Areas Of Psychosocial Functioning Research Articles

Service Dogs for Veterans and Military Members With Posttraumatic Stress Disorder

Military members and veterans (hereafter, veterans) with posttraumatic stress disorder (PTSD) increasingly seek psychiatric service dogs as a complementary intervention, yet the effectiveness of service dogs is understudied. To estimate the associations between psychiatric service dog partnership and self-reported and clinician-rated PTSD symptom severity, depression, anxiety, and psychosocial functioning after 3 months of intervention among veterans. This nonrandomized controlled trial used standardized and validated assessment instruments completed by participants and administered by blinded clinicians. Recruitment, eligibility screening, and enrollment were conducted between August 2017 and December 2019. Veterans were recruited using the database of an accredited nonprofit service dog organization with constituents throughout the US. Participants were veterans with a PTSD diagnosis; they were allocated to either the intervention group (n = 81) or control group (n = 75). Outcome assessments were performed at baseline and at the 3-month follow-up. Data analyses were completed in October 2023. Participants allocated to the intervention group received a psychiatric service dog for PTSD, whereas those allocated to the control group remained on the waiting list based on the date of application submitted to the service dog organization. Both groups had unrestricted access to usual care. The primary outcomes were PTSD symptom severity, depression, and anxiety after 3 months, and the secondary outcomes were psychosocial functioning, such as quality of life and social health. The self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was used to measure symptom severity, and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was used to assess PTSD diagnosis (score range for both instruments: 0-80, with higher scores indicating greater PTSD symptoms). The 156 participants included in the trial had a mean (SD) age of 37.6 (8.3) years and included 117 males (75%), 17 Black or African American individuals (11%), 30 Hispanic individuals (19%), and 117 White individuals (76%). Compared with the control group, the intervention group had significantly lower PTSD symptom severity based on the PTSD Checklist for DSM-5 mean (SD) score (41.9 [16.9] vs 51.7 [16.1]; difference in means, -11.5 [95% CI, -16.2 to -6.6]; P < .001) and the CAPS-5 mean (SD) score (30.2 [10.2] vs 36.9 [10.2]; difference in means, -7.0 [95% CI, -10.8 to -4.5]; P < .001) at 3 months. The intervention group also had significantly lower depression scores (odds ratio [OR], 0.45 [95% CI, 0.23-0.86]; difference in means, -3.3 [95% CI, -6.8 to -0.6]), anxiety (OR, 0.25 [95% CI, 0.13-0.50]; difference in means, -4.4 [95% CI, -6.9 to -2.1]), and most areas of psychosocial functioning (eg, social isolation: OR, 0.34 [95% CI, 0.18-0.64]). This nonrandomized controlled trial found that compared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and higher psychosocial functioning in veterans. Psychiatric service dogs may be an effective complementary intervention for military service-related PTSD. ClinicalTrials.gov ID: NCT03245814.

Narcissistic Personality Disorder

Publisher Summary Narcissistic personality disorder is a newly recognized diagnostic entity in clinical psychiatry. The cardinal feature of narcissistic personality disorder is heightened narcissism. Individuals with this disorder display grandiosity, intense ambition, and an insatiable craving for admiration. Their consuming self-interest renders them incapable of appreciating and understanding the independent motivations and needs of others. Consequently, they come across as cold, unempathic, exploitative, and having little concern for those around them. The clinical features of narcissistic personality disorder involve six areas of psychosocial functioning: self-concept, interpersonal relations, social adaptation, ethics, standards, and ideals, love and sexuality, and cognitive style. In each of these areas there are “overt” and “covert” manifestations. These designations do not necessarily imply their conscious or unconscious existence although such topographical distribution might also exist. In general, however, the overt and covert designations denote seemingly contradictory phenomenological aspects that are more or less easily discernible. Moreover, these contradictions are not restricted to the individual's self-concept but permeate his or her interpersonal relations, social adaptation, love life, morality, and cognitive style.

Fertility Issues in Adolescent and Young Adult Cancer Survivors.

