Michael Killian

The Index of Attitudes Toward Homosexuals 30 Years Later: A Psychometric Study

Objective: The authors report a validation study of the Index of Attitudes toward Homosexuals (IAH) to examine its ongoing usefulness. Method: Students (n = 331) completed surveys anonymously. Exploratory factor analyses were conducted and group differences analyzed. Results: Content validity was established conceptually, and preliminary discriminant validity was established statistically. Factor analyses suggest a shortened 19-item measure (α = .92) with two subscales. Convergent validity was established by comparing the scores on the IAH and another measure of antigay bias. Groups differed on sex, age, religiosity, parenthood, race, and childhood urbanicity. Conclusion: The revised IAH demonstrates sound psychometric properties. It can be useful to evaluate antigay bias, it can prompt discussion, and it can be used as an outcome measure in intervention studies.

Information about human sexuality: sources, satisfaction, and perceived knowledge among college students

This study explored how 333 undergraduate and graduate students attending a large university in the southeastern USA learned about sex, their satisfaction with how they learned about sex, and their self-perceived knowledge before and after taking a human sexuality course. An anonymous, voluntary survey was administered to students in the first and last sessions of human sexuality classes each semester from fall 2004 until spring 2006. Standardized measures included how students learned about sex, satisfaction with ways they learned about sex, barriers to parent–child discussions, and self-perceived knowledge about sex. Although 67% of students indicated parents should be instrumental in sex education, only 15% indicated parents as a primary source. Thirty-seven percent reported some level of dissatisfaction with how they learned about sex. Self-perceived knowledge increased significantly following the course. College courses addressing sexuality as integral to human development should complement college programming that focuses on risk reduction for sexually transmitted diseases/infections, sexual assault, and unintended pregnancy.

Validity of the Working Alliance Inventory Within Child Protection Services

The Working Alliance Inventory remains a widely studied measure of quality of therapeutic relationships between the practitioner and client. No prior study has examined the psychometrics and validity of the Working Alliance Inventory–Short (WAI-S) in a sample of families, social workers, and trained observers within child protection services. Surveys were completed by 130 families, social workers concerning 274 cases, and observers following 165 home visits during the first wave of data collected from a randomized controlled trial of child protection services. Confirmatory factor analyses were conducted on three versions of the WAI-S and demonstrated moderate to good model fit. Convergent construct validity was found with other standardized measures. Results support the use of the WAI-S during in child protection services practice and research. Future research into family engagement in child protection social work services should focus on the working relationship.

Integrated health care for decreasing depressive symptoms in Latina women: Initial findings.

There exists a lack of studies focusing on integrated care for racial and ethnic minorities. This is particularly true for Latina women, who are at even greater risk for poor mental health outcomes because of cultural and language barriers, as well as limited income and resources. This study examined the effectiveness of a measurement-based integrated health care program in improving depressive symptoms for a low-income, Spanish-speaking population of women within a federally qualified health center in Texas. Sixty participants were enrolled during a 1-year evaluation period of the program. The final sample included adult, Latina women who engaged in care with a Care Manager during the evaluation period. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), which was administered at baseline and follow-up visits. PHQ-9 scores were significantly different following the intervention. Over two thirds of the patients reported reduction in their depression symptoms, with over a third reporting clinically significant reductions. Overall, the effect size of the intervention was moderate and suggests the efficacy of measurement-based integrated health care in a primary care setting with low-income, uninsured, Spanish-speaking Latinas. These preliminary findings suggest an opportunity to reduce disparities for a population who lacks access to mental health specialists, and warrant further exploration. Existe una falta de estudios enfocando en salud integral para personas minorías raciales y étnicas. Esto es particularmente cierto para las mujeres Latinas, que están en mayor riesgo para malos resultados de salud mental, a causa de barreras culturales y de lenguaje, similar a los ingresos y recursos limitados. Este estudio examinó la efectividad de un programa de salud integral para mejorar los síntomas depresivos en una población de mujeres hispanohablante de bajos ingresos, dentro de un centro de salud primaria en Texas. Sesenta participantes se matricularon durante el año de evaluación del programa. El grupo final de participantes fueron mujeres adultas Latinas que recibieron servicios de un administrador de cuidado para depresión (Care Manager) durante el año de evaluación. Los síntomas depresivos se midieron utilizando el Cuestionario de Salud del Paciente (PHQ-9), que se administró al inicio del estudio y durante cada visita. Los resultados del PHQ-9 fueron significativamente diferentes después de la intervención. Más de dos tercios de las pacientes reportaron reducción en sus síntomas de depresión, con más de un tercio reportando reducciones clínicamente significativas. En general, el tamaño del efecto de la intervención fue moderado y indica la eficacia de la salud integral basada en un centro de salud primaria con Latinas hispanohablante con bajos ingresos y sin seguro. Estos resultados preliminares indica la posibilidad de reducir las disparidades para una población que le falta acceso a especialistas de salud mental y justifican mas exploración.

Adverse outcomes in bereaved mothers: The importance of household income and education

Intense and enduring psychological distress has been well-documented in numerous studies on bereaved parents including anxious, depressive, and traumatic stress symptoms. A state of poverty is also known to increase the risk of psychological distress in the general population, yet this variable has not yet been sufficiently evaluated in outcomes specifically for bereaved parents. This study is the first to investigate poverty, education, and parental bereavement while examining the relative risk of other variables as informed by the literature. The findings reveal that poverty was the strongest predictor of psychological distress when compared to others factors which have traditionally been considered significant in parental bereavement. Bereaved parents living in poverty may be less likely to seek support and have fewer available resources. Practice and policy implications are discussed.

Psychosocial predictors of medication adherence in pediatric heart and lung organ transplantation.

