Levent Dumenci

The Generalizability of the Youth Self-Report Syndrome Structure in 23 Societies.

As a basis for theories of psychopathology, clinical psychology and related disciplines need sound taxonomies that are generalizable across diverse populations. To test the generalizability of a statistically derived 8-syndrome taxonomic model for youth psychopathology, confirmatory factor analyses (CFAs) were performed on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) completed by 30,243 youths 11-18 years old from 23 societies. The 8-syndrome taxonomic model met criteria for good fit to the data from each society. This was consistent with findings for the parent-completed Child Behavior Checklist (Achenbach & Rescorla, 2001) and the teacher-completed Teachers Report Form (Achenbach & Rescorla, 2001) from many societies. Separate CFAs by gender and age group supported the 8-syndrome model for boys and girls and for younger and older youths within individual societies. The findings provide initial support for the taxonomic generalizability of the 8-syndrome model across very diverse societies, both genders, and 2 age groups.

Ten-Year Comparisons of Problems and Competencies for National Samples of Youth Self, Parent, and Teacher Reports

The Youth Self-Report (YSR;Achenbach, 1995),Child Behavior Checklist (CBCL;Achenbach,2001),and Teachers Report Form (TRF; Achenbach & Rescorla, 2001) were used to compare U.S. national samples of 11- to 18-year-olds assessed in 1989 and 1999. Reports by all informants concurred in showing small improvements in competencies and adaptive functioning and small declines in problems from 1989 to 1999. Correlations of .98 to .99 between mean problem item scores in 1989 and 1999 indicated very high stability for assessment via self-reports, parent reports, and teacher reports over 10 years. Cross-informant correlations were (a) YSR × CBCL = .38, (b) CBCL ×TRF = .36, and (c) TRF ×YSR = .20. No scales showed significant differences between scores obtained from any type of informant for youths assessed shortly before and after the Columbine High School shootings.

Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews.

Standardized diagnostic interviews (SDIs) have become de facto gold standards for clinical research. However, because clinical practitioners seldom use SDIs, it is essential to determine how well SDIs agree with clinical diagnoses. In meta‐analyses of 38 articles published from 1995 to 2006 (N = 15,967 probands), mean kappas (z‐transformed) between diagnoses from clinical evaluations versus SDIs were 0.27 for a broad category of all disorders, 0.29 for externalizing disorders, and 0.28 for internalizing disorders. Kappas for specific disorders ranged from 0.19 for generalized anxiety disorder to 0.86 for anorexia nervosa (median = 0.48). For diagnostic clusters (e.g. psychotic disorders), kappas ranged from 0.14 for affective disorders (including bipolar) to 0.70 for eating disorders (median = 0.43). Kappas were significantly higher for outpatients than inpatients and for children than adults. However, these effects were not significant in meta‐regressions. Conclusions: Diagnostic agreement between SDIs and clinical evaluations varied widely by disorder and was low to moderate for most disorders. Thus, findings from SDIs may not fully apply to diagnoses based on clinical evaluations of the sort used in the published studies. Rather than implying that SDIs or clinical evaluations are inferior, characteristics of both may limit agreement and generalizability from SDI findings to clinical practice. Copyright

Parenting and Children's Externalizing Problems in Substance-Abusing Families

This study tested associations in path models among positive and negative parenting and childrens rule-breaking behavior, aggressive and oppositional behavior, and attention problems for families with a drug-dependent parent. A structural model tested relations between parenting and childrens externalizing problems for 251 families with 399 children between the ages of 6 and 18, controlling for nonindependence of ratings at the family level. The model also tested potential moderators, including child age, gender, and ethnicity (White vs. other), and caregiver gender (families with a female substance-abusing caregiver vs. families with a male substance-abusing caregiver). Results indicated that caregiver ratings of monitoring predicted rule-breaking behavior and use of inconsistent discipline predicted ratings of all 3 externalizing syndromes, after controlling parenting and externalizing problems for the effects of the moderators and after controlling significant relations among types of parenting and types of externalizing problems.

