Behavioral Skills Intervention Research Articles

A Pilot Randomized Controlled Trial of Motivation-Based Social Skills Group Treatment with Parent Training.

Despite the popularity of social skills groups, there remains a need for empirical investigation of treatment effects, especially when targeting pivotal aspects of social functioning such as initiations to peers. The goal of the present study was to conduct a randomized controlled trial of a 12-week social intervention (SUCCESS), which combined an inclusive social group with a parent education program. Twenty-five 4- to 6-year-olds with Autism Spectrum Disorder (ASD) were randomized to SUCCESS (N = 11) or to treatment as usual (N = 14). Combining a peer group model with a parent training program, the SUCCESS intervention used naturalistic behavioral techniques (e.g., environmental arrangement, natural reinforcement) to increase social initiations to peers. After 12 weeks, children participating in the SUCCESS program made more frequent initiations to peers than children in the treatment-as-usual group, including more prompted and unprompted initiations to request. Additional gains in clinician-rated social functioning were observed in children randomized to SUCCESS, while differential treatment effects were not detected in parent-rated measures. However, lower baseline social motivation was associated with greater parent-reported initiation improvement. This study provides preliminary support for the efficacy of a naturalistic, behavioral social skills intervention to improve peer initiations for children with ASD. The findings suggest that using a motivation-based social skills group was effective in increasing both prompted and spontaneous initiations to peers, and highlights the need for further research into the role of baseline social motivation in predicting social skills treatment response.

Youth voices and experiences regarding a school-based cognitive behavioral therapy skills intervention: lessons for future engagement and adaptation

BackgroundThe Cognitive Behavioral Therapy Skills Intervention (or CBTSI) aims to build mental health literacy and knowledge, allowing youth to build resilience and improve mental health broadly. In Ontario, Canada, youth voice is scant and European studies have largely reported on youth factors supporting stigma reduction, help-seeking intentions and overall satisfaction with a given intervention. Process evaluations and implementation that underpin what youth require to embrace mental health literacy interventions, particularly those that embed key learning principles in the everyday curriculum, have not been broached. The goal of this study is to understand both barriers and facilitators to engagement with the CBTSI (an intervention novel in itself because of the combined mental health plus cognitive behavior therapy (CBT) skills principles embedded in literacy) and the resources and structures that students report requiring, to fully engage with such an intervention.MethodsStudent focus groups were conducted utilizing qualitative interviews that were analyzed thematically. Analysis was informed using principles of pragmatism and analyzed inductively using thematic analysis (Braun and Clarke, Qual Res Psychol 3:77–101, 2006), first looking at the whole and then coding for themes, within an interpretivist framework. Youth were in middle school (grade 7 and 8) in Toronto, Canada who had received the CBTSI. Face to face interview guides with iterative questioning were conducted in February of 2020, and these interviews were audio-recorded and professionally transcribed. Teachers randomly chose a subset of youth whose parents consented to the research to ensure ethno-racial similarity to classroom demographics.ResultsThere were eight groups with sixty students who participated. Students were 12 to 14 years of age. Major themes were identified: maximizing the opportunities for involvement and self-determination created an atmosphere where confidence and self-compassion could flourish, signalling to the students that they understood and were able to deploy the strategies they were taught; students expressed that the intervention needs to be adapted to enhance personal dignity, respecting both individual wishes and goals in light of the variability in student reported mental health. A model explains the structures and adaptations required to maximize learning based on youth feedback.InterpretationMental health literacy incorporating CBT is a promising population-based health promotion intervention. Future adaptations and implementation decisions regarding the CBTSI need to address the wishes and experiences of these youth. Youth voice in this study explored factors that prevent and promote the uptake of the key lessons within the context of existing variability in student mental health that is often found within the context of a regular classroom. The results should be used to adapt the CBTSI as it is disseminated more broadly.

Addressing A Mental Health Intervention Gap in Juvenile Detention: A Pilot Study

ABSTRACT Research suggests that 60–70% of adolescents detained in the juvenile justice system meet criteria for a mental health disorder compared to 20% of the general adolescent population; however, the vast majority do not receive services. Unfortunately, mental health symptoms often worsen during detainment, and detainment is linked to lower levels of educational attainment and increased risk of adult recidivism. Thus, not only are these adolescents unlikely to receive needed mental health care but also the lack of interventions in detention may exacerbate inequities of contact with the criminal justice system in adulthood. In addition to these youth being an underserved population broadly, youth of color are also disproportionately incarcerated compared to their white counterparts. The current paper describes results of a pilot study of an Acceptance and Commitment Therapy (ACT)-based behavioral skills intervention, aimed at providing evidence-based mental health treatment for anadolescent population at risk of long-term adverse mental health outcomes. The study included 128 males aged 14–17 who resided in juvenile detention. Results demonstrated that the intervention was acceptable to participants, feasible to provide in detention, and could be implemented with fidelity and competency. Intervention participants demonstrated declines in symptoms of mental health, and ACT-specific constructs of experiential avoidance, cognitive fusion, and perceived barriers to moving toward their values. These results have important implications for the possibility of an effective intervention that could disrupt systemic inequity in youth mental health, and thus support further testing of this intervention in a randomized controlled trial.

