John Paul Jameson

Older Adults’ Preferences For Religion/Spirituality In Treatment For Anxiety And Depression

Objectives: To examine patient preferences for incorporating religion and/or spirituality into therapy for anxiety or depression and examine the relations between patient preferences and religious and spiritual coping styles, beliefs and behaviors. Method: Participants (66 adults, 55 years or older, from earlier studies of cognitive-behavioral therapy for late-life anxiety and/or depression in primary care) completed these measures by telephone or in-person: Geriatric Anxiety Inventory, Client Attitudes Toward Spirituality in Therapy, Patient Interview, Brief Religious Coping, Religious Problem Solving Scale, Santa Clara Strength of Religious Faith, and Brief Multidimensional Measure of Religiousness and Spirituality. Spearmans rank-order correlations and ordinal logistic regression examined religious/spiritual variables as predictors of preferences for inclusion of religion or spirituality into counseling. Results: Most participants (77–83%) preferred including religion and/or spirituality in therapy for anxiety and depression. Participants who thought it was important to include religion or spirituality in therapy reported more positive religious-based coping, greater strength of religious faith, and greater collaborative and less self-directed problem-solving styles than participants who did not think it was important. Conclusion: For individuals like most participants in this study (Christians), incorporating spirituality/religion into counseling for anxiety and depression was desirable.

Diagnosis and Treatment of Depression and Anxiety in Rural and Nonrural Primary Care: National Survey Results

OBJECTIVE Data from the 2006 National Ambulatory Medical Care Survey were examined for differences in the diagnosis and treatment of depressive and anxiety disorders in rural and nonrural primary care settings. METHODS A sample of 11,658 patient visits to primary care providers was examined. ICD-9-CM codes were used to identify prevalence rates of depressive and anxiety disorder diagnoses. Treatments also were examined with criteria from American Psychiatric Association practice guidelines. RESULTS No rural-nonrural differences were found in diagnosis rates for depression (about 3%) or anxiety disorders (about 1.5%). Approximately 67% of individuals with a depressive disorder and 36% of those with an anxiety disorder received a recommended treatment during the visit, with no rural-nonrural differences. CONCLUSIONS Although few differences were found between rural and nonrural primary care visits, these data support the notion that anxiety and depression are underdiagnosed in primary care. Moreover, recognition and diagnosis often do not translate into adequate treatment in both rural and nonrural primary care settings.

VA Community Mental Health Service Providers’ Utilization of and Attitudes Toward Telemental Health Care: The Gatekeeper’s Perspective

CONTEXT Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined. PURPOSE The purpose of this study was to investigate the attitudes of CBOC providers about TMH services, current utilization of these technologies in their clinics, and sources of knowledge regarding TMH. METHOD The study employed a mixed-methods design to examine aspects of TMH in CBOCs located in a VA network in the south-central United States. Semistructured, on-site group interviews conducted with 86 CBOC MH providers were followed by in-depth phone surveys with an MH provider identified as a key informant at each of 36 CBOCs in the VA network. FINDINGS The utilization of TMH services varied widely between CBOCs, and the scope of services provided typically focused on delivery of medication management, with little provision of psychological services. Further, several important barriers to expanded use of TMH were identified, including limited education and training and shortage of dedicated space for TMH encounters. CONCLUSIONS General attitudes toward TMH were positive, and most CBOC providers indicated that they would like to expand use of TMH in their clinics.

The relationship between stigma and self-reported willingness to use mental health services among rural and urban older adults

The large number of rural older adults suffering from untreated psychiatric illnesses suggests that stigma may be a significant barrier to the utilization of mental health services in this population. The current study examines self-stigma, public stigma, and attitudes toward specialty mental health care in a community sample of older adults living in a geographically isolated rural area, a rural area adjacent to a metropolitan area, and an urban area. One hundred and 29 older adults age 60 and above from the 3 geographic areas completed self-report measures of these constructs, and differences on the measures were assessed among the groups. Results indicated that older adults living in isolated rural counties demonstrated higher levels of public and self-stigma and lower levels of psychological openness than older adults in urban areas even after accounting for education, employment, and income. However, no differences emerged in reported willingness to use specialized mental health care in the event of significant distress. Results are discussed in the context of rural values, beliefs, and community structural factors. We further suggest that conventional binary rural/urban distinctions are not sufficient to understand the relationship between rurality and stigma.

An evaluation of the brief multidimensional measure of religiousness/spirituality in older patients with prior depression or anxiety

The Primary objective of the study was to examine the psychometric properties of the Brief Multidimensional Measure of Religiousness and Spirituality (BMMRS) in older adults. Older adults (N = 66) completed a survey in-person or over the phone. Measures included the BMMRS, Religious Problem Solving Scale, Brief Religious Coping Scale, Functional Assessment of Chronic Illness Therapy – Spiritual Well-being, Satisfaction with Life Scale, Geriatric Anxiety Inventory, and Geriatric Depression Scale. Cronbachs alphas evaluated internal consistency, zero-order correlations tested construct validity, and multiple regressions assessed the association of BMMRS domains with well-being. Most BMMRS domains were reliable and valid. Collectively, they explained 26% to 68% of the variance in well-being and psychological symptoms. Daily spiritual experiences uniquely predicted spiritual well-being, satisfaction with life, and depressive symptoms. The BMMRS is useful in older populations and may help identify those who could benefit from religious or spiritually integrated therapy.

