) and the latent moderated structural equation modeling procedure (LMS) in situations where quadratic and interaction terms are tested simultaneously and investigates their limitations with regard to the employment of parallel and congeneric measures, relatively low indicator reliabilities, and relatively large numbers of indicators. By means of a Monte Carlo study, we found LMS to be the best option for testing multiple nonlinear effects given sufficient sample size (n ≥ 500) and normally distributed exogenous variables. Its advantages became more prominent when indicator reliabilities were heterogeneous and small. The EXUC was a viable option for estimating the model when indicators were parallel and exhibited large indicator reliabilities. An empirical example of the results is provided, and the relevance of measurement model characteristics to assess nonlinear relationships is discussed.     

Adolescents with high mental toughness adapt better to perceived stress: A longitudinal study with Swiss vocational students

A mindset of mental toughness enables an individual to cope successfully with the pressures and demands of life. This 10-month study prospectively examined the association between mental toughness and stress resilience in 865 students (M = 17.86 years, 42.7% girls) from two vocational schools. Within each school, separate cluster analyses identified groups with different profiles of risk (assessed with perceived stress) and adaptation (operationalized with depressive symptoms and life satisfaction). Four clusters emerged characterizing students with well-adjusted (low risk, good adaptation), maladjusted (elevated risk, bad adaptation), deteriorated (low initial risk, worsening adaptation) and resilient profiles (elevated initial risk, improving adaptation). The latter two clusters reported similar levels of mental toughness at baseline, but resilient adolescents scored significantly higher on mental toughness at follow-up. After controlling for possible confounds, baseline toughness levels predicted depressive symptoms and life satisfaction over time. This study shows that mental toughness operates as a stress resilience resource. Mental toughness is, therefore a topic of interest for health specialists working with adolescent populations.     

The Benefits,Costs, and Paradox of Revenge

In this article, we examine the psychology of revenge. We begin by discussing challenges associated with defining revenge. We then review the relative costs and benefits associated with taking revenge. Although revenge can deter future harm, promote cooperation, and restore avengers’ self-worth and power, it can also contribute to conflict escalation and adverse psychological outcomes for avengers, such as depression and reduced life satisfaction. Next, we examine the prevalence of revenge. In distinguishing between the desire for revenge and act of revenge, we challenge the notion that the act of revenge is an automatic or pervasive response to injustice. We highlight four factors that influence whether victims of injustice choose to take revenge: the persistence of anger, perceptions of the costs of revenge, cultural and religious values regarding revenge, and the presence of external systems that can restore justice on behalf of victims.