Sample Of Psychiatric Outpatients Research Articles

Perfectionism and Suicidal Ideation in Outpatient Depressed Adults: The Moderating Role of Self-Esteem, Loneliness and Rumination

IntroductionIdentifying factors that contribute to the development of suicidal ideation (SI) is crucial for prevention and treatment. Perfectionistic Concerns (PC) represent the experience of external pressure to be perfect and have been consistently linked to SI, but it is unclear how PC and SI are associated in depressed adults. This study examined the association between PC and SI and whether self-esteem, loneliness and rumination (brooding, reflection and depression-related rumination) moderated this association in a clinical sample.MethodsThis cross-sectional study used a psychiatric outpatient sample of depressed adults, selected for the presence of SI. In total 110 adults (mean age 33.54 (SD = 12.03) and 60% female) participated in this study. Associations were estimated by regression analyses.ResultsPC was not associated with SI in the sample (r = .16, p = .087). However, high levels of PC in combination with low self-esteem (β = -.29, p = .007) or with high levels of depression-related rumination (β = .22, p = .017) were positively associated with SI. Loneliness, brooding and reflection did not moderate the PC-SI relationship.DiscussionThese findings underline the importance of taking into account the individual characteristics in depressed, perfectionistic individuals when estimating SI severity and selecting the focus of intervention. Due to the cross-sectional design no causal inferences can be made.

The Holland Sleep Disorders Questionnaire: Factorial structure and measurement invariance in a psychiatric sample relative to the general population.

Although common, sleep disorders often remain undiagnosed in psychiatric patients. A screening instrument, like the Holland Sleep Disorders Questionnaire (HSDQ) could improve this. Previous work indicated a 6-factor structure for the HSDQ, but this hasn't been investigated in psychiatric patients. HSDQ data was collected in a psychiatric-outpatient sample (n=1082) and general-population sample (n=2089). Internal reliability of the HSDQ was investigated and Confirmatory Factor Analyses (CFA) were used to compare 1-, 6-, and second-order 6-factor models in both samples. Next, multigroup-CFA was used to investigate measurement invariance. Except for one subscale, internal reliability was acceptable in both samples. The 6-factor structure model fitted best in both samples and investigation of measurement invariance showed evidence for equality of the overall factor structure (configural invariance). Addition of equality constraints on factor loadings (metric invariance) and item thresholds (scalar invariance) showed good fit for all fit statistics, except for one. Exploratory analyses identified three items for metric and three different items for scalar invariance explaining this non-invariance. The HSDQ has a 6-factor structure in psychiatric patients, which is comparable to the general population. However, due to the observed non-invariance, users should be cautious with comparing HSDQ scores between psychiatric and general populations.

Assessment of psychometric properties of the union physio-psycho-social assessment questionnaire (UPPSAQ-70) in a large sample of general hospital psychiatric outpatients

ObjectiveTo evaluate the psychometric properties of the Union Physio-Psycho-Social Assessment Questionnaire (UPPSAQ-70) among general hospital psychiatric outpatients. MethodsA total of 2000 participants responded to the survey. Factor analyses were used to test the construct validity of the scale. Convergent validity was evaluated by the correlation between UPPSAQ-70 and symptoms measured using the Chinese versions of Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Patient Health Questionnaire-15 (PHQ-15), Somatic Symptom Disorder - B Criteria Scale (SSD-12) and Pittsburgh Sleep Quality Index (PSQI). ResultsThe nine-factor model was supported (χ2 = 8816.395, df = 2309, χ2/df = 3.818, RMSEA = 0.053, CFI = 0.929). The UPPSAQ-70 showed significant correlation with the SAS (r = 0.396, P < .001), SDS (r = 0.451, P < .001), PHQ-15 (r = 0.381, P < .001), SSD-12 (r = 0.324, P < .001) and PSQI (r = 0.220, P < .001). UPPSAQ-70 and its subscales showed good internal consistency with Cronbach's alpha coefficients ranging from 0.79 to 0.96. ConclusionsThe UPPSAQ-70 was a rating scale with good construct validity and reliability, which can measure overall health in the biological, psychological, and social domains for Chinese psychiatric outpatients, but its convergent validity still requires further empirical research.

