Amy S. Leiner

Stigma and treatment delay in first‐episode psychosis: a grounded theory study

Aim: A longer duration of untreated psychosis (DUP) is associated with greater morbidity in the early course of schizophrenia. This formative, hypothesis‐generating study explored the effects of stigma, as perceived by family members, on DUP.

Intimate Partner Violence, Psychological Distress, and Suicidality: A Path Model Using Data from African American Women Seeking Care in an Urban Emergency Department

Intimate partner violence (IPV) and suicidal behavior are major public health problems in the African American community. This study investigated whether or not IPV and suicidal ideation are correlated in urban African American women, and if the IPV–suicidal ideation link is explained by symptoms of depression and posttraumatic stress disorder (PTSD). With 323 abused African American females, path analysis revealed that: (1) IPV → depressive symptoms → suicidal ideation, and (2) IPV → PTSD symptoms → depressive symptoms → suicidal ideation. When evaluating abused women, depressive and PTSD symptoms and suicidal thoughts must be assessed. Interventions for reducing suicidal behavior in abused, low income African American women should reduce symptoms of depression and PTSD.

Suicidal, Abused African American Women's Response to a Culturally Informed Intervention

OBJECTIVE This study examined (a) the efficacy of a manualized, culturally informed, empowerment-focused psychoeducational group intervention (Nia) designed in accord with the theory of triadic influence or treatment as usual (TAU) for reducing psychological symptomatology (suicidal ideation, depressive symptoms, posttraumatic stress symptoms, general psychological distress), and (b) the effect of Nia versus TAU on the relation between exposure to intimate partner violence (IPV) and psychological symptomatology in these women. METHOD Two hundred eight low-socioeconomic-status African American women with a recent history of IPV and a suicide attempt were randomized to Nia or TAU and assessed at baseline, postintervention, and 6- and 12-month follow-up. They were assessed on their levels of IPV (Index of Spouse Abuse), suicidal ideation (Beck Scale for Suicidal Ideation), depressive symptoms (Beck Depression Inventory-II), posttraumatic stress symptoms, and general psychological distress (Brief Symptom Inventory). RESULTS Hierarchical linear modeling found that women receiving the culturally informed Nia intervention showed more rapid reductions in depressive symptoms and general distress initially, and the between-group difference in depressive symptoms persisted at follow-up. Following intervention, compared with women randomized to TAU, women in Nia exhibited less severe suicidal ideation when exposed to physical and nonphysical IPV. CONCLUSIONS Findings highlight the value of incorporating Nia as an adjunctive intervention for abused, suicidal, low-income women. They underscore the ways the intervention needs to be bolstered to address more directly more mediating and moderating constructs, as well as the need to target more effectively the key outcomes.

The period of untreated psychosis before treatment initiation: a qualitative study of family members' perspectives.

AIM This study used a qualitative research methodology to explore common themes pertaining to the period of untreated psychosis before treatment initiation in hospitalized, urban, African American, first-episode psychosis patients. METHODS Twelve family members of 10 patients were interviewed at length to gather detailed narrative accounts of factors related to untreated psychosis and treatment delay. Using qualitative analysis, verbatim transcripts were reviewed by 2 researchers to identify prominent themes useful for generating future research hypotheses. RESULTS Four themes emerged as informative of the period of untreated psychosis before treatment initiation: (1) misattribution of symptoms or problem behaviors (eg, depression, drug use, and adolescent rebellion), (2) positive symptoms causing unusual or dangerous behaviors that served as a catalyst for initiating treatment, (3) views about personal autonomy of an adult or nearly adult patient, and (4) system-level factors (eg, unaffordability of health care and inefficiency on the part of health care providers). CONCLUSIONS Family members encountered numerous barriers when seeking treatment, including their own misattributions, the nature of the patients symptoms, financial issues, and system-level delays. The themes uncovered in this formative analysis merit further exploration with additional qualitative and quantitative research.

Avoidant Coping and Treatment Outcome in Rape-Related Posttraumatic Stress Disorder.

OBJECTIVE This study investigated the impact of avoidant coping on treatment outcome in rape-related posttraumatic stress disorder (PTSD). METHOD Adult women with rape-related PTSD (N = 62) received 9 sessions of prolonged exposure (PE) or eye movement desensitization and reprocessing (EMDR). The mean age for the sample was 34.7 years, and race or ethnicity was reported as 67.7% Caucasian, 25.8% African American, 3.2% Latina, and 3.2% other. PTSD was assessed with the PTSD Symptom Scale-Self-Report (Foa, Riggs, Dancu, & Rothbaum, 1993), and avoidant coping was assessed using the Coping Strategies Inventory-Disengagement subscale (CSI-D; Tobin, Holroyd, Reynolds, & Wigal, 1989). RESULTS Pretreatment avoidant coping was negatively associated with posttreatment PTSD symptom severity even when controlling for initial severity of total PTSD symptoms and when removing PTSD avoidance symptoms from the analysis to account for potential overlap between avoidant coping and PTSD avoidance symptoms: ΔR2 = .08, b* = -0.31, 95% CI [-0.17, -0.01], t(60) = -2.27, p = .028. The CSI-D pretreatment mean score of 100 predicted a 96% likelihood of experiencing clinically significant change (CSC) during treatment. A CSI-D pretreatment score of 61 was associated with a 40% likelihood of experiencing CSC. CONCLUSIONS PE and EMDR appear to be beneficial for women who frequently engage in avoidant coping responses following rape. A small subset of women with initially low levels of avoidant coping are unlikely to experience a therapeutic response from PE or EMDR.

