ORIGINAL ARTICLES

Effective Screening for Emotional Distress in Refugees: The Refugee Health Screener
Michael Hollifield, MD, Eric C. Toolson, PhD, Sasha Verbillis-Kolp, MSW, Beth Farmer, LICSW, Junko Yamazaki, LICSW, Tsegaba Woldehaimanot, MSW, Annette Holland, BS

Refugee Health Screener 15 (RHS-15) and diagnostic proxy (DP) instruments assessing anxiety, depression, and posttraumatic stress disorder were administered to refugees from 3 countries at their public health examination. Properties of the RHS-15 and its components were evaluated. Scale Cronbach α was 0.95, and a factor analysis identified 1 factor accounting for 66% of scale variance. Refugee Health Screener 15 scores and cases discriminated between refugee groups similar to DPs. Refugee Health Screener 15 case sensitivity and specificity to DPs AQ1 were acceptable (≥0.87/0.77). A shorter, 13-item component had acceptable metric properties. The RHS-15 appears to be a valid screener for emotional distress of refugees. The 13-item scale may be more efficient and as efficacious for case identification.

Engaging African-American Veterans in Mental Health Care: Patients' perspectives
Johanne Eliacin, PhD, Angela L. Rollins, PhD, Diana Burgess, PhD, Michelle P. Salyers, PhD, Marianne S. Matthias, PhD

Forty-nine African American veterans with mental illness receiving routine medication management visits were interviewed. Participants identified several barriers and facilitators to engagement in mental health services, including patient as well as provider related factors. Results emphasize the role of providers in facilitating sustained involvement of patients in their own care. Based on the findings, the authors offer a preliminary framework for patient engagement that encompasses patient and provider factors.

The Association of Social Inhibition and Post-Traumatic Stress Disorder: A vicious circle?
Results from the population-based KORA F4 study with 1,232 trauma-exposed participants
Karoline Lukaschek, PhD, Jens Baumert, PhD, Johannes Kruse, MD, Karl-Heinz Ladwig, MD, PhD

A total of 1232 individuals aged 32–71 years with a history of traumatic experience were identified from the population-based KORA F4 study conducted in 2006–2008. PTSD was assessed by the Impact of Event Scale, Posttraumatic Diagnostic Scale, and interview data. Social Inhibition (SI) was measured by the SI subscale of the German version and dichotomized in a high (score of ≥10) and nonhigh group. Even in the fully adjusted multinomial logistic regression model, high levels of SI were significantly associated with PTSD. Our findings suggest a dose-response relationship between PTSD and SI, and should be integrated in individual therapy plans.

Insomnia Symptoms Following Treatment for Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder
Héloïse Cousineau, MPs, André Marchand, PhD, Stéphane Bouchard, PhD, Claude Bélanger, PhD, Patrick Gosselin, PhD, Frédéric Langlois, PhD, Joane Labrecque, PhD, Michel J. Dugas, PhD, Geneviève Belleville, PhD

Our main objective was to assess the impact of cognitive-behavioral therapy (CBT) for panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (η2 = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment.

Coping Strategies and Associations with Depression Among 12-15-Year-Old Norwegian Adolescents Involved in Bullying
Anne Mari Undheim, PhD, Jan Wallander, PhD, Anne Mari Sund, PhD

A representative community sample of 2464 adolescents was assessed. Coping styles were measured by the Coping Inventory for Stressful Situations. Depressive symptoms were assessed by the Mood and Feelings Questionnaire. Adolescents being bullied or being aggressive toward others both showed more emotional coping than did noninvolved adolescents (p < 0.001). Being bullied and high emotional, low task, and high avoidant coping styles were independently related to more depressive symptoms. The association between being bullied and depressive symptoms was both moderated and partially mediated by emotional coping.

Executive (Dys)functioning and Impulsivity as Possible Vulnerability Factors for Aggression in Forensic Patients
Franca Tonnaer, Msc, Maaike Cima, PhD, Arnoud Arntz, PhD

Aggressive behavior, self-reported aggression, executive functioning (ie, working memory, flexibility, and divided attention), and impulsivity dimensions (ie, Sensation Seeking, Impulsive Decision Making, and [inadequate] Response Inhibition) were measured in 44 incarcerated psychiatric patients. Results show that both executive functioning (working memory) and impulsivity (Impulsive Decision Making) predicted self-reported reactive aggression, whereas Response Inhibition was the only predictor for reactive aggressive behavioral responses. The study suggests that Response Inhibition is a stronger predictor of reactive aggressive behavior than executive capacities of working memory, flexibility, and divided attention.