Cost-effectiveness of Telephone-Delivered Education and Behavioral Skills Intervention for African American Adults with Diabetes.

Evaluate cost-effectiveness of a telephone-delivered education and behavioral skills intervention in reducing glycemic control (HbA1c) and decreasing risk of complications. Data from a randomized controlled trial, conducted from August 1, 2008 - June 30, 2010 and using a 2x2 factorial design delivered to 255 African American adults not meeting glycemic targets for diabetes were used. Though the primary aim found no significant differences in HbA1c between groups, there was an overall drop in HbA1c across arms and differential cost. Primary clinical outcome was HbA1c measured at 12-months. Costs were estimated based on self-reported utilization of primary care, emergency, and other health care. Costs due to lost wages were calculated based on self-reported days of work missed due to illness. The Michigan Model for Diabetes was used to estimate 10-year probability of developing congestive heart failure, cardiovascular disease, end stage renal disease, stroke, myocardial infarction, all cause death, and CVD death. Total cost per patient and clinical outcomes were used to estimate an incremental cost effectiveness ratio (ICER) using non-parametric bootstrapping. ICERs indicated combined education and skills intervention was $3,630 less expensive than usual care to achieve a 0.6% decrease in HbA1c and was between $34,000 and $95,000 less expensive than usual care to reduce risk of complications. The knowledge only intervention was $661 less expensive than usual care and the behavioral skills only intervention did not indicate cost effectiveness. The combined intervention ICER for HbA1c is comparable to other education programs and the ICER to reduce the probability of complications falls below previously recommended long-term cut-off of $100,000, suggesting cost-effectiveness in an African American population.

Enhancing Social Initiations Using Naturalistic Behavioral Intervention: Outcomes from a Randomized Controlled Trial for Children with Autism.

Deficits in social skills are common in children with Autism Spectrum Disorder (ASD), and there is an urgent need for effective social skills interventions, especially for improving interactions with typically developing peers. This study examined the effects of a naturalistic behavioral social skills intervention in improving social initiations to peers through a randomized controlled trial. Analyses of multimethod, multi-informant measures indicated that children in the active group (SIMI) demonstrated greater improvement in the types of initiations which were systematically prompted and reinforced during treatment (i.e., behavior regulation). Generalization to joint attention and social interaction initiation types, as well as collateral gains in broader social functioning on clinician- and parent-rated standardized measures were also observed.

Cost-Effectiveness of Telephone-Delivered Behavioral Skills Intervention for African-American Adults with Diabetes

Background: To investigate cost differences between intervention arms of a telephone-delivered self-management training for African Americans with diabetes. Methods: This RCT used a 2x2 factorial design, randomizing African American adults with poorly controlled diabetes to: 1) knowledge only, 2) skills training only, 3) combined knowledge and skills training, or 4) control group receiving general health education. The primary outcome for cost effectiveness was glycemic control (HbA1c) at 12-months post-randomization. Costs for healthcare utilization were measured using Medical Expenditure Panel Survey (MEPS) estimates and costs for lost wages were estimated using interval regression. All costs were adjusted to 2012 dollars. Cost utility was quality-adjusted life years (QALYs) estimated via the area under the curve technique using utilities obtained from respondents’ answers to SF-12 questions and mortality estimates based on CDC lifetables. Empirical joint distribution of incremental costs, QALYs, and cost effectiveness acceptability curves were generated using non-parametric bootstrapping. Results: There was no significant difference in cost (p=0.44) or change of QALYs between arms (p=0.36). With no statistically significant difference in cost, the incremental cost effectiveness ratios (ICER) were not significant compared to control, however, the knowledge only arm was $660 less expensive, the behavioral skills arm was $813 more expensive, and the combined arm was $3,630 less expensive than the control arm to achieve a 0.6% decrease in HbA1c. Conclusions: Combined with the clinical findings, these results suggest telephone-delivered education and behavioral skills training is a cost-effective way to improve glycemic control. In particular, the combined knowledge and skills training intervention arm resulted in costs $3,600 lower than the control, and dropped HbA1c by 0.6%, achieving a clinically significant change for lower cost. Disclosure L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc.. C. Dismuke: None. C. Eiler: None. R.J. Walker: None.