Patient-level predictors and clinical correlates of duration of untreated psychosis among hospitalized first-episode patients.

OBJECTIVE Duration of untreated psychosis (DUP) has been associated with poor early course outcomes of nonaffective psychotic disorders; however, less is known about predictors of DUP. This study examined patient-level predictors of DUP and clinical correlates of both DUP and duration of untreated illness (DUI), both of which have been implicated as prognostic indicators. METHOD Participants included 109 first-episode patients hospitalized in 3 public-sector inpatient psychiatric units serving an urban, socially disadvantaged, predominantly African American community. DUP, DUI, and a number of clinical and psychosocial variables were measured using standardized methods. Patients were diagnosed with schizophrenia and related psychotic disorders according to the Structured Clinical Interview for DSM-IV Axis I Disorders. RESULTS The median DUP and DUI were 22.3 and 129.9 weeks, respectively. Survival analyses revealed that, at any given time point, patients not living with family members were, on average, about 1.5 times as likely to be hospitalized as those living with family when controlling for mode of onset of psychosis. Patients not living in poverty were, on average, about 1.6 times as likely to be hospitalized as those living in poverty when controlling for mode. A greater burden of negative symptoms was associated with longer DUP (r = 0.23, P = .02), and poorer insight was associated with longer DUI (r = -0.24, P = .01). Longer DUP and DUI were associated with diverse adverse clinical characteristics, such as greater impairment in global functioning, poorer social functioning, and more psychosocial problems. CONCLUSIONS There is a need for early intervention efforts to be directed to families (and their loved ones who live with them with emerging psychotic disorders or frank untreated psychotic syndromes), particularly families facing major socioeconomic challenges.

A pilot study of an exposure-based intervention in the ED designed to prevent posttraumatic stress disorder

Early interventions to prevent PTSD have been limited in scope and effectiveness. This pilot study examines the feasibility and preliminary effectiveness of a model for brief preventive intervention: 1-session individualized exposure-based therapy delivered in the emergency department (ED). Eligible patients who experienced exposure to a traumatic event in the previous 24 hours were screened and assigned to assessment-only (n = 5) or intervention (imaginal exposure, n = 5) conditions. Both groups returned for 1-week follow-up. Results indicate that patients receiving this intervention reported slightly decreased levels of depression at 1-week follow-up and were rated lower on clinician-rated global severity of symptoms than patients in the assessment-only condition. The level of subject participation and ED staff support in this pilot study argues for feasibility of data collection, intervention, and follow-up with this population. Results also offer evidence that the intervention did not appear to harm participants and in fact may be helpful.

Family strengths: a potential determinant of the duration of untreated psychosis among hospitalized African-American first-episode patients.

Aim: Evidence suggests that treatment delay, represented by the duration of untreated illness (DUI) and the duration of untreated psychosis (DUP), may be a potentially powerful determinant of the early course of primary psychotic disorders. Yet, research on the predictors of treatment delay has only just begun. To date, there are virtually no empirical data on the relationship between family functioning and treatment delay in the context of first‐episode psychosis. In this study, it was hypothesized that family strengths would be inversely correlated with DUI and DUP; and families of patients with a short DUI/DUP would have greater family strengths than those of patients with a long DUI/DUP.

Prevalence, Factorial Structure, and Clinical Correlates of First Rank Symptoms in Urban, African-American Patients with First-Episode Nonaffective Psychosis

Rationale: Given the dearth of research on the prevalence and clinical correlates of first rank symptoms in first-episode psychosis samples, this study focused on a relatively homogenous sample of hospitalized, first-episode, urban, African-American patients.Objective: To determine frequencies of eleven first rank symptoms based on previously published definitions, to conduct correlations and an exploratory factor analysis to reveal any potential latent structure of the eleven symptoms, and to assess associations between first rank symptoms and several select clinical variables.Methods: The sample included seventy-three African-American patients hospitalized for a first episode of nonaffective psychosis. A structured inventory was used to rate the presence of first rank symptoms. Additionally, positive, negative, and general psychopathology symptoms were assessed; duration of the prodrome and duration of untreated psychosis were estimated; and depression, insight, and social functioning were rated.Results...