Conversations for Connection: An Outcome Assessment of the Hold-Me-Tight Relationship-Education Program, and Recommendations for Improving Future Research Methodology in Relationship Education.

The Hold Me Tight (HMT) program is a new approach to relationship education based on Emotionally-Focused Therapy (Johnson, 2004), an evidence-based approach to couple therapy. In this exploratory longitudinal research, we examined individual growth in relationship satisfaction and trust for partners in 95 couples in 16 HMT groups across four occasions of measurement: Baseline, Pre-Program, Post-Program and at either 3- or 6-month Follow-Up. We found that relationship satisfaction and trust increased during program participation, and declined during follow-up. We believe our findings provide support for the short-term effectiveness of the HMT program, and suggest a longer period of program delivery may result in improved retention of gains. Finally, we present recommendations for improving the design of future longitudinal research in relationship education.

High-School Exit Examinations and the Schooling Decisions of Teenagers: Evidence From Regression-Discontinuity Approaches.

We examine whether barely failing one or more state-mandated high school exit examinations in Massachusetts affects the probability that students enroll in college. We extend the exit examination literature in two ways. First, we explore longer term effects of failing these tests. We find that barely failing an exit examination, for students on the margin of passing, reduces the probability of college attendance several years after the test. Second, we explore potential interactions that arise because students must pass exit examinations in both mathematics and English language arts in order to graduate from high school. We adopt a variety of regression-discontinuity approaches to address situations where multiple variables assign individuals to a range of treatments; some of these approaches enable us to examine whether the effect of barely failing one examination depends on student performance on the other. We document the range of causal effects estimated by each approach. We argue that each approach presents opportunities and limitations for making causal inferences in such situations and that the choice of approach should match the question of interest.

Efforts to Promote Reintegration and Rehabilitation of Traumatized Former Child Soldiers: Reintegration of Former Child Soldiers in Sierra Leone: The Role of Caregivers and Their Awareness of the Violence Adolescents Experienced During the War.

This article explores the role of caregivers in the reintegration of former child soldiers from Sierra Leone. Using data on 282 youth and their respective caregivers, our aim is to focus on the caregiver-child relationship after reintegration. We investigate the extent to which caregivers know about child soldiers' experiences of direct and indirect violence, as well as involvement in war activities. We further examine variables that might shape the degree of caregiver knowledge of child's war experiences. Finally, we examine if caregiver knowledge of war experiences is associated with child's psychosocial outcomes. Findings highlight the importance of developing thoughtful programs that consider the needs of the child in the context of the family and caregivers with whom he or she is reunified.

The impact of exposure to interpersonal violence on gender differences in adolescent-onset major depression: results from the National Comorbidity Survey Replication (NCS-R).

BACKGROUND: Beginning in adolescence, females are at significantly higher risk for depression than males. Despite substantial efforts, gaps remain in our understanding of this disparity. This study tested whether gender differences in adolescent-onset depression arise because of female's greater exposure or sensitivity to violence. METHODS: Data came from 5,692 participants in the National Comorbidity Survey Replication. Trained interviewers collected data about major depression and participants' exposure to four types of interpersonal violence (physical abuse, sexual assault, rape, and witnessing violence) using a modified version of the Composite International Diagnostic Interview. We used discrete time survival analysis to investigate gender differences in the risk of adolescent onset depression. RESULTS: Of the entire sample, 5.7% met DSM-IV criteria for depression by age 18; 5.8% of the sample reported being physically abused, 11.7% sexually assaulted, 8.5% raped, and 13.2% witnessed violence by age 18. Females had 1.51 times higher odds of depression by age 18 than males. Exposure to all types of violence was associated with an increased odds of depression in both the past year and the years following exposure. Adjusting for exposure to violence partially attenuated the association between gender and depression, especially for sexual assault (odds ratio [OR] attenuated = 1.28; 15.23%) and rape (OR attenuated = 1.32; 12.59%). There was no evidence that females were more vulnerable to the effects of violence than males. DISCUSSION: Gender differences in depression are partly explained by females' higher likelihood of experiencing interpersonal violence. Reducing exposure to sexual assault and rape could therefore mitigate gender differences in depression.

The assessment of school engagement: examining dimensionality and measurement invariance by gender and race/ethnicity.

The construct of school engagement has attracted growing interest as a way to ameliorate the decline in academic achievement and increase in dropout rates. The current study tested the fit of a second-order multidimensional factor model of school engagement, using large-scale representative data on 1103 students in middle school. In order to make valid model comparisons by group, we evaluated the extent to which the measurement structure of this model was invariant by gender and by race/ethnicity (European-American vs. African-American students). Finally, we examined differences in latent factor means by these same groups. From our confirmatory factor analyses, we concluded that school engagement was a multidimensional construct, with evidence to support the hypothesized second-order engagement factor structure with behavioral, emotional, and cognitive dimensions. In this sample, boys and girls did not substantially differ, nor did European-American and African-American students, in terms of the underlying constructs of engagement and the composition of these constructs. Finally, there were substantial differences in behavioral and emotional engagement by gender and by racial/ethnic groups in terms of second-order factor mean differences.

