Mental Health History Research Articles

Life Satisfaction Among Diverse Participants.

Mental health (MH) conditions are among the most common chronic health conditions in the United States. Previous studies suggested decreased in life satisfaction post-COVID-19 in other populations outside the United States. This study explored the correlations between life satisfaction and MH among diverse community post-COVID-19 pandemic. A cross-sectional, non-experimental, retrospective study. The primary outcome was the Satisfaction with Life Scale total score (SWLS_TS) and the characteristics of the cases from self-reported information. Statistical software SPSS was used for descriptive and inferential analyses. About 218 cases were included for analysis. Many of the cases were Asian Americans (n = 185, 84.1%). The multiple linear regression model significantly predicted 5.2% of the variance in SWLS_TS. Three out of 6 predictors significantly contributed to the model (age β = .172, t = 2.42, P = .017, ethnicity β = .148, t = 2.07, P = .039, and no history of MH β = .248, t = 3.31, P = .001). A diverse population was examined post-COVID-19 pandemic, and the findings suggest a positive correlation with age, ethnicity, and no history of MH with SWLS_TS.

Mental Health and Other Factors Associated with COVID-19 Vaccination Intention toward Children of Military Parents in Lambayeque, Peru.

There is evidence that vaccine acceptability is strongly associated with mental health. However, no studies assessing intention to vaccinate (ITV) intention toward children of military parents have been documented. The current research aimed to establish the prevalence and factors of ITV children against COVID-19 in military parents in Lambayeque-Peru, 2021. Analysis was conducted with the dependent variable ITV children reported by military parents. The independent variables were history of mental health, searching for mental health support, food insecurity, resilience, anxiety, depression, burnout, posttraumatic stress, and suicidal risk. Prevalence ratios and 95% confidence intervals were estimated. Of 201 military personnel evaluated, 92.5% were male, 82.5% were of the Catholic faith, and the median age was 40.9% of respondents reported seeking mental health help during the COVID-19 pandemic. It was reported anxiety (20.3%), depression (6.5%), and posttraumatic stress disorder (6.5%). Most reported ITV in children against COVID-19 (93%). In the multiple models, we found that Catholics had a 23% higher prevalence of ITV in the children where PR = prevalence ratios and CI = confidence intervals (PR = 1.23; 95% CI: 1.01-1.50). Likewise, seeking mental health support increased the prevalence of ITV by 8% (PR = 1.08; 95% CI: 1.00-1.15). Seeking mental health support and belonging to the Catholic faith had a higher ITV of children of Peruvian military personnel. Finding mental health support, experiencing burnout syndrome, having a relative who suffers from mental health problems, and being part of the Catholic religion were associated with a higher willingness to immunize the children of Peruvian military members.

History of Mental Health in the Philippines: A Response to the Call to Revolutionize Mental Health Services Toward Positive Well-being.

History of Mental Health in the Philippines: A Response to the Call to Revolutionize Mental Health Services Toward Positive Well-being.

Demographic and mental health profile of youth in a gender service: An African case series.

Despite a massive global increase in research on gender-diverse youth, there have been no studies in Africa on gender-diverse children and adolescents presenting to health services. This study aimed to present the first African findings of the demographic and mental health profile of youth who have presented at a gender service in South Africa. A specialist mental health outpatient service, consisting of psychiatry, psychology and nursing input, for gender-diverse child and adolescent patients in the Western Cape. All consenting youth seen at a gender service, consisting of psychiatry, psychology and nursing input, in state and by the same clinician in private practice between January 2012 and May 2019 were participants of a retrospective, sequential case series study. Data of interest, including gender identity and sexuality, mental health history and social information, were extracted from the psychiatry files of participants. Thirty-nine participants were part of the registry and qualified for the study: 72% self-identified as white, 15% as coloured and 13% as black African. The rate of co-occurring psychopathology was high (64%) and included high rates of autism, particularly in trans males (26%), suicidal ideation in 31% and a history of suicide attempt(s) in 10%. This first study describing gender-diverse youth seeking support relating to their gender identity in Africa showed they had remarkable similarities to those studied internationally. Establishing that transgender youth of all major racial groups in the province with similar demographic profiles to other parts of the world are presenting to services in South Africa and in need of mental health support and interventions.

