Stephen Hansell

Adolescent competence, psychological well-being, and self-assessed physical health

Longitudinal data from 1,057 adolescents in 19 public schools indicated that self-assessments of physical health were influenced by competence in several important areas of adolescent life and by psychological well-being, but not by physical symptoms. Specifically, adolescents who reported higher levels of school achievement and more participation in sports and other exercise assessed their health to be better over a one-year period, when we controlled for initial self-assessments, than those who reported lower achievement and less participation. Physical health status, as measured by common physical symptoms, was associated cross-sectionally with self-assessed health, but its longitudinal effect was mediated by initial levels of self-assessed health. Other longitudinal results showed that adolescents who were initially less depressed assessed their health more positively. The inclination among adolescents to associate competence and psychological well-being with self-assessed physical health may contribute to the expression of distress in somatic terms later in life, and may help explain this commonly observed pattern among adults.

Assessing clinical predictions of early rehospitalization in schizophrenia.

This study determines patient characteristics that predict early hospital readmission in schizophrenia and evaluates the extent to which inpatient staff accurately predict these readmissions. Adult inpatients with schizophrenia or schizoaffective disorder (N = 262) were evaluated at hospital discharge and 3 months later to assess hospital readmission. At hospital discharge, inpatient staff were asked to identify which patients were likely to be readmitted during this period. Comparisons were made between patients who were or were not readmitted and between readmitted patients who were or were not identified by staff as likely to be readmitted; 24.4% of the sample were readmitted within 3 months of hospital discharge. Early readmission was associated with four or more previous hospitalizations (85.7% vs. 57.7%, p = .004), comorbid substance use disorder (60.3% vs. 35.5%, p = .0006), major depression (40.6% vs. 26.8%, p = .04), absence of a family meeting with inpatient staff (58.2% vs. 41.8%, p = .02), and prescription of a conventional rather than an atypical antipsychotic medication (93.7% vs. 83.8%, p = .045). Twelve of the 63 readmitted patients were correctly predicted by staff to re-hospitalize. Staff tended to overestimate the risk of rehospitalization in patients with a poor therapeutic alliance, low global function, or initial involuntary admission and to underestimate the risk in patients with alcohol use disorders or four or more previous psychiatric hospitalizations. Early rehospitalization is common in schizophrenia and difficult to predict. Greater emphasis on comorbid alcohol use disorders and a history of multiple previous admissions may help clinicians identify patients at greatest risk for early rehospitalization.

Negative affect and self-report of physical symptoms: Two longitudinal studies of older adults.

The ability of negative affect (NA) to predict somatic complaints 6 months later was examined. State NA, including anxious affect (AA) and depressive affect (DA), was measured in 2 separate samples of older adults averaging 62 and 73 years of age. In the first study, DA reliably predicted later complaints, and a corresponding trend was noted for NA. The second study showed that state NA and its 2 constituent variables predicted somatic complaints associated with acute illness (e.g., colds) 6 months later. The second study also examined trait measures of the 3 predictor variables and found that NA and AA, but not DA, were associated with subsequent somatic complaints. However, these trait effects were less robust than those attributable to their state counterparts. The authors conclude that negative mood states are the more consistent predictors of later physical symptom reports.

Introspectiveness and Adolescent Symptom Reporting

A new measure of introspectiveness--the tendency to devote diffuse attention to thoughts and feelings about the self--was used to investigate adolescent symptom reporting. Introspectiveness was correlated with psychological distress (r = .40) and with physical symptoms (r = .27) in a random sample of college freshmen, and remained the strongest correlate of distress and symptoms when controlling for a variety of other measures. Women, Jews, and certain Hispanic groups were higher on introspectiveness than other students. An unanticipated, but possibly significant, result was that economic discontinuities and discontinuities involving significant others had markedly different relationships with health. Strong associations between perceptions of parental characteristics, adolescent introspectiveness, and health suggested the importance of socialization processes for understanding distress and symptoms. Finally, measures of emotional sensitivity and time spent alone were associated with introspectiveness and symptom reporting. Taken together, these findings suggest the importance of introspectiveness and its correlates for understanding the processes leading to adolescent symptom reporting.

