Joan M. Cook

Posttraumatic Stress Disorder and Current Relationship Functioning Among World War II Ex-Prisoners of War

This study examined the association of posttraumatic stress disorder (PTSD) with the quality of intimate relationships among present-day male World War II ex-prisoners of war (POWs). Ex-POWs had considerable marital stability; those with PTSD were no less likely to be in an intimate relationship. Ex-POWs in an intimate relationship who had PTSD (N=125 ) were compared with ex-POWs in a relationship who did not have PTSD (N=206). Marital functioning was within a range expected for persons without traumatic exposure. Yet, over 30% of those with PTSD reported relationship problems compared with only 11% of those without PTSD. Ex-POWs with PTSD reported poorer adjustment and communication with their partners and more difficulties with intimacy. Emotional numbing was significantly associated with relationship difficulties independent of other symptom complexes and severity of PTSD. Implications for clinical practice are discussed.

Physicians' perspectives on prescribing benzodiazepines for older adults: a qualitative study.

BackgroundThere is a continued high prevalence of benzodiazepine use by older community-residing adults and of their continued prescription by practitioners, despite well known adverse effects and the availability of safer, effective alternatives.ObjectivesTo understand factors influencing chronic use of benzodiazepines in older adults.DesignQualitative study, semistructured interviews with physicians.ParticipantsThirty-three practicing primary care physicians around Philadelphia.ApproachQualitative interviews were audiotaped, transcribed, and entered into a qualitative software program. A multidisciplinary team coded transcripts and developed themes.ResultsPhysicians generally endorsed benzodiazepines as effective treatment for anxiety, citing quick action and strong patient satisfaction. The use of benzodiazepines in older adults was not seen to be problematic because they did not show drug-seeking or escalating dose behavior suggesting addiction. Physicians minimized other risks of benzodiazepines and did not view monitoring or restricting renewal of prescriptions as an important clinical focus relative to higher-priority medical issues. Many physicians expressed skepticism about risks of continued use and considerable pessimism in the successful taper/discontinuation in older patients with long-term use and prior failed attempts. Physicians also anticipated patient resistance to any such efforts, including switching physicians.ConclusionsPrimary care physicians are averse to addressing the public health problem of benzodiazepine overuse in the elderly. Their attitudes generally conflict with practice guidelines and they complain of a lack of training in constructive strategies to address this problem. A 2-pronged effort should focus on increasing skill level and preventing new cases of benzodiazepine dependency through improved patient education and vigilant monitoring of prescription renewal.

Imagery Rehearsal for Posttraumatic Nightmares: A Randomized Controlled Trial

One hundred twenty-four male Vietnam War veterans with chronic, severe posttraumatic stress disorder (PTSD) were randomly assigned to imagery rehearsal (n = 61) or a credible active comparison condition (n = 63) for the treatment of combat-related nightmares. There was pre-post change in overall sleep quality and PTSD symptoms for both groups, but not in nightmare frequency. Intent-to-treat analyses showed that veterans who received imagery rehearsal had not improved significantly more than veterans in the comparison condition for the primary outcomes (nightmare frequency and sleep quality), or for a number of secondary outcomes, including PTSD. Six sessions of imagery rehearsal delivered in group format did not produce substantive improvement in Vietnam War veterans with chronic, severe PTSD. Possible explanations for findings are discussed.

Why Is Panic Disorder Less Frequent in Late life

Epidemiological studies have found that few cases of panic disorder arise for the first time after the age of 40 years, and there is a steady decline in the prevalence of existing cases in the latter half of life. The authors review these epidemiological findings and explore various hypotheses that might explain the decreased frequency of panic disorder in old age. There is no available evidence to suggest that methodological factors have led to an underestimation of the prevalence of this disorder in older rather than younger age groups. However, there is evidence that disorder-associated mortality and age-related changes in brain neurochemistry may contribute to the decreased frequency of this illness in later life. A cohort effect also should be considered, although currently there are no data available to support or refute this idea.

Organizational Measurement and the Implementation of Innovations in Mental Health Services

This paper presents a brief review of organizational measures related to implementation of new practices and technologies in sectors other than mental health, and discusses potential application of these measures to mental health implementation research. A few standardized organizational measures are presented along with considerations regarding the appropriateness of adapting existing measures rather than creating novel ones or using additional methodologies. Challenges and opportunities for researchers in measuring key organizational constructs related to implementation in mental health settings are discussed.

Suicidality in Older African Americans: Findings From the EPOCH Study

The authors examined the current frequency of suicidality and associated characteristics in a sample of 835 African-American older adult residents of six urban public housing developments who consented to participate in an intervention trial of mobile outreach. The frequency of passive and active suicidal ideation was 2.5% and 1.4%, respectively. Characteristics of individuals with both active and passive suicidality included elevated anxiety, social dysfunction, somatic symptoms, low social support, lack of a confidant, and low religiosity. Characteristics of those with passive, but not active, ideation also included older age, lower levels of education, elevated depressive symptoms, poorer cognitive functioning, and having recently discussed emotional problems with a healthcare provider. The characteristics of those reporting active, but not passive, ideation included having a history of mental health treatment and reporting no instrumental support. Multivariate analyses indicated that depression and religiosity were uniquely associated with passive suicidal ideation, and life satisfaction and religiosity were uniquely associated with active suicidal ideation. The authors discuss implications of these findings and offer suggestions for research and clinical practice.

Assessment and psychological treatment of posttraumatic stress disorder in older adults.

Knowledge regarding the assessment and treatment of posttraumatic stress disorder in older adults continues to be limited in both psychological research and practice. This article provides a summary of this literature. In particular, the psychometric properties of several posttraumatic stress disorder assessment measures in their use with older individuals are reviewed. Although the evidence base on effective treatments for posttraumatic stress disorder in older adults is virtually nonexistent, this article highlights the innovative clinical endeavors that have been conducted in this regard. Explicit suggestions for best practices are made.

A Test of the Tripartite Model of Depression and Anxiety in Older Adult Psychiatric Outpatients

This study examined the tripartite model of depression and anxiety in 131 psychiatric outpatients, ages 55-87. Confirmatory factor analyses revealed that a 3-factor model provided an adequate fit to the observed data, that the 3-factor model was empirically superior to 1- or 2-factor models, and that the 3-factor structure obtained in the current sample of older adult outpatients converged with that obtained on a separate, younger sample. Negative affect was significantly related to depression and anxiety symptoms and syndromes, and positive affect was more highly related to depression than anxiety symptoms and syndromes. Ways for taking into account possible age-associated differences in emotion in older adults and thus improving the conceptual model of anxiety and depression are briefly noted.

Barriers to adoption of new treatments: an internet study of practicing community psychotherapists.

Over 1,600 North American psychotherapists from a wide range of disciplines and practice settings completed an open-ended question on perceived barriers to adoption of new treatments as part of an internet survey. Content analysis indicated that there were five overall themes: clinician attitudes, client characteristics, contextual or institutional factors, training issues and other. The most frequently endorsed theme revolved around training issues, particularly, insufficient time and cost for training, lack of confidence in mastering the technique, and lack of opportunities for refining skills. Specific ideas for overcoming these barriers are identified.

Exposure to Trauma and Posttraumatic Stress Disorder Symptoms in Older Veterans Attending Primary Care: Comorbid Conditions and Self‐Rated Health Status

OBJECTIVES: Assess the prevalence of posttraumatic stress disorder (PTSD) symptomatology and its association with health characteristics in a geriatric primary care population.