Cathy K. Bell

Cumulative effect of family environment on psychiatric symptomatology among multiethnic adolescents.

PURPOSE To examine the influence of family adversity and support on levels of psychiatric symptomatology in Hawaiian and non-Hawaiian adolescents. METHOD More than 4000 students from five high schools in Hawaii completed a survey during the 1992-1993 school year about their family environment and mental health. The response rate was approximately 60%. Logistic regression analyses were performed and responses for Hawaiians and non-Hawaiians were compared. RESULTS Hawaiian adolescents experienced significantly more adversity than their non-Hawaiian counterparts. The cumulative effect of family adversity had a greater effect on psychiatric symptomatology than any single indicator. Family support reduced the risk for internalizing symptoms, particularly for Hawaiian adolescents. The influence of family support was less clear for externalizing symptoms, increasing the risk for some adolescents and decreasing the risk for others. CONCLUSION We identified strong associations between family adversity and levels of psychiatric symptomatology. We found that Hawaiian adolescents are at increased risk for psychiatric symptomatology, given the presence of family adversity and the effect of reduced family support. However, risk was also substantial for non-Hawaiians. Clinicians need to assess the family environment routinely and implement family-oriented interventions.

Influence of Family Adversity on School-Related Behavioural Problems among Multi-Ethnic High School Students

This study examines the influence of family adversity indicators on school-related behavioural problems among Hawaiian and non-Hawaiian adolescents. Questionnaire data from 2787 students were linked to school information, including grade point average (GPA), absences, suspensions and conduct infractions. Logistic regression analyses were performed. The cumulative effect revealed higher increases in the odds ratios for school-related behavioural problems among non-Hawaiians. Surprisingly, there was no cumulative effect of family adversity among Hawaiian adolescents. Given their high rates of adversity and behavioural problems, any family adversity may significantly impact this group. The family environment must be considered in the prevention and intervention of school-related behavioural problems.

Equivalencies Regarding the Measurement and Constructs of Self-Esteem and Major Life Events in an Asian-Pacific Islander Sampler.

Construct, scalar, and functional measurement equivalencies of the Rosenberg Self-Esteem Scale (RSES) and Major Life Events checklist (MLE) and the constructs assessed were investigated across groups differentiated on Hawaiian/part-Hawaiian and non-Hawaiian (e.g., Caucasian, Filipino, Hispanic, Japanese, and mixed/2 or more) ethnicity and gender. Initial results from maximum likelihood factoring with promax rotation showed that RSES negatively worded Item 5 loaded with the positively worded Items 1, 2, 4, 6, and 7 on 1 of 2 factors for Hawaiian/part-Hawaiian female participants. Similarly, negatively worded Item 8 and the same positively worded items comprised 1 of 2 factors for non-Hawaiian male participants. For the other 2 Ethnicity x Gender groups, factors were respectively comprised of the 5 positively and 5 negatively worded RSES items. Construct equivalence or simple (2-factor) structure underlying the RSES was indicated across the 4 groups after Items 5 and 8 were excluded from a subsequent factoring procedure. Simple structure showed that Factor 1 comprised the positively worded Items 1, 2, 4, 6, and 7, and the remaining negatively worded Items 3, 9, and 10 loaded on Factor 2. Scalar equivalence of the self-esteem and major life events measures was supported by the statistical nonsignificance of the Major Life Events x Ethnicity x Gender interaction effect in multiple regression models. The consistency in the absolute size and direction of the intercorrelations between overall self-esteem, self-esteem Factors 1 and 2, and major life events variables indicated the functional equivalence of respective measures and constructs assessed. Measurement equivalency findings concerning the RSES and MLE, the constructs measured, and their utility versus caution against their use in multiethnic studies were discussed.

Association between Actual and Self-Reported Grades for Ethnically Diverse Asian/Pacific Islander Adolescents

