Preventing addiction related suicide: a pilot study.

Persons addicted to alcohol and drugs are at 5-10 times higher risk for suicide as compared to the general population. To address the need for improved suicide prevention strategies in this population, the Preventing Addiction Related Suicide (PARS) module was developed. Pilot testing of 78 patients demonstrated significant post-treatment changes in knowledge [t(66) = 12.07, p = .000] and attitudes [t(75) = 6.82, p = .000] toward suicide prevention issues. Significant gains were maintained at 1-month follow-up for changes in knowledge [t(55) = 6.33, p = .000] and attitudes [t(61) = 3.37, p = .0001], with changes in positive help seeking behaviors in dealing with suicidal issues in friends [χ(2)(1) = 10.49, p = .007], family [χ(2)(1) = 9.81, p = .015], and self [χ(2)(1) = 19.62, p = .008] also observed. The PARS was also highly rated by treatment staff as feasible within their standard clinical practice.

Global Appraisal of Individual Needs Short Screener (GSS): psychometric properties and performance as a screening measure in adolescents.

Psychiatric and substance use disorders, separately or combined, are frequent in adolescence. Brief, psychometrically sound screening tools are needed to identify those at-risk. The Global Appraisal of Individual Needs-Short Screener (GAIN-SS) is a brief, inexpensive screener that was derived from the well researched full GAIN interview. However, its validity has not been independently investigated based on independent validated screening instruments in an adolescent clinical population. In this project, the internal consistency, validity, and optimal screening cutoff scores were examined in 95 adolescents, most of whom were receiving treatment, and suffered from internalizing (52%; n = 49), externalizing (66%, n = 63), and co-occurring substance use disorders (55%, n = 56). Results indicated adequate internal consistency and overall and subscale construct validity. Receiver operating characteristics (ROC) analyses revealed that the GSS substance use disorder subscale had adequate sensitivity (88%) and specificity (89%). Psychiatric disorder subscales performed less well. The discussion focuses on the strengths and potential weaknesses of use of the GSS and its potential utility in other populations.

Impact of multiple-family groups for outpatients with schizophrenia on caregivers' distress and resources.

OBJECTIVE: The objective of this study was to evaluate the effects of multiple-family group treatment on distress and psychosocial resources among family caregivers of persons with schizophrenia. METHODS: A total of 97 consumers with schizophrenia or another psychotic disorder and their caregivers were randomly assigned to receive multiple-family group treatment (N=53) or standard psychiatric outpatient care (N=44). Reliable and valid measures were used to assess caregivers' distress, caregivers' resources, and consumers' clinical status. RESULTS: After consumers' clinical status and baseline rates of caregivers' distress and caregivers' resources were controlled for, the caregivers of consumers who received multiple-family group treatment experienced greater reductions in distress but no increases in resources compared with caregivers of consumers who received standard psychiatric care. CONCLUSIONS: Multiple-family group treatment reduced caregivers' distress but did not increase caregivers' resources relative to standard psychiatric care.

Service use among patients with schizophrenia in psychoeducational multiple-family group treatment.

OBJECTIVES: Outpatient and inpatient mental health service outcomes for outpatients with schizophrenia or schizoaffective disorder who received psychoeducational multiple-family group treatment were compared with outcomes for similar patients who received standard care. METHODS: A total of 106 outpatients with schizophrenia or schizoaffective disorder who were receiving services from a large community mental health center were randomly assigned to receive standard care or standard care plus multiple-family group treatment. The two-year multiple-family intervention consisted of weekly group sessions designed to educate patients and their family members about the biological basis of mental illness and treatment, to improve illness management and coping skills, and to provide social support. The group sessions were conducted by two clinicians using a standardized protocol. Each multiple-family group included five to eight families and consumers. Service records for the year before and after random assignment to the study groups were examined in an intent-to-treat analysis. RESULTS: During the year after random assignment to study groups, multiple-family group treatment was associated with a lower rate of psychiatric hospitalization than standard care. It was only marginally associated with lower use of crisis services, and it was not associated with the amount of outpatient service time. CONCLUSIONS: The findings suggest that implementation of multiple-family group treatment in a capitated community mental health setting improves hospitalization outcomes without increasing the overall volume of outpatient mental health services.

Relationship between coping, cognitive dysfunction and depression in multiple sclerosis.

Given its relatively high prevalence, one possible source of stress for patients with multiple sclerosis (MS) is cognitive dysfunction. The authors' study was guided by a new theoretical model suggesting that cognitive dysfunction in MS may be most likely to lead to depression when patients use high levels of avoidance coping and/or low levels of active coping. To test this model, 55 patients with definite MS were administered a neuropsychological battery and measures of depression and coping. Consistent with predictions, regression analyses showed that coping significantly moderated the relationship between cognitive dysfunction and depression. Specifically, cognitive dysfunction was most likely to be associated with depression when patients used either high levels of avoidance or low levels of active coping. Implications of these data for clinical applications and for our theoretical conceptualization are discussed and limitations of the model explored.

Contributing factors to depressed mood in Multiple Sclerosis.

By applying the behavioral theory of Lewinsohn et al. [1985. An integrative theory of depression. In: S. Reiss, & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 331-359). San Diego, CA: Academic Press.] to multiple sclerosis (MS), it was hypothesized that physical disability, fatigue, and psychosocial dysfunction would be significantly predictive of depressed mood in MS patients. Seventy-six MS patients completed the following measures: the Sickness Impact Profile (SIP), the Fatigue Impact Scale (FIS), and the mood subscale from the Chicago Multiscale Depression Inventory (CMDI). Structural equation modeling revealed that physical disability and fatigue were indirectly predictive of depressed mood via their effects on recreational functioning. Fatigue also had a direct effect on mood. If reductions in recreational activities actually cause decrements in mood, depressed mood in MS may be treatable by helping patients identify recreational activities that they can enjoy regardless of physical or fatigue-related difficulties.