Many adolescent and young adult (AYA) cancer survivors place great importance on fertility. This study explored AYAs' discussions of fertility in the context of discussing their survivorship experiences. Secondary analyses of a qualitative study of young adult survivors of adolescent cancers ("AYA survivors") was performed using semistructured individual interviews and focus groups. Analyses were conducted using grounded theory using thematic content analysis with an inductive data-driven approach. Participants (n = 43) were 16-24 years old, diagnosed with cancer between ages 14 and 18 years, and were at least 6 months post-treatment. Before treatment, 5 males banked sperm and no females preserved fertility. More males (50%) than females (39%) reported uncertainty about their fertility. Three major categories emerged from the data: fertility concerns, emotions raised when discussing fertility, and strategies used to manage fertility concerns. Fertility concerns focused on dating/partner reactions, health risks, and what potential infertility would mean for their life narrative. Emotions included distress, feeling overwhelmed and hopeful/wishful thinking. Females were more likely to feel distressed and overwhelmed than males. Strategies to manage concerns included acceptance/"making do," desire to postpone concerns, and reliance on assisted reproductive technology. Most AYAs in our study reported a number of reproductive concerns and fertility-related distress after treatment, which may affect other areas of psychosocial functioning. Females may be more at-risk for distress than males, particularly in situations of uncertainty and limited knowledge. Future work should explore how to best incorporate fertility-related informational and support services more fully into survivorship care. Implications for survivorship care are discussed.

Quality of Life, Body Image and Sexual Functioning in Bariatric Surgery Patients.

This article provides an overview of the literature on quality of life, body image and sexual behaviour in individuals with extreme obesity and who undergo bariatric surgery. Quality of life is a psychosocial construct that includes multiple domains, including health-related quality of life, weight-related quality of life, as well as other psychological constructs such as body image and sexual functioning. A large literature has documented the impairments in quality of life and these other domains in persons with obesity and extreme obesity in particular. These impairments are believed to play an influential role in the decision to undergo bariatric surgery. Individuals who undergo bariatric surgery typically report significant improvements in these and other areas of psychosocial functioning, often before they reach their maximum weight loss. The durability of these changes as patients maintain or regain weight, however, is largely unknown.

Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users.

BackgroundSubstance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help.ObjectiveThe aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO.MethodsFollowing initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined.ResultsSignificant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety (P=<.001 across all aspects of functioning). Additionally, significant improvements were found within specific subgroups of participants, including females (P=.001-<.001), males (P=.004-<.001), service users reporting alcohol dependence (P=.002-<.001), opiate and crack dependence (P=.014-<.001), and those seeking support for other substances that may be less well represented in the substance misuse sector (P=.001-<.001).ConclusionsData from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program.

Psychosocial Issues in Pediatric Inflammatory Bowel Disease

Pediatric inflammatory bowel disease (IBD) can affect many areas of psychosocial functioning, and comprehensive medical care includes consideration of psychosocial issues as well as disease factors. The purpose of this clinical report is to review research on psychosocial functioning in pediatric IBD and to provide recommendations for care providers in the areas of psychopathology, health-related quality of life, and social, family, and school functioning. Youth with IBD are at increased risk for difficulty in all areas reviewed, and many psychosocial factors are associated with disease activity, which highlights the importance of monitoring psychosocial functioning as part of clinical care. Several interventions have empirical support or show promise for addressing psychosocial difficulty, and recommendations for monitoring and treating these issues are provided.

Norms for Performance in the Workplace in Healthy People: Data from the National Comorbidity Survey Replication Study

IntroductionPsychiatric conditions affect multiple areas of psychosocial functioning, including functioning in the workplace. The purpose of this study was to establish norms for absenteeism (work days missed due to mental or physical illness) and work performance (quality of work performed when at work) for healthy individuals. We selected 300 individuals without psychiatric or medical conditions from the National Comorbidity Survey Replication study (NCS-R). Absenteeism and work performance were assessed using the NCS-R version of the Health and Work Performance Questionnaire (HPQ). Employees missed an average of 5.1 days of work in the past year. Absenteeism varied across occupations, with performers of routine tasks, office clerks, and professionals exhibiting the greatest variance in days missed. Work performance ratings were skewed toward high performance ratings and did not differ across occupations. Gender, age, race/ethnicity, and education level did not substantially moderate absenteeism and work performance norms.DiscussionSkewed ratings for work performance are consistent with previous findings using the HPQ. This may reflect a general tendency that individuals rate themselves favorably when they compare themselves to others. This study provides normative tables for absenteeism and work performance in individuals without psychiatric or medical conditions, against which individuals with such conditions may be compared.

Do young people attending addiction services differ from those attending youth mental health services?

