History Of Mental Health Diagnosis Research Articles

Adding perinatal anxiety screening to depression screening: is it worth it?

Screening for peripartum depression is widely recommended and should now be the standard of care. However, little research exists on peripartum anxiety screening. The purpose of this study was to assess whether adding perinatal anxiety screening would increase the identification of women who would benefit from mental health support. The existing practice at our clinic was depression screening via the Patient Health Questionnaire-2 at all prenatal visits; screenings were prospectively tracked for 3 months in women presenting for visit at 24-28 weeks gestation (Patient Health Questionnaire-2-only group). We then added Generalized Anxiety Disorder 2-item validated anxiety scale assessment to prenatal visits at 24-28 weeks gestation (Patient Health Questionnaire-2+Generalized Anxiety Disorder 2-item group). Our primary study outcome was the rate of positive depression and anxiety screens during pregnancy; secondary outcomes included referral rates to mental health services and obstetric and medical outcomes. A total of 100 women with visits at 24-28 weeks gestation were eligible to be screened during the Patient Health Questionnaire-2-only period; 125 women were eligible for screening during the Patient Health Questionnaire-2+Generalized Anxiety Disorder 2-item period. In the Patient Health Questionnaire-2-only group, 51 women were screened, with 2 positive depression screens. In the Patient Health Questionnaire-2+Generalized Anxiety Disorder 2-item group, 40 women were screened, with 5 positive screens for depression and 4 for anxiety. Three women who were anxiety-positive had been negative via depression screening. Mental health referral was not different between the 2 groups (odds ratio, 1.75; 95% confidence interval, 0.76-4.97), but a significant increase in referral was noted for Patient Health Questionnaire-2+Generalized Anxiety Disorder 2-item subgroups with a history of mental health diagnosis (odds ratio, 14.9; 95% confidence interval, 5.6-39.7) or substance abuse (odds ratio, 26.7; 95% confidence interval, 4.6-155.0). Screening for perinatal anxiety may increase referral rates to mental health professionals who can then diagnose and treat women who experience mood and anxiety disorders. Anxiety screening may be particularly useful in populations with a history of mental health diagnoses or substance abuse. Further research is necessary to understand how perinatal anxiety screening should be best implemented.

271 Higher Charlson-Deyo Score May Result in Delay to Colonoscopy in Veterans Subsequently Diagnosed With Colorectal Cancer

INTRODUCTION: Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy has been shown to be associated with increased risk of CRC. 1 Currently, the Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The compounding effects of an aging population, physician shortage, and increased military personnel entering the VAHS can increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy. METHODS: We retrospectively reviewed records of 600 patients referred for colonoscopy between January 1999 and January 2009 and were subsequently diagnosed with CRC. Patients were excluded if a prior CRC diagnosis had been established. The final study cohort consisted of 530 patients. Using Chi square and Fisher's testing, we examined the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Further logistic regression analysis adjusted for age, race, CRC location and C/D score. RESULTS: A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, P = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, P = 0.47, OR = 1.37, P = 0.48). CONCLUSION: Patients with a C/D score ≥2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.

Association between Charlson-Deyo Score and delay to colonoscopy in veterans subsequently diagnosed with colorectal cancer.

288 Background: Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy is associated with increased risk of CRC. The Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The effects of an aging population, physician shortage, and increased military personnel entering the VAHS may increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy. Methods: We retrospectively reviewed records of 600 patients referred for colonoscopy from January 1999 to January 2009, who were subsequently diagnosed with CRC. Patients with a prior CRC diagnosis were excluded. The final study cohort consisted of 530 patients. We analyzed the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Logistic regression analysis adjusted for age, race, CRC location and C/D score. Results: A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥ 2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, p = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, p = 0.47, OR = 1.37, p = 0.48). Conclusions: Patients with a C/D score ≥ 2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.

Development and evaluation of the Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS): assessment of parental concordance with guidelines for the prevention of child anxiety and depression.