The role of long-acting antipsychotics in illness relapse: an observational study

IntroductionIn patients affected by Schizophrenia and Bipolar Disorder disorders the use of antipsychotic drugs is essential in preventing the exacerbation of symptoms. The use of long-acting injectable (LAI) antipsychotics is considered an important treatment option. The aim of this study was to evaluate the incidence and predictors of relapse during antipsychotic treatment with LAIs in a sample of psychiatric outpatients up to a year after the start of long-acting therapy.ObjectivesThe study included 103 adult patients admitted to the psychiatric unit of Sant’Andrea University Hospital in Rome.MethodsWe evaluated duration of untreated illness, previous treatments, substance abuse, suicidal status, LAI dose, and use of other medicines for association with new episodes of illness or of symptomatic worsening as well as hospitalization, using bivariate and multivariate analyses.Results Seventy-three patients were diagnosed with schizophrenia spectrum and 30 with bipolar disorders. Age at study entry averaged 36.7 years (SD= 11.55). 40.8% of patients were women. The mean age at onset were 23.11 (SD= 7.0). All the other information were reported in Table 1. On 103 patients undergoing with LAI treatment for a year only 9 (8.7%) patients had a relapse during the study period. The two groups differed according to the presence of hospitalization during the 12 months before the LAI treatment (p = .022), in particular patients with relapse were more hospitalized than patients with no relapse (62.5% vs. 21.7%). Moreover, group with relapse were more at risk of suicide during the 12 months before the LAI treatment than the other group, for both suicidal ideation (11.1% vs. 4.3%; p= .015) and attempt (25.0% vs. 3.2%; p= .049). Finally, the two groups differed according to the side effects reported during the year of LAI treatment (χ² =38.48; p&lt; .001). Specifically, patients’ group with relapse reported more side effects caused by parkinsonism (25.0% vs. 1.1%) and tremor (25.0% vs. 0%). No differences were found for the other variables (See table 1).Image:ConclusionsIn conclusion, our observations confirm the importance of LAI therapy in real word. However, our results indicate that these drugs might not prevent subsequent exacerbations for a proportion of individuals whose illness is stabilised on continuous antipsychotic treatment. Extra pyramidal symptoms in particular might have pathophysiological implications for relapse.Disclosure of InterestNone Declared

Examining cognitive disengagement syndrome in a psychiatric outpatient sample: Psychometric support and associations with internalizing symptoms and sleep problems.

The internal (structural) and external validity of a self-report measure of cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) relative to a self-report measure of attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with adults from university outpatient psychiatric clinics in Turkey. A total of 274 outpatients (75.9% women; ages 18-64 years; Mage = 31.06; SDage = 10.84; 50.4% anxiety disorders; 41.6% depressive disorders; 2.9% ADHD; 1.5% sleep disorders; 0.7% eating disorders; 2.9% no mental disorder) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), sleep problems, depression, and stress. All 15 CDS symptoms measured by the Adult Concentration Inventory (ACI) showed convergent (moderate to high loadings on the CDS factor) and discriminant (loading close to zero on the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations than ADHD-IN with sleep problems, depression, anxiety, and stress, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-HI. This is the first study to provide support for the scores from this 15 item self-report measure of CDS by the ACI in a clinical sample of adults, with findings consistent with previous studies examining parent and teacher rating scale measures with the same 15 CDS symptoms. These findings provide additional support for usefulness of these 15 CDS symptoms as measured by the ACI to study CDS across various cultures.

Problematic use of Internet in a sample of psychiatric outpatients: preliminary observations from the "real world".

