Emre Umucu

Psychometric validation of the Clubhouse climate questionnaire as an autonomy support measure for people with severe mental illness

Abstract Background: Self-determination represents a paradigm shift from “shoulds” to “decisions and behaviors” as the best options for helping people with mental illness achieving recovery goals. Autonomy support plays an important role in self-determination. Aims: The purpose of this study was to validate the Clubhouse climate questionnaire (CCQ) as an autonomy support measure. Method: One hundred and twenty-four participants were recruited from eight Clubhouse programs in Hawaii. Measurement structure of the CCQ was evaluated using exploratory and confirmatory factor analysis. Findings: CCQ is a unidimensional scale with good reliability and acceptable levels of divergent and convergent validity. Conclusions: CCQ is a brief, reliable and valid instrument for assessing autonomy support and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

Cognitive variability—A marker for incident MCI and AD: An analysis for the Alzheimer's Disease Neuroimaging Initiative

The potential of intra‐individual cognitive variability (IICV) to predict incident mild cognitive impairment (MCI) or Alzheimers disease (AD) was examined and compared to well‐established neuroimaging and genetic predictors.

Self-efficacy as a mediator for the relationship between secure attachment style and employment status in individuals with spinal cord injuries

PURPOSE: To evaluate the mediation effect of self-efficacy on the relationship between secure attachment and employment status of people with spinal cord injuries (SCI). DESIGN: Quantitative descriptive research design using logistic regression, multiple regression, and correlational techniques. METHODS: One hundred and ninety individuals with SCI were recruited from the Canadian Paraplegic Association. Only individuals ages between 25–54 years (prime working age) were selected for this study. RESULTS: Secure attachment and self-efficacy were significantly related to employment status. Self-efficacy was found to be a significant mediator of the relationship between secure attachment and employment status. CONCLUSION: Results provide support for the importance of building a strong working alliance and helping individuals with SCI in the professional practice of rehabilitation counseling.

Psychometric Properties of the Vocational Rehabilitation Engagement Scale When Used with People with Mental Illness in Clubhouse Settings.

Purpose: The purpose of this study was to validate the Vocational Rehabilitation Engagement Scale (VRES) for use in the Clubhouse Model of Psychosocial Rehabilitation. Method: There were 124 individuals with serious mental illness recruited from 8 Clubhouse programs in Hawaii. Measurement structure of the VRES was evaluated using exploratory factor analysis. Results: Exploratory factor analysis of the Clubhouse version of the VRES yielded 2 reliable factors (cognitive-affective engagement and behavioral engagement). Both the cognitive-affective engagement and behavioral engagement factors were found to correlate with other self-determination theory constructs including autonomy support, relatedness, and outcome expectancy. Conclusions: The Clubhouse version of the VRES is a brief, reliable, and valid instrument for assessing vocational rehabilitation (VR) engagement and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

Assessing College Life Adjustment of Students With Disabilities: Application of the PERMA Framework:

The clearest career path to the middle class generally involves access, and completion, of postsecondary education. However, persons with disabilities are less likely to enroll or graduate from college compared with their same-age peers without disabilities. The quality of life of students with disabilities, and their well-being, may be a root cause of low graduation rates. To flourish in life is to both feel good and function effectively. Seligman developed the Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA) model that may be useful in understanding the well-being of individuals. The purpose of this study is to examine the factorial structure of the PERMA model in sample college students with disabilities and then examine the model’s relationship with outcomes important to college adjustment such as academic achievement, relationship problems, stress, life satisfaction, and core self-evaluation. Ninety-seven college students with disabilities enrolled in Science, Technology, Engineering, and Mathematics (STEM) were recruited for the study. Findings support a one-factor solution for the PERMA measurement model. Furthermore, PERMA was negatively correlated with factors associated with college difficulty and positively associated with factors linked to college success. The PERMA model also demonstrated that well-being mediates the relationship between functional disability and life satisfaction. Implications for rehabilitation researchers and practitioners are reviewed.

Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain.

Objective: To compare adults aged ≥50 years with serious mental illness reporting moderate-to-severe pain to older adults with serious mental illness without pain with respect to sociodemographic characteristics, health conditions, and functional impairment. Method: Secondary data analyses were conducted using baseline assessments of 183 participants recruited for the Helping Older People Experience Success (HOPES) study from three community mental health centers. The primary outcome was self-reported, nonexperimentally induced, moderate-to-severe pain (referent = no-to-mild pain). Predictor variables consisted of sociodemographic characteristics, health conditions, and functional impairment. We conducted univariable and multivariable logistic regression analyses to examine the associations between these variables. Results: Sixty-one participants (33.3%) from our sample reported pain. Pain was associated with all of the sociodemographic and health-related factors in univariable analyses. In the multivariable model, only older age, pain-related activity interference, and physical and emotional health-related social limitations were significantly associated with pain. Conclusions and Implications for Practice: The presence of moderate-to-severe pain in older adults with serious mental illness is associated with pain-attributable impairment of activities and social problems above and beyond the substantial functional limitations routinely experienced by this high-risk, high-need group. Given the high rates of preexisting conditions and persistent social impairment among these older adults, our findings suggest that pain may contribute to worse overall functional outcomes. Future research and clinical interventions focused on improving outcomes should include an evaluation of pain as a contributor to decreased functioning and assess the need for early intervention, nonpharmacological pain management, or other health promotion services in psychiatric rehabilitation.

Cognitive Variability Predicts Incident Alzheimer's Disease and Mild Cognitive Impairment Comparable to a Cerebrospinal Fluid Biomarker.

BACKGROUND Alzheimers disease (AD) biomarkers are emerging as critically important for disease detection and monitoring. Most biomarkers are obtained through invasive, resource-intense procedures. A cognitive marker, intra-individual cognitive variability (IICV) may provide an alternative or adjunct marker of disease risk for individuals unable or disinclined to undergo lumbar puncture. OBJECTIVE To contrast risk of incident AD and mild cognitive impairment (MCI) associated with IICV to risk associated with well-established biomarkers: cerebrospinal fluid (CSF) phosphorylated tau protein (p-tau181) and amyloid-β 42 (Aβ42) peptide. METHODS Dispersion in cognitive performance, IICV, was estimated with a published algorithm, and included Trail Making Test A and B, Rey Auditory Verbal Learning Test (RAVLT), and the American National Adult Reading Test (ANART). CSF biomarkers were expressed as a ratio: p-tau181/Aβ42, wherein high values signified pathognomonic profiles. Logistic regression models included longitudinal data from 349 Alzheimers Disease Neuroimaging Initiative (ADNI) participants who completed lumbar puncture. All subjects were cognitively healthy (n = 105) or diagnosed with MCI (n = 244) at baseline. We examined odds of conversion associated with baseline elevations in IICV and/or ratio of CSF p-tau181/Aβ42. RESULTS When included in models alone or in combination with CSF p-tau181/Aβ42, one standard IICV unit higher was associated with an estimated odds ratio for incident AD or MCI of 2.81 (95% CI: 1.83-4.33) in the most inclusive sample, and an odds ratio of 3.41 (95% CI: 2.03-5.73) when restricted to participants with MCI. Iterative analyses suggested that IICV independently improved model fit even when individual index components were included in comparative models. CONCLUSIONS These analyses provide preliminary support for IICV as a marker of incident AD and MCI. This easily-disseminated, non-invasive marker compared favorably to well-established CSF biomarkers.