Association between disrespect and abuse during labor and the risk of postpartum depression: a cross-sectional study

This study aimed to analyze the relationship between disrespect and abuse during labor and the risk of postpartum depression. This is a cross-sectional study carried out with women from the rural and urban areas of Caxias, Maranhão State, Brazil. Postpartum depression was considered the dependent variable, assessed using the Edinburgh Postnatal Depression Scale. The independent variables were sociodemographic characteristics, mental health history, behavioral aspects, obstetric characteristics and self-perception of disrespect and abuse during labor. Pearson's chi-square test and multiple logistic regression were used to assess the association between postpartum depression and disrespect and abuse during labor. A total of 190 women were interviewed. The prevalence of postpartum depression was 16.3%. The occurrence of at least one type of disrespect and abuse during labor was 97.4%, with health system conditions and restrictions predominating (94.7%). More than half of the women (66.3%) suffered two forms of disrespect and abuse during labor, while three or more forms were reported by 22.6%. Suffering two (adjustedOR = 3.01; 95%CI 1.08-8.33) and three or more forms of disrespect and abuse during labor (adjustedOR = 3.41; 95%CI: 1.68-24.40) increased the chance of postpartum depression. There was a significant association between disrespect and abuse during labor and postpartum depression, and dignified and respectful care for women during childbirth were found to reduce the risk of postpartum depression symptoms.

Exploring mental health literacy among prospective university students using GIS techniques in Bangladesh: an exploratory study.

Prospective university students experience substantial academic stressors and psychological vulnerabilities, yet their mental health literacy (MHL) remains inadequately explored. This study investigates four dimensions of MHL - help-seeking behaviors, stigma, knowledge about mental health and understanding of mental illnesses. Besides, Geographic Information System (GIS) techniques are employed to analyze spatial disparities in MHL, which is the first in the context of MHL research. A total of 1,485 students were assessed for sociodemographic characteristics, admission-related variables, health behaviors and family histories of mental health issues. Data were analyzed using SPSS and ArcGIS software. Multivariable linear regression analyses unveiled predictors of the MHL dimensions, with gender, family income, admission test performance, smoking, alcohol and drug use, physical and mental health history, current depression or anxiety and family history of mental health and suicide incidents emerging as common predictors. GIS analysis unraveled notable regional disparities in MHL, particularly in knowledge of mental health and mental illness, with northern and some southern districts displaying higher literacy levels. In conclusion, these findings accentuate significant gender and sociodemographic inequalities in MHL among prospective university students, highlighting the imperative for targeted interventions to enhance MHL and foster mental well-being in this cohort.

What is the impact of successive COVID-19 lockdowns on population mental health? Findings from an Australian natural experiment using health service data.

ObjectiveThe causal effect of successive population-wide lockdowns in response to increased COVID-19 cases on mental health has yet to be examined using robust methods. A natural experiment design underpinned by objective data can improve our understanding surrounding the definitive impact of social distancing restrictions.MethodsThe study employed a natural experiment design underpinned by objective data. Health service cost for visits to general practitioners and psychologists and medication dispensing costs served as objective measures of mental health. Difference-in-difference (DID) estimators, which in this study quantify differences in spending changes between groups over time, were produced based on three comparisons: Victoria 2020 lockdown comparison, Victoria 2021 lockdown comparison, and New South Wales (NSW) 2021 lockdown comparison. Specifically, differences in public health service spending during lockdown periods and the same timeframe in 2019 for Victoria and NSW, and control groups (remaining states and territories), were compared.ResultsPositive estimator values indicate that public health service spending for Victoria and NSW increased more during lockdown periods compared to control states and territories. The Victorian lockdowns of 2020 and 2021, but not the NSW lockdown of 2021, resulted in increased public spending for general practitioner mental health consults (2020 DID estimator: $8498.96 [95% CI $4012.84, $12,373.57], 2021 DID estimator: $6630.06 [95% CI $41.27, $13,267.20], all monetary values in AUD$) and short visits to psychologists (2020 DID estimator: $628.82 [95% CI $466.25, $796.00], 2021 DID estimator: $230.11 [95% CI $47.52, $373.98]). The first Victorian lockdown in 2020 and the NSW lockdown in 2021 resulted in greater spending on short visits to clinical psychologists. Spending on long visits to psychologists and clinical psychologists and medication spending did not change.ConclusionsStrict lockdowns can have an adverse impact on population mental health. The impact is particularly evident in those who have a history of previous mental health concerns but does not necessitate extra use of medications, suggesting that psychological care can address the adverse impact of the lockdowns.

