Kirstin Stauffacher Gros

Relations Between Anxiety Symptoms and Relational Aggression and Victimization in Emerging Adults

Although it has been suggested that relational aggression (RA) and relational victimization (RV) are associated with elevated rates of social anxiety (SA), the nature of how these behaviors relate to the symptom development of SA has not yet been explored. In the present study, we investigated the relations between the symptoms of SA and general anxiety and RA and RV in a questionnaire study of 315 emerging adults. To identify the unique predictive power of RA/RV, a series of hierarchical regression analyses were conducted, controlling for gender, age, and physical aggression and victimization. All symptoms of anxiety were uniquely and positively predicted by RA; however, only symptoms of cognitive and somatic anxiety were predicted positively and uniquely by RV. These findings further elucidate the linkage between RA and anxiety in early adulthood, serving to highlight the importance of considering lifetime social history when investigating anxiety and aggression and victimization behaviors.

National Trainers’ Perspectives on Challenges to Implementation of an Empirically-Supported Mental Health Treatment

This study examined perceived challenges to implementation of an empirically supported mental health treatment for youth (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT) and explored the potential use of technology-based resources in treatment delivery. Thematic interviews were conducted with 19 approved national TF-CBT trainers to assess their perspectives about challenges to implementation of TF-CBT and to explore their perceptions about the potential value of innovative, technology-based solutions to enhance provider fidelity and improve quality of care. These data offer some important insights and implications for training in evidence-based treatments, provider fidelity and competence, and patient engagement, particularly for those interventions targeting trauma-related symptoms among youth.

Randomized Controlled Trial of an Internet-Based Intervention Using Random-Digit-Dial Recruitment: The Disaster Recovery Web Project

Disasters occur with high frequency throughout the world and increase risk for development of mental health problems in affected populations. Research focused on the development and evaluation of secondary prevention interventions addressing post-disaster mental health has high potential public-health impact. Toward this end, internet-based interventions (IBIs) are particularly attractive in that they: (1) offer a low-cost means of delivering standardized, targeted, personalized intervention content to a broad audience; and (2) are easily integrated within a stepped care approach to screening and service delivery. We describe a unique study design intended to evaluate an IBI with a disaster-affected population-based sample. Description and rationale are provided for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this intervention include the use of a population-based sample, telephone and internet-based assessments, and development of a highly individualized web-based intervention. Challenges related to the development and large-scale evaluation of IBIs targeting post-disaster mental health problems, as well as implications for future research and practice are discussed.

Nonuse and dropout attrition for a web-based mental health intervention delivered in a post-disaster context.

Web-based mental health interventions are an excellent means to provide low cost, easily accessible care to disaster-affected populations shortly after exposure to an event. However, the extent that individuals will access and use such interventions is largely unknown. We examined predictors of nonuse and dropout attrition for a web-based mental health intervention in 1,249 randomly selected adults in two Texas counties—Galveston and Chambers—that were hardest hit by Hurricane Ike in 2008. Participants completed a structured telephone interview to assess demographics, impact of disaster exposure, history of traumatic events, mental health symptoms, and service utilization. Following the interview, participants were oriented and invited to access a web-based intervention and then contacted four months later to evaluate their use of the website and mental health functioning. Separate logistic and Poisson regressions were used to determine baseline predictors of nonuse attrition, predictors of dropout attrition, and predictors of completing intervention modules. Results suggested that the strongest buffer against nonuse attrition and dropout attrition was having considered seeking formal mental health treatment. Results of this study inform the development and dissemination of web-based interventions in future disaster affected areas.

Bounce Back Now! Protocol of a population-based randomized controlled trial to examine the efficacy of a Web-based intervention with disaster-affected families

Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including depression and posttraumatic stress disorder. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several Web based evaluation studies with various adult populations has shown that Web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This is a protocol paper that describes an innovative study design in which we evaluate a self-help Web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. The paper includes description and justification for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and Web-based assessments, and development and evaluation of a highly individualized Web intervention for adolescents. Challenges related to large-scale evaluation of technology-delivered interventions with high-risk samples in time-sensitive research are discussed, as well as implications for future research and practice.