This study aims to explore the prevalence, characteristics, and psychopathology related to Problematic Use of Internet (PUI), including Internet Addiction (IA), within a sample of psychiatric outpatients. 143 psychiatric stable outpatients (18-65, mean age: 49; F=84) were included in this study, regardless of their categorical diagnosis. Socio-demographic, clinical, psychopathological, and Internet use-related data (PIU-Scale, Internet Addiction Test, devices, use, activities) were collected across the sample. The prevalence of PUI ranged between 1% (IAT) and 25% (PIU-S), with a homogeneous distribution of PUI symptoms' severity among the four main psychopathological areas (depressive, bipolar, anxiety, and psychotic disorders). PUI was correlated with age and was higher in students as in the general population. Significant associations were found between PUI symptoms and both personality and eating disorders; PUI was also positively correlated with the presence of other addictions (e.g., alcohol and/or substances). A greater proportion of patients with PUI presented other forms of behavioural addiction compared to non-symptomatic patients. Social media and online shopping, as well as video-streaming, resulted to be the main forms of PUI among patients with problematic use of the Internet. More studies are required among students diagnosed with eating and personality disorders. The association between PUI and other addictive disorders would support the hypothesis of their common shared pathophysiology. Healthcare providers and educators should be made aware of such risks. More studies are needed to confirm such preliminary findings.

Narcissistic personality syndrome in relation to emotional states: Preliminary findings in a Dutch psychiatric outpatient sample

The aims of the current study was to investigate the relation between the narcissistic personality syndrome (NPS) and schema modes, which refer to the predominant emotional state, schemas, and coping responses that are active for an individual at a particular time. Participants consisted of 25 clients who filled out the Schema Mode Inventory and 25 clinicians who provided assessment of NPS using the Shedler-Westen Assessment Procedure. This study showed a significant correlation between NPS and a lack of frustration tolerance (i.e., undisciplined child mode). There were no significant relations with self-aggrandizement (i.e., self-aggrandizer mode), feeling intensely angry (i.e., angry child and enraged child modes), and trying to suppress painful emotions by compulsively and excessively committing to distracting and soothing activities, such as abusing drugs (i.e., detached self-soother mode). This preliminary study contributes to our understanding of pathological narcissism in Dutch outpatient clients. We point to the importance of a self-reported lack of frustration tolerance as a potentially valuable diagnostic characteristic of pathological narcissism. We additionally emphasize the importance of diagnostic approaches based on clinical judgement when it comes to pathological narcissism.

Psychometric Properties of the Persian Version of the Revised Temperament and Character Inventory (TCI-140) in a Psychiatric Outpatient Sample in Iran

Background: Cloninger first proposed the personality theory, considering both normal and abnormal personality traits. Later, different complementary versions of the Temperament and Character Inventory (TCI) found their way into the academic milieu to enhance their psychometric properties and efficiency in both experimental and clinical settings. Objectives: The main objective of the current research was to investigate the principal psychometric properties of the Persian version of the Temperament and Character Inventory (TCI-140). Methods: This research is a cross-sectional study. The data included information on psychiatric outpatients visiting Roozbeh psychiatric hospital in 9 months in 2021. Purposive sampling was performed on volunteers. A total of 471 outpatients filled out the TCI-140, 150 of whom also filled out the Personality Inventory for the DSM-5 (PID-5). Exploratory factor analysis (EFA) was performed using principal component analysis (PCA) by Promax rotation. Results: The internal consistency of all dimensions (Cronbach's alpha: Above 0.70, except for reward dependence) was proved to be satisfactory, but that of some subscales (NS1, NS4, RD4, CO3, and CO5) was quite poor. Test-retest reliability confirmed that for all dimensions, ICC &gt; 0.70, indicating a high reliability. The findings of the PCA revealed that all dimensions were loaded in accordance with the theoretical expectations. At the facet level, all the facets were loaded on their factors except for sentimentality and dependence. According to the correlation findings, the concurrent validity of TCI-140 was acceptable for PID-5. The results showed that HA had relatively high positive correlations with detachment (r = 0.55) and negative affect (r = 0.48). Conclusions: The results confirmed the satisfactory reliability and validity of the Persian version of TCI-140 despite its drawbacks. Hence, it can be employed to examine personality traits.

Autism in adult psychiatric out-patients: self-reported suicidal ideation, suicide attempts and non-suicidal self-injury.

The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services. We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group. Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made. In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women. Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.

