Corey S. Mackenzie

Mindfulness training as an evidenced-based approach to reducing stress and promoting well-being among human services professionals

Abstract Two novel mindfulness-based interventions designed to be integrated either in academic or work settings to mitigate the effects of stress and promote well-being among human services professionals are described. Study 1 explored whether a brief mindfulness intervention was superior to a traditional relaxation intervention for nursing staff. Results demonstrated that both interventions significantly improved relaxation and life satisfaction, with mindfulness participants exhibiting a trend toward particular improvements in emotional exhaustion. In study 2, teacher trainees who participated in a Mindfulness- Based Wellness Education (MBWE) program as part of their academic training experienced significantly greater increases than controls in mindfulness, satisfaction with life, and teaching self-efficacy. We recognize that systemic factors need to be addressed for the long-term resolution of stress-related problems among human services professionals. In the interim, mindfulness-based interventions are proving to be an effective way to support these pivotal members of our society. Human services professionals are pivotal members of our society. They often work under duress and as a result, stress related health and mental health problems commonly lead to job burnout in this population (Maslach 2003). In addition to the negative physical and mental health outcomes associated with stress and burnout, there are also substantial financial costs to organizations as a result of decreased work performance and increased disability, absenteeism, and turnover (Palmer et al 2004; Statistics Canada 2007). Across human services professions, the causes and consequences of stress, as well as factors contributing to ones ability to cope with stress or to develop burnout, are well documented (e.g., for nurses, see Gelsema et al 2006; for social workers, see Seibert 2005; for teachers, see Montgomery & Rupp 2005). Theoretical models map out the factors contributing to, and the trajectory leading toward, outcomes such as burnout (e.g., Bakker & Demerouti 2007). However, the literature focusing on solutions to work-related stress and burnout is scant (Maslach 2003). This article outlines the development and evaluation of two mindfulness-based interventions for human services professionals. These programs are based on evidence of impressive benefits of Kabat- Zinns (1990) mindfulness-based stress reduction (MBSR) program in clinical settings, burgeoning interest in applying this program in non-clinical settings, and our own mindfulness practices. After a brief overview of mindfulness and current research developments, we describe the results of two studies we conducted, one with nurses and one with teachers- in-training.

Measuring and enhancing self-efficacy among professional caregivers of individuals with dementia.

Nurses who provide care for individuals with Alzheimers disease and other dementias are at risk of burnout. Self-efficacy is a psychological construct with the potential to help reduce or prevent the impact of caregiver stress. Evidence supporting a link between higher levels of self-efficacy and lower levels of stress is emerging among lay caregivers. However, concurrent research for professional caregivers lags behind, partly due to a lack of appropriate self-efficacy measures for this population. We developed an intervention to enhance self-efficacy and an inventory to measure its improvements among long-term care nurses. Training resulted in lasting improvements in knowledge and selfefficacy regarding the management of challenging team, resident, and family situations. Short-term reductions in caregiver burnout were also evident. Suggestions for maintaining improvements in caregiver burnout over longer periods are offered.

Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey.

Data on the prevalence of psychiatric disorders in late life are lacking. The present study addresses this gap in the literature by examining the prevalence of the broadest range of psychiatric disorders in late life to date; comparing prevalences across older adult age groups using the largest sample of adults aged 85+; and exploring gender differences in the prevalence of psychiatric disorders in late life. Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, we examined the prevalence of past‐year mood, anxiety, and substance use disorders, and lifetime personality disorders in a nationally representative sample of 12,312 U.S. older adults. We stratified our analyses by gender and by older age groups: young‐old (ages 55‐64), middle‐old (ages 65‐74), old‐old (ages 75‐84), and oldest‐old (ages 85+). The proportion of older adults who experienced any past‐year anxiety disorder was 11.4%, while the prevalence of any past‐year mood disorder was 6.8%. A total of 3.8% of older adults met criteria for any past‐year substance use disorder, and 14.5% of older adults had one or more personality disorder. We observed a general pattern of decreasing rates of psychiatric disorders with increasing age. Women experienced higher rates of mood and anxiety disorders, while men had higher rates of substance use disorders and any personality disorder. Gender differences in rates of most psychiatric disorders decreased with increasing age. These data indicate that psychiatric disorders are prevalent among U.S. older adults, and support the importance of prevention, diagnosis, and treatment of psychiatric disorders in this population.

