Mental Health-related Functioning Research Articles

Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms

Posttraumatic stress disorder (PTSD) remains prevalent among individuals exposed to the 9/11 World Trade Center (WTC) terrorist attacks. The present study compared an Internet-based, therapist-assisted psychotherapy for PTSD to an active control intervention in WTC survivors and recovery workers with WTC-related PTSD symptoms (n = 105; 75% syndromal PTSD). Participants were randomized to integrative testimonial therapy (ITT), focused on WTC-related trauma, or modified present-centered therapy (I-MPCT), each comprising 11 assigned written narratives. The primary outcome was baseline-to-post-treatment change in PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). Secondary measures included PTSD symptom clusters, depressive/anxiety symptoms, functioning, and quality of life. A significant main effect of time was observed for the primary outcome (average “large” effect size improvement, d = 1.49). Significant and “moderate-to-large” main effects of time were also observed for all PTSD symptom clusters, depressive symptoms, quality of life, and mental health-related functioning (d range=0.62–1.33). Treatment and treatment-by-time interactions were not significant. In planned secondary analyses incorporating 3-month follow-up measures, ITT was associated with significantly greater reductions than I-MPCT in PTSD avoidance and negative alterations in cognitions and mood, anxiety, and mental health-related functioning. Both therapies significantly lowered PTSD symptoms, suggesting they may benefit hard-to-reach individuals with chronic WTC-related PTSD symptoms.

Depressive Symptoms Are Related to Poorer Psychological Functioning in Youth with Functional Abdominal Pain Disorders

Functional abdominal pain disorders, recurrent abdominal pain conditions without an identifiable organic cause, impact approximately 10% of children. These youth can experience significant impairment in functioning (e.g., school absences) and are at increased risk for mental health challenges, including the development of depression. This study examines the relationship between depressive symptoms, pain-related impairment, and broader psychological functioning in youth with FAPD. We predict higher levels of depressive symptoms are related to increased pain-related impairment and poorer mental health functioning. Ninety-four participants diagnosed with FAPD per Rome IV criteria between the ages of 9 and 14 (59.6% female, 40.4% male, 91% non-Hispanic white) were recruited from GI clinics as part of a larger psychological treatment study (NCT03134950). Validated questionnaires assessed depressive symptoms (Children's Depression Inventory 2, [CDI2]), anxiety (Screen for Child Anxiety Related Disorders [SCARED]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), pain-related impairment (e.g., functional disability (Functional Disability Inventory, [FDI])), and average pain intensity (0-10 rating via a visual analogue scale). Descriptive data and multiple regressions, controlling for age and sex assigned at birth, were used to examine associations between depressive symptoms and physical (FDI, pain levels) and mental health (SCARED, PCS) functioning. Bonferroni corrections (p<0.05/4=0.0125) were applied to control for multiple analyses. The sample was broadly categorized by moderate levels of pain, functional disability, and mental health symptoms. All study variables were positively correlated with depressive symptoms (all p's<0.05), and females expressed significantly higher depressive symptoms than males (t(92)=2.365, p=0.020). Multiple regressions revealed higher rates of depressive symptoms predicted higher levels of anxiety (F(3, 89)=12.69, p<0.001) and pain catastrophizing (F(3, 90)=15.607, p<0.001), but were not associated with physical health related impairment. Findings suggest the importance of screening youth with FAPD for depressive symptoms to better understand their mental health-related functioning. Grant support from Sharon S. Keller American Pain Society Grant and the Cincinnati Children's Hospital Place Outcomes Award.

Food insecurity and mental health outcomes among homeless adults: a scoping review.

This review summarises and synthesises the existing literature on the relationship between food insecurity (FS) and mental health conditions among adult individuals experiencing homelessness. Scoping review. Papers published between 1 January 2008 and 2 November 2018, searched in PubMed, Web of Science, Scopus, PsycINFO, Cochrane Library and CINAHL, using homelessness, food security and mental health keywords. Global evidence. Homeless adults aged 18 years or more. Nine articles (eight cross-sectional and one longitudinal) were included in the present review. FS was measured using the Household Food Insecurity Access Scale, the United States Department of Agriculture Household Food Security Survey Module, as well as single-item or constructed measures. Depression and depressive symptoms were the most common mental health conditions studied. Other mental health conditions assessed included alcohol and substance use, emotional disorders, mental health problems symptoms severity and psychiatric hospitalisations. Composite measures such as axis I and II categories and a cluster of severe mental conditions and mental health-related functioning status were also analysed. FS and mental health-related problems were considered as both exposure and outcome variables. The existing evidence suggests a potential association between FS and several mental health conditions, particularly depression, mental health symptoms severity and poor mental health status scores. This review suggests the potential association between some mental health conditions and FS among homeless adults. However, there is a need for more longitudinal- and interventional-based studies, in order to understand the nature and directionality of the links between FS and mental health in this population group.

