Debra Siegel Levine

Environmental Attitudes, Knowledge, Intentions and Behaviors Among College Students

ABSTRACT College students (N = 90) reported their pro-environment behaviors as well as their pro-environment intentions, their explicit and implicit attitudes about the environment, and their knowledge about environmental issues. Intentions and knowledge significantly and independently predicted behavior. Environmental knowledge was not significantly related to attitudes. Implicit and explicit attitudes were significantly but only moderately related. Only explicit attitudes, however, were strongly related to intentions, and intentions completely mediated the influence of explicit attitudes on behavior. Men were found to be more knowledgeable than women about environmental issues; older students had more favorable implicit and explicit environmental attitudes. This research suggests that knowledge about the environment and explicit attitudes influence behavior through different pathways, which may have implications for interventions seeking to increase environmentally friendly behavior.

Discrimination and social anxiety disorder among African-Americans, Caribbean blacks, and non-Hispanic whites.

Abstract The present study investigated the relationship between discrimination and social anxiety disorder (SAD) in a sample of African-Americans, Caribbean blacks, and non-Hispanic whites using the National Survey of American Life, the most comprehensive study of psychopathology among American blacks to date (N = 6082). Previous work has highlighted a strong association between discrimination and mental health symptoms (Keith, Lincoln, Taylor, and Jackson [Sex Roles 62:48–59, 2010]; Kessler, Mickelson, and Williams [J Health Soc Behav 40:208–230, 1999]; Soto, Dawson-Andoh, and BeLue [J Anxiety Disord 25:258–265, 2011]). However, few studies have examined the effects of particular types of discrimination on specific anxiety disorders or among different black subgroups. In this study, logistic regression analyses indicated that everyday but not major experiences of discrimination are associated with SAD for African-Americans, Caribbean blacks, and non-Hispanic whites. This study adds to the extant literature by demonstrating that specific types of discrimination may be uniquely associated with SAD for different ethnic/racial groups.

Employment status, employment functioning, and barriers to employment among VA primary care patients

BACKGROUND Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes. METHODS The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center. Bivariate and multivariable analyses were conducted examining associations between socio-demographic and clinical predictors of six employment domains, including: employment status, job search self-efficacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans. RESULTS 54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-efficacy, had lower levels of work performance, and reported more employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss among employed or likelihood of job seeking among not employed. LIMITATIONS Single VA primary care clinic; cross-sectional study. DISCUSSION Employment rates are low among working-aged VA primary care patients, particularly those with mental health conditions. Offering primary care interventions to patients that address mental health issues, job search self-efficacy, and work performance may be important in improving health, work, and economic outcomes.

Employment barriers, skills, and aspirations among unemployed job seekers with and without social anxiety disorder.

OBJECTIVE The literature has consistently demonstrated that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examined the association between perceived barriers to employment, employment skills, and job aspirations and social anxiety among adults seeking vocational rehabilitation services. METHODS Data from intake assessments (June 2010-December 2011) of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan were examined to assess perceived barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who did or did not screen positive for social anxiety disorder. Bivariate and multiple logistic regression analyses were performed. RESULTS After adjustment for other factors, the multiple logistic regression analysis revealed that perceiving more employment barriers involving experience and skills, reporting fewer skills related to occupations requiring social skills, and having less education were significantly associated with social anxiety disorder. Participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. CONCLUSIONS Employment-related characteristics that were likely to have an impact on occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations revealed important information for designing psychosocial interventions for treatment of social anxiety disorder. The findings underscored the need for vocational services professionals to assess and address social anxiety among their clients.

Panic disorder among African Americans, Caribbean blacks and non-Hispanic whites

IntroductionThis study investigated co-morbidities, level of disability, service utilization and demographic correlates of panic disorder (PD) among African Americans, Caribbean blacks and non-Hispanic white Americans.MethodsData are from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R).ResultsNon-Hispanic whites are the most likely to develop PD across the lifespan compared to the black subgroups. Caribbean blacks were found to experience higher levels of functional impairment. There were no gender differences found in prevalence of PD in Caribbean blacks, indicating that existing knowledge about who is at risk for developing PD (generally more prevalent in women) may not be true among this subpopulation. Furthermore, Caribbean blacks with PD were least likely to use mental health services compared to African Americans and non-Hispanic whites.ConclusionThis study demonstrates that PD may affect black ethnic subgroups differently, which has important implications for understanding the nature and etiology of the disorder.