Impacto Emocional do diagnóstico de mutação genética relacionada ao câncer de mama: uma revisão sistemática

Abstract Objective Based on the premise that the diagnosis of a genetic mutation related to breast cancer causes emotional distress for the patient and their family members, a systematic literature review was conducted to clarify this relationship commonly observed in oncologic clinical practice. Method In total, 18 articles confirmed through bias analysis were reviewed. The articles were retrieved from the PubMed, Cochrane Wiley, SciELO, and APA-PsycInfo databases. Results These studies confirmed the hypothesis that a positive result in the genetic test triggers significant distress for both the patient and their family members, although each individual reacts in a unique way. The researchers recommend that the diagnosis should not be considered the sole factor for the studied outcome. It should be related to personal or family history of illness, previous experiences, and previous mental health. Conclusion We conclude, by a slight tendency, to include qualitative studies as a way to evaluate experiences in a more in-depth manner.

Mental Health in the Shadow of the Holocaust: Psychological Interventions in Jewish Displaced Persons Camps

This study interrogates the historical methodology that underpins research undertaken by historians writing about mental health in the postwar world. I question their near-exclusive reliance on medical elites’ studies, correspondence and reports, and call instead for a closer analysis of the experiences of front-line workers, including social workers and nurses, to better understand the social, political, cultural, economic and gender dynamics that shape the diagnosis and treatment of civilian wartime trauma. Drawing upon the case reports and correspondence of a psychiatric social worker who counselled Holocaust survivors in a Displaced Persons camp in the American Zone of Allied-occupied Germany, I use this article as an opportunity to rethink how we write about the history of trauma and mental health.

Assessment of the Psychosocial Impact of Pancreatic Cancer Surveillance in High-Risk Individuals.

Pancreatic cancer (PC) surveillance of high-risk individuals (HRIs) downstages PC and improves survival. However, it remains less clear whether PC surveillance has a positive psychosocial impact on HRIs. Herein, we aimed to define the attitudes and beliefs of HRIs undergoing PC surveillance, and the immediate and sustained psychosocial impact of PC surveillance in HRIs. 100 HRIs undergoing PC surveillance by endoscopic ultrasound (EUS) completed three surveys addressing different components of the psychosocial impact of PC surveillance. Logistic regression analyses were performed to identify predictive factors relating to these components. Most HRIs reported increased perceived benefits of PC surveillance, self-efficacy, and perceived severity of PC. HRIs reported few negative emotions prior to surveillance and frequent positive emotions after surveillance. Compared to prior to surveillance, there was a 53.5% decrease in the level of distress reported by HRIs after surveillance, which was sustained for 4-6 weeks post-surveillance. Family history of PC and lower self-reported mental health were identified as predictors for increased perceived susceptibility to PC (p < 0.01) and greater change in distress pre- to post-surveillance (p < 0.01), respectively. Our findings suggest that PC surveillance can lead to sustained psychosocial benefits in HRIs.

