It's not that Difficult: An Interrater Reliability Study of the DSM-5 Section III Alternative Model for Personality Disorders.

The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013 ) Section III Alternative Model for Personality Disorders (AMPD) represents a novel approach to the diagnosis of personality disorder (PD). In this model, PD diagnosis requires evaluation of level of impairment in personality functioning (Criterion A) and characterization by pathological traits (Criterion B). Questions about clinical utility, complexity, and difficulty in learning and using the AMPD have been expressed in recent scholarly literature. We examined the learnability, interrater reliability, and clinical utility of the AMPD using a vignette methodology and graduate student raters. Results showed that student clinicians can learn Criterion A of the AMPD to a high level of interrater reliability and agreement with expert ratings. Interrater reliability of the 25 trait facets of the AMPD varied but showed overall acceptable levels of agreement. Examination of severity indexes of PD impairment showed the level of personality functioning (LPF) added information beyond that of global assessment of functioning (GAF). Clinical utility ratings were generally strong. The satisfactory interrater reliability of components of the AMPD indicates the model, including the LPF, is very learnable.

Knowledge and perceptions of familial and genetic risks for breast cancer risk in adolescent girls.

Evidence suggests early events might modify adult breast cancer risk and many adolescents learn of familial and genetic risks for breast cancer. Little is known about how adolescent girls understand and respond to breast cancer risk. Semi-structured interviews with 11-19 year-old girls at high-risk and population-risk for breast cancer evaluated knowledge and perceptions of breast cancer risk and risk modification. Framework analysis and descriptive statistics were utilized to analyze open-ended responses. Risk group and age differences were evaluated by Fisher's exact and McNemar's tests. Fifty-four girls (86 % of invited), 35 high-risk (65 %), and 19 population-risk (35 %) completed interviews. The most frequently reported risk for breast cancer was family history/hereditary predisposition (66 %). Only 17 % of girls were aware of BRCA1/2 genes. The majority (76 %) of high-risk girls perceive themselves to be at increased risk for breast cancer, compared to 22 % of population-risk girls (p = 0.001). Half of girls reported that women can get breast cancer before 20-years-old. The majority believe there are things women (70 %) and girls (67 %) can do to prevent breast cancer. Mother was the most frequently reported source of information for breast cancer among both high-risk (97 %) and population-risk (89 %) girls. In this study, many high-risk girls perceive themselves to be at increased risk for breast cancer, and many girls believe that breast cancer can occur in teens. Yet, most girls believe there are things women and girls can do to prevent breast cancer. Research evaluating the impact of awareness and perceptions of breast cancer risk on psychosocial, health, and risk behaviors is needed to develop strategies to optimize responses to cancer risk.

Is mindfulness one-size-fits-all?: Consulting community members and stakeholders to adapt mindfulness for communities with low-income and economic marginalization.

BACKGROUND AND PURPOSE: Although stress is pertinent to all people, individuals with low-income and economic marginalization (LIEM) tend to experience greater psychosocial stressors as well as different relationship stressors than individuals with higher income. While mindfulness may be a particularly useful tool for individuals with LIEM, it has yet to be adapted for this community. Using a community-based participatory research (CBPR) approach, the present study conducted focus groups with community members with LIEM to identify effective dissemination strategies. MATERIALS AND METHODS: Thirteen individuals with LIEM were recruited to participate in one of two focus groups. The focus groups collected information on how individuals with LIEM cope with stress, how these individuals perceive mindfulness, and how to reduce barriers to participating in a brief mindfulness intervention for stress. Focus groups were transcribed and coded by four coders using thematic analysis within a grounded theory framework. RESULTS: Twelve themes were identified: movement-based coping, behavioral/tactile coping, interest in mindfulness, familiarity with mindfulness, tangible mindfulness, narrow understanding of practicing mindfulness, relaxing, affiliation, alliance with healthcare facility, storytelling, breaking bread, and mental health treatment stigma. CONCLUSION: Themes derived from the focus groups were discussed with community stakeholders. Findings from this study informed clinical considerations for using mindfulness with individuals with LIEM.