Centrally Assisted Collaborative Telecare for Posttraumatic Stress Disorder and Depression Among Military Personnel Attending Primary Care: A Randomized Clinical Trial.

It is often difficult for members of the US military to access high-quality care for posttraumatic stress disorder (PTSD) and depression. To determine effectiveness of a centrally assisted collaborative telecare (CACT) intervention for PTSD and depression in military primary care. The STEPS-UP study (Stepped Enhancement of PTSD Services Using Primary Care) is a randomized trial comparing CACT with usual integrated mental health care for PTSD or depression. Patients, mostly men in their 20s, were enrolled from 18 primary care clinics at 6 military installations from February 2012 to August 2013 with 12-month follow-up completed in October 2014. Randomization was to CACT (n = 332) or usual care (n = 334). The CACT patients received 12 months of stepped psychosocial and pharmacologic treatment with nurse telecare management of caseloads, symptoms, and treatment. Primary outcomes were severity scores on the PTSD Diagnostic Scale (PDS; scored 0-51) and Symptom Checklist depression items (SCL-20; scored 0-4). Secondary outcomes were somatic symptoms, pain severity, health-related function, and mental health service use. Of 666 patients, 81% were male and the mean (SD) age was 31.1 (7.7) years. The CACT and usual care patients had similar baseline mean (SD) PDS PTSD (29.4 [9.4] vs 28.9 [8.9]) and SCL-20 depression (2.1 [0.6] vs 2.0 [0.7]) scores. Compared with usual care, CACT patients reported significantly greater mean (SE) 12-month decrease in PDS PTSD scores (-6.07 [0.68] vs -3.54 [0.72]) and SCL-20 depression scores -0.56 [0.05] vs -0.31 [0.05]). In the CACT group, significantly more participants had 50% improvement at 12 months compared with usual care for both PTSD (73 [25%] vs 49 [17%]; relative risk, 1.6 [95% CI, 1.1-2.4]) and depression (86 [30%] vs 59 [21%]; relative risk, 1.7 [95% CI, 1.1-2.4]), with a number needed to treat for a 50% improvement of 12.5 (95% CI, 6.9-71.9) and 11.1 (95% CI, 6.2-50.5), respectively. The CACT patients had significant improvements in somatic symptoms (difference between mean 12-month Patient Health Questionnaire 15 changes, -1.37 [95% CI, -2.26 to -0.47]) and mental health-related functioning (difference between mean 12-month Short Form-12 Mental Component Summary changes, 3.17 [95% CI, 0.91 to 5.42]), as well as increases in telephone health contacts and appropriate medication use. Central assistance for collaborative telecare with stepped psychosocial management modestly improved outcomes of PTSD and depression among military personnel attending primary care. clinicaltrials.gov Identifier: NCT01492348.

U.S. Female Veterans Who Do and Do Not Rely on VA Health Care: Needs and Barriers to Mental Health Treatment.

To determine mental health service utilization and barriers among female veterans, this study examined the prevalence of U.S. female veterans who identified the U.S. Department of Veterans Affairs (VA) as their main source of health care. This observational study used data from a nationally representative sample of 1,202 veterans who completed a Web-based survey. The analysis compared sociodemographic and clinical characteristics, mental health service use, and perceived barriers to mental health care among female veterans who do and do not use the VA as their main source of health care and male veterans who mainly use VA health care. By gender, 23.4% of female veterans and 19.6% of male veterans identified the VA as their main source of health care, which was not significantly different. Compared with male VA patients, women were more likely to be single, younger, and from a racial-ethnic minority group and to screen positive for depression and posttraumatic stress disorder (PTSD), but they were less likely to have a substance use disorder. Compared with female veterans who did not mainly use VA care, female VA patients were more likely to be on a low income, not employed, from racial-ethnic minority groups, and combat veterans, and they were more likely to have a disability, to screen positive for PTSD, and to report poorer mental health-related functioning. There were no group differences in mental health service use, and the most frequently endorsed barriers to using mental health care across veteran groups were "high treatment costs" and "being seen as weak." These findings highlight the health care needs of female VA service users and support efforts to dispel misconceptions and stigma related to mental health care.

Dimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the National Health and Resilience in Veterans Study.

To evaluate the prevalence of DSM-5 posttraumatic stress disorder (PTSD) and factor structure of PTSD symptomatology in a nationally representative sample of US veterans and examine how PTSD symptom clusters are related to depression, anxiety, suicidal ideation, hostility, physical and mental health-related functioning, and quality of life. Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of 1,484 US veterans conducted from September through October 2013. Confirmatory factor analyses were conducted to evaluate the factor structure of PTSD symptoms, and structural equation models were constructed to examine the association between PTSD symptom clusters and external correlates. 12.0% of veterans screened positive for lifetime PTSD and 5.2% for past-month PTSD. A 5-factor dysphoric arousal model and a newly proposed 6-factor model both fit the data significantly better than the 4-factor model of DSM-5. The 6-factor model fit the data best in the full sample, as well as in subsamples of female veterans and veterans with lifetime PTSD. The emotional numbing symptom cluster was more strongly related to depression (P < .001) and worse mental health-related functioning (P < .001) than other symptom clusters, while the externalizing behavior symptom cluster was more strongly related to hostility (P < .001). A total of 5.2% of US veterans screened positive for past-month DSM-5 PTSD. A 6-factor model of DSM-5 PTSD symptoms, which builds on extant models and includes a sixth externalizing behavior factor, provides the best dimensional representation of DSM-5 PTSD symptom clusters and demonstrates validity in assessing health outcomes of interest in this population.

