Meaghan A. Leddy

Consequences of High Incarceration Rate and High Obesity Prevalence on the Prison System

Incarceration and obesity rates have both increased in the United States. An implication is that there will be more obese inmates, which likely will raise the prevalence of obesity-related diseases, affecting the cost and performance of correctional health care. Other issues include increased costs of transport, restraint, and housing. There is surprisingly little published information on inmate obesity prevalence. The few published research studies suggest obesity prevalence in prisons reflects that of their region. Cardiovascular-related prisoner deaths appear to be associated with state-level obesity, though other risk factors are likely involved. Weight gain while incarcerated is common, and the prevalence of diabetes is increasing. The data suggest that preventive care is not a priority in prisons. Evidence from Japan suggests restricted diets and enforced activity can improve inmate health.

Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries

AbstractThis quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.

Specificity of Effects of Cognitive Behavior Therapy on Coping, Acceptance, and Distress Tolerance in a Randomized Controlled Trial for Smoking Cessation

OBJECTIVE Although there is extensive evidence of the efficacy of cognitive-behavioral therapy (CBT), it is less certain what potential mechanisms of change are specifically affected by CBT interventions. This study was intended to test the specific effects of CBT on compensatory coping skills, acceptance, and distress tolerance or persistence. METHOD Using data from a randomized controlled trial of 8-session group CBT and a time-matched comparison condition for cigarette smokers, we evaluated CBT effects on compensatory coping skills, self-rated acceptance and behavioral markers of persistence and distress tolerance. Because depression proneness had moderated treatment response in the parent clinical trial (Kapson & Haaga, 2010), we tested not only main effects (CBT vs. comparison condition) but also moderated effects (treatment condition X depression proneness). RESULTS CBT significantly improved compensatory coping skills only among the less depression-prone participants, who were the subset of smokers who did not benefit from CBT in terms of smoking cessation outcomes. There were no specific effects of CBT on acceptance or behavioral persistence. CONCLUSIONS To the extent that CBT had specific effects on compensatory coping skills, it was for the participants who did not benefit clinically from the intervention. Much more theory-driven research on multiple candidate change mechanisms is needed to clarify how effective and specific treatments have their effects, for either patients in general or subsets of patients as in moderated effects.

Witchcraft and Biopsychosocial Causes of Mental Illness: Attitudes and Beliefs About Mental Illness Among Health Professionals in Five Countries.

Abstract This study examines the intercorrelation of measures reflecting beliefs about and attitudes toward people with mental illness in a sample of health professionals (N = 902) from five countries: Brazil, China, Ghana, Nigeria, and the United States, and, more specifically, the association of beliefs in supernatural as contrasted with biopsychosocial causes of mental illness. Factor analysis of a 43-item questionnaire identified four factors favoring a) socializing with people with mental illness; b) normalizing their roles in society; c) belief in supernatural causes of mental illness (e.g., witchcraft, curses); and d) belief in biopsychosocial causes of mental illness. Unexpectedly, a hypothesized negative association between belief in supernatural and biopsychosocial causation of mental illness was not found. Belief in the biopsychosocial causation was weakly associated with less stigmatized attitudes towards socializing and normalized roles.

Health and well-being of homeless veterans participating in transitional and supported employment: Six-month outcomes.

Supported employment, specifically individual placement and support (IPS), improves competitive employment (CE) rates for individuals with serious mental illness, but has not shown greater improvement in non-vocational outcomes than other rehabilitation approaches. The Department of Veterans Affairs offers two types of vocational services, IPS and transitional work experience (TWE), but no study has compared the effectiveness of these approaches. This secondary analysis of data from a study of homeless veterans compared 6 mo improvement in diverse outcomes for five employment patterns: never worked, worked only in TWE, worked in TWE followed by CE, worked in CE without IPS, and worked in CE with IPS referral. Veterans referred to IPS were more likely to be competitively employed. Those who worked in CE (whether following TWE or with or without IPS referral) showed the greatest increase in days worked, employment income, and total income and the greatest decrease in public support income when compared with those who worked only in TWE or not at all. Veterans in TWE showed the greatest increase in residential treatment days, but there were no other differences in non-vocational outcomes between groups. There are multiple paths to CE, but few differences in non-vocational outcomes across employment experiences.

Obstetrician-Gynecologists and Perinatal Infections: A Review of Studies of the Collaborative Ambulatory Research Network (2005–2009)

Background. Maternal infection is associated with adverse pregnancy outcomes, and ob-gyns are in a unique position to help prevent and treat infections. Methods. This paper summarizes studies completed by the Research Department of the American College of Obstetricians and Gynecologists regarding perinatal infections that were published between 2005 and 2009. Results. Obstetrician-gynecologists are routinely screening for hepatitis B and HIV, and many counsel prenatal patients regarding hepatitis B and toxoplasmosis. However, other infections are not regularly discussed, and many cited time constraints as a barrier to counseling. A majority discusses the transmission of giardiasis and toxoplasmosis, but few knew the source of cryptosporidiosis or cyclosporiasis. Conclusions. Many of the responding ob-gyns were unaware of or not adhering to infection management guidelines. Obstetrician-gynecologists are knowledgeable regarding perinatal infections; however, guidelines must be better disseminated perhaps via a single infection management summary. This paper identified knowledge gaps and areas in which practice can be improved and importantly highlights the need for a comprehensive set of management guidelines for a host of infections, so that physicians can have an easy resource when encountering perinatal infections.

Obstetrician-gynecologists’ knowledge, attitudes and practices regarding major depressive disorder

Abstract Background: Obstetrician-gynecologists (ob-gyns) provide depression screening and treatment, but these practices could be improved. This study investigated the use of depression screening tools and treatment of adolescents with depressive symptoms. Methods: Surveys were sent to 220 members of the American College of Obstetricians and Gynecologists (ACOG) who had responded to a survey on depression in the past two years. Response rate was 66% (n = 145). Questions included those related to standardized depression screening, antidepressant prescribing behavior, use of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) and knowledge of adolescent depression. Results: A total of 40% use standardized screening tools for depression with 46% using the Beck Depression Inventory-II and only 5% using the Patient Health Questionnaire-2 (PHQ-2). The majority (89%) of ob-gyns do not employ the DSM-IV to confirm a diagnosis of major depressive disorder. Of the ob-gyns indicating treating depression with antidepressants, 97% prescribe selective serotonin reuptake inhibitors. Only 19 respondents do not prescribe antidepressants, and instead refer depressed patients to mental health specialists. Most (79%) ob-gyns identified sexual problems as the primary side effect deterring prescribing of antidepressant medication. Ob-gyns were fairly accurate at estimating the prevalence of adolescent depression. Conclusion: Ob-gyns are not utilizing the recommended validated resources such as the DSM-IV or PHQ-2 for diagnosis of depression or prior to prescribing antidepressants.