Roland D. Maiuro

Raw versus relative scores in the assessment of coping strategies

Raw scores (frequency of efforts) versus relative scores (percentage of efforts) were compared on the five scales of the revised Ways of Coping Checklist. It was hypothesized that, conditional on the source of and appraisal of a stressor, problem-focused coping should be inverselyrelated and Wishful Thinking should be positively related to depression when relative scores were used but that raw problem-focused scores would be less clearly related to depression in such a way. It was further hypothesized that these relationships would hold for very diverse samples: psychiatric outpatients (n=145), spouses of patients with Alzheimers disease (n=66), and medical students (n=185). Given the maladaptive status of the psychiatric outpatients, it was hypothesized that they would report more emotion-focused strategies and less problem-focused coping than the nonclinical samples and that these differences would be better observed using relative rather than raw scores. The hypotheses were generally supported.

Appraised changeability of a stressor as a modifier of the relationship between coping and depression: a test of the hypothesis of fit.

The goodness of fit among the appraised changeability of a stressor, coping, and depression in people with psychiatric, physical health, work, and family problems was examined (N = 746). It was expected that problem-focused coping (as opposed to emotion-focused coping) would be used more and be more adaptive in situations appraised as changeable as compared with situations appraised as not changeable. Although few relationships existed between appraisal and coping, tests of fit between coping and depressed mood (maladaption) were much stronger. In people with nonpsychiatric conditions, problem-focused coping and depressed mood were negatively related when a stressor was appraised as changeable but were unrelated when a stressor was appraised as not changeable. Emotion-focused coping was positively related to depression when a stressor was appraised as changeable. No general relations were observed in the people with psychiatric conditions.

Predictors of Burden in Spouse Caregivers of Individuals With Alzheimer's Disease

This study used the following model of distress: Distress = [Exposure to Stress + Vulnerability]/[Psychological and Social Resources]. The constructs in the model were operationalized as (a) distress in response to caregiver experiences (burden); (b) exposure to stress (care recipient functional impairment in activities of daily living [ADLs]); (c) vulnerability (caregiver health problems, anger, and anxiety); and (d) resources (coping, outlook on life, and social supports). Long-term burden (15-18 months after entry) was predicted by several baseline variables: burden, care recipient ADLs, vulnerability and resource variables, and specific interactions of burden, ADLs, vulnerability, and resource variables. The interactions showed that caregivers with high vulnerability and low resources had higher burden scores than caregivers with other combinations of these variables.

Anger, hostility, and depression in domestically violent versus generally assaultive men and nonviolent control subjects

Anger, hostility, and depression were examined across four groups: a clinical sample of domestically violent men, two samples of more generally assaultive men, and a nonviolent control group. All subjects (N = 129) were assessed using the Buss-Durkee Hostility Inventory, the Hostility and Direction of Hostility Questionnaire, and the Beck Depression Inventory. The domestically violent men and the generally assaultive men evidenced significantly higher levels of anger and hostility than the control subjects. The anger and hostility scores were very similar in the domestically violent and the generally assaultive men. However, the domestically violent men were more likely to be significantly depressed. The findings support the idea that anger dyscontrol is a key issue in the psychological profile of domestically violent men and indicate the need for clinical attention to depression as well as anger.

Identification and Management of Domestic Violence A Randomized Trial

Background: Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. Methods: We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. Results: Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67–2.7). Conclusions: The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.BACKGROUND Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. METHODS We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. RESULTS Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67-2.7). CONCLUSIONS The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.

Medical student distress. A longitudinal study.

This longitudinal study investigated the relative importance of correlates of psychological distress in first year medical students (N = 312) in September and May. Anxiety levels were one SD above the mean when compared with nonpatient levels in both September and May, and the percentage of students reporting depression doubled over the study period. Problem-focused coping decreased, emotion-focused coping increased, and satisfaction with social supports decreased over the year. In contrast, type A behavior and anger expression were more stable. Students distressed in September were at higher risk for distress in May. Students distressed in May were also characterized by higher scores for suppressed anger and type A behavior in May, even after controlling for distress in September.

II. violence prevention and intervention in health care and community settingsIdentification and management of domestic violence: A randomized trial1

Background: Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. Methods: We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. Results: Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67–2.7). Conclusions: The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.BACKGROUND Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. METHODS We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. RESULTS Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67-2.7). CONCLUSIONS The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.

State Standards for Domestic Violence Perpetrator Treatment: Current Status, Trends, and Recommendations

We empirically surveyed and analyzed existing standards for the treatment of perpetrators of domestic violence across the United States. Specific areas examined included: presence and scope; administrative entity for certifying; screening and risk assessment protocols; minimum length of treatment; theoretical or conceptual orientation; treatment content; preferred or allowable modalities of treatment; whether research findings are mentioned; methods for revising standards; and minimum education and training required for providers. We examined trends using several methods including comparisons between present and previous survey data (Maiuro et al., 2001). Positive trends were evident including increased use of multivariate models of treatment content, use of an intake assessment prior to treatment, use of a danger/lethality assessment to manage risk, recognition of the need for program evaluation and supportive research, and the requirement of a minimum level of formal education as a prerequisite for providers. We identify specific areas for further research and development and make recommendations for improving existing practice and standards of care.

A Brief Measure for the Assessment of Anger and Aggression

A brief, six-item measure was developed for the rapid screening and identification of anger and aggression levels in violence-prone men. Four studies were conducted to examine the reliability and validity of the measure using a clinical data base of 401 men. Analyses indicated a satisfactory degree of internal consistency, test-retest reliability, and a significant relationship between the brief measure and Buss-Durkee Hostility Inventory total scores. Significantly higher scores were observed for three types of assault samples, including a group of domestic batterers, a group of generally assaultive men, and a mixed assault group, when compared to nonviolent controls. A cutting score for violent versus nonviolent group classification was determined via discriminant analysis. Significant differences observed at post-test between an anger management treatment group and waiting-list control subjects further illustrated the measures sensitivity to changes in psychological status and provided additional support for its clinical validity and utility.

Coping profiles associated with psychiatric, physical health, work, and family problems.

Compares the coping profiles of 11 samples (total N = 1,298) of individuals experiencing psychiatric, physical health, work, or family problems. Comparisons are made in individuals with and without anxiety and depression to control for the effects of distress. Coping was similar for samples in similar problem categories but different for samples in different categories. Psychiatric patients made more use of avoidance and less use of social supports than individuals in the other categories. Samples with physical health problems were among the most frequent users of social supports. Individuals with a family problem were among the most frequent users of problem-focused coping and the least frequent users of self-blame. Groups with work stress were the most frequent users of self-blame. These results suggest that coping profiles may be useful in describing and differentiating groups of stressed individuals.