Effects of the Sleep SAAF responsive parenting intervention on rapid infant weight gain: A randomized clinical trial of African American families.

Responsive parenting (RP) interventions reduce rapid infant weight gain but their effect for underserved populations is largely unknown. The Sleep SAAF (Strong African American Families) study is a two-arm randomized clinical trial for primiparous African American mother-infant dyads that compares an RP intervention to a child safety control over the first 16 weeks postpartum. Here we report on intervention effects on rapid infant weight gain and study implementation. Families were recruited from a mother/baby nursery shortly after delivery. Community Research Associates (CRAs) conducted intervention home visits at 3 and 8 weeks postpartum, and data collection home visits at 1, 8, and 16 weeks postpartum. To examine rapid infant weight gain, conditional weight gain (CWG) from 3 to 16 weeks, the primary outcome, and upward crossing of 2 major weight-for-age percentile lines were calculated. Among the 212 mother-infant dyads randomized, 194 completed the trial (92% retention). Randomized mothers averaged 22.7 years, 10% were married, and 49% participated in the Supplemental Nutrition Assistance Program (SNAP). Adjusting for covariates, mean CWG was lower among RP infants (0.04, 95% CI [-0.33, 0.40]) than among control infants (0.28, 95% CI [-0.08, 0.64]), reflecting non-significantly slower weight gain (p = 0.15, effect size d = 0.24). RP infants were nearly half as likely to experience upward crossing of 2 major weight-for-age percentile lines (14.1%) compared to control infants (24.2%), p = 0.09, odds ratio = 0.52 (95% CI [0.24, 1.12]). Implementation data revealed that participating families were engaged in the intervention visits and intervention facilitators demonstrated high fidelity to intervention materials. Findings show that RP interventions can be successfully implemented among African American families while suggesting the need for modifications to yield stronger effects on infant weight outcomes.

The Protecting Strong African American Families Program: a Randomized Controlled Trial with Rural African American Couples.

This study presents results from a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program, a family-centered intervention designed to promote strong couple, coparenting, and parent-child relationships in two-parent African American families. A total of 346 African American couples with an early adolescent child participated; all families lived in rural, low-income communities in the southern USA. Intent-to-treat growth curve analyses involving three waves and spanning 17 months indicated that ProSAAF participants, compared with control participants, reported greater improvements in relationship communication, confidence, satisfaction, partner support, coparenting, and parenting. More than 80% of the couples attended all six of the in-home, facilitator-led sessions; costs to implement the program averaged $1739 per family. The findings inform the ongoing debate surrounding prevention programs for low-income and ethnic minority couples.

Seabird mortality induced by land-based artificial lights.

Artificial lights at night cause high mortality of seabirds, one of the most endangered groups of birds globally. Fledglings of burrow-nesting seabirds, and to a lesser extent adults, are attracted to and then grounded (i.e., forced to land) by lights when they fly at night. We reviewed the current state of knowledge of seabird attraction to light to identify information gaps and propose measures to address the problem. Although species in families such as Alcidae and Anatidae can be grounded by artificial light, the most affected seabirds are petrels and shearwaters (Procellariiformes). At least 56 species of Procellariiformes, more than one-third of them (24) threatened, are subject to grounding by lights. Seabirds grounded by lights have been found worldwide, mainly on oceanic islands but also at some continental locations. Petrel breeding grounds confined to formerly uninhabited islands are particularly at risk from light pollution due to tourism and urban sprawl. Where it is impractical to ban external lights, rescue programs of grounded birds offer the most immediate and employed mitigation to reduce the rate of light-induced mortality and save thousands of birds every year. These programs also provide useful information for seabird management. However, these data are typically fragmentary, biased, and uncertain and can lead to inaccurate impact estimates and poor understanding of the phenomenon of seabird attraction to lights. We believe the most urgently needed actions to mitigate and understand light-induced mortality of seabirds are estimation of mortality and effects on populations; determination of threshold light levels and safe distances from light sources; documentation of the fate of rescued birds; improvement of rescue campaigns, particularly in terms of increasing recovery rates and level of care; and research on seabird-friendly lights to reduce attraction.