How health behaviors link romantic relationship dysfunction and physical health across 20 years for middle-aged and older adults.

RATIONALE: There has been substantial research linking marital quality to physical health outcomes; however, the mechanisms linking marital quality and physical health have been studied less extensively, especially with longitudinal data. Of the hypothesized mechanisms, only psychological distress (anxiety/depression) and physiological mechanisms (inflammation) have been tested and confirmed. Health behaviors such as diet, exercise, smoking, drinking, and sleeping have not previously been examined as mechanisms linking marital quality and physical health. OBJECTIVE: The present study tests how the emotional influence of the marital relationship is linked to subsequent health outcomes through behavioral mechanisms. A biopsychosocial theoretical model, the Biobehavioral Family Model (BBFM), is used to hypothesize the mediating paths between marital dysfunction and physical health. METHOD: The study hypotheses are tested with publicly accessible survey data, Midlife in the United States (MIDUS). We examined married or cohabiting participants (N = 5023) across the three time points of MIDUS, or 20 years. Specifically, we tested whether five health behaviors at Time 2 (smoking, alcohol, sleep, food to cope, and physical activity) function as mechanisms linking marital dysfunction (Time 1) to subsequent physical health (Time 3). We tested each health behavior as a mechanism in a series of mediating Structural Equation Models. RESULTS: Two health behaviors were significant mechanisms (food to cope and physical activity), while three were not (smoking, alcohol, and sleep). CONCLUSION: Diet and exercise are mechanisms linking marital dysfunction and health across 20 years because they may be linked to the emotional influence and not functional influence of the marriage context. According to the BBFM, diet and exercise may be part of the mediating construct of the model (i.e., biobehavioral reactivity), which explains how emotional stress from a marriage may produce declines in physical health over time. Implications for biopsychosocial healthcare interventions are discussed.

Psychosocial Adjustment and Perceived Risk Among Adolescent Girls From Families With BRCA1/2 or Breast Cancer History.

PURPOSE: To evaluate the impact of breast cancer family history and maternal BRCA1/2 mutation on the psychosocial adjustment and perceived risk in girls age 11 to 19 years old. MATERIALS AND METHODS: Girls age 11 to 19 years old with one or more relatives with breast cancer or a familial BRCA1/2 mutation (breast cancer family history [BCFH] positive, n = 208; n = 69 with BRCA1/2-positive mother), peers (BCFH negative, n = 112), and their mothers completed assessments of psychosocial adjustment, breast cancer-specific distress, and perceived risk of breast cancer. RESULTS: General psychosocial adjustment did not differ significantly between BCFH-positive and BCFH-negative girls, either by self-report or mother report, except for higher self-esteem among BCFH-positive girls (P = .01). BCFH-positive girls had higher breast cancer-specific distress than BCFH-negative girls (P < .001), but girls from BRCA1/2-positive families did not differ from other BCFH-positive peers. BCFH-positive girls were more likely to report themselves at increased self-risk for breast cancer in adulthood than BCFH-negative peers (74% v 33%, respectively; P ≤ .001). Girls from BRCA1/2-positive families were more likely than other BCFH-positive and BCFH-negative peers to report themselves at increased risk (P < .001). In all groups, perceived risk of breast cancer was associated with older age. Higher breast cancer-specific distress among adolescent girls was associated with higher self-perceived risk of breast cancer and higher maternal breast cancer-specific distress. CONCLUSION: Adolescent girls from BRCA1/2-positive and breast cancer families have higher self-esteem and do not have poorer psychosocial adjustment than peers. However, they do experience greater breast cancer-specific distress and perceived risk of breast cancer, particularly among older girls. Understanding the impact is important to optimize responses to growing up in families at familial and genetic risk for breast cancer, particularly given the debate over the genetic testing of children for cancer susceptibility in adulthood.