Evidence-based psychological treatments for insomnia in older adults

The review describes evidence-based psychological treatments (EBTs) for insomnia in older adults. Following coding procedures developed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology, two treatments were found to meet EBT criteria: sleep restriction-sleep compression therapy and multicomponent cognitive-behavioral therapy. One additional treatment (stimulus control therapy) partially met criteria, but further corroborating studies are needed. At the present time, there is insufficient evidence to consider other psychological treatments, including cognitive therapy, relaxation, and sleep hygiene education, as stand-alone interventions beneficial for treating insomnia in older adults. Additional research is also needed to examine the efficacy of alternative-complementary therapies, such as bright light therapy, exercise, and massage. This review highlights potential problems with using coding procedures proposed in the EBT coding manual when reviewing the existing insomnia literature. In particular, the classification of older adults as persons age 60 and older and the lack of rigorous consideration of medical comorbidities warrant discussion in the future.     

Model stability of the 15-item Geriatric Depression Scale across cognitive impairment and severe depression

The 15-item Geriatric Depression Scale (GDS) is used in a wide variety of clinical and research settings. The study's purpose was to further establish the validity of the 15-item GDS by exploring the underlying factor structure in a healthy, nondemented sample of older adults and then analyzing whether this factor structure remained stable across a sample of demented individuals and a sample of individuals with a history of depression 6 months after discharge from an inpatient psychiatric setting. A 2-factor model fit the data best in the exploratory analyses. The 2 factors, Life Satisfaction and General Depressive Affect, found in the nondemented sample (r = .39) remained stable across cognitive impairment (r = .12) but merged into a 1-factor model in the psychiatric sample (r = .93). The results indicate that nondepressed older adults with poor life satisfaction may be identified as depressed on screening instruments such as the 15-item GDS.     

An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups

Many of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) personality disorder (PD) diagnostic criteria focus on a younger social and occupational context. The absence of age-appropriate criteria for older adults forces researchers and clinicians to draw conclusions based on existing criteria, which are likely inadequate. To explore which DSM-IV PD criteria contain age group measurement bias, the authors report 2 analyses of data on nearly 37,000 participants, ages 18-98 years, taken from a public data set that includes 7 of the 10 PDs (antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid). The 1st analysis revealed that older age groups tend to endorse fewer PD criteria than younger age groups. The 2nd analysis revealed that 29% of the criteria contain measurement bias. Although the latent variable structure for each PD was quite similar across younger and older age groups, some individual criteria were differentially endorsed by younger and older adults with equivalent PD pathology. The presence of measurement bias for these criteria raises questions concerning the assessment of PDs in older adults and the interpretation of existing data.     

Grandparents' psychological well-being after loss of contact with their grandchildren.

This study examined how loss of contact with grandchildren due to parental separation or divorce, family feud, or a sudden event, such as relocation, affected the emotional well-being of grandparents (N = 442). Using data from the Longitudinal Study of Generations, the depressive symptoms of grandparents were tracked over 15 years. Growth curve analysis was used to compare grandparents who had lost contact with their grandchildren with those who had not and to examine preloss to postloss change in depressive symptoms. Grandparents who lost contact with their grandchildren experienced a steeper increase in depressive symptoms as they aged compared with other grandparents. Depressive symptoms of grandparents who lost contact because of a sudden event increased up to 3 years following the loss but returned to equilibrium thereafter. The authors conclude that grandparents who lost contact with their grandchildren experienced a negative impact on their emotional health.     

Adolescent Perceptions of Parental Behaviors,Adolescent Self-Esteem,and Adolescent Depressed Mood

Using symbolic interaction, we developed a research model that proposed adolescent perceptions of parental support and psychological control would be related to adolescent depressed mood directly and indirectly through self-esteem. We tested the model using self-report questionnaire data from 161 adolescents living with both of their biological parents. To examine possible gender of adolescent differences, we tested two multigroup models separately for adolescents’ perceptions of mothers’ and fathers’ parental behaviors. Both the fathers’ and mothers’ models yielded (a) direct paths from self-esteem to depressed mood (for boys and girls), psychological control to depressed mood (for boys) and (b) an indirect path from support to self-esteem to depressed mood (for girls and boys) and an indirect path from psychological control to self-esteem to depressed mood (for girls). In addition, in the fathers’ model a significant direct path was found between fathers’ support and depressed mood (for girls).     