Feasibility assessment of a brief, web-based behavioral activation intervention for adolescents with depressed mood

Objective: Adolescent depression is a major public health concern. Efficacious interventions exist, but are underutilized. Novel approaches to improving access are therefore a top priority. Web-based approaches offer a viable treatment delivery solution; this approach may reach adolescents who might not otherwise receive formal treatment. Behavioral activation (BA) approaches have had success in treatment of depressive symptoms in youth. The purpose of this article is to: (1) describe the development process of a web-based, behavioral activation intervention for adolescents; (2) summarize the preliminary feasibility data; and (3) discuss the benefits and challenges associated with development and evaluation of adolescent self-help resources. Methods: The current study is part of a larger NIMH funded study focusing on the development and evaluation of Bounce Back Now (BBN), an evidence-informed, web resource for disaster-affected adolescents and their families. This study is specifically on the development of the BA component of the mood module of BBN, which was evaluated more extensively than other components. We present data from a formal usability evaluation conducted with 24 adolescents, and preliminary usage data collected from 2,000 disaster affected adolescents recruited from the tornado-affected coordinates in Alabama and Joplin, MO. Results: Preliminary data supported the feasibility of this approach: qualitative data with the clinic-based sample revealed favorable reactions to the intervention, and preliminary data from the large ongoing randomized controlled trial have indicated moderate levels of access. Conclusions: Brief, web-based approaches may offer a promising alternative to address access barriers for adolescents with depressed mood.

Community support as a moderator of postdisaster mental health symptoms in urban and nonurban communities

OBJECTIVE We examined the association between disaster exposure, community support, and mental health outcomes in urban and nonurban participants of Galveston and Chambers counties after Hurricane Ike. The moderating effect of community support was evaluated as a protective factor relative to postdisaster mental health. METHODS A representative population-based sample of 157 urban and 714 nonurban adults were interviewed 12 to 17 months after the hurricane about their mental health functioning, disaster exposure, and perceptions of community support. RESULTS A series of multiple regressions demonstrated that disaster exposure was associated with mental health outcomes for both groups. The strength of the association varied across population samples.Community support moderated the association between interpersonal effects of the disaster and posttraumatic stress disorder (PTSD) and depression outcomes in nonurban participants and the association between property damage and PTSD in urban participants. CONCLUSIONS Community support played a larger role in reducing PTSD and depression symptoms associated with the interpersonal effects of a disaster in the nonurban sample only. Communities may play a more beneficial role in the recovery process in nonurban areas that have elevated levels of injury or death attributed to a disaster.

The Associations between Loss and Posttraumatic Stress and Depressive Symptoms Following Hurricane Ike

UNLABELLED Disasters can have wide-ranging effects on individuals and their communities. Loss of specific resources (e.g., household contents, job) following a disaster has not been well studied, despite the implications for preparedness efforts and postdisaster interventions. OBJECTIVE To provide information about the effects of loss on postdisaster distress, the present study assessed associations between disaster-related variables, including the loss of specific resources, and postdisaster distress. METHOD Random-digit dialing methodology was used to recruit hurricane-affected adults from Galveston and Chambers, TX, counties one year after Hurricane Ike. Data from 1,249 survivors were analyzed to identify predictors of distress. RESULTS Variables that were significantly associated with posttraumatic stress disorder symptoms included sustained losses, hurricane exposure, and sociodemographic characteristics; similar results were obtained for depressive symptoms. CONCLUSIONS Together, these findings suggest risk factors that may be associated with the development of posthurricane distress that can inform preparedness efforts and posthurricane interventions.

SiHLEWeb.com: Development and usability testing of an evidence-based HIV prevention website for female African-American adolescents

African-American adolescent girls are at disproportionate risk for HIV infection. Although numerous evidence-based risk-reduction interventions exist, dissemination and implementation resources remain limited, and prevention services remain notably inaccessible to the very populations at highest risk for HIV infection. Internet delivery of HIV risk-reduction programming has promise as a mechanism for extending the reach of existing prevention efforts and overcoming barriers associated with traditional service delivery. This article (1) details the development process for the creation of SiHLEWeb, a web-adapted version of an evidence-based, culturally informed HIV prevention program traditionally delivered to female African-American adolescents via an in-person group format, and (2) presents findings from quantitative and qualitative usability testing conducted among 18 African-American girls (13–18 years). Results suggest that users found the website improved knowledge and learning, was helpful, efficient to use, and generally attractive. Users reported some concerns about website navigation. Implications for Internet delivery of health prevention programming are discussed.

Development and preliminary testing of a web-based, self-help application for disaster-affected families

Technology-based self-help interventions have the potential to increase access to evidence-based mental healthcare, especially for families affected by natural disasters. However, development of these interventions is a complex process and poses unique challenges. Usability testing, which assesses the ability of individuals to use an application successfully, can have a significant impact on the quality of a self-help intervention. This article describes (a) the development of a novel web-based multi-module self-help intervention for disaster-affected adolescents and their parents and (b) a mixed-methods formal usability study to evaluate user response. A total of 24 adolescents were observed, videotaped, and interviewed as they used the depressed mood component of the self-help intervention. Quantitative results indicated an above-average user experience, and qualitative analysis identified 120 unique usability issues. We discuss the challenges of developing self-help applications, including design considerations and the value of usability testing in technology-based interventions, as well as our plan for widespread dissemination.