BackgroundInvolving parents in the prevention of mental health problems in children is prudent given their fundamental role in supporting their child’s development. However, few measures encapsulate the range of risk and protective factors for child anxiety and depression that parents can potentially modify. The Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS) was developed as a criterion-referenced measure to assess parenting against a set of evidence-based parenting guidelines for the prevention of child anxiety and depressive disorders.MethodsIn Study 1, 355 parents of children 8–11 years old across Australia completed the PaRCADS and measures of parenting, general family functioning, child anxiety and depressive symptoms, and parent and child health-related quality of life. Their children completed measures of parenting, anxiety and depressive symptoms, and health-related quality of life. In Study 2, six subject-experts independently evaluated the PaRCADS items for item-objective congruence and item-relevance. Item analysis was conducted by examining item-total point-biserial correlation, difficulty index, B-index, and expert-rated content validity indices. Reliability (or dependability) was assessed by agreement coefficients for single administration. Construct validity was examined by correlational analyses with other measures.ResultsFour items were removed to yield a 79-item, 10-subscale PaRCADS. Reliability estimates for the subscale and total score range from .74 to .94. Convergent validity was indicated by moderate to strong correlations with other parenting and family functioning measures, and discriminant validity was supported by small to moderate correlations with a measure of parents’ health-related quality of life. Higher scores on the PaRCADS were associated with fewer anxiety and depressive symptoms and better health-related quality of life in the child. PaRCADS total score was associated with parental age, parent reported child’s history of mental health diagnosis and child’s current mental health problem.DiscussionResults showed that the PaRCADS demonstrates adequate psychometric properties that provide initial support for its use as a measure of parenting risk and protective factors for child anxiety and depression. The scale may be used for intervention and evaluative purposes in preventive programs and research.

Suicide attempts among activated soldiers in the U.S. Army reserve components

BackgroundAlthough the majority of active duty U.S. Army soldiers are full-time personnel in the Active Component (AC), a substantial minority of soldiers on active duty are in the Reserve Components (RCs). These “citizen-soldiers” (Army National Guard and Army Reserve) represent a force available for rapid activation in times of national need. RC soldiers experience many of the same stressors as AC soldiers as well as stressors that are unique to their intermittent service. Despite the important role of RC soldiers, the vast majority of military mental health research focuses on AC soldiers. One important goal of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is to address this gap. Here we examine predictors of suicide attempts among activated RC soldiers.MethodsThis longitudinal, retrospective cohort study used individual-level person-month records from Army and Department of Defense administrative data systems to examine socio-demographic, service-related, and mental health predictors of medically documented suicide attempts among activated RC soldiers during 2004–2009. Data from all 1103 activated RC suicide attempters and an equal-probability sample of 69,867 control person-months were analyzed using a discrete-time survival framework.ResultsEnlisted soldiers comprised 84.3% of activated RC soldiers and accounted for 95.7% of all activated RC suicide attempts (overall rate = 108/100,000 person-years, more than four times the rate among officers). Multivariable predictors of enlisted RC suicide attempts included being female, entering Army service at age ≥ 25, current age < 30, non-Hispanic white, less than high school education, currently married, having 1–2 years of service, being previously deployed (vs. currently deployed), and history of mental health diagnosis (particularly when documented in the previous month). Predictors among RC officers (overall rate = 26/100,000 person-years) included being female and receiving a mental health diagnosis in the previous month. Discrete-time hazard models showed suicide attempt risk among enlisted soldiers was inversely associated with time in service.ConclusionsRisk factors for suicide attempt in the RCs were similar to those previously observed in the AC, highlighting the importance of research and prevention focused on RC enlisted soldiers in the early phases of Army service and those with a recent mental health diagnosis.

Longitudinal Determinants of Housing Stability Among People Living With HIV/AIDS Experiencing Homelessness.