Three-year incidence and predictors of first-onset of DSM-IV mood, anxiety, and substance use disorders in older adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE The aim of this study was to determine the incidence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mood disorders, anxiety disorders, and substance use disorders in older adults and to identify sociodemographic, psychopathological, health-related, and stress-related predictors of onset of these disorders. METHOD A nationally representative sample of 8,012 community-dwelling adults aged 60 and above was interviewed twice over a period of 3 years, in 2000-2001 and 2004-2005. First incidence of mood, anxiety, and substance use disorders was assessed over a period of 3 years using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS The 3-year incidence rates of DSM-IV mood, anxiety, and substance use disorders were highest for nicotine dependence (3.38%) and major depressive disorder ([MDD] 3.28%) and lowest for drug use disorder (0.29%) and bipolar II disorder (0.34%). Incidence rates were significantly greater among older women for MDD (99% CI, 1.22-3.13) and generalized anxiety disorder (GAD; 99% CI, 1.20-4.26) and greater among older men for nicotine dependence and alcohol abuse and dependence. Posttraumatic stress disorder predicted incidence of MDD, bipolar I disorder, panic disorder, specific phobia, and GAD, while Cluster B personality disorders predicted incident MDD, bipolar I and II disorders, panic disorder, social phobia, GAD, nicotine dependence, and alcohol dependence. Poor self-rated health increased the risk for the onset of MDD, whereas obesity decreased the incidence of nicotine dependence. CONCLUSIONS Information about disorders that are highly incident in late life and risk factors for the onset of psychiatric disorders among older adults are important for effective early intervention and prevention initiatives.

Prevalence and correlates of generalized anxiety disorder in a national sample of older adults.

OBJECTIVES The objectives of this study are to provide current estimates of the prevalence and correlates of generalized anxiety disorder (GAD). METHODS The authors used Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, which included 12,312 adults 55+ and older. In addition to examining the prevalence of GAD in the past year, this study explored psychiatric and medical comorbidity, health-related quality of life, and rates of help-seeking and self-medication. RESULTS The past-year prevalence of GAD in this sample was 2.80%, although only 0.53% had GAD without Axis I or II comorbidity. The majority of individuals with GAD had mood or other anxiety disorders, and approximately one quarter had a personality disorder. Individuals with GAD were also more likely to have various chronic health problems although these associations disappeared after controlling for psychiatric comorbidity. Health-related quality of life was reduced among older adults with GAD, even after controlling for health conditions and comorbid major depression. Finally, only 18% of those without and 28.3% with comorbid Axis I disorders sought professional help for GAD in the past year. Self-medication for symptom relief was rare (7.2%). CONCLUSIONS GAD is a common and disabling disorder in later life that is highly comorbid with mood, anxiety, and personality disorders; psychiatric comorbidity is associated with an increased risk of medical conditions in this population. Considering that late-life GAD is associated with impaired quality of life but low levels of professional help-seeking increased effort is needed to help individuals with this disorder to access effective treatments.

Changes in attitudes toward seeking mental health services: a 40-year cross-temporal meta-analysis.

Although rates of treatment seeking for mental health problems are increasing, this increase is driven primarily by antidepressant medication use, and a majority of individuals with mental health problems remain untreated. Helpseeking attitudes are thought to be a key barrier to mental health service use, although little is known about whether such attitudes have changed over time. Research on this topic is mixed with respect to whether helpseeking attitudes have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on Fischer and Turners (1970) helpseeking attitude measure among university students (N=6796) from 1968 to 2008. Results indicated that attitudes have become increasingly negative over time, r(44)=-0.53, p<0.01, with even stronger negative results when the data are weighted (w) for sample size and study variance, r(44)=-0.63, p<.001. This disconcerting finding may reflect the greater emphasis of Fischer and Turners scale toward helpseeking for psychotherapy. Such attitudes may be increasingly negative as a result of the unintended negative effects of efforts in recent decades to reduce stigma and market biological therapies by medicalizing mental health problems.

Associations Between Psychological Distress, Learning, and Memory in Spouse Caregivers of Older Adults

Family caregivers of older adults experience high levels of chronic stress and psychological distress, which are known to impair cognition. Very little research, however, has assessed the impact of caregiving on key cognitive outcomes such as learning and memory. This study compared 16 spouse caregivers with 16 matched controls using standardized neuropsychological measures of learning, episodic memory, and working memory. Analyses compared groups on these cognitive outcomes and examined whether psychological distress mediated group differences in cognition. Results indicated that caregivers were significantly more distressed than non-caregivers and exhibited deficits in learning, recall of episodic information after short and long delays, and working memory. Furthermore, the majority of group differences in cognitive outcomes were mediated by psychological distress. This study adds to a small body of literature demonstrating impaired cognitive functioning among family caregivers. It also suggests that distress is one of a number of possible underlying mechanisms leading to disruptions in learning and memory in this population.