Primary Care–Mental Health Integration in the VA Health System: Associations Between Provider Staffing and Quality of Depression Care

OBJECTIVES The study examined whether staffing of Primary Care-Mental Health Integration (PCMHI) services in the Department of Veterans Affairs (VA) health system is related to quality of depression care. METHODS Site surveys and administrative data from 349 VA facilities for fiscal year 2013 were used to calculate PCMHI staffing (full-time equivalents) per 10,000 primary care patients and discipline-specific staffing proportions for PCMHI psychologists, social workers, nurses, and psychiatric medication prescribers. Multivariable regression analyses were conducted at the facility level and assessed associations between PCMHI staffing ratios and the following indicators of depression treatment in the three months following a new episode of depression: any antidepressant receipt, adequacy of antidepressant receipt, any psychotherapy receipt, and psychotherapy engagement (three or more visits). RESULTS Higher facility PCMHI staffing ratios were associated with a greater percentage of patients who received any psychotherapy treatment (B=1.16, p<.01) and who engaged in psychotherapy (B=.39, p<.01). When analyses controlled for total PCMHI staffing, the proportion of social workers as part of PCMHI was positively correlated with the percentage of patients with adequate antidepressant treatment continuation (B=3.16, p=.03). The proportion of nurses in PCMHI was negatively associated with the percentage of patients with engagement in psychotherapy (B=-2.83, p=.02). CONCLUSIONS PCMHI programs with greater overall staffing ratios demonstrated better performance on indicators of psychotherapy for depression but not on indicators of antidepressant treatment. Further investigation is needed to determine whether differences in discipline-specific staffing play a causal role in driving associated differences in receipt of treatment.

Occupational functioning and employment services use among VA primary care patients with posttraumatic stress disorder.

Objective: Veterans with posttraumatic stress disorder (PTSD) exhibit high levels of unemployment. The Department of Veterans Affairs’ Veterans Health Administration (VHA) offers a variety of employment services; however, few veterans with PTSD use these services. Because many veterans with mental health conditions are seen in primary care clinics, employment service needs may be best addressed in this setting. The current study was designed to assess employment status and support needs in VHA primary care patients who screen positive for PTSD. Method: In the study, 287 working-age VHA patients with recent primary care use completed web-based surveys that assessed employment status, PTSD symptoms, employment support preferences, and barriers to service usage. Results: Individuals who screened positive for PTSD were less likely to be employed than were those without PTSD (55% vs. 69%; p = .03). After adjusting for sociodemographic characteristics, individuals with PTSD had higher barriers to employment (&bgr; = 3.52, p < .001) and higher barriers to employment service use (&bgr; = 0.57, p = .02). Only 14% of those with PTSD had used VHA employment services, but 86% said they would use those services. Conclusions: Although the single site included in the study may not be representative of all VHA primary care clinics, our results suggest that there is high need for and substantial interest in VHA employment services among VHA patients with PTSD. Future work should focus on implementing employment support services for individuals with PTSD in primary care settings.

National Guard Service Member Reintegration Experiences: The Transition Back Home

ABSTRACT As citizen-soldiers who maintain military and civilian roles, National Guard service members may experience unique challenges during reintegration. In the current study, 78 Operation Enduring Freedom/Operation Iraqi Freedom National Guard service members completed semistructured interviews on their reintegration experiences. Many soldiers reported smooth reintegration experiences, but others reported challenges. When soldiers reported mental health issues, they usually reported anger problems and alcohol misuse. Help seeking was not frequently reported. The findings highlight the complex interactions among reintegration domains, particularly the influence of family members on help-seeking. Continued efforts are needed to facilitate service delivery and promote smooth reintegration experiences among National Guard service members.

Poorer physical health is associated with greater mental health service utilization in a sample of depressed U.S. Army National Guard soldiers

OBJECTIVE Operation Iraqi Freedom/Operation Enduring Freedom service members returning from deployment suffer from high rates of depression and report low levels of physical functioning compared to age-adjusted norms. Treatment for depression may be limited in this group and there are few data on whether Veterans receive medication treatment versus psychotherapy. We assessed rates of depression, physical functioning, and treatment with either medication or psychotherapy among recently returning service members. METHODS Study participants were recruited from National Guard soldiers in a Midwestern state (n = 1,448). Logistic regression modeling was used to examine associations between physical health and odds of receiving different types of mental health treatment for depressed individuals (n = 299). RESULTS 21% of soldiers reported significant depression and 44% of depressed service members reported poor physical health. Poorer physical health was associated with increased odds of any treatment (odds ratio: 1.27, confidence interval: 1.1-1.45) and medication treatment (odds ratio: 1.23, confidence interval: 1.08-1.40) but physical health was not associated with individual psychotherapy. CONCLUSIONS Poor physical health is associated with increased likelihood of pharmacological but not individual psychotherapeutic treatment. Physical health problems may increase the need for depression care or increase contact with the medical system leading to higher levels of pharmacological treatment. Access to psychotherapy may need to be increased for Veterans with poor physical health.