Perceived stigma and depression among caregivers of patients with bipolar disorder.

This study investigates the associations between perceived stigma, depressive symptoms and coping among caregivers of people with bipolar disorder. Caregivers of 500 people with DSM-IV bipolar disorder responded to measures of these constructs at study entry. Patients' clinical and functional status were evaluated within 30 days of the caregiver assessment. Perceived stigma was positively associated with caregiver depressive symptoms, controlling for patient status and socio-demographic factors. Social support and avoidance coping accounted for 63% of the relationship between caregiver stigma and depression. Results suggest that caregivers' perceptions of stigma may negatively affect their mental health by reducing their coping effectiveness.

Family connections: a program for relatives of persons with borderline personality disorder.

This study assessed changes in family members who participated in Family Connections, a 12-week manualized education program for relatives of persons with borderline personality disorder (BPD). Family Connections, led by trained family members, is based on the strategies of standard Dialectical Behavior Therapy (DBT) and DBT for families. The program provides (a) current information and research on BPD, (b) coping skills, (c) family skills, and (d) opportunities to build a support network for family members. Forty-four participants representing 34 families completed the pre-, post-, and 6-month postbaseline self-report questionnaires. Analyses employing hierarchical linear modeling strategies showed significant reductions in grief and burden, and a significant increase in mastery from pre- to post-group assessment. Changes were maintained at 6 months post baseline.

Developing a scale for measuring professional equity among Canadian physicians.

This paper reports on progress made in defining and measuring the concept of professional equity through the development of a summative measure of professional equity and three of its components: financial, intrinsic and recognition equity. The study sample consisted of a stratified sample of 8375 Canadian physicians with usable responses from 2749 (32.8%). Following preliminary components analysis, items were grouped into constructs. Reliability of the constructs was then determined using Cronbach's alpha and total inter-item correlations followed by confirmatory factor analysis. A summary scale using all 15 equity items yielded a reliability: Cronbach's alpha=0.86. The sub-scales reliabilities were: financial equity (Cronbach's alpha=0.91); intrinsic equity (Cronbach's alpha=0.86); and recognition equity (Cronbach's alpha=0.70). The professional equity measures reported are therefore capable of assessing different aspects of equity and represent an advance over more general effort-reward scales or those that only measure the range of rewards.

Impact of family burden and affective response on clinical outcome among patients with bipolar disorder.

OBJECTIVE: This study evaluated the direct and indirect effects of family burden and affective response on medication adherence and outcome among patients with bipolar disorder. METHODS: Data were examined for 126 patients who were consecutively admitted to the psychiatric service at a university-affiliated hospital and who met research diagnostic criteria for bipolar I or II disorder or for schizoaffective disorder, manic type, and their family caregivers. A total of 101 pairs of patients and family caregivers (80 percent) completed 15 months of study and were included in the analyses. Patients and their identified caregivers were assessed within two weeks of either discharge from the index inpatient admission or initiation of outpatient treatment (baseline assessment). Patients and caregivers were also assessed seven and 15 months after the baseline assessment. Structural equation modeling was used to evaluate caregivers' influences on patients' medication adherence seven months after baseline and on clinical outcome 15 months after baseline. RESULTS: The indexes of overall fit for the path model confirmed the a priori measurement model. Significant paths were found from the caregiver's perceived burden at baseline to the caregiver's emotional overinvolvement at baseline, from the caregiver's emotional overinvolvement at baseline to the patient's medication adherence at the seven month follow-up, and from the patient's medication adherence at the seven-month follow-up to the patient's outcome at the 15-month follow-up. The paths from the caregiver's perceived burden at baseline to the patient's medication adherence seven months after baseline and the patient's outcome 15 months after baseline were not significant. CONCLUSIONS: When caregivers of patients with bipolar illness experience a high burden, patient outcome is adversely affected. This relationship is mediated through families' affective response and patients' medication adherence.

Posttraumatic stress disorder and treatment seeking in a national screening sample.

The behavioral model of service use was employed to identify predictors of mental health treatment seeking and treatment readiness among individual with PTSD (N = 2,713) in data from the 1996 National Anxiety Disorders Screening Day (NADSD). This model examines the contribution of predisposing (age, sex, marital status, race/ethnicity, education), enabling (employment, geographic location), perceived need (interference of symptoms with daily life), and evaluated need (other diagnoses) factors to treatment seeking and treatment readiness for individuals with PTSD. Results indicate that although need factors (interference by anxiety symptoms with daily life, diagnosis of panic disorder) are related to both receiving and readiness for treatment, predisposing (age, marital status, minority race) factors influence which individuals receive treatment for PTSD.

Internal validity of an anxiety disorder screening instrument across five ethnic groups.

We tested the factor structure of the National Anxiety Disorder Screening Day instrument (n=14860) within five ethnic groups (White, Black, Hispanic, Asian, Native American). Conducted yearly across the US, the screening is meant to detect five common anxiety syndromes. Factor analyses often fail to confirm the validity of assessment tools' structures, and this is especially likely for minority ethnic groups. If symptoms cluster differently across ethnic groups, criteria for conventional DSM-IV disorders are less likely to be met, leaving significant distress unlabeled and under-detected in minority groups. Exploratory and confirmatory factor analyses established that the items clustered into the six expected factors (one for each disorder plus agoraphobia). This six-factor model fit the data very well for Whites and not significantly worse for each other group. However, small areas of the model did not appear to fit as well for some groups. After taking these areas into account, the data still clearly suggest more prevalent PTSD symptoms in the Black, Hispanic and Native American groups in our sample. Additional studies are warranted to examine the model's external validity, generalizability to more culturally distinct groups, and overlap with other culture-specific syndromes.

Helpseeking and access to mental health treatment for obsessive-compulsive disorder.

OBJECTIVE: To identify predictors of helpseeking and use of mental health treatment for obsessive-compulsive disorder (OCD) using the behavioral model of health service use. METHOD: Data were drawn from the 1996 National Anxiety Disorders Screening Day. Participants (n=14 860) completed screening measures providing information about demographics, mental disorders, helpseeking, and treatment experiences for OCD. RESULTS: Previous use of mental health treatment was associated with comorbid panic disorder [odds ratio (OR)=1.6 (1.3-1.98)], while minority racial status [OR=0.7 (0.5-0.9)] emerged as a barrier to receiving care among individuals with OCD. Among those who had never received mental health care, comorbid panic disorder [OR=2.0 (1.5-2.8)], post-traumatic stress disorder [OR=1.7 (1.3-2.4)], and suicidal ideation [OR=1.7 (1.2-2.3)] increased readiness to seek treatment while being employed [OR=0.7 (0.5-0.9)], and feeling one could handle the problem on his/her own [OR=0.5 (0.3-0.7)] decreased readiness to seek help for the first time. CONCLUSION: These data suggest that access to treatment for OCD may not be equally accessible to all in need by revealing non-disease related factors (e.g. race, health beliefs) that have a significant impact on decisions to seek and use mental health treatment.