Effects of involuntary outpatient commitment on subjective quality of life in persons with severe mental illness

Recent evidence suggests that involuntary outpatient commitment (OPC), when appropriately applied, can improve adherence with psychiatric treatment, decrease hospital recidivism and arrests, and lower the risk of violent behavior in persons with severe mental illness. Presumably these are benefits that improve quality of life (QOL); however, insofar as OPC involves legal coercion, the undesirable aspects of OPC could also exert a negative effect on quality of life, thus offsetting clinical benefits. Involuntarily hospitalized subjects, awaiting discharge under outpatient commitment, were randomly assigned to be released or continue under outpatient commitment in the community after hospital discharge, and were followed for one year. Quality of life was measured at baseline and 12 months follow-up. Treatment characteristics and clinical outcomes were also measured.Subjects who underwent longer periods of outpatient commitment had significantly greater quality of life as measured at the end of the 1 year study. Multivariable analysis showed that the effect of OPC on QOL was mediated by greater treatment adherence and lower symptom scores. However, perceived coercion moderated the effect of OPC on QOL. Involuntary outpatient commitment, when sustained over time, indirectly exerts a positive effect on subjective quality of life for persons with SMI, at least in part by improving treatment adherence and lowering symptomatology.     

Assessment of behavioral and psychological symptoms of dementia

In spite of their prevalence and persistence, why are behavioral and psychological symptoms of dementia difficult for clinicians to assess and manage? This paper provides an overview of the methodological challenges encountered in measuring behavioral disturbances of dementia. Specifically, conceptual constructs of behavioral and psychological symptoms of dementia, the strengths and weaknesses of the currently existing rating instruments, analytic methodologies, and the utility of technological devices are outlined in the service of formulating future directions in behavioral and psychological symptoms of dementia assessment research.     

The Relationship Between Marital Characteristics,Marital Interaction Processes,and Marital Satisfaction

Structural Equation Modeling techniques were used to clarify the relationship between marital characteristics, marital processes, and the dependent variable—marital satisfaction—in a sample of 201 participants who were in 1st marriages. The Dyadic Adjustment Scale (DAS; G. B. Spanier, 1976) and the Enriching and Nurturing Relationship Issues, Communication and Happiness Inventory (ENRICH; D. H. Olson, D. G. Fournier, & J. M. Druckman, 1987) provided scales to measure marital interaction processes and marital satisfaction. A new instrument, the Characteristics of Marriage Inventory (CHARISMA; J. R. Rosen‐Grandon & J. E. Myers, 2001), was developed using factor analysis to determine which marital characteristics were statistically significant. Structural equation modeling identified a path model wherein 6 marital interaction processes had a statistically significant influence on marital satisfaction when mediated by 3 latent factors of marital characteristics (love, loyalty, and shared values) and 2 moderating variables (length of marriage and gender of participant).     

Self-coded indirect memory associations and

Indirect memory associations for substance use predict both the concurrent and prospective levels of substance use. These methods assess spontaneous, possibly implicit, and easily accessible associations that predict substance use over direct (explicit) methods of assessment (e.g., outcome expectancies). The present study tested and expanded the application of a coding method for alcohol and marijuana associations on the basis of self-coding of indirect responses (Frigon & Krank, 2009). College students generated free associates to (1) ambiguous words (e.g., draft or weed), (2) situations (e.g., at a party, hanging out with friends), and (3) emotions (having fun, feeling dreamy). Later, participants were shown their responses and were asked to code their responses according to both nonrisk and risk activities, such as alcohol and marijuana use. Self-coded scores were higher than researcher-coded scores, captured the same variance, and improved the prediction of substance use. Self-coding of indirect memory associations provides accurate and efficient prediction of the level of alcohol and marijuana. Self-coding is efficient and may be useful for reducing ambiguities in coding of many different kinds of open-ended responses.     

Object-based warping: an illusory distortion of space within objects

Visual objects are high-level primitives that are fundamental to numerous perceptual functions, such as guidance of attention. We report that objects warp visual perception of space in such a way that spatial distances within objects appear to be larger than spatial distances in ground regions. When two dots were placed inside a rectangular object, they appeared farther apart from one another than two dots with identical spacing outside of the object. To investigate whether this effect was object based, we measured the distortion while manipulating the structure surrounding the dots. Object displays were constructed with a single object, multiple objects, a partially occluded object, and an illusory object. Nonobject displays were constructed to be comparable to object displays in low-level visual attributes. In all cases, the object displays resulted in a more powerful distortion of spatial perception than comparable non-object-based displays. These results suggest that perception of space within objects is warped.     

