Janyce G. Dyer

Resilience: Analysis of the concept

Resilience describes a process whereby people bounce back from adversity and go on with their lives. It is a dynamic process highly influenced by protective factors. Protective factors are specific competencies that are necessary for the process of resilience to occur. Competencies are those healthy skills and abilities that the individual can access and may occur within the individual or the interpersonal or family environment. Psychiatric-mental health nursing has always focused on mental-health promotion and attempted to discern positive outcomes from adversity and states of wellness amidst difficult circumstances or severe illness. Defining specific protective factors that facilitate mental health in high-risk groups would enhance our position in todays health care climate.

Triple jeopardy for HIV: substance using Severely Mentally Ill Adults.

SUMMARY Severely Mentally Ill (SMI) adults have disproportionately high HIV seroprevalence rates. Abuse of alcohol and other substances (AOD) and lifetime exposure to trauma by others are particularly potent risk factors, which, in combination with psychiatric disabilities, create triple jeopardy for HIV infection. This study examined the predictive utility of demographic characteristics; history of physical, emotional, or sexual abuse; extent of drug and alcohol abuse; knowledge about HIV/AIDS; sexual self-efficacy; and condom attitudes toward explaining the variance in a composite of HIV high-risk behavior among 188 SMI women and 158 SMI men. History of sexual abuse, engaging in sexual activities while high on substances, and lower cannabis use were the most significant predictors of HIV sexual risk behaviors. Given the triple jeopardy for HIV risk in this population, a triple barreled approach that simultaneously addresses multiple health risks within an integrated treatment setting is warranted.

Gender Differences in Adolescent Depression

Depression in adolescents is more common in girls; this gender disparity becomes more apparent during the teen years when girls have close to twice the rate of depression compared with boys. Vulnerability-stress models help explain these differences, and a tendency toward rumination may play a role both in the development and continuation of depressive symptoms. Psychiatric nursing interventions must focus on reappraisal of relationships, challenging rumination, and promoting autonomy.

The psychiatric-primary care nurse practitioner: A futuristic model for advanced practice psychiatric-mental health nursing

A new paradigm for delivering comprehensive mental and general health services has been born out of the necessity to integrate all aspects of health care. Because of issues of cost-effectiveness and capitation, fragmentation of services is no longer viable. Graduate programs in nursing will need to: (1) effectively prepare its practitioners to manage the complexity of both medical and psychiatric problems of clients, (2) promote health and prevent disease, and (3) counsel and refer clients. The psychiatric nurse practitioner is uniquely suited to provide comprehensive health care to both clients in psychiatric settings as well as primary care environments. An overview of the Psychiatric-Primary Care Nurse Practitioner program at the University of Pittsburgh is described.

Reducing HIV risk among people with serious mental illness.

The rate of HIV infection among U.S. citizens who live with serious mental illness (SMI) is significantly higher than among the general population. Research on the determinants of risk behavior is limited. The purpose of this article is to explore the effects of HIV-related health disparities on people with SMI by analyzing the multiple determinants, or domains of risk, and describing issues related to tailoring HIV primary prevention risk reduction strategies to people with SMI. According to the model proposed by Meade and Sikkema, domains of risk include psychiatric illness, substance use, cognitive-behavioral factors, social relationships, and demographics. The majority of people with SMI are sexually active and engage in behaviors that place them at high risk for HIV/AIDS. Mental illness may affect HIV risk through interacting domains that influence sexual behavior. HIV risk reduction strategies must consider psychiatric illness and comorbidities, social relationships, and trauma history. In addition, these efforts should be integrated into existing services.

Familial influence in unipolar depression: Effects of parental cognitions and social adjustment on adult offspring

As part of an ongoing study of risk factors for unipolar depression in adult first-degree relatives of depressed probands, we have evaluated the relationship between cognitions and social adjustment in parents and adult offspring. Asymptomatic relatives of families with at least one parent with major depression, of families with no affected parent, and of normal control families were assessed. Maternal social adjustment was associated with both negative thinking and social adjustment in adult offspring. These effects were independent of the influence of personal history of depression in offspring, an effect that also influenced offspring thinking and social adjustment. These findings suggest that impairments in social adjustment in mothers may persist well beyond an episode and influence the adjustment and thinking of at least some of their offspring. Within the context of parent-child interaction, increased vulnerability for depression in offspring of depressed parents may be mediated in part by the enduring impact of these factors.

Update on early intervention in schizophrenia.

Early intervention is a popular idea for helping people with schizophrenia. There are two major approaches: intervening when the first symptoms of psychosis are expressed during adolescence and treating individuals at high risk during adolescence before psychotic symptoms become apparent. The risks and benefits of each approach are discussed.

Integrated HIV care: HIV risk outcomes of pregnant substance abusers.

Identifying contextual factors that may influence the effects of HIV risk-reduction strategies aimed at inner-city, minority female populations may be critical to interrupting the alarming trends in seroprevalence in the United States, especially among pregnant women with substance use–related problems. The objective of this Phase I, NIDA-funded project was to determine which contextual and cognitive factors were most predictive of HIV outcomes in this population. Eighty-one HIV-negative women were enrolled in a maternal addiction program with a cognitive-behavioral HIV risk-reduction component. Measures were administered between 1996 and 1998, one week post-admission, and follow-up assessments were conducted on 69 participants at 6 months post-discharge Paired t-tests were conducted to assess changes in sex risk behaviors, HIV/AIDS-related knowledge, and HIV risk–related attitudes/behaviors. Hierarchical regression analyses were conducted to investigate the relationship between attitudes/knowledge with contextual variables. At six months follow-up, there were significant increases in favorable condom attitudes (t = 3.36, p =. 01) and in factual knowledge regarding HIV (t = 3.20, p = .01), with a significant decrease in the number of sexual partners (t = 2.21, p = .05). Hierarchical regression analysis revealed that the strongest predictors of the number of partners—a key outcome variable—were alcohol use, intentions to engage in safer sex behaviors, psychiatric symptoms, and a history of physical abuse (F[11, 57] = 6.58, p <. 001). This study also reinforces the strategic importance of utilizing substance user treatment programs as crucial vehicles for integrating HIV risk-reduction strategies. Additionally, it will further guide the design of effective procedures to test the feasibility of an integrated HIV risk-reduction intervention for a larger randomized controlled study. The studys limitations are noted.