Objectives. To examine patterns of and factors associated with housing stability over time among people living with HIV (PLWH) experiencing homelessness with co-occurring substance use and mental health disorders enrolled in a patient-centered medical home (PCMH) intervention.Methods. Between September 2013 and February 2017, we ascertained housing trajectories among PLWH in 9 sites in the United States by conducting interviews at baseline, 6, and 12 months after and dichotomized them as improved consistently versus did not improve consistently. We identified covariates affecting housing stability using the socioecological model.Results. Forty-three percent (n = 198) experienced consistent housing improvement. Participants with history of mental health diagnosis (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.02, 2.35; P = .04) or trauma (AOR = 1.72; 95% CI = 1.22, 2.41; P = .006) had improved housing status; those with recent injecting drug use (AOR = 0.41; 95% CI = 0.19, 0.90; P = .03) had less consistent housing improvement.Conclusions. Improved housing stability may possibly reflect the importance of PCMH interventions that integrate housing, health, and behavioral services with patient navigators to address complex needs of PLWH experiencing homelessness.

Army May Be Missing Risk Factors Beyond MH for Attempted Suicide Among Soldiers

Suicide attempts among U.S. Army soldiers are not always preceded by a diagnosis of mental illness.

Mental Health Diagnoses and Symptoms in Preschool and School Age Youth Presenting to Insomnia Evaluation: Prevalence and Associations with Sleep Disruption

ABSTRACTObjective/Background: Sleep problems and emotional and behavioral difficulties are highly correlated in community samples of youth and in youth presenting to mental health treatment. However, fewer studies have characterized the associations between sleep and psychopathology symptoms in youth presenting to pediatric sleep clinics. This retrospective, cross-sectional study examined the prevalence of psychopathology symptoms and their associations with sleep disruption in youth presenting to a behavioral sleep medicine clinic. Participants: Participants were 373 preschoolers (1.5 to 5 years old) and 300 school age youth (6 to 10 years old) presenting to a pediatric behavioral sleep medicine clinic with a primary insomnia diagnosis. Methods: As a part of routine clinical care, parents completed a battery of pre-evaluation measures assessing insomnia severity, sleep disturbance, history of mental health diagnosis, and psychopathology symptoms. Results: Both preschool and school age youth had high rates of parent-reported mental health diagnoses (35% and 74%, respectively) and clinically elevated psychopathology symptoms (69% of preschoolers and 77% of school age youth) at initial insomnia evaluation. These symptoms were significantly associated with sleep disruption, with ADHD and affective problems most consistently associated with sleep problems in preschoolers and symptoms of anxiety, affective, and behavioral problems most consistently associated with sleep problems in school age youth. Conclusions: Psychopathology symptoms should be regularly assessed in youth presenting to behavioral sleep medicine clinics. Further, the role of psychopathology should be considered in insomnia conceptualization and treatment and, when appropriate, psychopathology symptoms should be targeted in treatment or appropriate referrals should be made.

Risk Factors Associated With Attempted Suicide Among US Army Soldiers Without a History of Mental Health Diagnosis

