Anjana Sengupta

Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse.

The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample.

PTSD and utilization of medical treatment services among male Vietnam veterans.

This study investigated the effect of posttraumatic stress disorder (PTSD) on help-seeking for physical problems. Merging two large data sets resulted in a sample of 1773 male Vietnam veterans from white, black, Hispanic, Native Hawaiian, and Japanese American ethnic groups. Predictors of utilization included PTSD, other axis I disorders, and substance abuse. In analyses that adjusted only for age, PTSD was related to greater utilization of recent and lifetime VA medical services, and with recent inpatient care from all sources. Further analysis showed that the increased utilization associated with PTSD was not merely due to the high comorbidity between PTSD and other axis I disorders. The uniqueness of the association between PTSD and medical utilization is discussed in terms of somatization and physical illness.

Trauma exposure among children with oppositional defiant disorder and attention deficit-hyperactivity disorder.

Consecutive admissions to an outpatient child psychiatry clinic diagnosed with oppositional defiant disorder (ODD), attention deficit-hyperactivity disorder (ADHD), or adjustment disorder were assessed for trauma exposure by a structured clinical interview and parent report. Controlling for age, gender, severity of internalizing behavior problems, social competence, family psychopathology, and parent-child relationship quality (assessed by parent report), an ODD diagnosis, with or without comorbid ADHD, was associated with increased likelihood of prior victimization (but not nonvictimization) trauma. ADHD alone was not associated with an increased likelihood of a history of trauma exposure. Traumatic victimization contributed uniquely to the prediction of ODD but not ADHD diagnoses. Children in psychiatric treatment who are diagnosed with ODD, but not those diagnosed solely with ADHD, may particularly require evaluation and care for posttraumatic sequelae.

Enhanced skills training and health care management for older persons with severe mental illness

This report describes a combined skills training (ST) and health management (HM) intervention for older adults with severe mental illness (SMI) and one-year pilot study outcomes. Findings are reported for twelve older persons with SMI (age 60+) who received ST+HM and twelve who received only HM. ST addressed interpersonal and independent living skills. HM included promotion of preventive health care. ST+HM was associated with improved social functioning and independent living skills, whereas functioning remained constant or declined for the HM only group. Both groups receiving HM demonstrated increased use of preventive health services and identification of previously undetected medical disorders.

A Longitudinal Study of Retirement in Older Male Veterans

In this study, the authors examined the effect of retirement on psychological and physical symptoms in 404 older male veterans who were taking part in an ongoing longitudinal study. Hierarchical linear modeling was used to analyze symptom trajectories from preretirement, peri-retirement, and postretirement periods in veterans with either lifetime full or partial posttraumatic stress disorder (PTSD), trauma exposure only, or no traumatic exposure. As expected, the PTSD group experienced greater increases in psychological and physical symptoms during retirement, relative to the other groups. Retirement due to poor health in the PTSD group did not account for the findings regarding physical symptoms. Results indicate that clinicians should recognize and address the potential for older individuals with PTSD to experience difficulties during retirement.

The Hawaii Vietnam Veterans Project: is minority status a risk factor for posttraumatic stress disorder?

The Hawaii Vietnam Veterans Project (HVVP) was congressionally mandated as a follow-up to the National Vietnam Veterans Readjustment Study (NVVRS) to assess current and lifetime prevalence of posttraumatic stress disorder (PTSD). The Hawaii Vietnam Veterans Project used the original two-stage NVVRS design in which a lay interview, conducted with a large sample, was followed by a clinical interview with a smaller subsample. Reported results are from the clinical subsample consisting of 100 Native Hawaiian and 102 American of Japanese ancestry veterans compared with white veterans from the NVVRS cohort. The major finding is that veterans of Japanese ancestry exhibited significantly lower prevalence of current full, current partial, and lifetime full PTSD than white veterans. Adjustment for age and war zone exposure did not eliminate most of these differences. These results indicate that minority status per se is not a risk factor for PTSD.

Status of minor depression or dysthymia in primary care following a randomized controlled treatment

This report describes the rates of recovery and remission from minor depression or dysthymia in primary care patients three months after completing a randomized controlled treatment trial. The subjects were primary care patients who received > or =4 treatment sessions with Problem-Solving Treatment, paroxetine, or placebo and who completed an independent assessment 3 months after the study (201 with minor depression, 229 with dysthymia). The 17-item Hamilton Rating Scale for Depression (HAMD), semistructured questions about postintervention depression treatments, and baseline medical comorbidity, neuroticism, and social function were the primary measures. For minor depression 76% and for dysthymia 68% of subjects who were in remission at the end of the 11-week treatment trial were recovered (HAMD < or =6) three months after the treatment trial. Of patients who were not in remission at 11 weeks, for minor depression 37% and for dysthymia 31% went on to achieve remission at 25 weeks. The majority of patients chose not to use antidepressants or psychotherapy after the trial. Patients with minor depression that had greater baseline social function and lower neuroticism scores were more likely to be recovered. For patients with minor depression, these findings suggest a need for some matching of continuation and maintenance treatment to patient characteristics rather than uniform, automatic treatment recommendations. Because of the chronic, relapsing nature of dysthymia, practical improvements in encouraging effective continuation and maintenance phases of treatment are indicated.

Using Discrete-Time Survival Analysis to Examine Patterns of Remission from Substance Use Disorder Among Persons with Severe Mental Illness

Investigators in mental health research are often interested in examining critical events such as onset, relapse, and recovery from illness, including substance use disorders. As data on these critical events are often collected at discrete-time intervals (e.g., weekly, monthly, or yearly), discrete-time survival models are more appropriate than well-known continuous-time methods. In this paper, we present discrete-time survival analysis methods at an introductory level. Using data collected every 6 months from a 3-year study of assertive community treatment in New Hampshire, we show that discrete-time survival models can be used to analyze patterns of remission from substance use disorder among clients with severe mental illness. The main questions investigated are (1) when are remissions more likely to occur? and (2) what variables predict remission? The results indicate that remission is more likely to occur in the first 6 months and in the 3rd year of the study. Gender, age, baseline use of substances, and diagnosis are strong predictors of remission.

The relationship of aging and dysthymia in primary care.

The authors compared symptomatic and functional characteristics between older (age > or =60; n=91) and younger (age 18-59; n=125) primary care patients with dysthymia. Three of six significantly different depression symptoms were of moderate-to-large effect size, with the older group having a lower proportion reporting the symptom. The older group had a worse physical health function score but a better mental health function score. There appears to be a core of symptoms and functional impairment that generalizes across the age span. There are also significant age differences. Growing older appears to have an impact on the nature of what it means to have dysthymia.

An Application of the Thresholds of Change Model to the Analysis of Mental Health Data

The threshold of change model (TCM) is a statistical technique for analyzing ordered stages of change variables. TCM focuses on the thresholds that separate the ordered stages, and the effects of explanatory variables are evaluated in terms of raising or lowering the thresholds. TCM also allows the explanatory variables to exert differential influence on each threshold. In this paper, we use TCM to analyze the data from a clinical trial that compared assertive community treatment (ACT) with standard case management (SCM) for patients with co-occurring severe mental illness and substance use disorder. Endpoint data (36-month follow up) were used for this analysis. The response variable is the recoded Substance Abuse Treatment Scale with three ordered levels (engagement/persuasion, active treatment, and recovery/relapse prevention), and hence two thresholds. The explanatory variables are gender and group (ACT vs. SCM). The results indicate that gender exerts constant and significant effects on both thresholds. The group effect is somewhat mixed: ACT lowers the first threshold (active treatment), but raises the second threshold (recovery/relapse prevention).