Implementing Family-Centered Prevention in Rural African American Communities: a Randomized Effectiveness Trial of the Strong African American Families Program.

Efforts to disseminate evidence-based prevention programs are hampered by a lack of real-world effectiveness trials undertaken with community providers. The Strong African American Families (SAAF) program is an empirically validated intervention designed to prevent problem behavior among rural African American youth. To evaluate the effectiveness of SAAF and its implementation protocols when delivered by a community provider, we conducted a randomized, wait-list-controlled trial with outcome measurements assessed longitudinally at baseline and 6 months after baseline. A total of 465 African American youth and their parents were recruited randomly from public school lists of fifth- and sixth-grade students in eight rural counties in south Georgia. Youth and parents assessed targeted outcomes in their homes. The main outcome, problem behavior vulnerability, was operationalized as a latent construct comprising three indicators: tolerance for deviance, intentions to engage in risky behavior, and affiliations with risk-taking peers. SAAF was implemented with uniformly high levels of adherence (85.5%; SD = 10.8) and attendance (M = 4.1, SD = 2.9, range = 0-7). Intent-to-treat and complier average causal effect analyses revealed significant program effects on intervention-targeted parenting practices, youth self-regulatory processes, and problem behavior vulnerability. SAAF influenced problem behavior vulnerability indirectly via effects on targeted parenting and youth processes. This study supported the effectiveness of SAAF in a community setting when a systematic implementation model supports participant engagement and intervention adherence.

Lifetime and current prevalence of common DSM-IV mental disorders, their demographic correlates, and association with service utilisation and disability in older Australian adults.

OBJECTIVE: To describe lifetime and 12 month prevalence of common DSM-IV mental disorders, their demographic correlates, and association with service utilisation and disability in Australians aged 65-85 years of age. METHODS: The sample included Australian residents aged 65-85 years who participated in the 2007 Australian National Survey of Mental Health and Well-being (n=1905). The prevalence of DSM-IV mental disorders was estimated using the lay-interviewer administered World Mental Health version of the Composite International Diagnostic Interview. RESULTS: Eight percent had experienced an affective disorder, 10% an anxiety disorder, and 12% a substance use disorder at some point in their life. Sex, age, and marital status were significant correlates of any lifetime mental disorder. Approximately, 2%, 4%, and 1% of old age respondents met criteria for mood, anxiety, and substance use disorders in the past 12 months, respectively. The presence of physical disorder, disability, and greater treatment service use were associated with any mental disorder in the past 12 months. Prevalence of lifetime and 12 month disorders by age band revealed a decrease as age increased. CONCLUSIONS: A substantial number of community dwelling old age Australians have experienced a mental disorder in their lifetime. Demographic correlates of mental disorder were relatively consistent between lifetime and 12 month prevalence of disorders, although sex made less of an impact and the presence of physical disorders more of an impact in recent disorders. Twelve month prevalence data suggest that a high proportion of old age Australians still experience mental disorders, predominantly anxiety and major depression.

Demographic, clinical, and lifestyle correlates of subjective memory complaints in the Australian population.