The US Army suicide attempt rate increased sharply during the wars in Afghanistan and Iraq. Although soldiers with a prior mental health diagnosis (MH-Dx) are known to be at risk, little is known about risk among those with no history of diagnosis. To examine risk factors for suicide attempt among soldiers without a previous MH-Dx. In this retrospective longitudinal cohort study using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), person-month records were identified for all active-duty Regular Army enlisted soldiers who had a medically documented suicide attempt from January 1, 2004, through December 31, 2009 (n = 9650), and an equal-probability sample of control person-months (n = 153 528). Data analysis in our study was from September 16, 2017, to June 6, 2018. In a stratified sample, it was examined whether risk factors for suicide attempt varied by history of MH-Dx. Suicide attempts were identified using Department of Defense Suicide Event Report records and International Classification of Diseases, Ninth Revision, Clinical Modification E95 × diagnostic codes. Mental health diagnoses and related codes, as well as sociodemographic, service-related, physical health care, injury, subjection to crime, crime perpetration, and family violence variables, were constructed from Army personnel, medical, legal, and family services records. Among 9650 enlisted soldiers with a documented suicide attempt (74.8% male), 3507 (36.3%) did not have a previous MH-Dx. Among soldiers with no previous diagnosis, the highest adjusted odds of suicide attempt were for the following: female sex (odds ratio [OR], 2.6; 95% CI, 2.4-2.8), less than high school education (OR, 1.9; 95% CI, 1.8-2.0), first year of service (OR, 6.0; 95% CI, 4.7-7.7), previously deployed (OR, 2.4; 95% CI, 2.1-2.8), promotion delayed 2 months or less (OR, 2.1; 95% CI, 1.7-2.6), past-year demotion (OR, 1.6; 95% CI, 1.3-1.8), 8 or more outpatient physical health care visits in the past 2 months (OR, 3.3; 95% CI, 2.9-3.8), past-month injury-related outpatient (OR, 3.0; 95% CI, 2.8-3.3) and inpatient (OR, 3.8; 95% CI, 2.3-6.3) health care visits, previous combat injury (OR, 1.6; 95% CI, 1.0-2.4), subjection to minor violent crime (OR, 1.6; 95% CI, 1.1-2.4), major violent crime perpetration (OR, 2.0; 95% CI, 1.3-3.0), and family violence (OR, 2.9; 95% CI, 1.9-4.4). Most of these variables were also associated with suicide attempts among soldiers with a previous MH-Dx, although the strength of associations differed. Suicide attempt risk among soldiers with unrecognized mental health problems is a significant and important challenge. Administrative records from personnel, medical, legal, and family services systems can assist in identifying soldiers at risk.

Predicting household residency among youth from vulnerable families

This study examined the relationship between maternal social stability and household residency among youth in vulnerable families. Data on the household residency of biological children (under 18 years of age) was collected from 259 mothers in Baltimore, Maryland. Only half (50%) of the mothers lived with at least one of their biological children. Multivariate logistic regression analyses were conducted to determine which maternal characteristics and stability factors predicting the likelihood of a child not living with their biological mother. A history of mental health diagnoses as well as economic and housing instability were the strongest predictors of children not living with their biological mothers. Social stability factors such as incarceration history, and receipt of food stamps were not associated with an increased likelihood that children were not living with their biological mother. Maternal economic and housing instability may be the basis on which vulnerability begins for youth. These findings serve as the foundation for future researchers interested in identifying factors that may moderate or mediate the complex relationship between maternal stability and childhood outcomes.

Incidence and Associated Risk Factors of Traumatic Brain Injury in a Cohort of Homeless and Vulnerably Housed Adults in 3 Canadian Cities

To examine the factors associated with incident traumatic brain injury (TBI) among homeless and vulnerably housed persons over a 3-year follow-up period. Data were obtained from the Health and Housing in Transition study, which tracked the health and housing status of 1190 homeless or vulnerably housed individuals in 3 Canadian cities for 3 years. Main measure was self-reported incident TBI during the follow-up period. Factors associated with TBI were ascertained using mixed-effects logistic regression. During first, second, and third years of follow-up, 187 (19.4%), 166 (17.1%), and 172 (17.9%) participants reported a minimum of 1 incident TBI, respectively. Among 825 participants with available data for all 3 years of follow-up, 307 (37.2%) reported at least 1 incident TBI during the 3-year follow-up period. Lifetime prevalence of TBI, endorsing a history of mental health diagnoses at baseline, problematic alcohol and drug use, younger age, poorer mental health, and residential instability were associated with increased risk of incident TBI during follow-up period. Mental health support and addressing residential instability and problematic substance use may reduce further risk of TBI and its associated poor health and social outcomes in this population.