Prevalence and Predictors of Persistent Versus Remitting Mood, Anxiety, and Substance Disorders in a National Sample of Older Adults

OBJECTIVES Relatively little is known about whether mental disorders other than depression remit versus persist in later life, especially within nationally representative samples. Our objectives were to examine the prevalence of persistent mood, anxiety, and substance disorders in older adults and to explore a range of physical and mental health predictors of disorder chronicity. METHODS This study involved a 3-year follow-up design using Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Participants included 1,994 adults aged 55 years and older who had a past-year mental disorder at Wave 1 and who completed Wave 2. The primary outcome was the prevalence of persistent mood, anxiety, and substance disorders at Wave 2. Potential predictors of persistence included sociodemographic variables, physical health (chronic health conditions and physical health-related quality of life), and mental health (childhood adversity, suicide attempts, mental health-related quality of life, comorbid mental disorders, personality disorders, and lifetime treatment-seeking). RESULTS With the exception of nicotine dependence, the prevalence of persistent mood, anxiety, and substance disorders ranged from 13% to 33%. Only younger age predicted substance disorder chronicity. Significant predictors of persistent mood and anxiety disorders included physical and mental health comorbidity, physical health- and mental health-related quality of life, suicide attempts, comorbid personality disorders, and treatment-seeking. CONCLUSIONS At least two-thirds of mental disorders in these older adults were not persistent. Sociodemographic variables had little influence on chronicity, whereas a number of markers of mental disorder severity and complexity predicted persistent mood and anxiety disorders. The findings have important treatment and prevention implications.

Time Does Not Heal All Wounds: Older Adults Who Experienced Childhood Adversities Have Higher Odds of Mood, Anxiety, and Personality Disorders

OBJECTIVE We aimed to examine the prevalence of several types of childhood adversity across adult cohorts, whether age moderates the effect of childhood adversity on mental health, the relationship between childhood adversity and psychopathology among older adults, the dose-response relationship between number of types of childhood adversities and mental disorders in later life, and whether lifetime mental health treatment reduces the odds of psychopathology among older survivors of childhood adversity. METHODS In a population-based, cross-sectional study on a nationally representative U.S. sample, we studied 34,653 community-dwelling Americans 20 years and older, including 7,080 adults 65 years and older from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Trained lay interviewers assessed past-year mood and anxiety disorders and lifetime personality disorders. Participants self-reported childhood adversity based on questions from the Adverse Childhood Experiences Study. RESULTS Childhood adversity was prevalent across five age cohorts. In our adjusted models, age did not moderate the effect of childhood adversity on mental disorders. Older adults who experienced childhood adversity had higher odds of having mood (odds ratio: 1.73; 95% confidence interval: 1.32-2.28), anxiety (odds ratio: 1.48; 95% confidence interval: 1.20-1.83), and personality disorders (odds ratio: 2.11; 95% confidence interval: 1.75-2.54) after adjusting for covariates. An increasing number of types of childhood adversities was associated with higher odds of personality disorders and somewhat higher odds of anxiety disorders. Treatment-seeking was associated with a reduced likelihood of anxiety and, especially, mood disorders in older adult childhood adversity survivors. CONCLUSION These results emphasize the importance of preventing childhood adversity and intervening once it occurs to avoid the negative mental health effects that can last into old age.

A longitudinal examination of anxiety disorders and physical health conditions in a nationally representative sample of U.S. older adults

BACKGROUND There has been growing interest in the relation between anxiety disorders and physical conditions in the general adult population. However, little is known about the nature of this association in older adults. Understanding the complex relationship between these disorders can help to inform prevention and treatment strategies unique to this rapidly growing segment of the population. METHODS A total of 10,409 U.S. adults aged 55+ participated in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Lifetime and past-year DSM-IV anxiety, mood, and substance use disorders, and lifetime personality disorders, were assessed in both waves. Participants self-reported on whether they had been diagnosed by a healthcare professional with a broad range of physical health conditions; this study focuses on cardiovascular disease, gastrointestinal disease, and arthritis. Multivariable logistic regressions adjusted for sociodemographics, comorbid mental disorders, and number of physical health conditions assessed: (1) the relation between past-year physical conditions at Wave 1 and incident past-year anxiety disorders at Wave 2 and; (2) the relation between individual lifetime anxiety disorders at Wave 1 and incident physical conditions at Wave 2. A second set of adjusted multinomial logistic regressions examined Wave 1 sociodemographic and physical and mental health risk factors associated with incident physical condition alone, anxiety disorder alone, and comorbid anxiety and physical condition at Wave 2. RESULTS Past-year arthritis at Wave 1 was significantly associated with increased odds of incident generalized anxiety disorder at Wave 2. Further, any lifetime anxiety disorder and posttraumatic stress disorder at Wave 1 were significantly associated with increased odds of incident gastrointestinal disease at Wave 2. Differential sociodemographic and physical and mental health predictors were significantly associated with increased odds of incident comorbid anxiety disorder and physical conditions. CONCLUSION Results of the current study elucidate the longitudinal bidirectional relationships between anxiety disorders and physical health conditions in a large, nationally representative sample of older adults. These results have important implications for identifying at risk older adults, which will not only impact this growing segment of the population directly, but will also potentially lessen burden on the healthcare system as a whole.