The Efficacy of Parent Management Training With or Without Involving the Child in the Treatment Among Children with Clinical Levels of Disruptive Behavior: A Meta-analysis.

A systematic review and meta-analysis was conducted where we evaluated the effects of Parent Management Training (PMT), Parent-Child Interaction Therapy (PCIT) and PMT combined with child cognitive behavioral therapy (CBT) using data from 25 RCTs on children with clinical levels of disruptive behavior (age range 2-13 years). Results showed that PMT (g = 0.64 [95% CI 0.42, 0.86]) and PCIT (g = 1.22 [95% CI 0.75, 1.69]) were more effective than waiting-list (WL) in reducing parent-rated disruptive behavior, and PMT also in improving parental skills (g = 0.83 [95% CI 0.67, 0.98]) and child social skills (g = 0.49 [95% CI 0.30, 0.68]). PCIT versus WL had larger effects in reducing disruptive behavior than PMT versus WL. In the few studies found, the addition of child CBT to PMT did not yield larger effects than PMT or WL. These results support offering PMT to children with clinical levels of disruptive behavior and highlight the additional benefits of PCIT for younger ages.

Gender differences in the treatment of patients with borderline personality disorder.

It is debated whether men with borderline personality disorder (BPD) are less often treated for their disorder, compared to women, even when they have sought care. Here, the aim was to examine gender differences in the treatment of patients with BPD. Through linkage to Swedish health and administrative registers, we identified all patients diagnosed with BPD (n = 5530) in Stockholm County from 2012 to 2016. We ascertained information on sociodemographic characteristics, comorbid psychiatric diagnoses, and all mental health care utilization within inpatient and outpatient mental health care, including receipt of psychiatric medication and various psychological therapies. We identified 802 men and 4,728 women with BPD during the study period. Men with BPD were less likely than their female counterparts to be treated with psychotherapy as well as psychiatric medication. Most of the differences in treatment with psychological therapies were nonsignificant in the multivariate model, indicating they are likely the result of differences in sociodemographic variables and comorbidity between men and women with BPD. Men with BPD were in average 4 years older than women at the time of the first BPD diagnosis, had lower education, and were also more likely to receive social welfare support. In conclusion, few men are diagnosed with BPD and those who are diagnosed are likely to receive somewhat less psychiatric medication and psychological therapies compared to women. Researchers and clinicians need to focus more on men with BPD to improve help-seeking and recognition of this disabling condition in men and enable equal treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Rapid Implementation of a Psychological Support Model for Frontline Healthcare Workers During the COVID-19 Pandemic: A Case Study and Process Evaluation.

The COVID-19 pandemic highlighted the need for psychological support initiatives directed toward frontline healthcare workers, which can be rapidly and sustainably implemented during an infectious disease outbreak. The current case study presents a comprehensive model of psychological support that was implemented at an intensive care unit (ICU) during the first wave of the COVID-19 pandemic. The psychological support model aimed at promoting a resilient stress reaction among frontline staff by protecting physical, social, and psychological resources. The initiatives, targeting different groups of workers, included education and training, peer support, psychologist-supervised and unsupervised group sessions, on-boarding for transferred staff, manager support, and individual sessions for workers experiencing strong stress reactions. The results of the process evaluation of this rapid implementation suggest that peer support initiatives as well as daily group sessions were the most appreciated forms of psychological support. Psychologists involved in organizing and providing the support highlighted several aspects of a successful implementation of the support model: offering support during work hours (preferably after shift), positive attitude of line managers that framed support initiatives as a team effort, and involvement of experienced psychologists able to quickly adjust the content of the support according to the current needs. The study also identified two main problems of the current implementation: the lack of efficient planning due to the use of volunteer work and the need for more structural resources on the organizational level to ensure long-term sustainability of the support model and its implementation among all groups of healthcare staff. The current case study highlights the importance of establishing permanent structural resources and routines for psychological support integrated in clinical practice by healthcare organizations to improve both rapid and sustainable response to future crises.

Gambling at Work: A Qualitative Study of Swedish Elite Athletes, Coaches, and Managers.

