Post-traumatic growth in PhD students during the COVID-19 pandemic.

Throughout the COVID-19 pandemic, graduate students have faced increased risk of mental health challenges. Research suggests that experiencing adversity may induce positive psychological changes, called post-traumatic growth (PTG). These changes can include improved relationships with others, perceptions of oneself, and enjoyment of life. Few existing studies have explored this phenomenon among graduate students. This secondary data analysis of a survey conducted in November 2020 among graduate students at a private R1 University in the northeast United States examined graduate students' levels and correlates of PTG during the COVID-19 pandemic. Students had a low level of PTG, with a mean score of 10.31 out of 50. Linear regression models showed significant positive relationships between anxiety and PTG and between a measure of self-reported impact of the pandemic and PTG. Non-White minorities also had significantly greater PTG than White participants. Experiencing more negative impact due to the pandemic and ruminating about the pandemic were correlated with greater PTG. These findings advance research on the patterns of PTG during the COVID-19 pandemic and can inform future studies of graduate students' coping mechanisms and support efforts to promote pandemic recovery and resilience.

Containing the spread of mumps on college campuses.

College campuses are vulnerable to infectious disease outbreaks, and there is an urgent need to develop better strategies to mitigate their size and duration, particularly as educational institutions around the world adapt to in-person instruction during the COVID-19 pandemic. Towards addressing this need, we applied a stochastic compartmental model to quantify the impact of university-level responses to contain a mumps outbreak at Harvard University in 2016. We used our model to determine which containment interventions were most effective and study alternative scenarios without and with earlier interventions. This model allows for stochastic variation in small populations, missing or unobserved case data and changes in disease transmission rates post-intervention. The results suggest that control measures implemented by the University's Health Services, including rapid isolation of suspected cases, were very effective at containing the outbreak. Without those measures, the outbreak could have been four times larger. More generally, we conclude that universities should apply (i) diagnostic protocols that address false negatives from molecular tests and (ii) strict quarantine policies to contain the spread of easily transmissible infectious diseases such as mumps among their students. This modelling approach could be applied to data from other outbreaks in college campuses and similar small population settings.

Social value of supported employment for psychosocial program participants.

Members of a psychiatric psychosocial program designed to provide both supported employment and peer support were surveyed about their current social activities, sources of social support, and social life improvement since joining the program. Survey respondents who worked a mainstream job (n=17) reported greater peer contact in community locations, and correspondingly greater social life improvement, than those who remained unemployed or worked volunteer jobs (n=45). Results of a hierarchical regression analysis (N=62) that explored this positive correlation between mainstream work, community-based peer contact, and social life satisfaction suggest that working a job in an integrated setting that paid at least minimum wage encouraged program participants to meet and interact in community locations, thereby strengthening peer mutual support while furthering social integration. This unique pattern of findings requires replication, and we recommend that other psychosocial programs conduct similar quality improvement studies to provide further insights into the relationship between peer support and community integration.

Adapting evidence-based interventions to fit usual practice: staff roles and consumer choice in psychiatric rehabilitation.

This proof-of-concept study tested the viability of adapting a specialized practice to fit multi-service programs by switching from specialist to generalist staff roles. The intervention under study was supported employment, an evidence-based practice for adults with severe mental illness. Program data on participant characteristics, attendance, staff contact, and employment were retrieved for the 2007 calendar year (N = 99). Two hierarchical regression analyses compared (1) participants with any versus no mainstream employment, and (2) participants who started a new job in 2007 versus all other participants. In both analyses, individual participant counts of days on which employment services were provided and count of different employment service providers independently predicted mainstream employment over and above program attendance and background factors. The study program's employment rate approximated rates published for specialized supported employment programs, suggesting that it is feasible to adapt specialized evidence-based practices to fit multi-service settings without compromising service quality.

Viability of using employment rates from randomized trials as benchmarks for supported employment program performance.

Cumulative employment rates published by randomized trials are based on each enrollee's pre-planned 18-24-months of study participation. By contrast, community programs typically report employment rates for clients active in services during a calendar quarter. Using data from three supported employment programs in randomized trials, we show that trial cumulative employment rates are about twice as large as quarterly employment rates for the same program. Therefore, we recommend that administrators, service networks, and mental health authorities begin to publish quarterly employment rates, and quarterly median earnings, to allow policymakers to set realistic performance expectations for supported employment programs.

Preference in random assignment: implications for the interpretation of randomized trials.