Religious/Spiritual Struggles and Suicide Ideation Among Adult Psychiatric Outpatients: A 12-Month Longitudinal Study

BackgroundInitial empirical evidence links religious/spiritual (R/S) struggles to suicide ideation. However, few longitudinal studies have examined the temporal associations of R/S struggles and suicide ideation, and none have focused on treatment-seeking individuals. This study addresses these gaps. MethodsWe assessed suicide ideation and six subtypes of R/S struggles in a sample of adult psychiatric outpatients (N = 120) at their initial psychiatry appointment (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Following the analytic template for outcome-wide longitudinal designs, separate linear regression models tested the association of (a) T2 R/S struggle subtypes with T3 suicide ideation and (b) T2 suicide ideation with T3 R/S struggle subtypes. All models adjusted for salient demographics, organizational and nonorganizational religiousness, depression symptoms, T1 suicide ideation, and prior values of all six R/S struggle subtypes. ResultsRobust evidence supported a positive bidirectional temporal association between suicide ideation and ultimate-meaning R/S struggles, but not other R/S struggle subtypes. LimitationsWe recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data. ConclusionsFindings highlight the importance both of assessing ultimate-meaning R/S struggles as part of suicide risk assessment and of using clinical interventions that nurture adult psychiatric patients’ sense of ultimate meaning.

Identifying clinical risk factors correlated with addictive features of non-suicidal self-injury among a consecutive psychiatric outpatient sample of adolescents and young adults.

Non-suicidal self-injury (NSSI) is an issue primarily of concern in adolescents and young adults. Recent literature suggests that persistent, repetitive, and uncontrollable NSSI can be conceptualized as a behavioral addiction. The study aimed to examine the prevalence of NSSI with addictive features and the association of this prevalence with demographic and clinical variables using a cross-sectional and case-control design. A total of 548 outpatients (12 to 22years old) meeting the criteria for NSSI disorder of DSM-5 were enrolled and completed clinicalinterviews by 4 psychiatrists. NSSI with addictive features were determined by using a single-factor structure of addictive features items in the Ottawa self-injury inventory (OSI). Current suicidality, psychiatric diagnosis, the OSI, the revised Chinese Internet Addiction Scale, the Childhood Trauma Questionnaire, and the 20-item Toronto Alexithymia Scale were collected. Binary logistic regression analyses were used to explore associations between risk factors and NSSI with addictive features. This study was conducted from April 2021 to May 2022. The mean age of participants was 15.93 (SD = 2.56) years with 418 females (76.3%), and the prevalence of addictive NSSI was 57.5% (n = 315). Subjects with addictive NSSI had a higher lifetime prevalence of nicotine and alcohol use, a higher prevalence of current internet addiction, suicidality, and alexithymia, and were more likely to have physical abuse/neglect, emotional abuse, and sexual abuse than NSSI subjects without addictive features. Among participants with NSSI, the strongest predictors of addictive features of NSSI were female (OR = 2.405, 95% CI 1.512-3.824, p < 0.0001), alcohol use (OR = 2.179, 95% CI 1.378-3.446, p = 0.001), current suicidality (OR = 3.790, 95% CI 2.351-6.109, p < 0.0001), and psysical abuse in childhood (OR = 2.470, 95% CI 1.653-3.690, p < 0.0001). Nearly 3 out of 5 patients (12-22years old) with NSSI met the criteria of NSSI with addictive features in this psychiatric outpatients sample. Our study demonstrated the importance of the necessity to regularly assess suicide risk, and alcohol use, as well as focus more on females and subjects who had physical abuse in childhood to prevent addictive NSSI.

Disinhibition domain and facets uniquely predict changes in depressive symptoms and psychosocial functioning.

This study aimed to understand the role of disinhibition (low conscientiousness)-in conjunction with the other major personality traits of negative affectivity, detachment, antagonism, and psychoticism-in predicting changes in depressive symptoms and psychosocial functioning. Both the disinhibition trait domain and its primary facets (i.e., irresponsibility, impulsivity, and distractibility) were examined. In a large sample (Time 1 N = 605, Time 2 N = 497) of psychiatric outpatients and high-risk community residents, personality traits, depressive symptoms (both self-reported and interviewer-rated), and psychosocial functioning levels (i.e., daily functioning, interpersonal functioning, health-related quality of life, and global quality of life) were collected across two time points. Results showed that the disinhibition domain was the strongest predictor of changes in depressive symptoms and general quality of life levels. Disinhibition facets also predicted changes in depressive symptoms but showed a less consistent pattern compared to the broader trait domain. Finally, the irresponsibility and distractibility facets significantly and uniquely explained changes in interpersonal functioning. The study highlights the importance of assessing the disinhibition trait rather than only negative and positive affectivity (which are well-known correlates of depression), for understanding changes in depressive symptoms and psychosocial functioning. The findings identify potential targets in psychotherapy for individuals with disinhibition traits and depressive disorders.