Reliability and Validity of Prototype Diagnosis for Adolescent Psychopathology
Greg Haggerty, PhD, Jennifer Zodan, PhD, Ashwin Mehra, PhD, Ayyan Zobair, Krishnendu Ghosh, MD, Caleb J. Siefert, PhD, Samuel J. Sinclair, PhD, Jared DeFife, PhD

The current study investigated the interrater reliability and validity of prototype ratings of 5 common adolescent psychiatric disorders: attention-deficit/ hyperactivity disorder, conduct disorder, major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder among 157 adolescent inpatient participants. We compared ratings from 2 inpatient clinicians, blinded to each other's ratings and patient measures, after their separate initial diagnostic interview to assess interrater reliability. Prototype ratings completed by clinicians after their initial diagnostic interview with adolescent inpatients and outpatients were compared with patient-reported behavior problems and parents' report of their child's behavioral problems. Prototype ratings demonstrated good interrater reliability. Clinicians' prototype ratings showed predicted relationships with patient-reported behavior problems and parent-reported behavior problems. Prototype matching seems to be a possible alternative for psychiatric diagnosis. Prototype ratings showed good interrater reliability based on clinicians' unique experiences with the patient (as opposed to video-/audio-recorded material) with no training.

Pathways to Care for Patients with First Episode Psychosis in Singapore
Edward Chesney, BM BCh, Edimansyah Abdin, PhD, Lye Yin Poon, MBA, Mythily Subramaniam, MBBS, MD, Swapna Verma, MBBS, MD

We analyzed data from 900 individuals accepted by the Singapore Early Psychosis Intervention Programme between 2007 and 2012. The most common first contacts were specialist care (59%), primary care (27%), and the police (12%). Multivariate regression models showed that first contact with services varied according to demographic variables and diagnosis. The duration of untreated psychosis, total number of contacts before referral, and rate of referral to the Early Psychosis Intervention Programme varied according to demographic and clinical variables and first contact. We hope that this information will enable clinicians, managers, and other service providers to target interventions to streamline referrals, reduce distress, and improve the treatment of young people with psychotic illnesses.

Risk Factors for Posttraumatic Stress Symptoms Among Avalanche Survivors:  A 16 Year Follow-up
Edda Bjork Thordardottir, BA, Ingunn Hansdottir, PhD, Jillian C. Shipherd, PhD, Unnur Anna Valdimarsdottir, PhD, Heidi Resnick, PhD, Ask Elklit, MSc, Ragnhildur Gudmundsdottir, MSc, Berglind Gudmundsdottir, PhD

The aim of this study was to identify factors associated with clinically significant posttraumatic stress symptoms (CSPTSDS) in avalanche survivors (n = 399) 16 years after the disaster. Completed self-report questionnaires were received from 286 (72%) survivors. Predictors of CS-PTSDS in a multivariate analysis were secondary sequelae factors of lack of social support and financial hardship in the aftermath of the trauma. In addition, the community factor of providing assistance in the aftermath of the avalanche was inversely associated with CS-PTSDS. Screening for these factors may be useful in identifying those most vulnerable to developing chronic PTSD after this unique type of disaster.

Agreement Between Self and Informant-Reported Ratings of Personality Traits: The moderating effects of major depressive and/or panic disorder
Lynne Lieberman, MA, Stephanie M. Gorka, MA, Ashley A. Huggins, BA, Andrea C. Katz, MA, Casey Sarapas, MA, Stewart A. Shankman, PhD

We investigated whether self-informant agreement on positive and negative affectivity (PA and NA) and anxiety sensitivity differs for individuals with major depressive disorder (MDD) and/or panic disorder (PD; total n = 117). Informant- and self-reported PA was correlated among those with MDD, but not among those without MDD. Informant- and self-reported anxiety sensitivity was correlated among those with PD, but not among those without PD. Informant- and self-reported NA was correlated irrespective of diagnosis. Results indicate that the agreement of self- and informant-reported personality may vary as a function of depression and/or anxiety disorders.