Foster Parents’ Involvement in Authoritative Parenting and Interest in Future Parenting Training

We surveyed 191 Southwest Ohio foster parents regarding their involvement in authoritative parenting and interest for additional parenting education. Our results showed that most respondents reported using an authoritative parenting style and were interested in receiving future training. Involvement in authoritative parenting differed significantly based on level of education and number of years as a foster parent. Foster parents with a college degree or higher were significantly more involved in authoritative parenting than foster parents with a high school diploma or less. Those who had been a foster parent for greater than five years were significantly more likely than those who been a foster parent for five years or less to use authoritative parenting and desire future training in authoritative parenting.     

Predictors of Satisfaction with Obstetric Care in High-risk Pregnancy: The Importance of Patient–Provider Relationship

The study set out to examine the predictive effects of patients’ emotional distress and their relationships with their health care providers on satisfaction with obstetric services in high-risk pregnancies. Participants were 104 pregnant women with a history of recurrent losses, fetal demise, previous or current fetal genetic abnormality, advanced maternal age, or obstetric or medical complications of the present pregnancy. Self-report measures of emotional distress and the quality of their relationships with their medical provider were administered. Hierarchical multiple regression analyses were conducted to assess the predictive effect of these variables on satisfaction with services. Provision of information, constructive communication, and good relationships predicted elevated satisfaction with health services. Provision of information also buffered against the adverse effect of emotional distress on satisfaction with health services. These findings elucidate the central role of provider–patient interaction, particularly as it is related to provision of information, in high-risk pregnancy.     

Concurrent Validity of the Multidimensional Health Profile—Health Functioning Scales (MHP-H) in the Pre-operative Assessment of Applicants for Gastric Bypass Surgery

The concurrent validity of a brief screening test, the Multidimensional Health Profile-Health Functioning (MHP-H) was examined in conjunction with a much more lengthy pre-operative assessment procedure in 449 applicants for gastric bypass surgery (GBS). The MHP-H is a 69-item screening inventory that assesses five areas of health functioning: Adult Health History, Health Habits, Health Care Utilization, Health Beliefs and Attitudes, and Response to Illness. The more lengthy procedure included a comprehensive 273-item structured interview plus the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Basic Personality Inventory (BPI), and Beck Depression Inventory (BDI). The MHP-H showed significant correspondence with the more comprehensive assessment on measures of potential relevance to outcome in GBS, supporting the use of the MHP-H as a low-cost alternative to the more extensive procedure. The utility of the MHP-Psychosocial Functioning (MHP-P), a companion instrument to the MHP-H, was demonstrated in an earlier study.     

Neurogenesis and learning: acquisition and asymptotic performance predict how many new cells survive in the hippocampus

Previous research has shown that some associative learning tasks prevent the death of new neurons in the adult hippocampus. However, it is unclear whether it is mere exposure to the training stimuli that rescues neurons or whether successful learning of the task is required for enhanced neuronal survival. If learning is the important variable, then animals that learn better given the same amount of training should retain more of the new cells after learning than animals that do not learn as well. Here, we examined the effects of training versus learning on cell survival in the adult hippocampus. Animals were injected with BrdU to label a population of cells and trained one week later on one of two trace conditioning tasks, one of which depends on the hippocampus and one that does not. Increases in cell number occurred only in animals that acquired the learned response, irrespective of the task. There were significant correlations between acquisition and cell number, as well as between asymptotic performance and cell number. These data support the idea that learning and not simply training increases the survival of the new cells in the hippocampus.