The impact of the 2014 Ebola virus disease outbreak in Liberia on parent preferences for harsh discipline practices: a quasi-experimental, pre-post design.

This paper uses data from a cohort of parents and guardians of young children living in Monrovia, Liberia collected before and after the 2014 outbreak of Ebola virus disease (EVD) to estimate the impact of EVD exposure on implicit preferences for harsh discipline. We hypothesized that parents exposed to EVD-related sickness or death would exhibit a stronger preference for harsh discipline practices compared with non-exposed parents. The data for this analysis come from two survey rounds conducted in Liberia as part of an intervention trial of a behavioral parenting skills intervention. Following a baseline assessment of 201 enrolled parents in July 2014, all program and study activities were halted due to the outbreak of EVD. Following the EVD crisis, we conducted a tracking survey with parents who completed the baseline survey 12 months prior. In both rounds, we presented parents with 12 digital comic strips of a child misbehaving and asked them to indicate how they would react if they were the parent in the stories. Parents from households with reported EVD sickness or death became more 'harsh' (Glass's delta=1.41) in their hypothetical decision-making compared with non-exposed parents, t (167)=-2.3, p<0.05. Parents from households that experienced EVD-related sickness or death not only reported significantly more household conflict and anxiety, but also reported that their child exhibited fewer difficulties. Results support the need for family-based interventions, including strategies to help parents learn alternatives to harsh punishment.

Capsule Commentary on Egede et al., Telephone-Delivered Behavioral Skills Intervention for African American Adults with Type 2 Diabetes: A Randomized Controlled Trial.

Capsule Commentary on Egede et al., Telephone-Delivered Behavioral Skills Intervention for African American Adults with Type 2 Diabetes: A Randomized Controlled Trial.

Telephone-Delivered Behavioral Skills Intervention for African American Adults with Type 2 Diabetes: A Randomized Controlled Trial

Diabetes disproportionately affects African Americans and is associated with poorer outcomes. Self-management is important for glycemic control; however, evidence in African Americans is limited. To assess the efficacy of a combined telephone-delivered education and behavioral skills intervention (TBSI) in reducing hemoglobin A1c (HbA1c) levels in African Americans with type 2 diabetes, using a factorial design. This is afour-year randomized clinical trial, using a 2 x 2 factorial design.: Participants: African American adults ≥18years) with poorly controlled type 2 diabetes (HbA1c ≥9%) were randomly assigned to one of four groups: 1) knowledge only, 2) skills only, 3) combined knowledge and skills (TBSI), or 4) control group. All participants received 12 telephone-delivered 30-min intervention sessions specific to their assigned group. Participants were assessed at baseline and 3, 6, and 12months. The primary outcome was HbA1c at 12 months post-randomization in the intent-to-treat (ITT) population. Two hundred fifty-five participants were randomly assigned to the four groups. Based on the ITT population after multiple imputation, the analysis of covariance with baseline HbA1c as the covariate showed that HbA1c at 12months for the intervention groups did not differ significantly from that of the control group (knowledge: 0.49, p = 0.123; skills: 0.23, p = 0.456; combined: 0.48, p = 0.105). Absolute change from baseline at 12months for all treatment arms was 0.6. Longitudinal mixed effects analysis showed that, on average, there was a significant decline in HbA1c over time for all treatment groups (-0.07, p < 0.001). However, the rates of decline for the intervention groups were not significantly different from that of the control group (knowledge: 0.06, p = 0.052; skills: 0.02, p = 0.448; combined: 0.05, p = 0.062). Results from per-protocol populations were similar. For African Americans with poorly controlled type 2 diabetes, combined education and skills training did not achieve greater reductions in glycemic control (i.e., HbA1c levels) at 12months compared to the control group, education alone, or skills training alone. This trial is registered with ClinicalTrials.gov, identifier no. NCT00929838.

A brief information-motivation-behavioral skills intervention to promote human papillomavirus vaccination among college-aged women.

BackgroundHuman papillomavirus (HPV) is prevalent among college-aged women. Although HPV vaccines decrease women’s risk for cervical cancer, the vaccination rates remain inadequate.ObjectiveThis study explored the utility of an information–motivation–behavioral skills (IMB) intervention in promoting HPV vaccination knowledge, motivation, and intentions among college-aged women.MethodsIn Spring/Fall 2012, 62 participants were randomly assigned to a single-session intervention or attention control and were assessed baseline, post-intervention, and at 1 month.ResultsThe participants demonstrated adequate baseline vaccine knowledge, low HPV/cancer knowledge, and ambivalence about the vaccination. Post-intervention, the IMB arm demonstrated increased HPV/cancer and vaccination knowledge, motivation, and intentions. There were no group differences in vaccination at 1 month; however, the odds of wanting to get vaccinated increased sevenfold in the IMB arm.ConclusionThese results provide preliminary support for an IMB-based intervention in increasing vaccination knowledge, motivation, and intentions among at-risk women. Future research examining the efficacy of longer trials with larger, diverse populations is warranted.

Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion.

This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.

Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study.

BackgroundChildren are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period.ObjectiveThe purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting.MethodsFifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck’s Cognitive Theory guided the TEXT2COPE intervention content and Fogg’s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention’s relevance to the family’s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation.ResultsSelf-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week.ConclusionsUtilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted.

Neighborhood and Parental Supports for Physical Activity in Minority Adolescents

Few studies have examined environmental, home, and parental supports for physical activity in underserved adolescents (low income, ethnic minority). Given the increasing incidence of obesity in minority adolescents, it is important to better understand ecologic determinants of physical activity in these youth. This study used an ecologic model to evaluate the significance of neighborhood, home, and parental supports for physical activity on moderate-to-vigorous (MV) physical activity in underserved adolescents. The study was a secondary data analysis of a randomized controlled school-based trial "Active by Choice Today" (ACT) for increasing physical activity in underserved sixth-graders. Schools were matched on school size, percentage minorities, percentage entitled to free or reduced-price lunch, and urban or rural setting prior to randomization. This study used a randomly selected sample of parents (n=280) from the intervention and control schools whose adolescent was enrolled in the larger trial. A total of 679 6th-grade students (mean age=11.4 years, 70% African-American, 76% free or reduced-price lunch, 52% female) participated in the larger trial. Parents of 280 youth were contacted to participate in a telephone survey and 198 (71%) took part in the study. The ACT trial was designed to test the efficacy of a 17-week (1 academic year) motivational plus behavioral skills intervention versus comparison after-school programs on increasing physical activity. A telephone survey was developed and was administered within 6 months after the trial began on parents of 198 adolescents from the ACT randomized school-based trial during 2005-2007. The primary outcome measure was adolescent MVPA based on 7-day accelerometry estimates from baseline to mid-intervention. The data were analyzed in 2010-2011 and included both parent and adolescent self-reports of environmental, home, and family supports for physical activity. Regression analyses indicated a significant effect of parental and neighborhood supports for physical activity on adolescent MVPA. Adolescents who perceived higher (vs lower) levels of parental support for physical activity engaged in more minutes of MVPA (B=3.01, SE=1.38, p<0.05) at mid-intervention. Adolescents who lived in neighborhoods with more (vs fewer) supports for physical activity (parks, lighting), also engaged in more minutes MVPA (B=4.27, SE=2.15, p<0.05). Support from parents and neighborhood quality are both associated with increased physical activity in underserved adolescents.

Results of the “Active by Choice Today” (ACT) randomized trial for increasing physical activity in low-income and minority adolescents.

This study reports the results of the "Active by Choice Today" (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents. The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduce lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program. The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention. At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention. Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA.

HIV/AIDS Risk Reduction Counseling for Alcohol Using Sexually Transmitted Infections Clinic Patients in Cape Town, South Africa

HIV is ravaging southern Africa, and HIV transmission risk behaviors are facilitated by alcohol use in sexual contexts. There are no known interventions that directly target HIV risk behavior among people who drink and are at risk for HIV in Africa. To test a behavioral risk reduction counseling intervention for use in sexually transmitted infection (STI) clinics in southern Africa. A randomized intervention trial was conducted with 143 STI clinic patients in Cape Town, South Africa. Participants received an experimental 60-minute HIV and alcohol risk reduction behavioral skills intervention or a control 20-minute HIV education condition. Participants were followed for 3 and 6 months after the intervention, with 73% retention. Overall, the experimental intervention demonstrated more than a 25% increase in condom use and a 65% reduction in unprotected intercourse over the 6-month follow-up period, with risk reduction significantly greater for the experimental condition than for the control condition at both follow-ups. Alcohol use in sexual contexts [F(1,94) = 6.2; P < 0.05] and expectancies that alcohol enhances sexual experiences [F(1,94) = 8.3; P < 0.01] were also significantly lower for the experimental condition at the 3-month follow-up. An HIV prevention counseling intervention reduced HIV transmission risks for up to 6 months in this STI clinic population. Effects may be sustained with structural interventions to reduce alcohol use in sexual contexts and support risk reduction behavior changes over the long-term.