Distress, Worry, and Functioning Following a Global Health Crisis: A National Study of Americans’ Responses to Ebola

The 2014 Ebola crisis received unprecedented media attention in the United States, despite low risk of transmission. We examined theoretically derived correlates of psychological response to the crisis, including Ebola-related media exposure, prior mental health history, and stress response to a recent prior collective trauma (the 2013 Boston Marathon bombing, BMB). A national probability sample completed a survey 2–4 weeks post-BMB; 18 months later, the same sample reported responses to the Ebola crisis ( N = 3,447). History of mental health diagnoses, acute stress response to the BMB, and Ebola-related media exposure were associated with greater psychological distress and functional impairment. Prior acute stress and Ebola-related media exposure were also associated with Ebola-related worry; individuals with higher BMB-related acute stress who consumed more Ebola-related media were more worried about contracting Ebola. Media coverage of the Ebola public health crisis was associated with negative psychological outcomes, even among individuals at low risk for contracting the disease.

Delirium and mental health history as predictors of aggression in individuals with dementia in inpatient settings

ABSTRACTObjectives: Aggressive behaviors by patients with dementia present risk to health care workers and patients. An information processing model, developed to study aggressive behaviors among children, was applied to study aggression among older hospital patients with dementia. Hypotheses were that delirium and mental health or depression history, would relate to increased risk of aggressive behaviors.Method: Electronic medical records were sampled for one year (n = 5008) and screened using the EMERSE search engine and hand review for dementia (n = 505) and aggressive behavior in individuals with dementia (n = 121). Records were reviewed for mental health history and presence of delirium.Results: Regression analyses found interaction effects representing delirium and mental health or depression history associated with greater risk of aggressive behavior. Significant main effects were found for both dementia and mental health or depression history. Of the lowest risk group, 12% of patients exhibited aggression compared to 24%–35% of those with delirium, mental health or depression history, or the combination of these risk factors.Conclusion: Delirium is the leading correlate of aggressive behaviors in hospitalized patients with dementia, and delirium or history of mental health diagnosis may lead to increased risk of aggressive behaviors in this setting.

The contribution of the socio-demographic characteristics on suicidal ideation among Israeli soldiers.

BackgroundSuicidal ideation is a risk factor for suicide attempt. The aim of the present study is to compare suicidal ideation of different groups with different distress.Methods100 soldiers, aged 18–21, divided into four research cohorts: soldiers who had carried out a suicide attempt (n = 40); soldiers with a psychiatric diagnosis (n = 20); soldiers having high severity adjustment difficulties (n = 20); and a control group of soldiers, having neither a history of mental health diagnosis, nor adjustment difficulties (n = 20). All completed the suicide ideation scale.ResultsHalf of the attempters had a psychiatric diagnosis (depression or anxiety) on the day of their enlistment and 37.5 % of them had a specified personality disturbance. The attempters were characterized by previously-attempted suicide (p < .01). The lowest mean values (M = 1.95, SD = .67) were among the attempter (F = 3.173, df = 3, p = .02) in motivation for military service. The variable expressing low motivation for military service was the sole predictor of suicide ideation (p = .032).ConclusionsEarly diagnosis facilitated better monitoring by military mental health officers.

Pre-placement psychological status and staff retention in a call centre.

There is a general lack of studies on staff retention and mental health status at the beginning of or prior to employment in call centres. To evaluate the relationship between psychological status at the beginning of employment and staff retention after 6 months of employment. The psychological well-being of new starters was evaluated using a questionnaire and Beck Depression Inventory (BDI). Early leavers were identified through a second survey performed 6 months later. Out of a cohort of 135 new starters, all of the 100 randomly selected employees returned their questionnaires. By the second round of the survey 6 months later, 30 employees had left. There was no significant difference between the BDI scores of leavers and those who remained in the company. Binary logistic regression showed no significant associations between leaving the company and gender, previous history of mental health diagnosis and history of mental health treatment. However, there was a significant association between age (25 or over) and leaving the company within the first 6 months of employment (odds ratio [OR] = 2.5; 95% confidence interval [CI] 1.04-6.01; P < 0.05). Previous mental health conditions or psychological status at the beginning of employment did not appear to contribute significantly to call centre employees leaving within 6 months. Further similar studies in other occupational sectors are recommended.

