Predictors of Client Attrition in a University-Based Community Counseling Clinic

The purpose of this study was to investigate how symptom distress, social role, interpersonal relationships, gender, age, number of supports, and education level predict client attrition in a community sample. Using binary logistic regression and cross-sectional data, the authors examined the predictive impact of 8 variables on adult client attrition in a university-based community counseling clinic. Results indicated that education level, interpersonal relationships, and number of supports significantly predicted attrition. In this sample, gender, age, symptom distress, social role, and race did not significantly predict attrition. Implications for clinical assessment and counseling practice are discussed.     

Battered women's coping strategies and psychological distress: differences by immigration status

People are rarely passive, and battered women are no exception. This study investigated the types of coping strategies women of Japanese descent (both Japan-born and U.S.-born) chose and their perceived effectiveness in dealing with their partners' violence. Japan-born respondents were significantly less likely to use active strategies and perceived them to be less effective than did U.S.-born respondents. For the Japan-born, the more effective they perceived active strategies, the higher their psychological distress, whereas the more effective they perceived passive strategies, the lower their psychological distress. In contrast, for the U.S.-born, the higher the perceived effectiveness of active strategies, the lower their psychological distress, and the perceived effectiveness of passive strategies had little effect on their psychological distress. The complex relationship between individuals' country of birth, the choice and perceived effectiveness of coping strategies, and psychological distress calls for increased attention to the role of culture in studies of coping and domestic violence.     

Partner Violence, Social Support, and Distress Among Inner-City African American Women

This study examined the role of social support in the partner violence–psychological distress relation in a sample of African American women seeking medical care at a large, urban hospital (n = 138). Results from bivariate correlational analyses revealed that partner violence was related to lower perceived social support and greater psychological distress, and lower social support was related to more distress. Furthermore, findings based on path analysis indicated that low levels of social support helped account for battered women's increased distress. Findings point to the need for service providers to screen for partner violence in nontraditional sites, such as hospital emergency rooms, and to address the role of social support resources in preventive interventions with African American battered women.     

Predictive Genetic Testing for Hereditary Breast and Ovarian Cancer: Psychological Distress and Illness Representations 1 Year Following Disclosure

This prospective study evaluates emotional functioning and illness representations in 68 unaffected women (34 carriers/34 noncarriers) 1 year after predictive testing for BRCA1/2 mutations when offered within a multidisciplinary approach. Carriers had higher subjective risk perception of breast cancer than noncarriers. Carriers who did not have prophylactic oophorectomy had the highest risk perception of ovarian cancer. No differences were found between carriers and noncarriers regarding perceived seriousness and perceived control of breast and ovarian cancer. Mean levels of distress were within normal ranges. Only few women showed an overall pattern of clinically elevated distress. Cancer-specific distress and state-anxiety significantly decreased in noncarriers from pre- to posttest while general distress remained about the same. There were no significant changes in distress in the group of carriers except for ovarian cancer distress which significantly decreased from pre- to posttest. Our study did not reveal adverse effects of predictive testing when offered in the context of a multidisciplinary approach.     

Pathways of Economic Influence on Adolescent Adjustment

An important part of a science aimed at the prevention of human dysfunction involves the development of empirically based models that identify processes of risk for or protection from emotional distress or behavioral problems over time. The present study developed and evaluated such a model that proposed two pathways through which family economic pressure was expected to influence change in adolescent internalizing symptoms (depression and anxiety) during the period from the eighth to the tenth grades. A total of 377 rural families in a midwestern state provided data for the analyses. The results were generally consistent with the conceptual model in that family economic pressure increased adolescent perceptions of family economic hardship, which, in turn, reduced the adolescent's sense of control or mastery over time. Lowered mastery was associated with increases in emotional distress. Also consistent with the model, prior levels of mastery appeared to reduce the magnitude of economic stress experienced by the adolescent, whereas prior emotional distress intensified the economic stress process. Although gender differences were found in these processes, the overall pattern of results suggests that girls and boys are both at risk for internalizing problems when families experience economic pressure. Implicatios of the findings for the dvelopment of effective preventive interventions with financially stressed families in rural areas are discussed.     