PHYSICAL AND MENTAL HEALTH INFORMATION-SEEKING BEHAVIORS AMONG US-BASED LATINO ADULTS AGES 50–86

Abstract Introduction As U.S.-based Latino populations disproportionately experience chronic disease and age earlier than their non-Latino white counterparts, attentiveness to knowledge gaps in health communication is critical to address health disparities among Latino older adults. Methods We conducted a cross-sectional survey among U.S.-based Latinos ages 50-86 (N=274; 2021) that measured physical and mental health information seeking across four sources—TV/radio/print-media, Internet/social-media, family/friends, and healthcare providers. Linear regression models examined patterns of personal, family, and mental health factors on each information seeking outcome. Results Foreign-born Latinos had lower odds of mental health info-seeking on Internet/social media (p&amp;lt; 0.05) than U.S.-born Latinos. Compared to higher educational attainment, low education reduced odds of physical/mental health info-seeking in all media sources (p&amp;lt; 0.05). Family mental health history vs none saw 3-5 times the odds of physical/mental health info-seeking to all sources (p&amp;lt; 0.01). Additionally, moderate/severe mental health vs mild/none was associated with 2-3 times the odds of physical/mental health info-seeking among family/friends and healthcare providers (p&amp;lt; 0.01). English media use increased odds of physical health info-seeking in TV/radio/print-media and family/friends (p&amp;lt; 0.05), while Spanish/English media use increased odds of mental health info-seeking to healthcare providers (p&amp;lt; 0.05). Conclusions Latino older adults report diverse yet unique patterns in health information acquisition. Those with self/familial mental illness especially seek health information more often than Latinos without a lived experience. Findings demonstrate the need to apply culturally appropriate health communication strategies to address the needs of older Latino adults, with special focus on families coping with mental illnesses.

Mortality in adolescents and young adults following a first presentation to the emergency department for alcohol.

We conducted a population-based, retrospective cohort study of first-time emergency department (ED) visits in adolescents and young adults (AYA) due to alcohol and compared mortality to AYA with nonalcohol ED visits between 2009 and 2015 using standardized all-cause mortality ratios (age, sex, income, and rurality). We described the cause of death for AYA and examined the association between clinical factors and mortality rates in the alcohol cohort using proportional hazard models. A total of 71,776 AYA had a first-time ED visit due to alcohol (56.1% male, mean age 20.7 years) between 2009 and 2015, representing 3.3% of the 2,166,838 AYA with an ED visit in this time period. At 1 year, there were 2396 deaths, 248 (10.3%) following an ED visit related to alcohol. First-time alcohol ED visits were associated with a threefold higher risk in mortality at 1 year (0.35% vs. 0.10%, adjusted hazard ratio [aHR] 3.07, 95% confidence interval [CI] 2.69-3.51). Mortality was associated with age 25-29 years (aHR 3.88, 95% CI 2.56-5.86), being male (aHR 1.98, 95% CI 1.49-2.62), having a history of mental health or substance use (aHR 3.22, 95% CI 1.64-6.32), cause of visit being withdrawal/dependence (aHR 2.81, 95% CI 1.96-4.02), and having recurrent ED visits (aHR 1.97, 95% CI 1.27-3.05). Trauma (42.7%), followed by poisonings from drugs other than opioids (38.3%), and alcohol (28.6%) were the most common contributing causes of death. Incident ED visits due to alcohol in AYA are associated with a high risk of 1-year mortality, especially in young adults, those with concurrent mental health or substance use disorders, and those with a more severe initial presentation. These findings may help inform the need and urgency for follow-up care in this population.

Jejak Sejarah Kesehatan Mental : Dari Prasejarah Hingga Era Kontemporer

The research aims to explain the history of mental health from pre-historic times to the contemporary era. The research focus involves the analysis of empirical factors, paradigm shifts, and the evolution of approaches to the treatment of mental disorders. The research method used is descriptive qualitative, allowing researchers to deepen historical concepts of mental health and analyze their development. Data was obtained through literature reviews from previous research and analysis of reference books. Relevant information is drawn from journal conclusions and book summaries to form a comprehensive understanding of the historical footprint of mental health. As a result of research from journals and books, it can be concluded that the history of the development of mental health has involved significant changes in the paradigm of treating mental disorders. Starting from the pre-scientific era with the concepts of animism and naturalism, to the transition to the modern era which marks the peak of scientific development in the field of mental health. With this shift, the history of mental health reflects the evolution of society's view of mental disorders from mystical beliefs to modern scientific understanding. This research summary provides in-depth insight into how the evolution of mental health concepts has influenced approaches and treatments in society.

Predictors of COVID-19-related posttraumatic stress and anxiety symptoms in high school students in China

Youth may be particularly vulnerable to negative consequences of the COVID-19 pandemic due to acute and chronic stressors (e.g., social distancing) during a critical period of development. The present study examined factors associated with COVID-19-related posttraumatic stress and anxiety in high school students in China (N = 294) during May 2020. Logistic and zero-inflated negative binomial regression were used to evaluate the effects of self-reported prior mental health concerns, duration of isolation/quarantine measures, impact from the pandemic, behaviors changed during COVID-19, and attitudes surrounding the pandemic on self-reported anxiety and pandemic-related posttraumatic stress. Self-reported history of mental health concerns significantly predicted anxiety and pandemic-related posttraumatic stress. While timing likely contributed to lower rates of clinically significant outcomes than have been reported in other studies, some students exhibited signs of enduring distress. History of mental illness may be a sign of negative psychological outcomes in adolescents and should prompt further screening.

Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis

BackgroundSubstance use and other health-risk risk factors, including mental health, trauma, and sexual-risk behaviors, often co-occur among youth experiencing homelessness (YEH). The present study aimed to identify subgroups of YEH based on polysubstance use and the linkages to sociodemographic and health-risk characteristics. MethodsFrom June 2016 to July 2017, 1,426 YEH (aged 18–26 years) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, sexual risk behaviors, and sociodemographic characteristics. The majority of YEH identified as Black (37.3%), cisgender (92.8%), and heterosexual (69.2%). On average, YEH were 20.9 years (SD = 2.1). This study employed latent class analysis (LCA) to identify subgroups of YEH according to their substance use. Multinomial logistic regression analyses were conducted to identify sociodemographic and health-risk characteristics associated with class-membership. ResultsFour latent classes of YEH substance use were identified: (1) high polysubstance use; (2) moderate stimulant and high marijuana, alcohol, and prescription drug use; (3) high marijuana, alcohol, and prescription drug use; (4) low/moderate marijuana and alcohol use. Multinomial logistic regression models indicated that geographic location, gender, race/ethnicity, mental health, trauma history, and sexual risk behaviors were significant correlates of substance use class membership among YEH. ConclusionsThese findings offer important implications for the prevention and treatment of substance use among YEH. Screening protocols should consider co-occurring risk factors such as traumatic experiences, sexual risk behaviors, and mental health history as indicators of polysubstance use.

Nursing Care in Tn. B And Tn. S with Disorders of Sensory Perception: Hallucinations

&#x0D; &#x0D; &#x0D; &#x0D; This study aims to explain and evaluate the implementation of nursing care for patients who experience auditory hallucinations. The research method uses a case study approach by collecting data from initial assessments, nursing diagnoses, care plans, nursing interventions, evaluations, and discharge planning. The research results show that an initial assessment is carried out by identifying mental health history, behavior related to hallucinations, and triggering factors that may influence the patient's condition. The nursing diagnosis was determined as sensory perception disorder: auditory hallucinations. The treatment plan involves collaboration with the mental health team, behavioral monitoring, emotional support, and education of the patient and family. Nursing interventions include explanation of the nature of hallucinations, assistance in identifying reality, and use of relaxation and distraction techniques. Evaluations are carried out to assess the patient's response to the interventions provided and monitor changes in the intensity or frequency of hallucinations, discharge planning and provide information regarding warning signs. Conclusion: Nursing care for patients with sensory perception disorders requires a holistic approach and collaboration between nurses and the mental health team. Education for patients and families also has an important role in supporting the management of this condition.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Nursing Care in Hallucination Patients

&#x0D; &#x0D; &#x0D; &#x0D; The aim of this study was to examine the implementation of nursing care for two patients who experienced hallucinatory sensory perception disorders. The research method uses a case study approach with data analysis through medical records, observations, and interviews with patients and families. The results showed that both patients experienced sensory perception disorders in the form of auditory hallucinations. The initial assessment includes identification of mental health history, observation of hallucinatory behavior, and precipitating factors. The nursing diagnosis was determined as sensory perception disorder: hallucinations. The treatment plan involves collaboration with the mental health team, use of drug therapy prescribed by the doctor, as well as nursing interventions such as education about stress management, distraction techniques, and increased coping. Evaluations are carried out periodically to monitor the patient's response to the interventions provided. The conclusion of this study is that nursing care for patients with sensory perception disorders requires a comprehensive approach that includes collaboration between nurses, mental health teams and families in order to help improve the quality of life of patients with sensory perception disorders, especially in managing the symptoms of hallucinations.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

I have not come here because I have nothing better to do: The lived experience of presenting to the emergency department for people with a psychosocial disability and an NDIS plan-A qualitative study.