OBJECTIVES: To provide estimates of the prevalence and correlates of subjective memory complaints in older individuals by using population-based Australian data. DESIGN: 2007 National Survey of Mental Health and Well-Being. SETTING: Australia. PARTICIPANTS: 1,905 community-dwelling participants aged 65-85 years. MEASUREMENTS: Subjective memory complaints were assessed by using two questions reflecting: (1) poorer memory compared with others of the same age ("worse memory"); and (2) a decline in memory performance over the previous 5 years ("declining memory"). Twelve-month and lifetime diagnoses were derived from structured diagnostic interviews. Other correlates investigated included chronic physical conditions, lifestyle factors, and service use. Analyses adjusted for scores on the Mini-Mental State Examination. RESULTS: Subjective memory complaints were reported by one-third (33.5%) of respondents. Those who reported either complaint were more likely to report psychological distress, poor functioning, service use, and negative self-assessed mental and physical health. "Declining memory" over the past 5 years was also related to an increase in the rates of psychiatric disorders. After adjusting for other variables of interest, associations were established between subjective memory complaints and psychological distress, poor functioning, negative self-assessed mental health, and alcohol use disorders. Except for the association between "declining memory" and anxiety and depression, these associations remained significant after excluding those with scores <27 on the Mini-Mental State Examination. CONCLUSIONS: Subjective memory complaints were associated with several negative clinical characteristics that should be considered when interpreting these complaints. Subjective memory complaints may be valid indicators of psychopathology and the need for clinical assessment.

The 10-item Kessler psychological distress scale (K10) as a screening instrument in older individuals.

OBJECTIVE: To provide population-based Kessler Psychological Distress Scale (K10) normative data for older adults and cut scores for screening. PARTICIPANTS: Adults age ≥65 years who participated in either the 1997 or 2007 Australian National Surveys of Mental Health and Well-being (N = 3,697). MEASUREMENTS: The proportion of respondents who reported psychological distress, and the correspondence of K10 scores with diagnosis of mental disorder, disability, and service use. RESULTS: Scores on the K10 corresponded well with rates of mental disorder. Higher K10 scores were associated with increased levels of internalizing disorder, comorbidity, functional disability, and service use. Receiver operating characteristic curve analysis revealed an area under the curve score of 0.86, suggesting good predictive power. For screening purposes, a cut score of 15 was found to be associated with the best balance between sensitivity (0.77) and specificity (0.78). Similar levels of predictive power were observed across various subgroups of the population. Score ranges for groups who met criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition affective or anxiety disorder showed that for those age 65-75, a score of 20 or greater and a score of 17 or greater for those older than 75 years warrant heightened clinical interest. CONCLUSIONS: The K10 exhibits sensitivity to internalizing disorders as they occur across the lifespan and can be used with confidence when assessing psychological distress in old-age community dwellers. The significant association between higher K10 scores and disability suggests that the presence of psychological distress, regardless of diagnostic status, requires clinician attention.

Internet-delivered cognitive behavioural therapy for depression: a feasibility open trial for older adults.

BACKGROUND: Depression is an important health issue amongst older adults. Internet-delivered cognitive behaviour therapy (iCBT) may help to reduce barriers and improve access to treatment, but few studies have examined its use with older adults. The present study evaluated the efficacy, acceptability and feasibility of a brief iCBT program, the Managing Your Mood Program, to treat depression amongst adults aged 60 years and older. METHOD: Using an open trial design, 20 participants with elevated symptoms of depression (Patient Health Questionnaire 9-item (PHQ-9) total scores ≥ 10) received access to five educational lessons and homework summaries, additional resources, a moderated discussion forum and weekly telephone or email contact from a clinical psychologist. Eighty percent of the sample met diagnostic criteria for a major depressive episode at pre-treatment. RESULTS: Completion rates and response rates were high, with 16/20 participants completing the five lessons within the 8 weeks, and post-treatment and 3-month follow-up data being collected from 17/20 participants. Participants improved significantly on the PHQ-9 and Geriatric Depression Scale (GDS), with large within-group effect sizes (Cohen's d) at follow-up of 1.41 and 2.04, respectively. The clinician spent a mean time of 73.75 minutes (SD = 36.10 minutes) contacting participants within the trial and the program was rated as highly acceptable by participants. CONCLUSIONS: The results are encouraging and support the potential value of iCBT in the treatment of depressive symptoms amongst older adults.

Family-Centered Prevention to Reduce Discrimination-Related Depressive Symptoms Among Black Adolescents: Secondary Analysis of a Randomized Clinical Trial.

