Ian Clara

The multidimensional structure of perfectionism in clinically distressed and college student samples.

Confirmatory factor analysis was used to evaluate 2 multidimensional measures of perfectionism (R. O. Frost, P. Marten, C. Lahart, & R. Rosenblate, 1990; P. L. Hewitt & G. L. Flett, 1991). On a first-order level, support was found for Hewitt and Fletts (1991) original 3-factor conceptualization of perfectionism, although only for an empirically derived 15-item subset. Support was also obtained for 5 of the 6 dimensions proposed by R. O. Frost et al. (1990), but the model only displayed good fit when a refined scale containing 22 of the original 35 items was used. A second-order analysis found evidence for 2 higher-order factors of adaptive and maladaptive perfectionism. Perfectionism dimensions correlated in expected directions with personality domains, symptom distress, and academic achievement. The brief measures of perfectionism also retained the construct-related validity displayed by the full-item versions.

Confirmatory Factor Analysis of the Depression–Anxiety–Stress Scales in Depressed and Anxious Patients

The Depression–Anxiety–Stress Scales (DASS; P. F. Lovibond & S. H. Lovibond, 1995) have shown considerable promise in their ability to differentially assess depression and anxiety symptoms. Most of the work to date has relied on normal or predominantly anxious clinical samples. To extend this research to a predominantly depressed sample, a psychiatric sample from a mood disorders program (N = 439) was used to investigate the factor structure of the DASS. Confirmatory factor analyses indicated that a 3-factor model for the 21-item DASS was supported. A 3-factor model with crossloading items for the 42-item version showed no practical improvement. Further confirmatory analyses evaluated the ability of item subsets from the DASS to represent the constructs specified in the tripartite model (L. A. Clark & D. Watson, 1991). Strong support was obtained for the DASS to represent the construct of anhedonia and physiological hyperarousal, and their relative importance is consistent with predictions of the tripartite model in understanding the relationship between anxiety and depression.

Perceived Barriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands

OBJECTIVE Although rates of mental health service utilization differ dramatically across countries, little information is available about differences in self-reported barriers to mental health service utilization. Perceived barriers were examined in three locations with differing health care systems. METHODS Data came from three methodologically similar population-based surveys of adults conducted in the 1990s in Ontario, Canada (N=6,261), the United States (N=5,384), and the Netherlands (N=6,031) that assessed DSM-III-R nonpsychotic mental disorders with the Composite International Diagnostic Interview. Respondents who reported a need for professional help were asked to indicate reasons for not seeking care. Multiple logistic regression analyses were used to determine the sociodemographic, mental disorder, and location-specific correlates of each perceived barrier. RESULTS The pattern of reported barriers to mental health service utilization was similar across locations: attitudinal barriers (thoughts that the problem would get better on its own) were more prevalent than structural barriers (inability to get an appointment). Fear of stigmatization was not commonly endorsed. With adjustment for sociodemographic factors and type of mental disorder, low-income respondents were significantly more likely to report a financial barrier in the United States than in either Ontario or the Netherlands. CONCLUSIONS Across locations, attitudinal barriers were more likely to be endorsed than structural barriers to service utilization. The most striking reported cross-national difference was structural, with many more U.S. respondents (especially those with low incomes) reporting financial barriers than respondents in either Ontario or the Netherlands.

The Manitoba IBD Cohort Study: A Population-Based Study of the Prevalence of Lifetime and 12-Month Anxiety and Mood Disorders

BACKGROUNDG AND AIMS: ven the impact of anxiety and mood disorders on health, it is important to consider these disorders in persons with inflammatory bowel disease (IBD). We assessed the prevalence of anxiety and mood disorders in a population-based IBD cohort.METHODS:A structured diagnostic interview was administered to participants in the cohort (N = 351), and rates were compared to age-, gender-, and region-matched controls drawn from a national survey (N = 779).RESULTS: A comparison of lifetime prevalence suggests higher rates of panic, generalized anxiety, and obsessive-compulsive disorders and major depression and lower rates of social anxiety and bipolar disorders in the IBD sample than in national samples in the United States and New Zealand. Direct comparisons with matched controls (with data available for three anxiety disorders) found lifetime prevalence (IBD vs controls) as follows: social anxiety disorder lower in IBD (6% vs 11%, OR 0.52, 95% CI 0.32–0.85), panic disorder not significantly different (8.0% vs 4.7%, OR 1.59, 95% CI 0.96–2.63), agoraphobia without panic not significantly different (1.1% vs 0.6%, OR 1.44, 95% CI 0.37–5.55), and major depression higher (27.2% vs 12.3%, OR 2.20, 95% CI 1.64–2.95). Comparing IBD respondents with and without lifetime anxiety or mood disorder, those with a disorder reported lower quality of life and earlier onset of IBD symptoms and there was a trend toward earlier IBD diagnosis.CONCLUSIONS:Clinicians should be aware of the increased prevalence of depression and possibly other anxiety disorders in persons with IBD as these disorders may influence response to treatment and quality of life.