Random assignment to a preferred experimental condition can increase service engagement and enhance outcomes, while assignment to a less-preferred condition can discourage service receipt and limit outcome attainment. We examined randomized trials for one prominent psychiatric rehabilitation intervention, supported employment, to gauge how often assignment preference might have complicated the interpretation of findings. Condition descriptions, and greater early attrition from services-as-usual comparison conditions, suggest that many study enrollees favored assignment to new rapid-job-placement supported employment, but no study took this possibility into account. Reviews of trials in other service fields are needed to determine whether this design problem is widespread.

Transforming Dissatisfaction with Services into Self-Determination: A Social Psychological Perspective on Community Program Effectiveness.

A field study of supported employment for adults with mental illness (N=174) provided an experimental test of cognitive dissonance theory. We predicted that most work-interested individuals randomly assigned to a non-preferred program would reject services and lower their work aspirations. However, individuals who chose to pursue employment through a non-preferred program were expected to resolve this dissonance through favorable service evaluations and strong efforts to succeed at work. Significant work interest-by-service preference interactions supported these predictions. Over two years, participants interested in employment who obtained work through a non-preferred program stayed employed a median of 362 days versus 108 days for those assigned to a preferred program, and participants who obtained work through a non-preferred program had higher service satisfaction.

Treatment of Alcohol Intoxication at University Health Services: Examining Clinical Characteristics, Drinking Patterns, and Adherence with Referral.

OBJECTIVE: This study examines demographics, clinical characteristics, and drinking patterns of students presenting with alcohol intoxication at a university health service. PARTICIPANTS: The sample included one hundred students (50% female, 48% freshmen) treated for alcohol intoxication at university student health services. Complete medical charts were obtained for 80 students (43% female, 46% freshmen). METHODS: A prospective case review was performed between September 2005 and March 2006. RESULTS: Although males reported having more drinks before admission, drinking more frequently, and having more drinks per drinking day than females, there were no other gender differences. Freshmen comprised almost half the admissions, but there were no significant differences in drinking patterns across school years. While only 54% of students were given follow-up referrals, 72.2% of students complied with recommended referrals. Additional assessment information included alcohol use disorders sceening scores, history of previous alcohol intoxication and problems related to use, symptoms of anxiety and depression, and use of anti-depressant medication. CONCLUSIONS: These results suggest that further investigations of student characteristics and experiences prior to contact with university health services are warranted and may necessary to the development and implementation of programs to reduce harmful alcohol consumption.

Exercise and emotion dynamics: An experience sampling study.

Though it has been widely demonstrated that regular exercise is associated with better emotional wellbeing, the nature of this association remains unclear. The present study explored the relationship between voluntary exercise and the temporal dynamics of daily emotions, and thus how voluntary exercise could be impacting emotional reactivity and recovery in naturalistic contexts. Seventy-six young adults participated simultaneously in this ecological momentary assessment study, and received 75 prompts over the course of 15 days. Emotional inertia (persistence of emotional states), emotional variability (intensity of emotional fluctuations), and emotional instability (tendency for emotional fluctuations) were considered. Past research has shown that low wellbeing tends to be associated with high inertia, variability, and instability. Each prompt included ratings of present emotions (anxiety, sadness, cheerfulness, contentment) and any recent physical activity. Greater average exercise time was significantly associated with less inertia (reduced autocorrelation) of anxiety. Exercise was not significantly associated with inertia of the other emotions, although results were in the same direction. Exercise habits were unrelated to emotional variability and instability. Results suggest that exercise may buffer against prolonged or persistent negative affective states and consequently could benefit a person's ability to self-regulate or recover from changes in the environment and internal emotional experiences, rather than simply reducing the frequency or intensity of anxious emotions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Supported employment outcomes of a randomized controlled trial of ACT and clubhouse models.

OBJECTIVE: In a randomized controlled trial, a vocationally integrated program of assertive community treatment (ACT) was compared with a certified clubhouse in the delivery of supported employment services. METHODS: Employment rates, total work hours, and earnings for 121 adults with serious mental illness interested in work were compared with published benchmark figures for exemplary supported employment programs. The two programs were then compared on service engagement, retention, and employment outcomes in regression analyses that controlled for background characteristics, program preference, and vocational service receipt. RESULTS: Outcomes for 63 ACT and 58 clubhouse participants met or exceeded most published outcomes for specialized supported employment teams. Compared with the clubhouse program, the ACT program had significantly (p<.05) better service engagement (ACT, 98 percent; clubhouse, 74 percent) and retention (ACT, 79 percent; clubhouse, 58 percent) over 24 months, but there was no significant difference in employment rates (ACT, 64 percent; clubhouse, 47 percent). Compared with ACT participants, clubhouse participants worked significantly longer (median of 199 days versus 98 days) for more total hours (median of 494 hours versus 234 hours) and earned more (median of $3,456 versus $1,252 total earnings). Better work performance by clubhouse participants was partially attributable to higher pay. CONCLUSIONS: Vocationally integrated ACT and certified clubhouses can achieve employment outcomes similar to those of exemplary supported employment teams. Certified clubhouses can effectively provide supported employment along with other rehabilitative services, and the ACT program can ensure continuous integration of supported employment with clinical care.