Alcohol use and motives for drinking across the menstrual cycle in a psychiatric outpatient sample.

Females who misuse alcohol experience high rates of negative physical and mental health consequences. Existing findings are inconsistent but suggest a relationship between ovarian hormones and alcohol use. We aim to clarify how alcohol use and drinking motives vary across the menstrual cycle in female psychiatric outpatients using the luteinizing hormone (LH)-confirmed cycle phase. Daily self-reports (n= 3721) were collected from 94 naturally cycling females, recruited for past-month suicidal ideation, during the baseline phase of three parent clinical trials between February 2017 and May 2022. Multilevel logistic and linear models estimated the relationship between the cycle phase (with LH-surge confirmed ovulation) and daily alcohol use or drinking motives, moderated by the weekend. Models were adjusted for age, legal drinking status, substance use disorder, and the COVID-19 pandemic, and included random effects. Participants were generally more likely to drink in the midluteal (vs. perimenstrual) phase, but more likely to drink heavily on weekends in periovulatory and perimenstrual (vs. midluteal) phases. Social motives for drinking were significantly higher on weekends in the periovulatory, mid-follicular, and midluteal phases (vs. weekdays), but this finding was non-significant in the perimenstrual phase. Participants rated drinking to cope higher in the perimenstrual phase (vs. midluteal phase), regardless of the weekend. In a psychiatric sample with LH-surge-confirmed ovulation, we find an increased likelihood to drink heavily in periovulatory and perimenstrual phases on weekends. We also find that the perimenstrual phase is associated with increased drinking to cope, and relatively lower weekend social drinking. Finally, random effects across models suggest individual differences in the extent to which the cycle influences drinking. Our findings stress (1) predictable phases of increased high-risk alcohol use across the menstrual cycle, and (2) the importance of individual assessment of cyclical changes in alcohol use to predict and prevent ovulation- and menses-related surges in heavy drinking.

Acute suicidal affective disturbance and borderline personality disorder symptoms: Distinct yet correlated constructs

ObjectiveAcute Suicidal Affective Disturbance (ASAD) has been proposed to address the need for a suicide-specific diagnostic entity that better accounts for the psychological symptoms that may emerge during an acute suicidal crisis and that may precede imminent suicidal behaviors. However, additional research is needed to establish ASAD's delimitation from preexisting psychological disorders, especially disorders that include suicidal thoughts and behaviors in their diagnostic criteria such as borderline personality disorder (BPD). MethodsWe estimated two Gaussian graphical models (GGMs), exploratory factor analysis (EFA) models, and confirmatory factor analysis models in a sample of psychiatric outpatients (N = 460) to examine the structure of ASAD and BPD symptoms. ResultsOur estimated models showed while most ASAD and BPD symptoms largely shared associations with other symptoms belonging to their respective disorder construct, strong associations connected some ASAD symptoms with BPD symptoms, which, in a network model, emerged in the form of nonzero edges among those symptoms, and in EFA models, as factors that featured both ASAD and BPD symptoms as indicators. ConclusionsOur findings suggest the network structure of the proposed criteria of ASAD features symptoms that are largely distinct to ASAD but do include symptoms that share meaningful correlations with BPD symptoms that suggest ASAD and BPD are correlated constructs.

Acceptance and Compassion-Based Therapy Targeting Shame in Body Dysmorphic Disorder: A Multiple Baseline Study.