Importance: Racial discrimination undermines the mental health of Black adolescents. Preventive interventions that can attenuate the effects of exposure to racial discrimination are needed. Objective: To investigate whether participation in the Strong African American Families (SAAF) program moderates Black adolescents' depressive symptoms associated with experience of racial discrimination. Design, Setting, and Participants: This secondary analysis used data from a community-based randomized clinical trial of SAAF (SAAF vs no treatment control). Participants were followed up at 10, 22, and 34 months after the baseline assessment. Assessment staff were blind to participant condition. Participants in this trial lived in 7 rural counties in Georgia. SAAF was delivered at local community centers. Eligible families had a child aged 11 to 12 years who self-identified as African American or Black. The joint influence of random assignment to SAAF and exposure to racial discrimination was investigated. Data were analyzed from September 2022 to March 2023. Intervention: SAAF is a 7-session (14 hours) family skills training intervention that occurs over 7 weeks. Small groups of caregivers and their adolescents participate in a structured curriculum targeting effective parenting behavior, adolescent self-regulation, and Black pride. Main Outcomes and Measures: The main outcome was adolescent-reported depressive symptoms, assessed at 34 months via the 20-item Center for Epidemiologic Studies Depression Scale for Children. Results: Of 825 families screened randomly from public school lists, 472 adolescents (mean [SD] age, 11.6 years; 240 [50.8%] female) were enrolled and randomized to SAAF (252 participants) or a no treatment control (220 participants). Exposure to racial discrimination at age 13 years was associated with increased depressive symptoms at age 14 years (ß = 0.23; 95% CI, 0.13 to 0.34; P < .001). Interaction analyses indicated that the experimental condition significantly moderated the association of racial discrimination with depressive symptoms: (ß = -0.27; 95% CI, -0.47 to -0.08; P = .005). Probing the interaction with simple slopes at ±SD revealed that for the control group, racial discrimination was significantly associated with depressive symptoms (ß = 0.39; 95% CI, 0.23 to 0.54; P < .001), while for the SAAF group, there was no association between racial discrimination and depressive symptoms (ß = 0.12; P = .09). Conclusions and Relevance: This randomized clinical trial found that the SAAF intervention reduced the incidence of racism-associated mental health symptoms among Black adolescents. SAAF is recommended for dissemination to health care practitioners working with rural Black adolescents. Trial Registration: ClinicalTrials.gov Identifier: NCT03590132.

Psychological distress across the lifespan: examining age-related item bias in the Kessler 6 Psychological Distress Scale.

BACKGROUND: Old age respondents may differ systemically in their responses to measures of psychological distress over and above their actual latent distress levels when compared to younger respondents. The current study aimed to investigate the potential for age-related bias(es) in the Kessler 6 Psychological Distress Scale (K6) items. METHODS: Data from the 2007 Australian National Survey of Mental Health and Wellbeing were analyzed using Item Response Theory to detect the presence of item bias in each of the K6 items. The potential for item bias was assessed by systematically comparing respondents classed as young (16-34 years), middle aged (35-64 years), and old aged (65-85 years). The significance and magnitude of the item bias between the age groups was assessed using the log-likelihood ratio method of differential item functioning. RESULTS: After statistical adjustment, there were no biases of significant magnitude influencing the endorsement of K6 items between young and middle-aged respondents or between middle-aged and old age respondents. There was a bias of significant magnitude present in the endorsement of the K6 item addressing levels of fatigue between young and old age respondents. CONCLUSIONS: Despite the identification of significant item bias in the endorsement of K6 items between the age groups, the magnitude and influence of the bias on total K6 scores is likely to have little influence on the overall interpretation of group data when comparing psychological distress across the lifespan. Researchers should be cautious, however, when examining individual levels of fatigue related to psychological distress in older individuals.

The strong African American families-teen trial: rationale, design, engagement processes, and family-specific effects.