Cerebral blood volume and clinical changes on the third day of placebo substitution for SSRI treatment.

BACKGROUND: Interruptions in SSRI treatment have been associated with adverse effects that can resemble depressive illness. We hypothesized that brain regions implicated in depression, with extensive serotonergic innervation, would exhibit changes in activity associated with emergence of symptoms following drug discontinuation. METHODS: Subjects meeting DSM-IV criteria for remitted major depression on 20 mg/day of either fluoxetine or paroxetine were recruited into this 6-week study. During weeks 2 and 6, subjects underwent a 3-day period in which either active drug or placebo was substituted for their medication under double-blind conditions. Cerebral blood volume (CBV) maps were obtained via dynamic susceptibility magnetic resonance imaging at the end of each double-blind period. RESULTS: In the paroxetine group, change in CBV in left medial superior frontal region and left caudate nucleus correlated significantly with change in Discontinuation Emergent Symptom Scale and Hamilton Depression Rating Scale (HDRS; R2 = 0.66, p =.0007; R2 = 0.51, p =.006; and R2 = 0.43, p =.015; R2 = 0.32, p =.043, respectively). CONCLUSIONS: These data demonstrate that changes in regional CBV of left prefrontal cortex and left caudate nucleus correlate with the emergence of discontinuation symptoms and increased HDRS after interruption of paroxetine treatment.

Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness.

OBJECTIVES: This study examined Medicaid claims forms to determine the prevalence, severity, and co-occurrence of physical illness within a representative sample of persons with serious mental illness (N=147). METHODS: Representativeness of health problems in the study sample was established through comparison with a larger sample of persons with serious mental illness enrolled in Medicaid within the same state. Standardized annual costs were then assigned to Medicaid claims diagnoses, and individual health problem severity was measured as the sum of estimated treatment costs for diagnosed conditions. RESULTS: Seventy-four percent of the study sample (N=109) had been given a diagnosis of at least one chronic health problem, and 50 percent (N=73) had been given a diagnosis of two or more chronic health problems. Of the 14 chronic health conditions surveyed, chronic pulmonary illness was the most prevalent (31 percent incidence) and the most comorbid. Persons with chronic pulmonary illness were second only to those with infectious diseases in average annual cost of treatment ($8,277). Also, 50 percent or more of participants in eight other diagnostic categories had chronic pulmonary illness. A regression analysis identified age, obesity, and substance use disorders as significant predictors of individual health problem severity. CONCLUSIONS: Risk adjustment for physical health is essential when setting performance standards or cost expectations for mental health treatment. Excluding persons with chronic health problems from mental health service evaluations restricts generalizability of research findings and may promote interventions that are inappropriate for many persons with serious mental illness.

When programs benefit some people more than others: tests of differential service effectiveness.

Practitioners need to know for whom evidence-based services are most or least effective, but few services research studies provide this information. Using data from a randomized controlled comparison of supported employment findings for two multi-service psychiatric rehabilitation programs, we illustrate and compare procedures for measuring program-by-client characteristic interactions depicting differential program effectiveness, and then illustrate how a significant program-by-client interaction can explain overall program differences in service effectiveness. Interaction analyses based on cluster analysis-identified sample subgroups appear to provide statistically powerful and meaningful hypothesis tests that can aid in the interpretation of main effect findings and help to refine program theory.

PARENTAL DEATH IN THE LIVES OF PEOPLE WITH SERIOUS MENTAL ILLNESS.

Nearly a fourth (22%) of the participants within a research sample of 148 individuals with serious mental illness reported the death of a loved one as a significant loss, and two thirds of these deaths involved the loss of one or both parents. The key determinant of the severity and duration of grief in response to the death of a parent was whether or not there were extenuating circumstances that complicated the death event, such as co-residence with the deceased at the time of death or a lack of regular social contact with anyone other than the deceased. In all instances of severe or prolonged grief, there was no preparation for the parental death, either through preparatory counseling or practical plans for funeral arrangements, financial repercussions, life-style changes, or residential relocation. Mental health agencies serving people with serious mental illness should begin to incorporate financial and emotional preparation for parental deaths and bereavement counseling as essential services.