Shame is considered central in body dysmorphic disorder (BDD) and empirical accounts highlight the link between shame and BDD symptoms as well as common negative psychosocial effects of the disorder, yet there is a lack of interventions addressing shame in this context. In the past decade, Acceptance and commitment therapy (ACT) and interventions that foster self-compassion have shown promise for reducing the negative effects of shame in a range of clinical problems. The aim of the present study was to develop and evaluate an acceptance and compassion-based treatment specifically targeting shame in BDD. Using a randomized nonconcurrent multiple baseline design, the 12-session intervention, ACT with Compassion (ACTwC), was examined in a psychiatric outpatient sample of five adults diagnosed with BDD. The daily ratings showed marked reductions in BDD-behaviors and self-criticism at posttreatment for four of five participants, while three participants demonstrated decreases in body shame compared to baseline. Improvements were maintained at 6-months follow-up. The intervention also led to reliable long-term improvements in general shame, overall BDD-symptoms, depressive symptoms, and quality of life for four of five participants. All treatment responders showed significant gains in psychological flexibility and self-compassion. Participants reported high credibility and satisfaction with the treatment. These preliminary results suggest that ACTwC may be a promising approach to treating shame in BDD, worthy of further investigation.

Exploring the Relationship Between Attachment and Pathological Personality Trait Domains in an Outpatient Psychiatric Sample.

The current study investigates the relationship between insecure attachment and pathological personality trait domains in a sample of psychiatric outpatients. Participants ( N = 150) completed measures for attachment and personality. Bivariate correlations and multiple regression analyses investigated the extent to which insecure attachment and personality pathology were associated. Insecure attachment positively correlated with overall personality pathology, with attachment anxiety having a stronger correlation than attachment avoidance. Distinct relationships emerged between attachment anxiety and negative affectivity and attachment avoidance and detachment. Insecure attachment and male sex predicted overall personality pathology, but only attachment anxiety predicted all five trait domains. Insecure attachment might be a risk factor for pathological personality traits. Assessing attachment in clinical contexts and offering attachment-based interventions could benefit interpersonal outcomes.

Factor structure, measurement invariance, and concurrent validity of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder scale-7 in a Norwegian psychiatric outpatient sample

ObjectiveThe aim of this study was to test factor structure, measurement invariance, and concurrent validity of the nine item Patient Health Questionnaire-9 (PHQ-9) and the seven item Generalized Anxiety Disorder scale-7 (GAD-7) in a heterogeneous outpatient sample.MethodOutpatients completed the PHQ-9, GAD-7, and the Working Social Adjustment Scale (WSAS) before starting treatment. Study design was cross-sectional, with convenience sampling. The total sample consisted of 831 participants (61% women).ResultsBoth PHQ-9 and GAD-7 demonstrated better fit statistics with two-factor and bifactor solutions consisting of a cognitive and somatic factor. Omega hierarchical was .78 for PHQ-9 and .81 for GAD-7. Both instruments achieved scalar invariance across gender, diagnosis, and comorbidity. However, the somatic factors demonstrated poor discriminant validity. These factors are not well separatable and risks being too similar if used together. The general factors of both instruments were most associated with functional impairment, although PHQ-9 demonstrated a stronger association with WSAS (γ = .74, r2 = .62) than GAD-7 (γ = .54, r2 = .32). Using latent mean difference, women and patients with comorbidity had significantly higher scores of both depression and anxiety.ConclusionThis study shows that the PHQ-9 and GAD-7 may be used as one-dimensional instruments in clinical settings. Tests for measurement invariance supported that both measures are understood and interpreted comparably across gender and diagnostic subgroups.

Evaluation of a standardized posttraumatic stress disorder treatment framework in routine mental health care: Effectiveness and predictors of treatment outcome in a consecutive sample

