An investigation of the effects of comorbid Axis II pathology on outcome of inpatient treatment for unipolar depression

DSM-based research on comorbidity has suggested thatdepression andpersonality disorder frequently occur together and that the combination of syndromes is associated with a poor response to treatment for depression. The present study was designed to explore the effect of comorbid Axis II pathology for a sample of 45 inpatients who received treatment for major depression. Both categorical and dimensional ratings of personality disorder were used in the statistical analysis. Positive categorical diagnosis of Cluster C (anxious-avoidant) disorder, as well as higher dimensional rating of Cluster A (odd-eccentric) pathology, was predictive of a poor response to treatment (p<.05), as measured by change in pre-post clinical ratings on the Montgomery-Asberg Depression Rating Scale. These results were construed as indicative of a significant Axis II comorbidity effect in the context of an inpatient, multimodal treatment setting for depression. The results also spotlight the influence of techniques of measurement in determining the outcome of statistical analysis.     

Selective mutism in children: A structural family therapy approach to treatment

When children refuse to speak in some social settings, but can understand and speak in other settings, the diagnosis of selective mutism must be considered. A review of the literature describes the disorder, the various types of mutism, and related family dynamics. A family systems approach to treatment using structural family therapy is suggested. The case history presented illustrates one type of mutism as well as the family rules and hierarchy which appeared to be maintaining it. Structural and strategic family systems theory techniques that were used to move the family toward resolution of this problem are discussed.Diane Wolf Tatem, MA, MS, completed graduate work in marriage and family therapy at New Mexico State University, Las Cruces, NM. She is employed at Life Management Center of El Paso's Child Development Services and also has a private practice in marriage and family therapy in El Paso, Texas. Robert L. DelCampo, PhD is a professor of family science at New Mexico State University and maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, NM. Please address all correspondence to Dr. DelCampo at Box 3470, New Mexico State University, Las Cruces, NM, 88003-3470.Appreciation is expressed to Dr. Charles Huber, New Mexico State University in Las Cruces, for his insightful critique of the final draft of this paper. This paper was presented at the Texas Association for Marriage and Family Therapy Annual Conference, January 25–29, 1995 in Dallas, TX.     

Analysis of long-term stress reactions in emergency room patients: An initial study

The psychological stress reactions of 44 family medicine patients who were treated in the emergency room were examined approximately a year after the event. Patients were assessed on several psychological measures, including one for posttraumatic stress disorder (PTSD), and on their perception of how stressful the event was initially and now. Results show continuing stress reactions related to the emergency room event. Three patients endorsed symptoms indicating full PTSD and 13 appeared to have at least partial PTSD. Age appeared to be a factor in the presence of stress symptoms and in degree of perceived communication with the physician.     

Differences in occupational stress in three European countries

In this study, the reliabilities of the Dutch translation of the Occupational Stress Inventory, which is based on the theory of Cooper (Cooper & Marshall, 1976), was investigated. The sample comprised 436 nurses. A comparison is made of the individual and job satisfaction stress levels of Dutch and British nurses (N = 546), and of British managers (N =123) and German managers (N =133). The differences in the reliabilities of the Dutch version, compared to the British and German, are small. The differences between the stress and satisfaction scores are found to be greater between occupational groups than between nations.     

Perceived stressors and stress responses among hospital-based nursing trainees

Perceived sources and levels of stress were assessed with a rating scale describing the experience of stressors and stress responses and an unstructured self-report about the reasons of such ratings in 60 nursing students in their first and final year of hospital training. The results, which show a significantly higher report of stress in the latter group, also point to identifiable sources of stressors in hospital-based nursing training procedures. Several recommendations to alleviate these conditions are discussed.     