BRIEF REPORTS

The Influence of Anxiety Sensitivity on a Wish to Die in Complicated Grief

Amanda W. Baker, PhD, Elizabeth M. Goetter, PhD, Eric Bui, MD, Riva Shah, BA, Meredith E. Charney, PhD, Christine Mauro, MA, M. Katherine Shear, MD, Naomi M. Simon, MD, MSc

This study aimed to investigate a possible association between anxiety sensitivity and a wish to die in individuals with complicated grief. Participants were 51 bereaved adults evaluated. Logistic regression was used to examine the relationship between anxiety sensitivity and a wish to die. Overall, anxiety sensitivity was associated with a wish to die at the level of a medium effect size, although it did not reach statistical significance. The anxiety sensitivity social concerns subscale was significantly associated with a wish to die. These findings add to a growing literature implicating anxiety sensitivity in reporting a wish to die.

Perceived Social Support in Multi-Era Veterans with PTSD
Rebecca Kaufman Sripada, PhD, Kristen E. Lamp, PhD, Mahrie Defever, BA, Margaret Venners, MPH, Sheila A. M. Rauch, PhD

In the current study, 741 VA patients who presented to a PTSD clinic between 2005 and 2013 completed assessments of symptom severity and social support. Analysis of variance and linear regression tested the associations between social support, sociodemographic characteristics, and PTSD symptom severity. In adjusted analyses, social support was robustly associated with PTSD severity (β = −0.30, p < 0.001). After stratification by combat era, this association remained significant for all era veterans except veterans of the post-Vietnam/Desert Storm era. Other sociodemographic characteristics did not affect the association between social support and PTSD. Our findings suggest that the detrimental effects of poor social support pervade across sociodemographic groups and that efforts to improve social support in veterans with PTSD are needed.

Mental Health Literacy, Attitudes to Help-Seeking and Perceived Need as Predictors of Mental Health Service Use: A longitudinal study
Herdis Bonabi, MD, Mario Müller, PhD, Vladeta Ajdacic-Gross, PhD, Jochen Eisele, MD, Stephanie Rodgers, PhD, Erich Seifritz, MD, Wulf Rössler, MD, MSc, Nicolas Rüsch, MD

In this longitudinal, population-based study, we investigated the influence of mental health literacy, attitudes toward mental health services, and perceived need for treatment at baseline on actual service use during a 6-month follow-up period, controlling for sociodemographic variables, symptom level, and a history of lifetime mental health service use. Positive attitudes to mental health care, higher mental health literacy, and more perceived need at baseline significantly predicted use of psychotherapy during the follow-up period. Greater perceived need for treatment and better literacy at baseline were predictive of taking psychiatric medication during the following 6 months. Our findings suggest that mental health literacy, attitudes to treatment, and perceived need may be targets for interventions to increase mental health service use.

BOOK REVIEWS

Handbook of Adolescent Drug Use Prevention: Research, Intervention Strategies, and Practice. Lawrence M. Scheier, PhD (2015), Washington, DC: American Psychological Association. 575 pp.
Reviewed by Pedro Ruiz, MD.

DBT Skills Manual for Adolescents. Jill H. Rathus and Alec L. Miller (2014), New York, NY: Guilford Press. 392 pp.
Reviewed by Elissa P. Benedek, MD.

Neuropsychology of the Unconscious: Integrating Brain and Mind Into Psychotherapy. Efrat Ginot (2015), New York, NY: W. W. Norton & Company, Inc. 336 pp.
Reviewed by Rene Hernandez-Cardenache, PsyD and Arlene Raffo, PsyD.

Mindfulness Based Compassionate Living. Erik van den Brink and Frits Koster (2015), New York, NY: Routledge. 258 pp.
Reviewed by Nyapati R. Rao, MD and Robert Barris, MD.

Clinical Manual of Geriatric Psychopharmacology. Sandra A. Jacobson (2014) Washington, DC: American Psychiatric Publishing. 536 pp.
Reviewed by Elizabeth Crocco, MD.