Predictors of Length of Stay Among Youths Hospitalized in State Hospitals in Illinois

Using data from the Integrated Database on Children and Family Services in Illinois, we examined factors associated with the length of psychiatric hospitalization of youths in state hospitals between July 1, 1987 and June 30, 1992. Univariate analysis indicated that those diagnosed with attention deficit, psychotic, and conduct disorder experienced longer hospitalizations. In contrast, youths diagnosed with depressive disorders, drug and alcohol disorders, and adjustment disorders had shorter hospitalizations. Youths receiving services from multiple sectors of the human service delivery system experienced longer hospitalizations. Youths living in communities with state hospital linked community-based mental health services had shorter hospitalizations. Males experienced longer hospitalizations than females and African American youths experienced longer hospitalizations than White youths. Hispanic youths experienced shorter stays than either White or African American youths. The proportional hazards model indicated that being female, a history of previous admissions, multiservice use, and dangerousness were all associated with the decreased likelihood of discharge. Psychotic, attention deficit, and bipolar disorders were also associated with a decreased likelihood of hospital discharge. Youths with depressive disorders and African Americans with psychotic disorders had an increased likelihood of discharge. Increased age was also associated with the increased likelihood of discharge.     

Probability matrix decomposition models

In this paper, we consider a class of models for two-way matrices with binary entries of 0 and 1. First, we considerBoolean matrix decomposition, conceptualize it as alatent response model (LRM) and, by making use of this conceptualization, generalize it to a larger class of matrix decomposition models. Second,probability matrix decomposition (PMD) models are introduced as a probabilistic version of this larger class of deterministic matrix decomposition models. Third, an algorithm for the computation of the maximum likelihood (ML) and the maximum a posteriori (MAP) estimates of the parameters of PMD models is presented. This algorithm is an EM-algorithm, and is a special case of a more general algorithm that can be used for the whole class of LRMs. And fourth, as an example, a PMD model is applied to data on decision making in psychiatric diagnosis. This paper is based on a chapter of the first author's doctoral dissertation, written at the University of Leuven and supervised by Paul De Boeck.     

A MULTIPLE-BASELINE ANALYSIS OF SOCIAL-SKILLS TRAINING IN CHRONIC SCHIZOPHRENICS

Social-skills training was applied to two male chronic schizophrenics. Component behaviors of social skill requiring modification were identified for each patient by rating videotapes of role-played interactions. Training involved instructions and feedback for one subject and instructions, feedback, and modelling for the second. Target behaviors were treated sequentially and cumulatively in a multiple-baseline format. Training was applied for both positive and negative assertion and for situations involving males and females. The results were positive for all behaviors for both patients. Follow-ups at 2, 4, 6, and 8 weeks after training indicated that most effects were maintained at near-treatment levels.     

Clinical cutoffs for the beck Depression inventory and the Geriatric Depression scale with older adult psychiatric outpatients

The present study developed new clinical cutoffs for the Beck Depression Inventory (BDI) and the Geriatric Depression Scale (GDS) with 59 older adult psychiatric outpatients. Maximum discrimination of a current major depressive episode resulted, with cutoff scores of 22 for the BDI and 16 for the GDS. Specifically, the following validity scores emerged for the BDI: sensitivity, 64%; specificity, 73%; positive predictive power, 75%; negative predictive power, 61%; and hit rate 68%. For the GDS the validity scores were as follows: sensitivity, 79%; specificity, 69%; positive predictive power, 77%; negative predictive power, 72%; and hit rate, 75%. Combined BDI and GDS scores did not result in improved prediction of a current major depressive episode as compared to the GDS alone. These results support the notion that the BDI and GDS are valid quick screening instruments in discriminating a current major depressive episode for older adult psychiatric outpatients.     