Trajectories of family management practices and early adolescent behavioral outcomes.

Stage-environment fit theory was used to examine the reciprocal lagged relations between family management practices and early adolescent problem behavior during the middle school years. In addition, the potential moderating roles of family structure and of gender were explored. Hierarchical linear modeling was used to describe patterns of growth in family management practices and adolescents' behavioral outcomes and to detect predictors of interindividual differences in initial status and rate of change. The sample comprised approximately 1,000 adolescents between ages 11 years and 15 years. The results indicated that adolescents' antisocial behaviors and substance use increased and their positive behavioral engagement decreased over time. As adolescent age increased, parental knowledge of their adolescent's activities decreased, as did parental rule making and support. The level and rate of change in family management and adolescent behavioral outcomes varied by family structure and by gender. Reciprocal longitudinal associations between parenting practices and adolescent problem behavior were found. Specifically, parenting practices predicted subsequent adolescent behavior, and adolescent behavior predicted subsequent parenting practices. In addition, parental warmth moderated the effects of parental knowledge and rule making on adolescent antisocial behavior and substance use over time.

Active matrix metalloproteinase-2 activity discriminates colonic mucosa, adenomas with and without high-grade dysplasia, and cancers.

Pathologic assessment of colorectal adenomas, a complex task with significant interobserver variability, typically defines the scheduling of surveillance colonoscopies after removal of adenomas. We have characterized the activity levels of pro-matrix metalloproteinase-2, active matrix metalloproteinase-2, and matrix metalloproteinase-9 in colorectal adenomas and carcinomas as potential markers of pathologic progression during colorectal tumorigenesis. Endogenous fully activated matrix metalloproteinase-2, in particular, has been studied less frequently in adenomas due to difficulties in detection. For this report, tissues (n = 119) from 51 individuals were extracted and assayed on gelatin zymograms with digital standardization to nanogram quantities of purified active controls. Resulting data were assessed by graphical and multinomial logit regression analyses to test whether matrix metalloproteinase-2 or matrix metalloproteinase-9 activities could discriminate among 4 different types of colorectal tissue (normal mucosa, adenomas with or without high-grade dysplasia, and invasive carcinomas). Active matrix metalloproteinase-2 successfully discriminated among these tissue categories. Median activity for active matrix metalloproteinase-2 increased in a stepwise fashion with pathologic progression from normal mucosa to adenoma without high-grade dysplasia to adenoma with high-grade dysplasia to cancer. Although pro-matrix metalloproteinase-2 and pro-matrix metalloproteinase-9 activities could discriminate to some extent among tissue categories, those effects did not contribute additional information. Active matrix metalloproteinase-2 activity correlated significantly with histopathologic assessment of colorectal tissues. The ability of active matrix metalloproteinase-2 to distinguish adenomas with high-grade dysplasia from adenomas without high-grade dysplasia may be particularly useful in predicting future colorectal cancer risk for an individual, thus optimizing scheduling of surveillance colonoscopies.

Does change in temperament predict change in schizoid personality disorder? A methodological framework and illustration from the Longitudinal Study of Personality Disorders.

Personality disorders (PDs) have been thought historically to be enduring, inflexible, and set in psychological stone relatively firmly; however, empirical findings from recent prospective multiwave longitudinal studies establish otherwise. Nearly all modern longitudinal studies of personality disorder have documented considerable change in PDs over time, suggesting considerable flexibility and plasticity in this realm of psychopathology. The factors and mechanisms of change in the PDs remain essentially opaque, and this area of PD research is just beginning to be probed using candidate predictors of change, such as personality systems. In this report, we investigate whether change in temperament dimensions (emotionality, activity, and sociability) predicts change in schizoid personality disorder. We present a latent growth framework for addressing this question and provide an illustration of the approach using data from the Longitudinal Study of Personality Disorders. Schizoid personality disorder was assessed using two different methodologies (structured psychiatric interview and self-report) and temperament was assessed using a well-known psychometric measure of temperament. All constructs were measured at three time points over a 4-year time period. To analyze these panel data, we fitted a covariance structure model that hypothesized simultaneous relationships between initial levels and rates of change in temperament and initial levels and rates of change in schizoid personality disorder. We found that rates of change in the core temperament dimensions studied do not predict rates of change in schizoid personality over time. We discuss the methodological advantages of the latent growth approach and the substantive meaning of the findings for change in schizoid personality disorder.