A latent trait-state model of adolescent depression using the Center for Epidemiologic Studies-Depression Scale.

This study utilized the latent trait-state model for estimating stable and changing components of depressive symptomology in adolescents. The factorial structure of the CES-D was assessed separately for males and females at four measurement occasions, at six-month intervals. The variance decomposition of general trait, state, specific trait, and random error parameters for the CES-D scores was estimated simultaneously and tested statistically. Parameter estimates indicated that the CES-D measured both trait- and state-depression about equally well, and that the trait-specific variance parameter was statistically significant, but substantially smaller than those associated with general trait- and state-depression. Findings are discussed with regard to depressive mood fluctuations among adolescents and the potential usefulness of the latent trait-state model to capture such dynamic features of development.

Measurement Structure of the Turkish Translation of the Child Behavior Checklist Using Confirmatory Factor Analytic Approaches to Validation of Syndromal Constructs.

The new correlated 8-factor measurement structure of the Child Behavior Checklist for ages 6–18 (CBCL/6-18; T. M. Achenbach & L. A. Rescorla, 2001) derived from an American sample was used as a benchmark to evaluate its generalizability to Turkish general population (N = 5,195) and clinical (N = 963) samples. Item-level confirmatory factor analysis (CFA) was used to evaluate the adequacy of the correlated 8-factor model across 3 sample conditions (general population, clinical, and combined sample whose Total Problems scores were above the Turkish national median). The results supported the generalizability of the overall measurement structure of the CBCL to the Turkish population.

Sensory overresponsivity and anxiety in typically developing children and children with autism and attention deficit hyperactivity disorder: cause or coexistence?

OBJECTIVE. To explore the relationship between sensory overresponsivity (SOR) and anxiety in children with autism, attention deficit hyperactivity disorder, and typical development. METHOD. Path analysis was used to examine the primary SOR model (Green & Ben-Sasson, 2010) using both physiological and behavioral data. RESULTS. The magnitude of physiological responses to sensory challenge was a mediator variable between predictors (baseline arousal and attention) and outcomes (anxiety and physiological recovery). Behavioral SOR was correlated with anxiety but not with physiological variables. CONCLUSION. The intensity or magnitude of sensory responsivity mediates the relationship between baseline arousal and attention and outcome anxiety and physiologic recovery from sensory challenge. Behavioral tools used to measure SOR do not reflect physiological responsiveness; this mismatch warrants further investigation. SOR can prevent children from participating in the occupations of childhood; the greater the understanding of SOR, the more successful occupational therapy practitioners will be in developing effective interventions.

Parent psychopathology, parenting, and child internalizing problems in substance-abusing families.

A structural model accounting for child internalizing problems in substance-abusing families was tested. Parents receiving substance abuse treatment (N = 242) completed forms about children between the ages of 6 and 18 who resided in their home. The effects of parent gender, child gender, and child age were controlled. Negative parenting was examined as a mediator between parent internalizing and externalizing problems and child anxiety and affective problems using path analysis. Negative parenting mediated relations only between parent internalizing problems and child affective problems. High-positive involvement moderated relations between parent externalizing problems and child internalizing problems. Relations between parent externalizing problems and child anxiety and affective problems were significant only among families in which high-positive involvement was present.