Differential effects of cognitive behavior modification on seriously emotionally disturbed adolescents exhibiting internalizing or externalizing problems

This study examined the differential effects of a school-based cognitive behavior modification intervention on (a) the interpersonal/social skills and (b) the social competence and school adjustment of two groups of middle school students identified as seriously emotionally disturbed. One groups of students exhibited internalizing emotional problems and the other group exhibited externalizing emotional problems. The objective of the study was to investigate whether the effectiveness of a school-based cognitive behavior modification intervention was significantly related to the type of emotional disturbance a student exhibits (i.e. internalizing or externalizing emotional disturbance). The sample consisted of an experimental and a control group of middle school students identified as seriously emotionally disturbed. The intervention was implemented in 23 biweekly 42-minute sessions. The results indicated that teacher ratings of student social competence and school adjustment were sensitive to treatment effects, although students' social skills self-ratings were not significantly affected by the treatment. A differential treatment effect was established in that externalizing students were significantly more responsive than internalizing students.     

Parenting stress in parents of children with attention-deficit hyperactivity disorder and parents of children with learning disabilities

Parenting a child with ADHD can challenge parenting resources and coping. Increasingly, researchers are examining the relationship between the behavior of the child with ADHD and family functioning. While studies have shown inceased parenting stress in parents of children with ADHD, these studies have compared children with ADHD to non-disabled children. This study compares reports of parenting stress among mothers of children with ADHD, mothers of children with learning disabilities and mothers of non-referred children. Results showed that parenting stress was highest for mothers of children with ADHD. Increased parenting stress was associated with child characteristics and, in particular, with externalizing behavior problems.     

Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study

Studies that have found an association between unemployment and psychological depression often fail to establish the direction of causal influence. Analyses of Epidemiologic Catchment Area panel data revealed that of employed respondents not diagnosed with major depression at first interview, those who became unemployed had over twice the risk of increased depressive symptoms and of becoming clinically depressed as those who continued employed. Although the increase in symptoms was statistically significant, the effect on clinical depression was not, possibly because of the low power of the test. The reverse causal path from clinical depression at Time 1 to becoming unemployed by Time 2 was not supported. The unemployment rate in the respondent's community at time of interview was not related directly to psychological depression but appeared associated indirectly with depression via its impact on the risk of becoming unemployed. Implications for policy and further research were discussed. The research described in this paper was supported by Grant #5 RO1 AA08379-02 from the National Institute of Alcohol Abuse and Alcoholism. The authors appreciate the suggestions provided by members of the Consortium for Research Involving Stress Processes sponsored by the W. T. Grant Foundation and by two anonymous journal reviewers.     

An extension of the partial credit model with an application to the measurement of change

The partial credit model is considered under the assumption of a certain linear decomposition of the item × category parameters _ih into basic parameters _j. This model is referred to as the linear partial credit model. A conditional maximum likelihood algorithm for estimation of the j is presented, based on (a) recurrences for the combinatorial functions involved, and (b) using a quasi-Newton approach, the so-called Broyden-Fletcher-Goldfarb-Shanno (BFGS) method; (a) guarantees numerically stable results, (b) avoids the direct computation of the Hesse matrix, yet produces a sequence of certain positive definite matricesB _k ,k=1, 2, ..., converging to the asymptotic variance-covariance matrix of the . The practicality of these numerical methods is demonstrated both by means of simulations and of an empirical application to the measurement of treatment effects in patients with psychosomatic disorders.The authors thank one anonymous reviewer for his constructive comments. Moreover, they thankfully acknowledge financial support by the Österreichische Nationalbank (Austrian National Bank) under Grant No. 3720.     

A spanish translation and validation of the daily stress inventory and a comparison of the level of stress experienced by three culturally distinct hispanic groups

Two studies were conducted, the first to establish a valid Spanish version of the Daily Stress Inventory (DSI). A second study was conducted using the bilingual version of the DSI to assess differences in the level of stress experienced by three selected Hispanic groups: (a) very Hispanic/Hispanic-oriented bicultural, (b) true bicultural, and (c) Anglo-oriented bicultural/very Anglicized as determined by the adapted version of the Acculturation Rating Scale for Mexican Americans (ARSMA). It was expected that stress levels would be highest for the least acculturated group. The results of the first study indicate that the Bilingual DSI scores are highly correlated with the scores of the original DSI when both instruments are responded to simultaneously by fully bilingual individuals. In Study 2, the initial data analyses showed no difference in the level of stress reported by Hispanics at different levels of acculturation as measured by the ARSMA. When a median-split method was employed, differences in the DSI I/E measures between the two groups were significant, suggesting that acculturation level may be related to stress level.