Carmen R. Valdez

Neuropsychiatric syndromes in lupus Prevalence using standardized definitions

Objective:The San Antonio Lupus Study of Neuropsychiatric Disease is a longitudinal study designed to characterize the spectrum of and important risk factors for specific neuropsychiatric systemic lupus erythematosus (NPSLE) syndromes. Methods: Subjects must meet criteria for SLE and must be at least 18 years of age. A standardized medical history, neurologic, rheumatologic, and psychiatric examinations, computerized neuropsychological evaluation, and serologic testing are performed. Results: This report is based on the first 128 subjects (120 women and 8 men) who completed the initial study visit. Data from this initial study visit were evaluated for the prevalence of NPSLE using the American College of Rheumatology case definitions for 19 NPSLE syndromes. One or more NPSLE syndromes were present in 80% of subjects: cerebrovascular disease (2, 2%; ischemic stroke); headaches (73, 57%); mononeuropathy (9, 8%; median 8, ulnar 1); movement disorder (1, 1%; chorea); neuropathy, cranial (2, 2%; trigeminal); polyneuropathy (29, 22%; sensorimotor); seizures (21, 16%; partial); anxiety disorder (27, 24%); major depressive-like episode (37, 28%); mood disorder with depressive features (21, 19%); mood disorder with manic features (3, 3%); mood disorder with mixed features (1, 1%); psychosis (6, 5%). In a subset of 67 patients who received standardized neuropsychological testing, 21% had normal results. In the remainder, the following levels of impairment were seen: 43% mild, 30% moderate, and 6% severe. Conclusions: The prevalence of NPSLE was high in this cohort of unselected patients with SLE. Headaches, cognitive dysfunction, and psychiatric disorders were the most common NPSLE syndromes seen. These results will be easily comparable to other studies also using standardized diagnostic criteria. However, the lack of ethnicity and language-matched normative neuropsychological data may make comparisons of cognitive dysfunction in SLE populations difficult.

Negative Cognitive Biases Predict Subsequent Depression

We administered the Scrambled Sentences Test (SST; R. M. Wenzlaff, 1993), a measure of cognitive processing bias, to a large sample of college students at Time 1. Participants completed a portion of the SST under cognitive load (holding a six-digit number in memory) and a portion without load. At Time 2, 18–28 months later, we conducted diagnostic interviews with a subset of the original participants. As expected, SST scores (proportion of negative solutions) in the cognitive load condition predicted diagnoses of major depression during an 18–28 month follow-up period, even after controlling for self-reported Time 1 depression symptoms and worst lifetime symptoms. No significant prediction of depression was obtained using SST scores from the no-load portion of the task.

Identifying patterns of early risk for mental health and academic problems in adolescence: A longitudinal study of urban youth

This investigation examined profiles of individual, academic, and social risks in elementary school, and their association with mental health and academic difficulties in adolescence. Latent profile analyses of data from 574 urban youth revealed three risk classes. Children with the “well-adjusted” class had assets in the academic and social domains, low aggressive behavior, and low depressive symptoms in elementary school, and low rates of academic and mental health problems in adolescence. Children in the “behavior-academic-peer risk” class, characterized by high aggressive behavior, low academic achievement, and low peer acceptance, had conduct problems, academic difficulties, and increased mental health service use in adolescence. Children with the “academic-peer risk” class also had academic and peer problems but they were less aggressive and had higher depressive symptoms than the “behavior-academic-peer risk” class in the first grade; the “academic-peer risk” class had depression, conduct problems, academic difficulties, and increased mental health service use during adolescence. No differences were found between the risk classes with respect to adolescent outcomes.

Consequences of Arizona’s Immigration Policy on Social Capital Among Mexican Mothers With Unauthorized Immigration Status

This study explores the consequences of increasingly restrictive immigration policies on social capital among Mexican mothers with unauthorized immigrant status in Arizona. Three focus groups conducted in Arizona explore how mothers’ experiences with immigration policies have affected their neighborhood, community, and family ties. Focus group content and interactions revealed that perceived racial profiling was common among mothers and led to fear of family separation. Several described direct experiences with detention and deportation. Although detention and deportation strengthened social ties between mothers and other unauthorized immigrants, these experiences were detrimental to social ties between mothers and members of the mainstream society, including their children’s teachers. Finally, immigration policies were perceived to affect parent-child ties negatively, as mothers reported family stress, financial hardship, and decreased parental availability.

Fortalezas familiares program: building sociocultural and family strengths in latina women with depression and their families.