This study addresses two limitations in the literature on family-centered intervention programs for adolescents: ruling out nonspecific factors that may explain program effects and engaging parents into prevention programs. The Rural African American Families Health project is a randomized, attention-controlled trial evaluating the efficacy of the Strong African American Families-Teen (SAAF-T) program, a family-centered risk-reduction intervention for rural African American adolescents. Rural African American families (n = 502) with a 10th-grade student were assigned randomly to receive SAAF-T or a similarly structured, family-centered program that focused on health and nutrition. Families participated in audio computer-assisted self-interviews at baseline and 6-month follow-up. Program implementation procedures yielded a design with equivalent doses, five sessions of family-centered intervention programming for families in each condition. Of eligible families screened for participation, 76% attended four or five sessions of the program. Consistent with our primary hypotheses, SAAF-T youth, compared to attention-control youth, demonstrated higher levels of protective family management skills, a finding that cannot be attributed to nonspecific factors such as aggregating families in a structured, interactive setting.

Psychometric comparison of the generalized anxiety disorder scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalised anxiety disorder.

The Penn State Worry Questionnaire (PSWQ) is a widely used measure of the worry characteristic of generalised anxiety disorder (GAD). The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a new brief screening tool for GAD, which is being increasingly used in research and clinical practice. The present study sought to provide comparison data on the relative psychometric properties of these two scales. The data of 195 adults who met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for GAD and who participated in two randomised treatment controlled trials were used. Factor analyses, internal consistency, correlational analyses, responsiveness to change, and agreement between the scales based on indentified clinical cutoffs were conducted. Factor analyses confirmed a one-factor structure for the GAD-7 and a three-factor structure involving two method factors for the PSWQ. Both the GAD-7 and the PSWQ demonstrated adequate internal consistency (Cronbach's alpha: .79-.91 and .86-.91, respectively), and moderate correlations (r = .51-.71) were observed between the scales across the treatment time points. The scales exhibited small correlations with the Sheehan Disability Scale at pretreatment (GAD-7 r = .38; PSWQ r = .26), but moderate correlations at posttreatment and follow-up (r = .59-.79). Agreement between the scales was limited using various clinical cutoffs identified within the literature. Both measures were sensitive to change, although the GAD-7 appeared to be more sensitive and may, therefore, confer some advantages in clinical work.

Psychometric comparison of the PHQ-9 and BDI-II for measuring response during treatment of depression.

The Patient Health Questionnaire-9 Item (PHQ-9) and Beck Depression Inventory-II (BDI-II) are frequently used measures of depression severity, but little is known about their relative psychometric properties. The authors assessed psychometric properties of both measures during treatment for depression. The PHQ-9 and BDI-II scores from 172 depressed participants in two randomized controlled trials of treatment for depression were assessed and combined. Tests of internal consistency (Cronbach's α), factor analyses, correlational analyses, estimates of clinically significant change, and effect sizes (Cohen's d) were calculated after treatment and follow-up. Both scales demonstrated adequate internal consistency at pre- and posttreatment (PHQ-9 α = .74 and .81; BDI-II α = .87 and .90, respectively). Factor analysis failed to confirm the one-factor model previously reported for the PHQ-9, but two factors evidenced good fit for the BDI-II. Both scales converged more with each other than with the Sheehan Disability Scale at pre- but not at posttreatment. Responsiveness to change of PHQ-9 and BDI-II was similar at both posttreatment and follow-up. The consistency of agreement on indices of clinical significance was fair to moderate, but the BDI-II categorised a greater proportion of participants with severe depression than the PHQ-9. The BDI-II and PHQ-9 demonstrated adequate reliability, convergent/discriminant validity, and similar responsiveness to change. Differences were found in how they categorised severity. Pending the results of further studies, the attributes of the PHQ-9, of being shorter and based on the diagnostic criteria for depression, may indicate an advantage over the BDI-II.

Childhood neuropsychological deficits associated with adult obsessive-compulsive disorder.