Coping and emotional distress in a sample of Swedish unemployed.

The study investigated the associations between coping and symptoms of emotional distress within a sample of 166 unemployed men and women (mean age 40 +/- 10 years, range 22 to 63 years, 52% males). All variables were measured with a questionnaire comprising sociodemographic background, length of unemployment, financial strain, coping style ("Ways of Coping Checklist"), and emotional distress (Hopkins Symptom Check List-25). Emotional distress was positively related to financial strain and more common among younger subjects, divorced subjects and those with foreign background, but less frequent among subjects who had been unemployed for more than three years. After controlling for age, gender, education, foreign background, length of unemployment and financial strain, hierarchical regression analyses showed that emotion-focused coping, i.e. self-blame and wishful thinking, was positively related to emotional distress. Problem-focused coping and cognitive restructuring were negatively associated with emotional distress. Younger subjects and divorced subjects made frequent use of both emotion-focused and problem-focused coping. Female subject and subjects with mandatory school made frequent use of emotion focused coping, if exposed to high financial strain. Problem-focused coping was less frequent among subjects with a low education coupled with low financial strain. Cognitive restructuring was less common among subjects who had been unemployed for more than three years. Younger subjects who were also divorced made less use of both problem-focused coping and cognitive restructuring. The results confirm that coping style has importance for the mental health of the unemployed, and indicate a differential use of coping strategies among subjects with different sociodemographic backgrounds and different levels of financial strain.     

Subtypes of severe psychological distress among US Air Force remote warriors: A latent class analysis

US Air Force remote warrior personnel include a range of military personnel composed of remotely piloted aircraft aircrew, intelligence operators, and cyber warfare operators. Job duties in these professions entail long work hours, rotating shifts, and regular engagement in combat operations. Although research has identified a number of factors correlated with elevated burnout and emotional distress in this population, little is known about the unique needs of discrete subgroups of distressed personnel. In a sample of 7,550 US Air Force remote warriors, results of latent class analysis yielded four distinct classes. Three of the four reported moderately elevated burnout and job dissatisfaction but differed with respect to demographics and development career stage. The fourth group reported significantly higher levels of emotional distress, burnout, job dissatisfaction, and problems in living. This latter group was comparable to the mid-career group with respect to demographics, although this group had much lower levels of responsibility and indicators of career advancement. Results suggest that, among remote warrior personnel, there are several subtypes of elevated emotional distress. Prevention and intervention strategies that are matched to each subtype may yield better occupational and mental health outcomes than universal, “one size fits all” strategies.     

Distress tolerance but not impulsivity predicts outcome in concurrent treatment for posttraumatic stress disorder and substance use disorder

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) commonly co-occur. Emerging research suggests that both distress tolerance and impulsivity may underlie this comorbidity. However, to our knowledge no studies have examined whether these 2 constructs predict outcome in PTSD-SUD treatment. The current study investigated whether pretreatment distress tolerance and impulsivity predicted posttreatment PTSD and cravings severity in a sample of 70 Veterans receiving concurrent treatment for PTSD and SUD in a residential day treatment program. Veterans completed measures of symptom severity before and after treatment. Results demonstrated that pretreatment distress tolerance predicted posttreatment PTSD severity while controlling for pretreatment PTSD. By contrast, pretreatment impulsivity was not predictive of posttreatment PTSD while controlling for pretreatment values. Neither distress tolerance nor impulsivity predicted posttreatment cravings severity. The findings support the notion that distress tolerance may help to explain the co-occurrence of PTSD and SUD and suggest that targeting this construct in PTSD-SUD treatment may be important for successful outcomes.