Predictors of medication adherence in inflammatory bowel disease.

BACKGROUND AND AIMS:This study reports cross-sectional medication adherence data from year 1 of the Manitoba Inflammatory Bowel Disease (IBD) Cohort Study, a longitudinal, population-based study of multiple determinants of health outcomes in IBD in those diagnosed within 7 yr.METHODS:A total of 326 participants completed a validated multi-item self-report measure of adherence, which assesses a range of adherence behaviors. Demographic, clinical, and psycho-social characteristics were also assessed by survey. Adherence was initially considered as a continuous variable and then categorized as high or low adherence for logistic regression analysis to determine predictors of adherence behavior.RESULTS:Using the cutoff score of 20/25 on the Medication Adherence Report Scale, high adherence was reported by 73% of men and 63% of women. For men, predictors of low adherence included diagnosis (UC: OR 4.42, 95% CI 1.66–11.75) and employment status (employed: OR 11.27, 95% CI 2.05–62.08). For women, predictors of low adherence included younger age (under 30 versus over 50 OR 3.64, 95% CI 1.41–9.43; under 30 vs. 40–49 yr: OR 2.62, 95% CI 1.07–6.42). High scores on the Obstacles to Medication Use Scale strongly related to low adherence for both men (OR 4.05, 95% CI 1.40–11.70) and women (OR 3.89, 95% CI 1.90–7.99). 5-ASA use (oral or rectal) was not related to adherence. For women, immunosuppressant use versus no use was associated with high adherence (OR 4.49, 95% CI 1.58–12.76). Low trait agreeableness was associated with low adherence (OR 2.03, 95% CI 1.12–3.66).CONCLUSIONS:Approximately one-third of IBD patients were low adherers. Predictors of adherence differed markedly between genders, although obstacles such as medication cost were relevant for both men and women.

Parental bonding and adult psychopathology: results from the US National Comorbidity Survey

BACKGROUND Research using the parental bonding instrument (PBI) has suggested that lack of parental care and/or overprotection may be important risk factors for adult mental disorders. Much of this research, however, has relied on clinical populations with one or two disorders, or has used highly select community samples. METHOD The association between parenting experiences and the occurrence of 13 common mental disorders in adulthood was evaluated in the US National Comorbidity Survey (N = 5877). The effect of sociodemographic variables (age, education, income) was statistically controlled and the effects of six parenting variables (maternal and paternal care, overprotection and authoritarianism) were examined simultaneously. The effects in men and women were examined separately. RESULTS Lack of care was the parenting variable most consistently associated with adult psychopathology. Parenting experiences with ones mother were more consistently associated with adult mental disorders. In general the impact of parenting was diagnostically non-specific. However, there appeared to be some unique effects for externalizing disorders (substance use disorders and antisocial personality disorder) in males; paternal overprotection and authoritarianism conferred a reduced risk of externalizing disorders in adult males. The overall impact of parenting as assessed by the PBI was modest, accounting for about 1 to 5 % of the variance in the occurrence of adult mental disorders. CONCLUSION Parenting experiences, particularly lack of care, are potentially causally related in a non-specific manner to a wide variety of forms of adult psychopathology in both men and women. The overall magnitude of the effect is small but statistically significant in a nationally representative US sample.