We aimed to describe and compare the self-reported substance use, psychopathology and psychosocial morbidity in adolescents attending two adolescent outpatient services, a triage-based mental health service and an engagement-focused addiction service in Auckland, New Zealand. A naturalistic cross-section of 131 (addiction service = 67, mental health service = 64) 14-18-year-old boys and girls attending each service completed a standardised screening and assessment instrument, the Drug Use Screening Inventory-Revised. The Drug Use Screening Inventory-Revised measures self-reported problems across 10 domains of functioning, including substance use, behaviour, psychiatric symptoms and school and family functioning. Descriptive statistics were used to provide an overview of the self-reported morbidity in each group and t-tests were used to determine differences between the two groups. Adolescents attending the addiction service reported significantly more problems with substance use, school performance and peer relationships than those attending the mental health service. There was no significant difference in reported psychiatric symptoms, behavioural problems, social competency, health problems, family problems, difficulties in work functioning or leisure time between the two groups. Young people presenting to engagement-focused substance use services report similar difficulties to those at mental health services across most areas of psychosocial functioning. Addiction services may require equivalent staffing expertise and workforce development to that in mental health to effectively meet young people's needs.

Age of alcohol and marijuana use onset predicts weekly substance use and related psychosocial problems during young adulthood

The present study examined whether age of alcohol and marijuana use onset during adolescence predicted later substance use and related problems in several areas of psychosocial functioning among young adults. A total of 621 participants completed surveys regarding current substance use from 7th through 12th grades and also completed a survey as young adults (age 24) that included questions regarding the impact of alcohol and drug use on several areas of functioning. Findings indicated that earlier age of substance use onset was positively associated with weekly use of alcohol and marijuana during young adulthood, as well as substance-related occupational, relationship, and legal problems. The majority of young adults reporting problems due to alcohol or drug use had first reported alcohol and/or marijuana use before entering high school. For women, onset of substance use prior to high school was more strongly related to negative drug-related occupational outcomes than was concurrent weekly substance use as a young adult. Findings indicated that the negative effects of early onset substance use are strongest in social and occupational functioning, areas that correspond to the DSM criteria relevant to the diagnosis of alcohol or substance use disorder.

Adult attachment, cultural orientation, and psychosocial functioning of Chinese American college students.

This study examined the relationships among adult attachment, cultural orientation, and three areas of psychosocial functioning (i.e., emotional expressiveness, social difficulty, and depressive symptoms) with a sample of 112 Chinese American college students. Findings indicated that both attachment avoidance and anxiety were significantly associated with indictors of psychosocial functions in the directions predicted by the theory which provides support to the cross-cultural applicability of adult attachment perspectives on Chinese American populations. In addition, endorsement of independent cultural orientation was found to be negatively associated with both social difficulty and depressive symptoms, and independent cultural orientation moderated the relation between attachment anxiety and social difficulty. Findings and implications are discussed based on attachment perspectives and the acculturation processes and challenges experienced by Chinese American individuals.

Functional outcome following liver transplantation—A pilot study

Background/aims: We have previously shown that prior to liver transplantation, patients exhibit impairment in memory and psychomotor speed. Despite significant improvement following transplantation, recovery remained incomplete at 1 year post-transplant. This study aimed to investigate the effects of liver transplantation on a wider range of cognitive abilities, and to assess the impact of any impairment upon day-to-day functioning, particularly driving ability. Methods: This study was a between-group design involving three groups of participants: liver transplant candidates, liver transplant recipients and healthy controls. All participants completed measures of affective status, functional capacity, quality of life, neuropsychological status and driving ability. Results: For the majority of measures, healthy controls performed best, followed by liver transplant recipients and then liver transplant candidates, respectively. This pattern was most pronounced with respect to functional limitations, language and attention. No significant difference between the three groups was observed for simulated driving ability. Conclusions: The results suggest that while significant recovery occurs in many areas of psychosocial functioning following liver transplantation, this recovery may be incomplete, that is, many patients do not recover to their full pre-illness status. The measure we employed to assess driving ability was not a sensitive or discriminating measure in this study.

Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD)

This exploratory study aims to compare lifetime psychiatric axis-I-comorbidity and psychosocial functioning in a clinically referred sample of adult patients with attention-deficit/hyperactivity disorder (ADHD) with a population-based healthy control group and to examine whether patients with ADHD and lifetime comorbid diagnoses differ from patients with pure ADHD in their functional impairment. Seventy adult patients with ADHD according to DSM-IV criteria and a gender- as well as age-matched population based control group underwent diagnostic evaluations with clinical interviews for ADHD, DSM-IV disorders and demographic information. The prevalence of psychiatric lifetime comorbidity was 77.1% in patients with ADHD and thus exceeded the rate in the control group, which was 45.7%. Significantly more patients suffered from depressive episodes, substance related disorders and eating disorders. Compared to the control group adults with ADHD were significantly impaired in a variety of psychosocial functions (education, occupational training). Patients with ADHD and lifetime diagnosis of comorbid psychiatric disorders differed from patients with pure ADHD in their psychosocial functioning only in the percentage of unemployed individuals, which was higher in patients with psychiatric comorbidity. Adults with ADHD suffer significantly more often from other psychiatric disorders than individuals of the population-based control group and are impaired in several areas of psychosocial functioning. Poor psychosocial outcome is primarily related to ADHD and not to additional psychiatric disorders. Due to the limited number of assessed patients these results need to be confirmed by studies with larger sample size.

Medical and psychosocial outcome of patients with occupational contact dermatitis in Israel

Although the medical, financial and prognostic factors of occupational contact dermatitis (OCD) have been addressed, studies on the social outcome of OCD are sparse. To define the medical and psychosocial outcome of patients with OCD. Workers with OCD were interviewed by telephone using a questionnaire that included questions about the occupation, dermatological disease, sick leave, present working status and disability claims, and questions related to the subjective perceptions of OCD in all areas of psychosocial functioning and quality of life. Seventy workers (64.3% males and 35.7% females) were interviewed. Forty per cent had stopped working and one-third had taken sick leave because of OCD. Forty-seven (67.1%) were currently working while 23 (32.8%) were unemployed. Disability compensation was claimed by only 41.4% and was received by 24.3%. Eight workers (11.4%) had persistent postoccupational dermatitis (PPOD). Loss of employment affected the occupational area of the workers' lives (100%), and also interpersonal relationships (45.7%), relationships within the family (18.6%), daily functioning (45.7%) and mental health (24.3%). Considerable working time is lost because of unemployment or sick leave due to OCD. Only a small proportion of eligible patients with OCD apply for disability compensation and an even smaller proportion receive it. Our study demonstrates the significance of OCD to the psychosocial aspects of workers' lives and emphasizes that the assessment of OCD outcome should relate not only to the medical but also to the psychosocial aspect of the disease.

Logotherapy as an Adjunctive Treatment for Chronic Combat-related PTSD: A Meaning-based Intervention

Combat-related Post-traumatic Stress Disorder (PTSD) is often highly debilitating and affects nearly all areas of psychosocial functioning. Veterans with PTSD re-experience their traumas in the form of haunting intrusive memories, nightmares and flashbacks, and have chronic difficulty modulating arousal. As a way to cope with these symptoms, many survivors live isolated and avoidant lives, self-medicate with alcohol and substances of abuse, and numb themselves to emotional experiences and relationships with family and friends. Additionally, many combat veterans report survivor guilt, depression, affect dysregulation, and an altered world view in which fate is seen as uncontrollable and life is viewed as devoid of meaning. In this report we describe the use of logotherapy (healing through meaning) for the treatment of combat-related PTSD

Coping with Interpersonal Stress and Psychosocial Health Among Children and Adolescents: A Meta-Analysis

This meta-analysis examines the relationship between active coping and psychosocial health among youth. Results from 40 studies of coping with interpersonal stress were synthesized using a random-effects model. Four areas of psychosocial functioning were examined: externalizing and internalizing behavior problems, social competence, and academic performance. The magnitude of the relationship between active coping and psychosocial functioning was small, with correlations ranging from 0.02 for internalizing behavior to 0.12 for academic performance. Mean effects were moderated by stressor controllability: youth who used active coping in response to controllable stressors had fewer externalizing problems and higher social competence, as compared to those who used active coping in response to uncontrollable stressors. Implications for primary prevention programs and directions for future research on child and adolescent coping are discussed.