Threat-related processing supports prospective memory retrieval for people with obsessive tendencies

Obsessive-compulsive disorder can result in a variety of deficits to cognitive performance, including negative consequences for attention and memory performance. The question addressed in the current study concerned whether this disorder influenced performance in an event-based prospective memory task. The results from a subclinical population indicated that, relative to non-anxious controls and mildly depressed controls, people with obsessive-compulsive tendencies (washing compulsions) incur decrements in remembering to respond to cues related to a neutral intention (respond to animals). This deficit was ameliorated by giving the subclinical group an intention about a threat-related category (respond to bodily fluids) and cueing them with concepts that they had previously rated as particularly disturbing to them. Thus, their normal attentional bias for extended processing of threat-related information overcame their natural deficit in event-based prospective memory.

Empirically Supported Treatments in Rural Community Mental Health Centers: A Preliminary Report on Current Utilization and Attitudes Toward Adoption

Rural community mental health centers (CMHCs) face numerous problems that might be alleviated by the dissemination of empirically supported treatments (ESTs). The current study lays the groundwork for EST dissemination by examining current treatment practices in rural clinics as well as the attitudes of decision makers toward ESTs and perceived barriers to their adoption. Twenty-five rural and 38 non-rural clinical directors responded to a mailed survey. Rural respondents were as likely as non-rural respondents to report EST use in their clinic for most anxiety disorders, and more likely to report use of an EST for major depressive disorder and obsessive-compulsive disorder. However, ESTs represent a relatively small proportion of the treatments reported for depression and anxiety disorders. Attitudes toward manualized ESTs did not differ between groups. Further, rural and nonrural clinics did not see the barriers to the adoption of ESTs as insurmountable. These preliminary results suggest that rural CMHCs are open to the use of ESTs and should be included in widespread dissemination initiatives.

Establishing community partnerships to support late-life anxiety research: Lessons learned from the calmer life project

Objectives: This article outlines the development of the Calmer Life project, a partnership established between researchers and faith-based and social service organizations to examine the effectiveness of cognitive behavioral therapy (CBT) incorporating religious/spiritual components for older African Americans in low-income communities. Method: The program was designed to bypass several barriers to delivery of CBT within the specified community; it allows multimodal delivery (in person or by telephone) that occurs outside traditional mental health settings through faith-based organizations and neighborhood community centers. It includes religion/spirituality as an element, dependent upon the preference of the participant, and is modular, so that people can select the skills they wish to learn. Established relationships within the community were built upon, and initial meetings were held in community settings, allowing feedback from community organizations. Results: This ongoing program is functioning successfully and has strengthened relationships with community partners and facilitated increased availability of education and services in the community. The lessons learned in establishing these partnerships are outlined. Conclusions: The growth of effectiveness research for late-life anxiety treatments in underserved minority populations requires development of functional partnerships between academic institutions and community stakeholders, along with treatment modifications to effectively address barriers faced by these consumers. The Calmer Life project may serve as a model.

If we build it, they might come: an empirical investigation of supply and demand in the recruitment of rural psychologists

Past research has established that practicing doctoral level psychologists tend to cluster in metropolitan areas, leaving the rural population gravely underserved. Discussions of this problem have assumed that psychologists hold negative attitudes toward rural work for many reasons, leading to a supply shortage. The present study attempts to examine the accuracy of this hypothesis by examining attitudes of current doctoral students in clinical psychology. Eight hundred eighty-four students responded to an online survey. Results indicate that attitudes toward rural practice were not overwhelmingly negative as predicted. Additionally, a significant number of respondents endorsed positive attitudes toward rural practice. A follow-up study was conducted to determine if the shortage of rural psychologists might be attributed to a lack of demand from rural employers. A search of three popular job resources revealed that few rural jobs were advertised, indicating weak demand for psychologists in rural areas. Results indicate that efforts to recruit psychologists to rural areas should be rethought, and increasing the visibility of available opportunities for psychologists should be made a priority.

Sexual identity and risk behaviors among adolescents in rural Appalachia.

Previous research suggests that rural youth and youth who are lesbian, gay, bisexual, and questioning (LGBQ) have higher risk of multiple psychological and behavioral risk factors compared with their heterosexual counterparts. This study compared risk for bullying victimization, suicide risk, school violence, drug use, and sexual risk behavior between rural LGBQ youth and heterosexual youth. The Youth Risk Behavior Survey (YRBS), developed by the Centers for Disease Control and Prevention (CDC), was administered by the local health department in 2 high schools in rural Appalachia. Findings indicate that rural LGBQ youth are at much higher risk than rural heterosexual youth for suicide risk, bullying victimization, school violence, drug use, and sexual risk behavior. Risk was particularly high for LGBQ youth in regard to bullying victimization and for suicide risks. Further, bullying victimization resulting from the perception of LGBQ status partially mediated drug use, but not suicide risk or school violence. Our results have particular implications for possible interventions targeting LGBQ youth by high school system personnel in rural Appalachia.