The primary aim of the present study was to evaluate the effectiveness of standardized care package (CP) treatment for posttraumatic stress disorder (PTSD) in a Danish sample of adult psychiatric outpatients (N=948). Secondary aims were to identify baseline predictors of treatment outcomes and investigate between-group differences in outcomes with regard to sex and treatment modality (i.e., group vs. individual therapy). The naturalistic, nonrandomized study followed a pre-post design. Patient data from five psychiatric outpatient clinics were collected between March 2011 and November 2017. Data were drawn from self-report questionnaires (i.e., SCL-90-R, WHO-5, BHS) and therapist-reported measures (i.e., GAF-S, GAF-F) administered at baseline and posttreatment. Between-group effects for sex and therapy modality (group vs. individual) were analyzed using analyses of variance, and possible predictors of outcomes were selected through LASSO regression and analyzed via hierarchical regression. Pre-post effects were small to moderate, ds=0.39-0.69. No differences emerged regarding treatment modality, but women had significantly better outcomes than men. Aside from sex, only baseline symptom severity predicted outcomes. The effectiveness of the CP treatment was generally limited, indicating the need to implement improved therapeutic practices, such as the use of evidence-based treatments, and to provide better training to mental health clinicians. The findings underscore the need for further comparisons of group and individual treatment modalities using evidence-based therapies as well as the need to investigate factors that may affect treatment outcome.

Screening for ADHD in a general outpatient psychiatric sample of adults

Adults (n = 805) seeking outpatient psychiatric care completed the Adult ADHD Self-Report Scale (ASRS) and measures of impairment and co-occurring psychopathology as part of a measurement-based care initiative. Diagnostic indicators of ADHD (i.e., formal diagnosis and/or medication treatment) were recorded from the electronic medical record (EMR). Agreement between screening positive for ADHD and EMR indicators for the diagnosis was explored, and clinical characteristics of adults identified with ADHD using these indicators were examined. Lastly, the contribution of ADHD to functional impairment was examined, controlling for the contribution of other demographic and psychiatric comorbidities. In the full sample, 54.78% of adults screened positive for ADHD based on the ASRS, and using EMR indicators, only 11.93% of adults were identified with ADHD. Agreement emerged between self-reported ADHD and ADHD EMR indicators, although adults screening positive for ADHD generally reported greater psychiatric complexity relative to adults identified with ADHD in the EMR. ADHD was associated with clinical impairment even when controlling for other psychiatric comorbidities. The considerable difference in prevalence of ADHD based on self-report screening versus EMR indicators suggests that ADHD may be overlooked in adult psychiatric care. Findings point to the importance of assessing adult ADHD in routine psychiatric care.

Distinct patterns of emotional and behavioral change in child psychiatry outpatients during the COVID-19 pandemic

BackgroundStudies are documenting the impact of the COVID-19 pandemic on youth mental health. We extended this literature by characterizing a child psychiatric outpatient sample in the United States during the middle of the 2020–2021 school year. We also used a computational strategy to identify distinct patterns of psychopathology symptom change and examined correlates and predictors of such change. Among potential predictors were cognition and clinical diagnoses, which have not been studied in this context previously.MethodsParticipants were 171 youth (aged 10.6 ± 3.1) referred for neuropsychiatric evaluation who enrolled in research and whose parents filled out a survey on COVID-19. The questionnaire included eight psychiatric and six psychosocial domains rated retrospectively prior to the pandemic and currently at the time of evaluation. We examined change in severity of individual domains with Wilcoxon signed-rank tests. We used a latent profile analysis (LPA) to identify groups with distinct symptom change profiles. Using multinomial logistic regression, we examined potential predictors and correlates of LPA-derived groups. Models controlled for age, sex, and assessment date and corrected for multiple testing.ResultsAlthough the majority of individual psychopathology domains were worse on average during the 2020–2021 school year, youth showed distincive patterns of symptom change. In addition to a large group (72.2%) with relatively stable symptoms and a small group (6.4%) that improved on most symptoms, there were two groups with different constellations of worsening symptoms. These latter groups both showed increased sadness, anxiety and oppositionality; however, one had increased hyperactivity/impulsivity and no change in hopelessness while the other showed greater hopelessness and no change in hyperactivity. Symptoms related to the distinguishable domains of these groups predicted group membership, and changes in screen time, conflict with parents and social isolation were correlates of worsening. Cognition and lifetime clinical diagnoses failed to predict group membership.ConclusionsIn youth outpatients, psychiatric and psychosocial difficulties were worse on average during the school year following the spring 2020 COVID-19 lockdown; yet, some youth experienced greater and distinctive symptom change. A personalized approach to support may be needed as youth emerge from this period.