Few studies have identified the psychosocial characteristics of those children and their families associated with future non‐adherence to immunosuppressive medications following a heart or lung transplant. UNOS data and medical records information were used to test the association between patient and family psychosocial characteristics and medication adherence. Medication adherence outcomes were obtained using the physician assessments in the UNOS data and measured through patient‐level standard deviation scores of immunosuppressive medication blood levels. Complete data were collected on 105 pediatric heart and lung transplant recipients and their families. Multivariate, stepwise analyses were conducted with each adherence outcome. Physician reports of adherence were associated with age of the child at transplantation, parental education, two‐parent families, significant psychosocial problems, and the pretransplant life support status of the child. The resulting model (χ2=28.146, df=5, P<.001) explained approximately 39.5% of the variance in physician reports of adherence (Nagelkerke r2=.395). Blood level standard deviation scores were predicted by age at transplant (F=5.624, P=.02, r2=.05). Results point to the difficulties experienced by children and families when undergoing a heart or lung transplantation. Efforts to develop standardized and evidence‐based pretransplant psychosocial assessments in pediatric populations are suggested, especially those surrounding familial risk factors.

Exploratory Factor Analysis and Reliability of the Child Welfare Trauma-Informed Individual Assessment Tool

This article presents the development and psychometric analysis of the Child Welfare Trauma-Informed Individual Assessment Tool, an instrument designed to measure the extent to which child welfare service providers employ trauma-informed practices with the children and families that they serve. Using the responses of 213 front-line child welfare workers, exploratory factor analysis was used on a seventeen-item scale, resulting in a four-factor model. Based on the results of this analysis, implications for potential uses of the instrument are discussed, and specifications for additional evaluation of the measures validity are outlined.

Understanding Everyday Relationship Work: The Development of a Relationship Maintenance Scale

Relationship maintenance behaviors contribute to the longevity of intimate relationships, yet existing scales are limited. Available measurement tools are primarily constrained to the Relationship Maintenance Strategy Measure (RMSM) and its further revisions. Covering a number of domains, conceptual overlap with other aspects of an intimate relationship (e.g., household division of labor) may exist. Our cross-sectional exploratory study included participants from 60 countries (n=8,162) who completed an online survey. Participants were diverse in their relationship status, age, sexual orientation, and race/ethnicity. From their responses, we developed a parsimonious and brief measure of relationship maintenance (8 items) through exploratory and then confirmatory factor analyses. Results indicated that the Relationship Maintenance Scale (RMS) shows initial evidence of reliability and validity. The RMS may have utility in working with couples and families. Future research should seek to re-test its use with varied samples, such as couples seeking relationship support.

Examining Trauma and Readiness to Change among Women in a Community Re-Entry Program

ABSTRACT Background: Posttraumatic stress disorder (PTSD) and co-occurring substance use disorders (SUDs) are common among women who are incarcerated. Objective: The purpose of this study was to examine the relationship between trauma and readiness to change substance use behaviors. Methods: This study used data from 103 participants enrolled in a residential re-entry program for women with SUDs and trauma history. Women reporting clinically elevated Trauma Symptom Inventory (TSI) subscale scores were compared to those without elevated scores on the University of Rhode Island Change Assessment (URICA) readiness to change instrument. Primary analyses included t-tests and ANCOVA to control for age and ethnicity. Results: In general, women with clinically elevated trauma scores also reported greater readiness to change. The analyses revealed significant differences on the URICA Readiness to Change scores between women who had elevated Defensive Avoidance and Impaired Self-Reference according to the TSI. Results approached significance for women who had elevated TSI subscale scores for Sexual Concerns and Dissociation. Conclusions: These results point to a need to further understand links between trauma and readiness to change, particularly, the role of posttraumatic growth and psychological distress. This study has implications for social workers and clinicians delivering evidence-based treatment. Women who had high trauma symptoms were more willing to address change. Findings also suggest a need to tailor interventions to include motivational components that are also trauma-informed.

Psychometrics of the self-report concise associated symptoms tracking scale (CAST-SR): Results from the STRIDE (CTN-0037) study

OBJECTIVE The self-report Concise Associated Symptoms Tracking Scale (CAST-SR) was developed to track mania, irritability, anxiety, panic, and insomnia symptoms among depressed outpatients receiving antidepressant medication. Given the overlap between these domains, depression, and stimulant use disorders, we reexamined CAST-SR psychometrics in a novel sample: individuals with stimulant use disorder receiving aerobic exercise or health education interventions. METHODS Using the subsample of stimulant-dependent (following DSM-IV criteria) individuals prescribed antidepressants (N = 124) from the multisite Stimulant Reduction Intervention Using Dosed Exercise (CTN-0037) trial (total sample N = 302), conducted July 2010 to February 2013, we analyzed CAST-SR data collected at the first assessment after participants discharge from residential treatment. We also evaluated the convergent/discriminant validity of the CAST-SR with several self-report questionnaires. RESULTS Confirmatory factor analysis revealed a 12-item measure composed of 4 factors: irritability, anxiety, panic, and insomnia. This factor structure loaded only in participants prescribed antidepressant medication, not in those who were not prescribed antidepressants. These results replicate the original CAST-SR factor structure, except for the mania factor, which failed to load. Internal consistency was high (α = 0.92 for total scale and α = 0.78-0.89 for the 4 factors), and convergent validity was established, especially for the insomnia and irritability factors, alongside the total score with depressive symptoms, insomnia, quality of life, suicide risk, and physical health measures. CONCLUSIONS These results demonstrate the factor structure, reliability, and validity of the CAST-SR in a novel population of only individuals with stimulant use disorders receiving both exercise/health education interventions and antidepressant medication. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01141608.