Considering the financial connections between sport and the gambling industry, more should be learned about gambling and problem gambling in this setting. This study explores how male athletes, coaches, and sports managers experience gambling activities and problems in their sports. Interviews were conducted with 30 male elite athletes, coaches, and managers in four sports. The interviews were analysed using content analysis, and the results indicated two main themes: 1) desire for and concerns with money and 2) in the shadow of performance, and three categories. The first main theme emerged as a result of the respondents recurring reference to money as the reason to different actions: It is important to win money,'too little' or 'too much' money is described as reason for gambling, athletes status is affected by money and sponsor money from the gambling companies are considered important. 'In the shadow of the performance' captures the reason to and value of performance: The thrill and money are rewards for the gambling performance, everyday sporting life emphasizes performance both in training and matches. Lack of successful performance is perceived as a threat and evokes a fear of being seen as weak and being ejected from the team. This study identifies gambling as normalized within male elite sport. Preventing gambling problems calls for action at all levels of the involved socio-ecological framework. Management, coaches, and athletes need more knowledge of gambling and how to create a sustainable framework to prevent gambling problems.

Dialectical Behavior Therapy for Men With Borderline Personality Disorder and Antisocial Behavior: A Clinical Trial.

In addition to suicidal behaviors, men with borderline personality disorder (BPD) often display antisocial behavior that could impair contacts with mental health services. While research has established effective treatments for women with BPD, this is not yet the case for men. The authors evaluated 12 months of dialectical behavior therapy (DBT) for 30 men with BPD and antisocial behavior, using a within-group design with repeated measurements. The authors found moderate to strong, statistically significant pre-to posttreatment reductions of several dysfunctional behaviors, including self-harm, verbal and physical aggression, and criminal offending (rate ratios 0.17-0.39). Symptoms of BPD and depression were also substantially decreased. The dropout rate was 30%, and completing participants reported high satisfaction with treatment and maintained their improvements at 1-year follow-up. The authors conclude that DBT could be an effective treatment alternative for men with BPD and antisocial behavior, and it merits future studies with more rigorous design.

A pilot randomized controlled trial of Internet-delivered parent training for parents of teenagers.

Adolescents with externalizing behaviors are at risk for multiple social and health impairments that may persist into adulthood. Although empirically supported treatments are available for teenagers with severe externalizing behavior and their families, only a few parenting programs have been evaluated for adolescents with subclinical levels of behavior problems. In the present randomized controlled trial (N = 75), we examined the feasibility and efficacy of the Parent-Web, a new Internet-based parenting program for parents of teenagers. Participants reported high satisfaction with the program, 74% completed all five modules and dropout was only 14%. Generalized linear mixed models showed short-term (8 weeks) improvements in parent-reported teenager externalizing behaviors, family conflicts, and family warmth compared to a waitlist control condition. Receiving the Parent-Web was also associated with more improvements in parent-reported teenage emotional symptoms and peer problems, as well as parental stress and depression. No differences regarding parenting behaviors between the two groups were found. Those in the intervention group maintained their posttreatment gains on primary outcomes at the follow-up assessment, 6- to 9-months after the program. Although limited by relying solely on parent report, and by a relatively small sample size, we conclude that our study contributes some preliminary evidence for the utility of supporting parents of adolescents at risk of developing behavior problems through an Internet-based intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden.

INTRODUCTION: Borderline personality disorder (BPD) is a severely disabling condition, associated with substantially increased risk of deliberate self-harm and, particularly in men, also with interpersonal violence and other criminal behavior. Although BPD might be common among prison inmates, little is known about prevalence and psychiatric comorbidity in probationers and parolees. METHOD: In 2013, a consecutive sample of 109 newly admitted adult male offenders on probation or parole in all three probation offices of Stockholm, Sweden, completed self-report screening questionnaires for BPD and other psychiatric morbidity. Participants scoring over BPD cut-off participated in a psychiatric diagnostic interview. RESULTS: We ascertained a final DSM-5 BPD prevalence rate of 19.8% (95% CI: 12.3-27.3%). The most common current comorbid disorders among subjects with BPD were antisocial personality disorder (91%), major depressive disorder (82%), substance dependence (73%), attention deficit hyperactivity disorder (ADHD) (70%), and alcohol dependence (64%). Individuals diagnosed with BPD had significantly more current psychiatric comorbidity (M=6.2 disorders) than interviewed participants not fulfilling BPD criteria (M=3.6). Participants with BPD also reported substantially more symptoms of ADHD, anxiety and depression compared to all subjects without BPD. CONCLUSIONS: BPD affected one fifth of probationers and was related to serious mental ill-health known to affect recidivism risk. The findings suggest further study of possible benefits of improved identification and treatment of BPD in offender populations.