Perceived unfairness and socioeconomic inequalities in functional decline: the Dutch SMILE prospective cohort study

BackgroundPeople in lower socioeconomic positions report worse health-related functioning. Only few examined whether perceptions of unfairness are particularly common in these people and whether this perceived unfairness relates to their subsequent poor health outcomes. We thus set out to examine the contribution of perceived unfairness to the higher risks of physical and mental dysfunction in men and women with a lower socioeconomic position.MethodsSeven-year prospective cohort data from the Dutch SMILE study among 1,282 persons, 55 years old and older, were used. Physical and mental health-related functioning was measured with the SF-36, socioeconomic status with income and education, and the perception of unfairness with an extended new measure asking for such perceptions in both work and non-work domains.ResultsPerceived unfairness was more common in lower socioeconomic positions. Such perpection was related to both physical (odds ratio = 1.57 (95% confidence interval: 1.17-2.11)) and mental (1.47 (1.07-2.03)) decline, while low socioeconomic position was only related to mental decline (1.33 (1.06-1.67)). When socioeconomic position and perceived unfairness were simultaneously controlled, odds ratios for both determinants decreased only very little. Socioeconomic position and perceived unfairness were for the largest part independently related to longitudinal health-related decline.ConclusionsThe general perception of unfairness, at work and beyond work, might have implications for functional decline in middle and older age. We recommend that – rather than addressing and changing individual perceptions of unfairness – more research is needed to find out whether specific environments can be defined as unfair and whether such environments can be effectively tackled in an attempt to truly improve public health.

Social support from family and friends as a buffer of low spousal support among mothers of critically ill children: A multilevel modeling approach.

To investigate whether social support from family and friends (family/friend support) attenuated ("buffered") adverse effects of having low spouse support (spousal support) among mothers of children undergoing hematopoietic stem cell transplantation (HSCT). One hundred sixty-three married mothers who were their child's primary caregiver during treatment completed assessments during the child's hospitalization for HSCT and 3-, 6-, and 12-months post-HSCT. Family/friend support and spousal support were assessed during hospitalization. Maternal physical and mental health-related functioning (the main outcome measures) were assessed at all timepoints. Multilevel modeling was used to analyze trajectories of maternal functioning. Findings indicated that mothers with low spousal support and low family/friend support demonstrated the worst functioning across all timepoints. Mothers with low spousal support and high family/friend support demonstrated significantly better functioning, supporting the hypothesized buffering effect. Their functioning compared to the functioning of mothers with high spousal support. Moreover, mothers with high family/friend support demonstrated trajectories of physical health-related functioning that were more stable than the trajectories of mothers with low family/friend support. These findings have clinical implications in addition to advancing knowledge of social support processes among couples coping with the shared stressor of a child's life-threatening illness and treatment.

Self‐administered cognitive screening for a study of successful aging among community‐dwelling seniors: a preliminary study

Cognitive functioning is a central component of successful aging. Yet, there are few published instruments for brief and reliable self-administered cognitive assessment that could be used in large population-based studies of community-dwelling elderly people. We examined the utility of a self-administered cognitive screening instrument in a group of community-dwelling older adults, and we evaluated correlations of the performance on this measure with demographic variables and specific indicators of self-rated successful aging. We assessed 182 well-educated adults ages 58 to 99 with a modified version of a previously published cognitive screening instrument (Cognitive Assessment Screening Test--Revised; CAST-R), a measure of cognitive complaints (Cognitive Failures Questionnaire; CFQ), and a self-rating of successful aging. We used the SF-36 Physical and Mental Composite Scores as measures of physical and mental health-related functioning. As expected, most individuals performed well on the CAST-R; only 7% of participants fell below a previously established cut score for cognitive impairment. CAST-R scores were positively correlated with level of education, income, SF-36 Mental Composite Scores, and a self-rating of successful aging, and negatively correlated with chronological age. Scores on the CAST-R were not correlated with cognitive complaints (CFQ total score) or SF-36 Physical Composite Scores. A self-administered cognitive screening tool may be a useful, albeit limited, way of screening for cognitive disabilities among well-educated, community-dwelling older adults. Although preliminary, significant associations with several successful aging-related variables in expected directions represent the first step in establishing the validity of the CAST-R.