BACKGROUND: Existing neuropsychological studies of obsessive-compulsive disorder (OCD) are cross-sectional and do not provide evidence of whether deficits are trait-related (antecedent and independent of symptomatology) or state-related (a consequence, dependent on symptomatology). AIMS: To investigate whether there are premorbid neuropsychological deficits associated with adult OCD. METHOD: Longitudinal data were collected from participants of the Dunedin Multidisciplinary Health and Developmental study. Neuropsychological data collected at age 13 were linked with age 32 diagnosis of OCD. RESULTS: The group who had OCD at age 32 differed significantly from the control group with no OCD on their performance at age 13 on neuropsychological tests of visuospatial, visuoconstructive and visuomotor skills, controlling for gender and socioeconomic status, but did not differ on tests of general IQ or verbal ability. Performance of the group with OCD on tests of executive functioning was mixed. CONCLUSIONS: Individuals with OCD have premorbid impairment in visuospatial abilities and some forms of executive functioning, consistent with biological models of OCD.

Impact of substance-induced and general medical condition exclusion criteria on the prevalence of common mental disorders as defined by the CIDI.

OBJECTIVES: It has been previously argued that the methodology used by the Composite International Diagnostic Interview version 2.1 to assess the substance-induced and general medical condition exclusion criteria are inadequate. As a result prevalence estimates generated from epidemiological studies using this interview may be underestimated. The purpose of the current study was to examine the substance-induced and general medical condition exclusion criteria in the Australian National Survey for Mental Health and Well-being and determine the impact that they have on prevalence estimates of the common mental disorders. METHOD: Data from the 1997 Australian National Survey of Mental Health and Well-being were analysed. Frequencies were generated as an indication of how many respondents believed that their psychiatric symptoms were always due to a substance or general medical condition. New DSM-IV prevalence estimates were calculated ignoring the application of the substance-induced and general medical condition exclusion criteria and compared to standard DSM-IV prevalence estimates. RESULTS: The effect of the substance-induced and general medical condition exclusion criteria on final prevalence rates were minimal, with approximately a 0.1% increase when the exclusions were ignored. This equates to a relative difference ranging from no difference for generalized anxiety disorder to an increase of 12% of the base prevalence estimate for agoraphobia. CONCLUSIONS: In surveys that use the Composite International Diagnostic Interview version 2.1 the substance-induced and general medical condition exclusion criteria have a minor impact on determining final case definition in the majority of mental disorders.

Education Research: Physician identification and patient satisfaction on an academic neurology inpatient service.

OBJECTIVE: To determine the relationship between neurology inpatient satisfaction and (1) number of physicians involved in the patient's care and (2) patients' ability to identify their physicians. METHODS: A 10-item questionnaire addressing patient satisfaction and identification of physicians on the care team was administered to patients admitted to an academic, tertiary care, inpatient neurology service from May 1 to October 31, 2012. We hypothesized higher satisfaction among patients having fewer physicians on the care team and among patients able to identify their physicians. RESULTS: A total of 652 patients were enrolled. An average of 3.9 (range 3-8) physicians were involved in each patient's care. Patients were able to correctly identify on average 2.4 (60.7%) physicians involved in their care. Patients who were very satisfied correctly identified a larger percentage of physicians involved in their care (63.8% vs 50.7%, p < 0.001), were more likely to identify a physician who knew them best (94.3% vs 43.6%, p < 0.001) and who was "in charge" of their care (94.1% vs 57.6%, p < 0.001), and were more likely to have private insurance (82.8% vs 70.5%, p < 0.001) and fewer physicians involved in their care (3.84 vs 4.06, p = 0.02). CONCLUSIONS: Neurology inpatients' ability to identify physicians involved in their care is associated with patient satisfaction. Strategies to enhance patient satisfaction might target improving physician identification, reducing actual or perceived disparities in care based on payer status, and reducing handoffs or conducting handoffs at the bedside.

Community-Based Home Health Programs and Chronic Disease: Synthesis of the Literature.