Drug Stroop performance: Relationships with primary substance of use and treatment outcome in a drug-dependent outpatient sample

A modified Stroop protocol was administered to a sample of 80 dependent drug users (62 males, 18 females) prior to beginning a time-limited outpatient treatment study combining pharmacotherapy and cognitive–behavioral coping skills therapy for cocaine, marijuana, or heroin dependence. Results indicated that cocaine-dependent participants responded more slowly than marijuana-dependent participants to all stimulus words. Cocaine words yielded slower reaction times than neutral words across all treatment groups. The heroin- and cocaine-dependent groups' overall performance did not differ. There was no treatment group by drug word interaction. For cocaine-dependent participants, Stroop performance in the presence of cocaine stimuli was associated with worse treatment outcome. In conclusion, Stroop performance may have prognostic utility among drug-dependent patients in a cognitive–behavioral coping skills intervention and may highlight the mechanisms associated with changing substance use in this treatment modality.

The relative impact of treatment program ‘robustness’ and ‘dosage’ on client outcomes

The relationship between two aspects of program quality (robustness of model implementation and service dosage), client outcomes of self-reported and observer-rated psychosocial functioning, and intensive mental health service utilization costs was examined for 132 persons with dual mental and substance disorders. Membership in the ‘robustly implemented’ behavioral skills intervention was significantly associated with higher levels of self-reported and observer-rated psychosocial functioning, while membership in the ‘robustly implemented’ 12-step group was significantly related to higher intensive mental health service costs. Dosage of supportive service exhibited a significant, positive relationship to lower intensive mental health service costs but not to functioning. Although the addition of qualitative data was useful in interpreting the findings from the main study analyses, it had no discernable statistical impact on the regression equations for three major outcome variables.

Conjoint Behavioral Consultation and Social Skills Training: Enhancing the Play Behaviors of Boys With Attention Deficit Hyperactivity Disorder

In this study, we demonstrate the use of conjoint behavioral consultation (CBC) as a model to join parents and educators in the shared development and implementation of interventions for students. A behavioral social skills intervention was delivered in the context of CBC to enhance the cooperative peer interactions of young boys diagnosed with attention deficit hyperactivity disorder (ADHD). A multiple probe design across participants was used. The mothers and teachers of 3 boys between the ages of 8 and 9 years who were diagnosed with ADHD and who were exhibiting performance deficits in their cooperative play behaviors served as consultation participants. Direct observation data suggest that the behavioral social skills intervention implemented within the context of CBC was related to increases in positive, cooperative interactions with peers. In general, positive changes were noted from pretreatment to posttreatment administrations of the Social Skills Rating System (Gresham & Elliott, 1990). Measures of treatment acceptability, treatment integrity, and social validity also yielded positive results. This study lends support to the use of CBC as a means of joining parents and teachers in the delivery of effective behavioral interventions.

Reliability of sexual risk behavior interviews with psychiatric patients.

Test-retest interviews examining recent sexual activity were administered to 27 severely ill psychiatric patients after stabilization. Three reports were judged to be questionable. For the 16 sexually active patients among the remaining 24, high test-retest reliability was found for number of sexual partners, frequency of episodes, and proportions of episodes involving vaginal intercourse and use of condoms. The interviews did not exacerbate psychiatric symptoms.

HIV seroprevalence among patients admitted to two psychiatric hospitals

The authors determined the seroprevalence of HIV-1 among patients admitted to two psychiatric hospitals in New York City. Patients consecutively admitted to an acute psychiatric unit in Manhattan and a large state hospital in Queens were anonymously tested for HIV-1 antibodies from December 1989 through July 1990. Test results were linked to age, gender, ethnicity, and two risk behaviors: male homosexual activity and injection drug use. Blood was obtained from 83.0% of the eligible patients. The prevalence of HIV was 5.5% (25 of 451). Black patients accounted for 38.0% of the patients tested and 76.0% of positive results (N = 19), a rate of 11.1% for this group. The rate of seropositivity was comparable in women and men. Clinicians had charted risk behavior for nine (36.0%) of the 25 HIV-positive patients. Infection control records suggested that clinicians were aware of seven (28.0%) of the positive cases. One in every 18 patients admitted to two public psychiatric hospitals in New York City was HIV positive. Clinical staff largely failed to identify HIV-positive patients. Ethnicity and a history of homosexual activity among men or use of injected drugs were strongly associated with seropositivity. This pattern of infection may be linked to needle sharing and/or sexual activity with partners who have shared needles. Future research should clarify how psychiatric illness affects risk-taking behavior, focus on improving detection by clinicians, and identify effective prevention strategies in this population.