response bias (e.g. non-response, recall difficulties, confusion, acquiescence, social desirability, demand characteristics, faking, deviation [giving unusual responses]; Anastasi, 1988; Fowler, 1988; Lonner and Ibrahim, 1989; Nunnally and Bernstein, 1994). A critical issue from a methodological and psychometric perspective is the validity of self-reports, including how demographic variables (e.g. ethnicity, gender, socio-economic status [SES]) are associated with and influence the validity of these self-report data. As one example of response bias, social desirability involves responding in a manner that is socially acceptable, the way that most people are thought to respond, or the way that is perceived to reflect best on the respondent (Cozby, 1997). Although the literature on social desirability and different ethnic groups consists of mixed results (e.g. no discrepancy found between Canadian v. Japanese samples, Heine and Lehman, 1995), demographic and cross-cultural differences have been reported. For instance, Ross and Mirowsky (1984) found greater occurrence of socially desirable responding by individuals of Hispanic ancestry (those residing in Texas and Mexico) as compared with European-Americans. In addition, these investigators found that those of lower SES and those who were older provided more socially desirable responses. These researchers theorised that social groups that are relatively powerless (e.g. those low in SES, with minority status, who have not culturally integrated well into the dominant culture) or that emphasise the importance of proper image, conformity, and avoidance of shame will more likely provide socially desirable responses. Further, socially desirable responding should not necessarily be viewed as a negative trait, but may entail an adaptive strategy in light of the individual’s circumstances. In the fields of education and psychology one of the most utilised measures of academic achievement is the grade earned on a school course, which has been quantified across multiple courses into the grade-point average (GPA; 0 to 4·0 scale). Despite the apparent usefulness of self-reported grades (SRGs; e.g. Kleiber and Malik, 1989; Lall and Schandler, 1991; Reynolds and Miller, 1989; Rienzi et al., 1992; Roig and DeTommaso, 1995), this measure has been employed considerably less, perhaps simply owing to easier access to and A cual nd selfported gdes or A siaPacific Isnder adoscents

Implementation of problem-based learning in child and adolescent psychiatry: shared experiences of a special-interest study group.

Background/ObjectiveProblem-based learning (PBL) represents a major development and change in educational practice that continues to have a large impact across subjects and disciplines worldwide. It would seem that child and adolescent psychiatry, because of its inherently integrative, bio-psycho-social nature and emphasis on teamwork and collaboration, would be a specialty learned optimally through PBL. Thus, there was a need to establish an international group where experiences in implementing PBL in child and adolescent psychiatry could be shared. This article reports on the first meeting and plans of the Problem-Based Learning in Child and Adolescent Psychiatry (CAP) Special Interest Study Group (SISG), held at the annual meeting of the American Academy of Child and Adolescent Psychiatry.MethodsThrough international collaboration and information-sharing, the SISG aims to promote knowledge among Childand Adolescent Psychiatrists on PBL, to explore evaluation methods of PBL in CAP, and to discuss development of PBL-based curricula.ResultsProblem-based learning (PBL) represents a major change in education that has had a large impact across disciplines worldwide.ConclusionThe core steps in PBL are the following: presentation of the initial problem; discussion of the problem, and development of learning objectives; independent learning focused on the objectives; and discussion, exploration of new ideas, and discovery of solutions in the reconvened group. Different from the traditional teacher’s role, the PBL tutor is an active facilitator who guides learners to identify issues and ways to learn, rather than a “content expert” who provides facts.

General Principles of Pediatric Consultation-Liaison Psychiatry

This textbook brings together practitioners from around the world to explore essential concepts in pediatric consultation-liaison psychiatry (also known as pediatric psychosomatic medicine) utilizing a problem-based approach. Shaw et al. (Chapter 1. Pediatric psychosomatic medicine. In: Shaw RJ, DeMaso DR (eds) Textbook of pediatric psychosomatic medicine. American Psychiatric Publishing, Washington, DC, p 3, 2010) define pediatric psychosomatic medicine as the “subspecialty of child and adolescent psychiatry that is dedicated to providing mental health services to youngsters with physical illness.” The United States’ Accreditation Council for Graduate Medical Education (ACGME) describes psychosomatic medicine as “the discipline encompassing the study and practice of psychiatric disorders in patients with medical, surgical, obstetrical, and neurological conditions, particularly for patients with complex and/or chronic conditions” (ACGME, https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/409_psychosomatic_med_2016_1-YR.pdf. Accessed 26 Jan 2017, 2016).

Curricular adaptations in inpatient child psychiatry for the 21st century: the Flexner model revisited.

ObjectiveThe authors describe curricular modifications created in response to the changing culture of medical education, thealth care systems, academic medicine, and generational differences. The authors propose a model child psychiatry inpatient curriculum that is sustainable within a community teaching hospital in the 21st century.MethodsThe authors built upon the existing literature in health care financing, academic medicine, effective leadership, and the collective clinical, educational and administrative experience of its faculty to design a model inpatient curriculum that should be portable to other training programs.ResultsAn innovative training model was developed, implemented, and improved over a 5-year period without any additional fiscal resources.ConclusionThis training model has the potential to improve patient care, resident training, interdisciplinary functioning, and resident satisfaction.