PURPOSE OF STUDY: This article reviewed and evaluated literature on the various community-based home health programs and their effectiveness at preventing hospital admissions in adults. The research question addressed is as follows: Do community-based home health programs decrease hospital admissions in adult patients with chronic disease? PRIMARY PRACTICE SETTING: The primary practice setting evaluated in this review of the literature was community-based home health programs. METHODOLOGY AND SAMPLE: In this literature review, a seven-step review method was utilized to assess the evidence. Three electronic databases were used to conduct the initial search inquiry: CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus with Full Text, Medline, and PsycINFO. The search parameters include research from 2006 through 2016, English-language studies, and research published in peer-reviewed journals. The following search terms were used in multiple combinations: community-based health programs, chronic disease, and home. The primary sample population assessed was older adults with chronic disease. RESULTS: The research identified three common themes that influenced quality-of-life outcomes and health care utilization in participants of a community-based home health program. These themes were encouragement and emotional support, home visits, and multidisciplinary coordination of care. Additional concepts of depression and educational reinforcement were also noted. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: This literature review indicates that community-based home health programs are a viable solution to providing cost-effective health care to the adult population with chronic diseases. Community-based home health programs have been shown to have a positive impact on the quality of life and a decrease in health care utilization, including emergency department and primary care practitioner visits and hospital admissions, for adults with chronic disease.

The Strong African American Families Program: a cluster-randomized prevention trial of long-term effects and a mediational model.

The Strong African American Families Program, a universal preventive intervention to deter alcohol use among rural African American adolescents, was evaluated in a cluster-randomized prevention trial. This 7-week family skills training program is based on a contextual model in which intervention effects on youth protective factors lead to changes in alcohol use. African American 11-year-olds and their primary caregivers from 9 rural communities (N = 332 families) were randomly selected for study participation. Communities were randomized to prevention and control conditions. Intent-to-treat analyses indicated that fewer prevention than control adolescents initiated alcohol use; those who did evinced slower increases in use over time. Intervention-induced changes in youth protective factors mediated the effect of group assignment on long-term changes in use.

A thematic analysis of late recovery from stuttering.

This study used thematic analysis to gain a better understanding of the experiences of individuals who reported late recovery from stuttering. Using a semistructured interview, 6 adults who reported recovering from stuttering after the age of 10 were asked to relate their recovery stories, with particular emphasis on their perceptions of factors responsible for the recovery process. The interviews were parsed into information-rich quotations that were ultimately placed into thematic categories. Three thematic categories appeared to capture the majority of the recovery attributions: (a) increased confidence; (b) increased motivation, expressed as a desire to make positive changes in speech; and (c) direct speech changes. Narrative case studies were subsequently developed to illustrate the 3 different "pathways to recovery" that were described by our participants.

Structure of the DSM-5 generalized anxiety disorder criteria among a large community sample of worriers.

BACKGROUND: There is growing empirical and clinical consensus that many psychiatric disorders are continuous in nature. The DSM-5 however makes a categorical distinction between subthreshold and threshold cases of generalized anxiety disorder (GAD). This study tested the a priori assumption that the DSM-5 criteria identify a break in psychopathology between subthreshold and threshold cases of GAD. METHODS: Respondents of the 2007 National Survey of Mental Health and Well Being who self-identified as worriers were selected for analyses (n=1738). The GAD criteria were assessed using the World Mental Health version of the Composite International Diagnostic Interview. Item response, latent class and factor mixture models were estimated to assess the structure of the GAD criteria. RESULTS: The relative fit of the latent variable models suggested that a single continuous factor explains the way that worriers endorse the GAD criteria. However, the similar psychometric properties of the GAD criteria suggested that the GAD criteria impose a relatively finite threshold over this dimension of severity. LIMITATIONS: Although these structural analyses did not identify a break in psychopathology between subthreshold and threshold cases of GAD based on the way that respondents endorsed the DSM-5 criteria, it is possible that structural analyses of risk factors and other clinical correlates of GAD may identify such a break in the future. CONCLUSIONS: These data suggest that the DSM-5 GAD criteria lend themselves to making both categorical decisions about cases as well as being indices of a continuum of severity.