Parental and occupational stress as predictors of depressive symptoms among dual-income couples : A multilevel modeling approach

This study evaluates the influence of parental and occupational stress on depressive symptoms. Multi-level modeling is used with a matched pairs, couples research design to address statistical dependency relations among husband-wife pairs and to estimate the contributions of individual- and couple-level variables on depressive symptoms. The findings of 200 dual-earner, married couples with children (x = 2.8 children) indicate that higher levels of parental and occupational stress are equally predictive of depressive symptoms for husbands and their wives. Lower marital satisfaction, less family cohesion, and lengthier marriages are also equally predictive of depressive symptoms for husbands and their wives. Key Words: depression, dual-earners, occupational stress, parental stress. Dual-earner couples have become common in contemporary societys landscape of traditional and nontraditional families. Historical shifts in the workplace over the past few decades have included substantial increases in women working outside the home either part-time or full-time. The consequences of these historical shifts have been of considerable interest to a variety of investigators, including those interested in the impact of dual-earner couples on family functioning and mental health (e.g., Aneshensel & Pearlin, 1987; Barnett, Marshall, Raudenbush, & Brennan, 1993; Pleck, 1985; Wethington & Kessler, 1989). Some of the initial research on dual-earner couples focused not on family functioning and mental health, per se, but rather on the compounding of multiple-role stresses (e.g., occupational, as well as parental and marital) and their potentially adverse impact on womens mental health (e.g., Barnett, Marshall, & Singer, 1992; Frankenhaeuser, Lundberg, & Chesney, 1991; Repetti, Matthews, & Waldron, 1989). Much of this research centered on womens health, rather than on mens health, because there typically was not a commensurate shift in mens roles toward the addition of burdensome homemaking tasks. The upshot of this research was that workplace participation by women often increased their selfesteem and feelings of perceived worth, rather than increasing mental health problems (e.g., Barnett & Marshall, 1991; Repetti et al., 1989; Wilsnack & Cheloha, 1987). Parenthetically, this generalization of previous findings does not suggest that the occurrence of multiple stressors across these social roles (i.e., occupational, parental, marital) is not associated with poorer mental health, only that there is nothing inherently stressful in womens participation in the workplace that is inevitably associated with poorer mental health. Further, higher levels of multiple stressors are detrimental to the mental well-being of men, as well as women. For instance, the combined impact of occupational and parental role stress and marital discord is associated with lower levels of mental health for both men and women. More recent research in this area has focused on the importance of different social roles (e.g., occupational, parental) for men and women and the association of successful functioning in these roles to mental health indicators such as depression (e.g., Barnett et al., 1993; Bielby & Bielby, 1989; Deaux, 1984; Simon, 1992). The initial assumptions of many researchers investigating this topic were that occupational role functioning would be more salient than parental or family role functioning to mental health for men, whereas parental or family role functioning would be more salient than occupational role functioning to mental health for women. These assumptions have been seriously challenged by the empirical findings and critiques in the literature (e.g., Barnett, 1993; Rodin & Ickovics, 1990; Wethington & Kessler, 1989). Briefly, expectations and socialization for social roles, rather than inherent gender differences, account for the seemingly disparate findings in the literature. …

Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer.

OBJECTIVE To examine the influence of patient and physician communication factors on diagnostic delay (DD). METHODS 242 patients diagnosed with colorectal cancer (CRC) in the past 6 months who experienced symptoms prior to diagnosis were administered a 2-h semi-structured qualitative interview to assess communication with health care provider and ease of access to care, among other factors. Patient-provided information was verified via review of medical records. RESULTS The factors associated with DD>2 months included lower income (OR=0.56, p=0.03), having regular physician prior to receiving a cancer diagnosis (OR=2.52, p=0.03), having a physician who used temporizing communication strategies during the consultation (OR=2.41, p=0.02), receiving an initial alternate diagnosis (OR=3.36, p=0.02), experiencing referral delay (OR=3.61, p=<0.001), and experiencing follow-up delay of any kind (OR=3.32, p=0.01). CONCLUSION Excellent communication skills that appropriately probe for relevant social and economic patient information, assist patients in distinguishing and elaborating on symptoms, and provide clear rationale and instructions for future steps, will speed along the diagnosis process and could be the difference between early and late stage CRC. PRACTICE IMPLICATIONS Increased understanding of physician communication and practice styles that contribute to DD could have a positive impact on decreasing the morbidity and mortality from this disease.