Active MMP-2 effectively identifies the presence of colorectal cancer.

Fully active MMP-2 is expressed at such low levels in human tissues that studies often fail to confirm its value as a cancer marker despite strong associations with malignancy. Our study utilized careful extraction, accurate activity measurements, standardization to purified controls and a new statistical metric to determine whether active MMP-2 is an effective indicator of colorectal cancer compared to pro-MMP-2 or pro-MMP-9. MMP-2 and MMP-9 activities were analyzed in matched normal and cancer samples from 269 patients by gelatin zymography, computer-assisted image analysis, serial dilutions of strong samples and standardization to controls. An index of effect size was designed for comparative evaluation of active MMP-2, pro-MMP-2 and pro-MMP-9 activities. For each gelatinase, mean activity and protein levels/mg soluble protein in normal mucosa and colorectal cancer were calculated for the first time with respect to commercial standards. Active MMP-2 activity, detected in 99% of colorectal cancers, was higher in 95% of cancers (on average 10-fold) than in normal mucosa. Levels of pro-MMP-2 and pro-MMP-9, but not active MMP-9, activities were also significantly higher in cancers versus normal. However, active MMP-2 activity provided the most effective test for the presence of cancer (p<0.0.0001) with an effect size statistically significantly larger than for either pro-MMP-2 or pro-MMP-9. Receiver operating characteristic (ROC) curves demonstrated that a cut-off for active MMP-2 of >44 SDU activity/mg soluble protein (>180 pg/mg), which is three times mean normal levels, would permit detection of colorectal cancer with an estimated sensitivity of 84% and estimated specificity of 93%.

Predicting individual change in personality disorder features by simultaneous individual change in personality dimensions linked to neurobehavioral systems: the longitudinal study of personality disorders.

Personality disorders (PDs), long thought to be immutable over time, show considerable evidence of individual change and malleability in modern prospective longitudinal studies. The factors responsible for the evident individual change in PDs over time, however, remain essentially unknown. A neurobehavioral model that posits negative emotion (NEM), nonaffective constraint (CON), communal positive emotion (PEM-C), and agentic positive emotion (PEM-A) as important systems underlying PD provides a theoretical basis for investigating predictors of change in PD features over time. Thus, in this study, the authors investigated how individual change in NEM, CON, PEM-C, and PEM-A over time predicted individual change in PD features over time, using longitudinal data on PD assessed by the International Personality Disorders Examination (A. W. Loranger, 1999), as well as data on normal personality features gathered within a 4-year prospective multiwave longitudinal study (N = 250). The authors used the method of latent growth modeling to conduct their analyses. Lower initial levels of PEM-C predicted initial levels of the growth trajectories for those with elevated Cluster A PD features. Elevated NEM, lower CON, and elevated PEM-A initial levels were found to characterize the initial levels of growth trajectories for those with increased Cluster B PD features. Interestingly, subjects with higher initial levels of PEM-A revealed a more rapid rate of change (declining) in Cluster B PD features over time. Elevated NEM and decreased PEM-C initial levels were found to characterize the growth trajectories for subjects with increased Cluster C PD features. The substantive meaning of these results is discussed, and the methodological advantages offered by this statistical approach are also highlighted.

Individual growth curve analysis illuminates stability and change in personality disorder features: the longitudinal study of personality disorders.

BACKGROUND: The long-term stability of personality pathology remains an open question. Its resolution will come from prospective, multiwave longitudinal studies using blinded assessments of personality disorders (PD). Informative analysis of multiwave data requires the application of statistical procedures, such as individual growth curve modeling, that can detect and describe individual change appropriately over time. The Longitudinal Study of Personality Disorders, which meets contemporary methodological design criteria, provides the data for this investigation of PD stability and change from an individual growth curve perspective. METHODS: Two hundred fifty subjects were examined for PD features at 3 different time points using the International Personality Disorders Examination during a 4-year study. Stability and change in PD features over time were examined using individual growth modeling. RESULTS: Fitting of unconditional growth models indicated that statistically significant variation in PD features existed across time in the elevation and rate of change of the individual PD growth trajectories. Fitting of additional conditional growth models, in which the individual elevation and rate-of-change growth parameters were predicted by subjects' study group membership (no PD vs possible PD), sex, and age at entry into the study, showed that study group membership predicted the elevation and rate of change of the individual growth curves. Comorbid Axis I psychopathology and treatment during the study period were related to elevations of the individual growth trajectories, but not to rates of change. CONCLUSIONS: From the perspective of individual growth curve analysis, PD features show considerable variability across individuals over time. This fine-grained analysis of individual growth trajectories provides compelling evidence of change in PD features over time and does not support the assumption that PD features are traitlike, enduring, and stable over time.