Trauma Sequelae and Cortisol Levels in Women Exposed to Intimate Partner Violence

Intimate partner violence (IPV) is often a chronic form of trauma with deleterious mental health problems. Furthermore, IPV survivors have also often experienced trauma in childhood. Consequently, by examining a sample of IPV survivors, this study sought to assess typical trauma sequelae--Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), or dissociative symptoms-and trauma-related characteristics consistent with Herman's Trauma theory (1992; i.e., chronicity of trauma, age of first trauma exposure, and social support), in relation to hypothalamic-pituitary-adrenal axis function. The study compared basal and diurnal cortisol in women (n = 88) based on diagnostic status and symptom severity (PTSD [n = 14], PTSD and comorbid MDD [n = 43], subthreshold symptoms of PTSD and MDD [n = 19]), dissociative symptoms, and the aforementioned trauma-related characteristics to a matched control group (n = 12) without any lifetime history of mental health diagnoses or exposure to interpersonal trauma. Regardless of their diagnostic status and trauma-related characteristics, trauma-exposed women had higher levels of dissociative symptoms relative to women in the control group, and these dissociative symptoms were inversely related to awakening cortisol levels. Findings suggest that low cortisol levels may not be a diagnostic marker, but instead may be associated with a dissociative coping style developed in the context of trauma exposure, consistent with mechanisms posited by Trauma theory.

Depression screening in Black Americans with multiple sclerosis

Depression is prevalent in Multiple Sclerosis (MS) and impacts treatment adherence. Depression screening may be a useful mechanism to identify Blacks at risk for depression in an MS setting, as they frequently experience more disabling MS disease and also may be less likely than Whites to be accurately diagnosed with depression, which can further impact MS disease and diminish quality of life. The purpose of this study was to compare the clinical presentation (e.g. psychiatric histories, current symptoms, and provider treatment recommendations) of Black and White MS patients identified as at risk for depression using a validated depression screening instrument. Secondary analysis of an archival chart data-set of 279 MS patients (90 Blacks) indicated that Black patients were less likely than Whites to have a past mental health diagnosis (X2 = 12.794, p < .001), prior experience with psychotropics (X2 = 11.394, p < .001), or be prescribed psychotropics at the time of screening (X2 = 10.225, p < .001). No differences in depression scores were observed between Black and White patients. Approximately 44% of patients received provider treatment recommendations following a positive screening with no between group differences in the likelihood of receiving at least one recommendation. Consistent with the literature, our Black patient sample was less likely than Whites to have a history of mental health diagnosis or to have been treated with psychotropics. Although more research is needed, screening programs for depression in MS may facilitate access to services for all MS patients while reducing health disparities in Black American patients and removing barriers to early intervention and ongoing care.