Confirmatory Factor Analysis of The Multidimensional Scale of Perceived Social Support in Clinically Distressed and Student Samples

Previous authors (e.g., B. R. Sarason, Shearin, Pierce, & Sarason, 1987) have found that perceived social support can affect the emotional well-being of an individual. Consequently, the effective assessment of social supports is a key issue in both research and clinical practice. The Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) divides perceived social support into 3 distinct constructs-that derived from Family members, from Friends, and from Significant Others. This study is the first to assess the MSPSS using confirmatory factor analysis in both a college student (N = 549) and psychiatric outpatient (N = 156) sample. Based on several goodness-of-fit indicators, a 3-factor model for the MSPSS was supported in both samples, as was a single, higher order domain of Global social support. The perceived social support factors of Family and Friends consistently had the strongest associations with symptomatology. These results support the use of the MSPSS as a brief instrument for assessing the hierarchical structure of perceived social support in a variety of samples.

Longitudinal study of quality of life and psychological functioning for active, fluctuating, and inactive disease patterns in inflammatory bowel disease.

Background: The aim was to assess quality of life (QOL) and psychological functioning in inflammatory bowel disease (IBD) as related to patterns of disease activity over time. Methods: Study participants were 388 recently diagnosed individuals from the population‐based Manitoba IBD Cohort Study. They completed mail‐out surveys at 6‐month intervals and clinical interviews annually. Based on their 2‐year pattern of self‐reported disease activity, participants were assigned to 1 of 3 groups: consistently active, fluctuating, or consistently inactive disease. Disease type (Crohns disease [CD] or ulcerative colitis [UC]) was confirmed through chart review. Change over time was modeled for measures of QOL and positive and negative psychological functioning using mixed‐effects regression analyses. Results: Half of the participants had fluctuating disease activity, while almost one‐third of participants reported consistent active disease. Participants with the fluctuating activity pattern showed significant improvement in disease‐specific QOL compared to participants with consistent activity. Perceived stress, health anxiety, and pain anxiety decreased while pain catastrophizing and mastery increased over time, although the amount of change was not significantly different among disease activity patterns. However, when the data were averaged over time there were significant differences among disease activity patterns on most outcomes. Significant effects of CD versus UC were observed only for the pain measures. Conclusions: Change in IBD QOL is influenced by ones longitudinal profile of disease activity, but change in psychological functioning is not. Effects of disease activity on psychological functioning were modest, suggesting that disease has an impact even when patients are not experiencing active symptoms.

Adaptive and maladaptive perfectionism: developmental origins and association with depression proneness

An emerging body of evidence has supported the distinction of adaptive and maladaptive subtypes of perfectionism. Although it has been hypothesized that developmental factors, particularly parenting experiences, play a role in the genesis of adaptive and maladaptive perfectionism, there is little empirical work available. Accordingly, the present study investigated the relationship among parenting experiences, adaptive and maladaptive perfectionism and depression proneness in a group of 261 college students. Structural equation modeling was used to evaluate a causal model in which harsh and perfectionistic parenting lead to maladaptive perfectionism which, in turn, leads to depression proneness. The model also included a path in which perfectionistic parenting leads to adaptive perfectionism which, in turn, has an inverse relationship with depression proneness. Fit statistics demonstrated superior fit of the hypothesized model compared to alternative models. There was evidence that maladaptive perfectionism mediates the relationship between harsh parenting and depression proneness. The results suggested that adaptive and maladaptive perfectionism have shared and unique developmental origins and that adaptive and maladaptive perfectionism have a differential relationship with depression proneness in adulthood. The results also suggest one mechanism by which harsh parenting may lead to vulnerability to depression. The findings support the validity of the adaptive/maladaptive dichotomy of perfectionism.

Use of alcohol and drugs to self-medicate anxiety disorders in a nationally representative sample

This study examined the prevalence and correlates of self-medication of anxiety disorders with alcohol and drugs in a nationally representative sample (N = 5877). A modified version of the Composite International Diagnostic Interview was used to make DSM-III-R mental disorder diagnoses. Frequencies of self-medication ranged from 7.9% (social phobia, speaking subtype) to 35.6% (generalized anxiety disorder). Among respondents with an anxiety disorder, self-medication was significantly associated with an increased likelihood of comorbid mood disorders, substance use disorders, distress, suicidal ideation, and suicide attempts. Self-medication behavior remained significantly associated with an increased likelihood of suicidal ideation (adjusted odds ratio = 1.66; 1.17–2.36) as well as suicide attempts (adjusted odds ratio = 2.23; 1.50–3.31), even after adjusting for a number of sociodemographic and psychiatric variables. These results suggest that individuals with anxiety disorders who self-medicate their symptoms with alcohol or drugs may be at increased risk for mood and substance use disorders and suicidal behavior.