Almost 60 000 people have a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan. As PSD can be a fluctuating condition, people with a PSD and an NDIS plan, at times, may require crisis care and present to the emergency department (ED). This national study explored the experiences of people with a PSD and an NDIS plan when presenting to the ED. To understand the unique lived experience of people with a PSD and an NDIS plan, semi-structured interviews were conducted with 24 people between March and November 2022 and were analysed thematically. A lived experience advisory group was engaged as part of the research team. Participants were asked about their experiences in the ED including barriers to therapeutic care and what worked well. Participants reported emotional distress caused by receiving a biomedical rather than a person-centred mental health response. A previous mental health history overshadowed diagnostic decisions and most participants interviewed stated they would not choose to return to the ED. Half of the participants spoke of one presentation only where needs were met. Four main themes emerged from the data: (a) Diagnostic overshadowing; (b) Judgement and stigma; (c) Waiting without hope; and (d) If things went well. This study provides evidence of the unique lived experience of people with a PSD and an NDIS plan when presenting to the ED. The results highlight the need for clinicians in the ED to understand the complexity and nuances of supporting people with a PSD. Recommendations for a person-centred care approach are provided. Alternative support options for this group of people need to be explored.

Labour agentry and subsequent adverse mental health outcomes: A follow-up study of the ARRIVE Trial.

Labour can be traumatic for women who perceive they are not involved in decisions affecting their care during labour. Our objective was to assess the relation between labour agentry and subsequent mental health. Follow-up cohort study. U.S. Tertiary care center. Participants from Utah who participated in the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial. During the ARRIVE trial, participants completed the Labor Agentry Scale twice, a validated questionnaire measuring perceived control of patients during childbirth. ARRIVE participants from Utah subsequently were asked to complete questions about mental health history and stressful events occurring since the trial, as well as surveys including the Primary Care Posttraumatic Stress Disorder (PC-PTSD) screen, Edinburgh Postnatal Depression Scale (EPDS) and Generalised Anxiety Disorder-7 (GAD-7) screen. The lower quartile of both agentry measurements defined a person's ordinal agentry category, used for assessing cohort characteristics by exposure category. Continuous minimum agentry was included in adjusted modelling. The primary outcome was a mental health composite including a positive screen for depression, anxiety, or PTSD or self-report of a diagnosis or exacerbation since their delivery. In all, 766 of 1042 (74%) people responded to the survey (median 4.4, range 2.5-6.4 years after delivery) and 753 had complete data for analysis. In unadjusted comparisons across ordinal agentry category, lower agentry was significantly associated with the primary composite endpoint, and depressive symptoms (test of trend p = 0.003 primary, p = 0.004 depression). Lower labour agentry scores were associated with incremental odds of the primary endpoint (1 SD [24 units], adjusted odds ratio [aOR] 1.21, 95% CI 1.41-1.03), driven by depressive symptoms or self-reported diagnosis (aOR 1.25, 95% CI 1.47-1.05). Lower labour agentry at the time of birth was associated with a greater risk for mental health conditions years after delivery, indicating a potential opportunity for primary prevention of subsequent depression.

Examining the Joint Factor Structure of Mania, Internalizing, and Thought Disorder Symptoms in a Large Online Sample

The optimal classification of mania symptoms within dimensional models of psychopathology remains unclear, due in part to most prior research using composite categorical ratings of mania/bipolar disorder rather than ratings of specific symptoms. We addressed this gap by examining the structure of self-reported symptom-level ratings of mania, internalizing, and thought disorder in adults (N = 1,112) recruited online who self-identified as having significant mental health histories. Although prior research suggests that mania symptoms overlap strongly with both internalizing and thought disorder, our results indicated much closer alignment with thought disorder than internalizing when examining a two-factor structure. Even when examining a three-factor structure, manic symptoms such as grandiosity loaded strongly onto a common factor with positive psychosis symptoms. However, symptoms such as racing thoughts and excessive energy loaded strongly onto a separate Agitation factor potentially representing a subspectrum within thought disorder. Agitation showed some unique correlates (e.g., with stimulant medication use), indicating heterogeneity within the broader thought disorder spectrum. Future directions extending this research include incorporating assessment of other psychopathology (e.g., externalizing), examining the cross-method consistency of results (e.g., when using interviews), and determining symptom course and interrelations using intensive longitudinal designs.