The purpose of this article is to describe Fortalezas Familiares (FF; Family Strengths), a community-based prevention program designed to address relational family processes and promote well-being among Latino families when a mother has depression. Although depression in Latina women is becoming increasingly recognized, risk and protective mechanisms associated with childrens outcomes when a mother has depression are not well understood for Latino families. We begin by reviewing the literature on risk and protective psychosocial mechanisms by which maternal depression may affect Latino youth, using family systems theory and a developmental psychopathology framework with an emphasis on sociocultural factors shaping family processes. Next, we describe the theoretical basis and development of the FF program, a community-based 12-week intervention for Latina immigrant women with depression, other caregivers, and their children. Throughout this article, we use a case study to illustrate a Latina mothers vulnerability to depression and the familys response to the FF program. Recommendations for future research and practice include consideration of sociocultural processes in shaping both outcomes of Latino families and their response to interventions.

Academic Achievement and School Functioning among Nonincarcerated Youth Involved with the Juvenile Justice System.

The relationship between academic problems and delinquency is well documented among incarcerated populations but has not been examined among nonincarcerated youth involved with the juvenile justice system. This research examined the school functioning and academic achievement of 157 youth who had brief contact with a state department of juvenile justice and then returned to the community. More than half (62.4%) demonstrated problems in school functioning or academic performance, as measured with well-validated instruments. Standard achievement scores were below average and as low as 5 standard deviations below the normative mean. Non-Caucasian youth, and those who received special education services or lived in an urban area demonstrated significantly lower achievement. Juvenile justice agencies and schools should collaboratively address the education needs of these youth.

Provider Perspectives About Latino Patients: Determinants of Care and Implications for Treatment:

Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary care providers concerning their Latino patients, in particular issues affecting their patients’ access to and utilization of services. Interviews were conducted with eight primary care providers and analyzed using consensual qualitative research methods. In addition, observations were conducted of the primary care setting to contextualize providers’ perspectives. Providers indicated that care for Latinos was affected by several domains: (a) practical/instrumental factors that influence access to care; (b) cultural and personal factors that shape patients’ presentations and views about physical and mental health and treatment practices; (c) provider cultural competence; and (d) institutional factors that highlight the context of care. In addition to recommendations for research and practice, the need for interdisciplinary collaboration between psychology and medicine in reducing ethnic minority disparities was proposed.

Parenting influences on Latino children's social competence in the first grade: parental depression and parent involvement at home and school.

Although it is widely accepted that parental depression is associated with problems with children’s socioemotional adjustment, the pathways by which parental depression influences children’s adjustment, particularly in low-income Latino children are not fully understood. In our investigation of 1,462 low-income Latino children in the first grade and their Spanish- and English-dominant parents, a factor analysis revealed three main pathways of possible influence of parent involvement in children’s social development: emotional involvement and educational involvement at home and at school. The findings from multigroup structural equation modeling revealed that whereas the first two pathways mediated the effect of parental depression on child social competence for Spanish-dominant parents, only emotional involvement explained parental depression effects for English-dominant parents. Parent educational involvement at school did not mediate parental depression effects for either Spanish- or English-dominant Latino parents. Discussion and implications of findings with respect to research, practice, and policy with Latinos follow.

Emerging Adults’ Lived Experience of Formative Family Stress The Family’s Lasting Influence

In this article, we use a phenomenology framework to explore emerging adults’ formative experiences of family stress. Fourteen college students participated in a qualitative interview about their experience of family stress. We analyzed the interviews using the empirical phenomenological psychology method. Participants described a variety of family stressors, including parental conflict and divorce, physical or mental illness, and emotional or sexual abuse by a family member. Two general types of parallel processes were essential to the experience of family stress for participants. First, the family stressor was experienced in shifts and progressions reflecting the young person’s attempts to manage the stressor, and second, these shifts and progressions were interdependent with deeply personal psychological meanings of self, sociality, physical and emotional expression, agency, place, space, project, and discourse. We describe each of these parallel processes and their subprocesses, and conclude with implications for mental health practice and research.

Chapter 6 – Childhood Depression

Publisher Summary This chapter explains various aspects of childhood depression. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) for depression are remarkably similar. At a general level, both interventions share a problem-focused, time-limited approach in which the depressed child and the therapist work together to identify problems that contribute to depressive symptoms and then develop plans for overcoming the problems. Problem solving is a central component of both treatment programs. In IPT it is used as a means of enhancing interpersonal relationships and for developing plans that deal with problems that are the primary focus of treatment. Within CBT, problem solving is directly taught to the participants as a means of dealing with daily hassles, and more significant interpersonal and impersonal problems. Self-monitoring is also a central component of both treatment programs. In IPT, youngsters are asked to self-monitor their depressive symptoms and feelings. In the CBT program, youngsters are directly taught how to self-monitor thoughts, feelings, behavior, and extra therapy events. Interpersonal relationships are the focus of IPT and CBT. Relationships with peers and family members are considered to be important determinants of depressive symptoms. Research clearly demonstrates that disturbances in interpersonal functioning exist in the families and friendships of depressed youths. It may be more useful to recognize the reciprocal relationship between the cognitive and interpersonal domains.