Development of the brief inventory of perceived stress.

OBJECTIVES: To provide a measure of perceived stress that is psychometrically superior to existing instruments and novel in dimensionality. DESIGN: At 4-week intervals over 48 weeks, patients with multiple sclerosis (N = 138) completed 26 items from the Perceived Stress Scale (PSS) and the Perceived Stress Questionnaire (PSQ). RESULTS: Extant factor analytic models of the PSS fit poorly. A new measure using nine PSS and PSQ items, the Brief Inventory of Perceived Stress (BIPS), demonstrated good fit, construct validity, and stability with 3 factors: Lack of Control, Pushed, and Conflict and Imposition. CONCLUSIONS: Items commonly used to measure perceived stress may have a more sophisticated underlying structure than previously thought. The BIPS's multidimensionality and longitudinal stability offer potential benefits in conceptualization and outcome prediction.

Attributions for discriminatory events and satisfaction with social support in gay men.

Attributions modulate the impact of stressful events on mental health. However, little is known about attributions for discriminatory events and their relationship to psychosocial outcomes in sexual minority individuals. Relationships were examined between gay men's attributions for discrimination and their satisfaction with social support, a variable critical to mental health in this population. Gay men (N=307) completed online measures of satisfaction with social support, attributions for discriminatory events, and key minority stress constructs. Self blaming attributions for discrimination were associated with decreased satisfaction with social support, independent of the frequency with which participants reported experiencing discrimination. The link between self blaming and satisfaction with social support was partially mediated by a latent affective construct comprised of anxiety, depression, and low positive affect. A moderation effect was also found, such that the relationship between frequency of perceived discriminatory events and dissatisfaction with social support was amplified for men reporting more blame toward perpetrators of discrimination. Results support attributions for discrimination as valuable additions to minority stress models. Assessing self and other blame for these discriminatory events may help to clarify pathways by which discrimination can undermine gay men's satisfaction with their social support networks.

Do PTSD symptoms and course predict continued substance use for homeless individuals in contingency management for cocaine dependence?

Homeless individuals (n=187) entering contingency management (CM) for cocaine dependence were assessed for PTSD diagnosis, and a subset of 102 participants reporting traumatic exposure also periodically completed a self-report measure of PTSD symptoms. Patients with PTSD in full remission at 6 months (end of active treatment) and 12 months (end of aftercare) used substances much less frequently during aftercare than those with no PTSD diagnosis. Those whose PTSD diagnosis improved to full remission status during active treatment, and remained in full remission at 12 months, also had superior substance use outcomes. Severity of PTSD symptoms at 6 months, but not baseline or 2 months, was associated with substance use across treatment phases. Substance use during aftercare, however, was better predicted by changes in PTSD symptom severity. Patients whose PTSD symptoms improved more during active treatment fared better during aftercare than those with less improvement. Findings suggest homeless individuals with comorbid PTSD entering CM for cocaine dependence are not necessarily at increased risk for substance use compared to those without the comorbidity. However, course of PTSD does predict substance use, with the potential for CM to be unusually effective for those who respond with substantial, lasting improvements in PTSD.

Perceived barriers to psychological treatments and their relationship to depression.

In spite of repeated calls for research and interventions to overcome individual and systemic barriers to psychological treatments, little is known about the nature of these barriers. To develop a measure of perceived barriers to psychological treatment (PBPT), items derived from 260 participants were administered to 658 primary care patients. Exploratory factor analysis on half the sample resulted in 8 factors, which were supported by confirmatory factor analysis conducted on the other half. Associations generally supported the criterion validity of PBPT scales, with self-reported concurrent use of psychotherapy and psychotherapy attendance in the year after PBPT administration. Depression was associated with greater endorsement of barriers. These findings suggest that the PBPT may be useful in assessing perceived barriers.