Sexual Abuse, Sexual Orientation, and Obesity in Women

Among adult women an association between childhood sexual abuse (CSA) and obesity has been observed. Research with lesbian women has consistently identified high rates of obesity as well as frequent reports of CSA, but associations between sexual abuse and obesity have not been fully explored. Our aim was to investigate the relationship between sexual abuse (SA) history and obesity among heterosexual (n = 392) and lesbian (n = 475) women (age 35-64) who participated in the Epidemiologic STudy of HEalth Risk in Women (ESTHER) Project in Pittsburgh, Pennsylvania. Obesity was defined as body mass index (BMI) > or =30. Covariates included self-reported SA, sexual orientation, demographic factors, and history of a depression or anxiety diagnosis. SA history was assessed by three factors: (1) SA experienced under the age of 18 by a family member or (2) by a nonfamily member and (3) forced, unwanted sexual experience(s) at age > or =18. Data were analyzed using chi-square tests and logistic regression models. Multiple logistic regression analyses revealed that obesity was associated with African American race, lesbian sexual orientation, intrafamilial CSA, and history of mental health diagnosis. Protective factors were having a household income of at least $75,000 and having a bachelor's degree or higher. Results suggest that lesbian women may be at greater risk of obesity than heterosexual women and that intrafamilial CSA--regardless of sexual orientation--may play a role in the development of obesity.

What about Me? Siblings of Children with an Anxiety Disorder

Sibling relationships are enduring and influential and can have a profound impact on children's development (Dunn, 2000). Positive sibling relationships are associated with better friendships, higher self-esteem, and lower levels of loneliness, depression, and delinquent behaviors (Yeh & Lempers, 2004). Although there has been research on siblings of children with chronic illnesses, there has been limited research on the impact of children's anxiety disorders on the functioning of siblings (Lindhout et al., 2003). This lack of research is surprising because anxiety disorders are the most common mental health problem in children and adolescents, with an estimated six-month prevalence rate of 10.5% to 16.5% (Verhulst, van der Ende, Ferdinand, & Kasius, 1997). In addition, anxiety disorders tend to run in families (Skre, Onstad, Edvardsen, Torgersen, & Kringlen, 1994), and first-degree relatives, such as siblings, of a patient with an anxiety disorder are at greater risk of developing an anxiety disorder compared with the general population (American Psychiatric Association, 1994). In addition to possible genetic risk factors, the family context may also be related to the development of anxiety disorders. For example, the quality of attachment to the caregiver is an important antecedent to a generalized psychological vulnerability to anxiety (Thompson, 1998). Parents of children with anxiety disorders may be overprotective, offer excessive reassurance, or engage in negative and adverse parent--child interactions, which may affect family functioning and sibling relationships (Eisen & Kearney, 1995). In addition, anxious children may perceive more differential treatment by parents than nonanxious children (Lindhout et al., 2003). The few studies of siblings of children with an anxiety disorder examined how the sibling relationship affects the anxious child or how the siblings interact (for example, Fox, Barrett, & Shortt, 2002; Hudson & Rapee, 2002). This limited research on sibling relationships in families with a child with an anxiety disorder has yielded inconsistent findings. Some research suggests that there may be no difference in perceived affection or hostility between siblings and children with an anxiety disorder (Lindhout et al., 2003). However, others have found that the interactions between siblings and children with an anxiety disorder were characterized by more conflict and control and less warmth as compared with a nonclinical control group and that the anxious children engaged in more controlling behaviors than the children in the control group (Fox et al.). Given the prevalence of anxiety disorders in children and the inconsistent findings in the research done to date, more research is needed on siblings of children with anxiety disorders. In this article, we describe an exploratory study aimed at examining the psychosocial functioning (that is, internalizing and externalizing behaviors) of children who have a sibling with an anxiety disorder. Because we found no descriptive research, the first purpose of this study was descriptive. We expected to find some of the sibling children suffering from an anxiety disorder because anxiety disorders tend to run in families (Skre et al., 1994). The second purpose of this study was to examine predictors of siblings' internalizing and externalizing behaviors. On the basis of the limited research available, gender, anxious child's diagnosis, length of treatment (used as a proxy for severity),interference in family functioning, and parental history of mental health diagnosis (Cobham, Dadds, & Spence, 1998) were examined. METHOD Sample and Procedure We used a one-time survey with a convenience sample. Data were collected on 65 siblings of anxious children. The anxious child's average age was 11.4 years (SD = 2.5); 36 (55%) were male and 29 (45%) were female. The average length of treatment was two years (SD = 2. …