Primary prevention of secondary disorders: A proposal and agenda

This paper calls for consideration of a new class of preventive interventions designed explicitly to prevent comorbidity of psychiatric disorders. Epidemiologic data show that successful interventions of this type could be extremely valuable, as up to half of lifetime psychiatric disorders and an even larger percent of chronic and seriously impairing disorders occur to people with a prior history of some other disorder. Furthermore, a review of etiologic hypotheses concerning the causes of comorbidity suggests that interventions aimed at primary prevention of secondary disorders might be feasible. However, more basic risk factor research is needed on the causes of comorbidity before we can make a clear assessment of feasibility and discover promising intervention targets. A number of methodological problems arise in carrying out this type of formative research. These problems are reviewed and suggestions are offered for solutions involving innovations in measurement, design, and data analysis.     

Psychiatric Diagnoses and Clinical Characteristics of Asian American Youth in Children's Services

This study examined the psychiatric diagnoses and clinical characteristics of the 981 Asian American children enrolled in the first phase of the Comprehensive Community Mental Health Services for Children and Their Families Program. Asian Americans were less likely than non- Asian Americans to receive diagnoses of depression and ADHD and more likely to receive diagnoses of anxiety and adjustment disorder. As compared to non-Asians, Asian Americans were significantly more likely to be rated with severe functional impairment in community role performance, self-harmful behavior, and thinking. There was also a trend for fewer externalizing behavior problems. Implications for research and practice are discussed.     

Impact of Conflict on Mental Health in Northern Ireland: The Mediating Role of Intergroup Forgiveness and Collective Guilt

The aim of the present research was to investigate the mediating role of group-level forgiveness and guilt in the relationship between victimhood (the extent to which the conflict affected an individual's life), exposure to violence (the level of violence in their area of residence), and group identity on the one hand, and mild psychiatric morbidity on the other. Specifically the study focused on the psychological impact of the ethnopolitical conflict in Northern Ireland, utilizing people's identification with either the Catholic or Protestant community. Our results revealed that intergroup forgiveness mediated the relationship between both victimhood and group identification, as predictors, and mild psychiatric morbidity. Collective guilt, on the other hand, mediated the relationship between both exposure to violence and group identification, as predictors, and intergroup forgiveness. Overall this study shows that forgiveness and collective guilt can act as mediators in the relationship between impact of ethnopolitical conflict and mental health, at the group level, and thus demonstrates their centrality to the reconciliation process. Implications for intergroup reconciliation initiatives in Northern Ireland are discussed.     

唐山市三甲医院住院费用的灰色关联分析

利用灰色关联分析方法探索引起“看病贵”的主要因素,并提出有效的策略和措施。以唐山市2所三甲医院2004年出院的800名住院患者的医疗费用为研究对象,利用灰色关联分析法进行分析。提出灰色关联模型更加科学和合理;药费是造成外科疾病医疗费用过高的关键因素;需进一步改革医疗服务价格体系。     

Abuse Experiences in a Community Sample of Young Adults: Relations with Psychiatric Disorders, Sexual Risk Behaviors, and Sexually Transmitted Diseases

This study documents significant associations among lifetime abuse experiences, psychiatric diagnoses, and sexual risk behaviors in a multiethnic community sample of young men and women (N = 1803) in South Florida. Self-report data were collected via structured interviews as part of a longitudinal follow-up of a larger school-based study. Participants were grouped according to extent of lifetime abuse experiences. Cumulative lifetime abuse experiences were associated with increased risk for a broad range of individual lifetime psychiatric disorders, as well as cumulative lifetime psychiatric disorders. Both cumulative abuse experiences and cumulative psychiatric disorders were independently associated with (a) higher levels of sexual risk behaviors and (b) higher risk for lifetime sexually transmitted diseases (STDs). Implications for selective prevention of sexual risk behaviors and STDs among young adults with histories of abuse and psychiatric disorders are discussed.     

Chapter 4. The Intervention Process

Abstract

The qualitative research methods used by the author to study one parent-child activity group are shared. This qualitative research study documented what the participants of a parent-child activity group on a child psychiatric inpatient unit reported about their experiences with each other and how these participants interacted with each other in the group over the course of eight months. The group was studied through