Psychosocial functioning in patients with treatment resistant depression

Background. – Depression is a disorder that causes disability, with a profound adverse impact on all areas of psychosocial functioning. This is particularly true for those with treatment resistant depression (TRD). However, to date, no systematic assessments of psychosocial functioning for patients with TRD have been conducted. Methods. – In the present study, we used the Longitudinal Interval Follow-up Evaluation (LIFE) scale to measure psychosocial functioning in 92 patients with TRD. These patients met formal criteria for TRD and were part of a clinical trial examining the efficacy of lithium augmentation of nortriptyline. Results. – Clinicians rated this sample of patients as experiencing mild to moderate impairment in work-related activities, good to fair interpersonal relations, poor level of involvement in recreational activities, and mild impairment of ability to enjoy sexual activity. Patients and clinicians rated global social adjustment as poor. Conclusions. – Patients with formally defined TRD experience significant impairment in psychosocial functioning. In this sample a tendency existed for both clinicians and patients to assign more severely impaired global ratings when compared with ratings for specific functional areas.

Searching for a Gastrointestinal Subgroup Within the Somatoform Disorders

The authors examined whether patients suffering from functional gastrointestinal symptoms constitute a separate group within the broader concept of the somatoform disorders. The authors compared 103 patients with a severe gastrointestinal syndrome, 220 patients with a somatization syndrome according to DSM-IV, and 250 clinical control subjects with nonsomatoform mental disorders. The gastrointestinal group showed more catastrophizing thinking, complained more about autonomic sensations, felt bodily weaker, was less tolerant towards bodily discomfort, had developed more hypochondriacal fears and behaviors, was more depressed, and was more severely disabled in different areas of psychosocial functioning than the other groups. These differences, however, disappeared when general somatization was controlled for by analysis of covariance. Only a small effect related to dysfunctional cognitions remained specific to the gastrointestinal syndrome. Because these results do not confirm the idea of an independent gastrointestinal syndrome, general mechanisms of somatization seem to play the dominant role.

Social Cognition and Verbal Learning Disabilities

Abstract Considerable research suggests that the greatest proportion of learning disabilities involve reading and writing. In a majority of these cases, investigators have documented the presence of underlying weaknesses in various verbal/linguistic processes. Professionals have invested heavily in the treatment of academic outcomes associated with verbal learning disabilities. However, less emphasis has been given to the way in which these verbal deficiencies impact an individual's ability to process language information in order to understand, interpret and manage social communication or mentally construct an understanding of the world. Evidence suggests that many students with learning disability (LD) also have difficulties in areas of psychosocial functioning. A “social cognition” perspective is offered so as to view verbal learning disabilities not only as an academic skill deficit, but rather as a developmental compromise in the verbal/language systems that may impact cognitive, academic, and social...

Teaching schizophrenic patients recreational, residential and vocational skills

Three therapy programs have recently been devised as a further development of the Integrated Psychological Therapy (IPT) for patients with schizophrenia. They offer targeted and structured behavior therapy in residential, vocational and recreational activity-three areas of rehabilitation which have been neglected in Europe, despite evidence from numerous prospective and retrospective studies showing severe impairment in these areas of psychosocial functioning in schizophrenia. The three therapy programs, aimed at enabling patients to lead more independent and satisfying lives in the community, have shown promise but need further research for their empirical validation.

Coping with HIV Disease Among Seropositive Women: Psychosocial Correlates

ABSTRACT With HIV becoming more of a chronic illness, and with a shift in the demographics of the HIV pandemic to women, it is important to understand which psychosocial factors relate to positive coping behaviors in HIV-infected women. Additionally, socioeconomic factors have frequently confounded the interpretation of results of many other studies of stress and coping in HIV-infected individuals. In the present study, 58 HIV-infected women were assessed. These women were generally well-educated, employed women and therefore did not suffer from socioeconomic factors associated with inner city living, commercial sex work, or drug use. We performed a discriminant function analysis to determine which of five psychosocial variables could discriminate between those who strongly self-identified with each of three coping styles from those with low self-identification. The three coping styles included an active, problem solving style, a hopeless, given-up style, and a stoic style. Different patterns of psychosocial variables discriminated between those who strongly identified with a coping style from those who did not. For fighting spirit, the best combination of predictors (loadings > .25) were: strong social support, lower loneliness, depression, and anger, and a belief in a chance locus of control. The best combination of predictors for identification with a helpless coping style were: loneliness, depression, and anger, lower social support and less belief in a chance locus of control. Stronger identification with a stoic coping style were belief in a chance locus of control and lower social support, loneliness, and anger. Results of the study point to areas of psychosocial functioning which need to be strengthened or diminished in order to maintain effective coping for HIV-infected women and enhance their quality of life.