Patient and health care provider views of depressive symptoms and diabetes in American Samoa

High Type 2 diabetes prevalence, associated with recent cultural changes in diet and physical activity, characterizes the U.S. territory of American Samoa. Comorbid diabetes and depression rates are high worldwide and contribute to negative diabetes outcomes; these rates have not been assessed in American Samoa. In this study, 6 focus groups were conducted with 39 American Samoan adults with diabetes; questions on perceptions of diabetes and depressive symptoms were included. Thirteen health care staff interviews were conducted to gain insight into diabetes care in American Samoa. Focus groups and health care staff interviews were translated, transcribed, and entered into NVivo 8 to facilitate analysis. Thematic analysis showed that diabetes patients saw depressive symptoms as directly contributing to high blood sugar. However, these symptoms were rarely mentioned spontaneously, and providers reported they seldom assess them in patients. Many patients and health care staff believed the best ways to respond to feelings of depression involved relaxing, leaving difficult situations, or eating. Staff also discussed cultural stigma associated with depression and the importance of establishing rapport before discussing it. Health care providers in American Samoa need training to increase their awareness of depressive symptoms' negative impact on diabetes management in patients who screen positive for depression. All providers must approach the subject in a supportive context after establishing rapport. This information will be used for cultural translation of a community health worker and primary care-coordinated intervention for adults with diabetes in American Samoa, with the goal of creating an effective and sustainable intervention.     

Predicting preference for items during periods of extended access based on early response allocation

Top‐ranked items were identified during 30‐min free‐operant preference assessments for 9 individuals. Data from each session were analyzed to identify the item (a) that was engaged with first in each session and (b) to which the most responding was allocated after 5 min, 10 min, 15 min, 20 min, and 25 min had elapsed in each session. The results indicated that the first‐engaged item and the 5‐min high‐allocation item predicted the top‐ranked item in 55% and 62% of the sessions, respectively. The results also showed that engagement with the top‐ranked item from the first session decreased across subsequent sessions for 6 of the 9 participants. The implications of the results for brief versus extended stimulus preference assessments are discussed.     

Comparison of brain activation during word retrieval done silently and aloud using fMRI

Using functional MRI we compared the patterns of activation in an effortful word retrieval task (stem completion) performed both silently and aloud. The silent and overt conditions showed expected differences in activation magnitude in regions such as primary motor cortex. Some regions, such as frontal operculum and dorsolateral frontal cortex, showed similar activation magnitude across conditions. Thalamus was more active on the left in both conditions and showed a symmetric drop in activity in the silent compared with the overt condition. Putamen was also more active in the overt condition and showed a larger decrease in activity on the right than on the left in the silent compared with the overt condition. Thus it appears that silent and overt performance of this task engage the thalamus and putamen in different ways.     

Gone Today but here Tomorrow: Extending the Unfolding Model of Turnover to Consider Boomerang Employees

Turnover research typically views voluntary turnover as an end state that severs the employment relationship permanently. However, this perspective overlooks the possibility that an employee who quits may return in the future. Anecdotal and empirical evidence suggest that these “Boomerangs” can be a valuable staffing resource for their organizations. Yet, research regarding this type of employee is largely absent. Thus, we know little about whether the experiences of these temporary leavers differ from those who leave an organization permanently. In this paper, we examined differences between Boomerangs (employees who quit but are later rehired) and “Alumni” (employees who quit but will not return) using both qualitative and quantitative data. In a large sample of professional service employees, we found that Boomerangs and Alumni reported different reasons for having quit, which meant they were more likely to be classified on different paths in the unfolding model of turnover. In addition, survival analyses on the time to turnover suggest that Boomerangs quit earlier than Alumni in their original tenure, paradoxically suggesting that employees who quit earlier may be the very employees who will return in the future. Together, our findings suggest an extension to the unfolding model that considers how the timing of and reasons for turnover impact post‐turnover (return) decisions.     

Miami Thrives: Weaving a Poverty Reduction Coalition

In an environment where community based organizations are asked to do increasingly more to alleviate the effects of complex social problems, networks and coalitions are becoming the answer for increasing scale, efficiency, coordination, and most importantly, social impact. This paper highlights the formation of a poverty reduction coalition in south Florida. Our case study approach chronicles a developing coalition in Miami-Dade County and the role of one organization acting as lead to the initiative. Drawing on interviews with lead organization staff, participant observation field notes, network mapping and analysis of documents and artifacts from the initiative, we analyze the local organizational context and illuminate important processes associated with supporting a developing coalition. Findings offer a picture of the interorganizational relationships in the community using social network analysis and identify the organizational capacity factors that contribute to and inhibit the formation of a cohesive and effective coalition in this context. This study also highlights the utility of an action research approach to organizational learning about coalition-building in such a way that informs decision making.