Suicidality in nursing home residents: Part II. Special issues.

Professional psychologists working with suicidal nursing home residents often deal with a host of special issues that may not be relevant to other populations. This review article (Part 2 of a series) was written to acquaint professionals with the concept of indirect self-destructive behavior and dealing with ethical concerns. This article also summarizes health care systems issues, including how to involve staff and family members in assessment and management, as well as understanding Medicare/Medicaid related concerns and public policy regarding long-term care. The article concludes with information about training and continuing education offerings for psychologists who need more information about working in nursing home settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidality in nursing home residents: Part I. Prevalence, risk factors, methods, assessment, and management.

Professional psychologists often work in nursing home settings. As the number of older adults in nursing homes increases, the number of psychologists providing care to this population will likely increase as well. Even though literature has suggested that nursing home residents have a high rate of mental disorders, the literature investigating suicidality in this population is scarce. Our discussion includes two articles. This article (Part 1) summarizes types of suicidal behavior, prevalence, risk factors, methods, screening/assessment, and management issues. The second article (Part 2) describes indirect self-destructive behavior, ethical concerns, involving staff and family members, Medicare information, public policy, and suggestions for training/continuing education offerings. Because few psychologists receive training in geropsychology, this information can help clinicians who serve nursing home residents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Placebo-Controlled Test of Cognitive-Behavioral Therapy for Comorbid Insomnia in Older Adults.

The present study tested cognitive-behavioral therapy (CBT) for insomnia in older adults with osteoarthritis, coronary artery disease, or pulmonary disease. Ninety-two participants (mean age = 69 years) were randomly assigned to classroom CBT or stress management and wellness (SMW) training, which served as a placebo condition. Compared with SMW, CBT participants had larger improvements on 8 out of 10 self-report measures of sleep. The type of chronic disease had no impact on these outcomes. The hypothesis that CBT would improve daytime functioning more than SMW was only supported by a global rating measure. These results add to findings that challenge the dichotomy between primary and secondary insomnia and suggest that psychological factors are likely involved in insomnias that are presumed to be secondary to medical conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological and Behavioral Risk Factors for Obesity Onset in Adolescent Girls: A Prospective Study.

Because little is known about risk factors for obesity, the authors tested whether certain psychological and behavioral variables predicted future onset of obesity. The authors used data from a prospective study of 496 adolescent girls who completed a baseline assessment at age 11-15 years and 4 annual follow-ups. Self-reported dietary restraint, radical weight-control behaviors, depressive symptoms, and perceived parental obesity--but not high-fat food consumption, binge eating, or exercise frequency-predicted obesity onset. Results provide support for certain etiologic theories of obesity, including the affect regulation model. The fact that self-reported, weight-control behaviors identified girls at risk for obesity implies that high-risk youths are not engaging in effective weight-control methods and suggests the need to promote more effective strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimistic Social Comparisons of Older Adults Low in Primary Control: A Prospective Analysis of Hospitalization and Mortality.

Social comparison can be used strategically to bolster the self-concept. Such use may constitute secondary striving for control, when primary striving through action is unattainable. On the basis of the life span theory of control, the authors hypothesized and found that social comparison judgments would predict physical health outcomes among older adults with low primary control perceptions in the health domain. Only among such respondents, after age, sex, activities of daily living, chronic conditions, and prior hospitalization were adjusted for, did more positive social comparison judgments predict significantly lower odds of hospitalization and death over the next 2-6 years as reported in provincial health records. In later life, optimistic social comparisons may contribute to better health by providing secondary control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and protective factors for suicidal behavior in abused African American women.

This study examined risk and protective factors that differentiate low-income, abused African American women (N=200) who attempted suicide from those who had never made a suicide attempt. Results from multivariate analyses revealed that numerous and/or severe negative life events, a history of child maltreatment, high levels of psychological distress and depression, hopelessness about the future, and alcohol and drug problems were factors associated with attempter status. Protective factors associated with nonattempter status included hopefulness, self-efficacy, coping skills, social support, and effectiveness in obtaining material resources. Culturally competent intervention approaches for abused women should target increasing their protective factors and reducing their risk factors to decrease the likelihood that these women engage in suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Role of Primary and Secondary Control in Adaptation to Age-Related Vision Loss: A Study of Older Adults With Macular Degeneration.

This study examines the effect of primary and secondary control on 3 major outcomes experienced by visually impaired older adults, that is, functional ability, adaptation to vision loss, and positive affect. The authors' theoretical model is based on the J. Heckhausen and R. Schulz (1995) control framework, as well as a conceptual integration of these outcomes, and they hypothesized that control beliefs can substantially contribute to explaining interindividual differences in these outcomes. A path model applied to data from a sample (N = 90) of visually impaired older adults, suffering from age-related macular degeneration, the major cause of vision loss in old age, generally supports this expectation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for tardive dyskinesia in a large population of youths and adults.

This study was designed to identify predisposing factors for tardive dyskinesia (TD) in youths and adults within a large, predominantly developmentally disabled and mentally ill population. The findings support previously reported risk factors for TD, including increasing age, use of anticholinergic medication for those over 40 years old, and long duration of neuroleptic exposure for those over 18 years of age. Higher cumulative levels of "typical" neuroleptic dosage decreased the risk for TD for those over 18. Novel findings included the benefit of personality disorder in individuals 18 to 40 years old and the strong risk factor of profound mental retardation in all age groups. These findings reveal further complex interactions to the risk factors for TD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk Factors for Course of Posttraumatic Stress Disorder Among Vietnam Veterans: A 14-Year Follow-Up of American Legionnaires.

Risk factors affecting the course of posttraumatic stress disorder (PTSD) are poorly understood. As part of a larger study on characterizing exposure to herbicides in Vietnam, the authors investigated this issue in a random sample of 1,377 American Legionnaires who had served in Southeast Asia during the Vietnam War and were followed over a 14-year period. High combat exposure, perceived negative community attitudes at homecoming, minority race, depression symptoms at Time 1, and more anger at Time 1 predicted a more chronic course. Community involvement at Time 1 was protective and associated with decreased risk at Time 2. Discomfort in disclosing Vietnam experiences was associated with an increased risk for developing PTSD but did not predict its course. Combat exposure predicted PTSD course more strongly than any other risk factor. Findings suggest recovery from PTSD is significantly influenced by perceived social support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting.

The study examined the effectiveness of Functional Family Therapy (FFT), as compared to probation services, in a community juvenile justice setting 12 months posttreatment. The study also provides specific insight into the interactive effects of therapist model specific adherence and measures of youth risk and protective factors on behavioral outcomes for a diverse group of adolescents. The findings suggest that FFT was effective in reducing youth behavioral problems, although only when the therapists adhered to the treatment model. High-adherent therapists delivering FFT had a statistically significant reduction of (35%) in felony, a (30%) violent crime, and a marginally significant reduction (21%) in misdemeanor recidivisms, as compared to the control condition. The results represent a significant reduction in serious crimes 1 year after treatment, when delivered by a model adherent therapist. The low-adherent therapists were significantly higher than the control group in recidivism rates. There was an interaction effect between youth risk level and therapist adherence demonstrating that the most difficult families (those with high peer and family risk) had a higher likelihood of successful outcomes when their therapist demonstrated model-specific adherence. These results are discussed within the context of the need and importance of measuring and accounting for model specific adherence in the evaluation of community-based replications of evidence-based family therapy models like FFT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)