Factors associated with inpatient and outpatient treatment for children and adolescents with serious mental illness

OBJECTIVE This study describes the distribution of children and adolescents in psychiatric inpatient and outpatient facilities and identifies factors associated with the selection of individuals into inpatient versus outpatient care. SAMPLE DATA: The data are from a 1986 nationally representative sample surveyed by the National Institute of Mental Health. RESULTS Results indicate that the vast majority of children and adolescents with psychiatric problems receive outpatient treatment rather than inpatient care. Factors that predict psychiatric hospitalization rather than outpatient care are (1) public or private insurance coverage versus no insurance; (2) previous hospitalization; (3) psychiatric diagnosis of affective or psychotic disorders versus conduct disorders, adjustment disorders, drug and alcohol abuse, and other disorders; and (4) age, with adolescents more likely to be hospitalized than children. CONCLUSIONS Further research is needed to explore the role of insurance in mental health sorting processes. Moreover, systematic, controlled research is needed to determine how different financing strategies affect mental health outcomes for children and adolescents.

Introspectiveness and adolescent development

This study introduces a measure of introspectiveness for adolescents aged 12–18 and investigates its association with several aspects of adolescent development. Introspectiveness—the tendency to deveote diffuse attention to thoughts and feelings about the self—increased during adolescence, and may be stimulated by discontinuities associated with adolescent development, other kinds of discontinuities, and parental introspectiveness. Also, introspectiveness was positively associated with depression, anxiety, and physical symptoms, and may help explain the increase in symptom reporting during this developmental period. Highly introspective adolescents participated in more artistic activities and spent more time alone than those low on introspectiveness. Finally, highly introspective college students chose self-oriented academic majors, which may have implications for future occupational development. Together these results suggest that the concept of introspectiveness may increase our understanding of several important aspects of this developmental period.

Type A behavior pattern and hypertension among inner-city black women.

Inner-city Black women were administered Rosenman and Friedmans A-B interview and invited to discuss stress experiences and traditional coronary heart disease risk factors while their blood pressure was monitored at two-minute intervals. Results revealed the essential reliability of the A-B classification for the sample and demonstrated a general congruence with type A behaviors reported in previous (mostly white male) samples. While type A Black women were not significantly more likely to be hypertensive than type B women, analyses of the intrasubject blood pressure variability revealed an interaction between A-B and hypertensive-normotensive status. Consistent with earlier findings, hypertensives were more variable than normotensives, but this was true only for type Bs: type As were intermediate and not differentiated in their variability. This finding calls attention to the possible adaptive function of type A behavior among stressed inner-city Black females and raises the question of whether Rosenman and Friedmans personality theory might be objectionably simplistic.

Studying inpatient treatment practices in schizophrenia: An integrated methodology

A multi-phase research project examining current impatient psychiatric practices and the relationships between different treatments and patient outcomes is described. The study sample includes Medicaid patients with a diagnosis of schizophrenia who have been treated in inpatient units of general hospitals in New York State. The research is focused at the heart of the debate concerning the appropriate role of inpatient psychiatric care within a balanced system of mental health services. Addressed are the conceptual issues that guided the project, research strategies, instrument development, measures used and the preliminary findings that informed successive phases. Design issues are reviewed in light of the conceptual and pragmatic decisions made with a multiple site design. A compelling argument is made about the need for a long-term treatment orientation that prepares patients for what lies ahead and that assures communication and continuity between inpatient and outpatient care.

Body Awareness and Self-Assessed Health among Older Adults:

A longitudinal study of older adult members of a large health maintenance organization found that higher levels of body awareness were associated with significant longitudinal decreases in self-assessed health over time, controlling for physical and psychological health status, sex, age, and education. Also, psychological distress was a significant antecedent of body awareness. Individuals with higher distress had significant longitudinal increases in body awareness. However, physical illness was not associated significantly with changes in self-assessed health or body awareness over time. These results suggested that body awareness is part of a complex process through which global self-assessments of health are constructed.

Changing patterns of inpatient care for children and adolescents at the Menninger clinic, 1988-1994

The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N = 784) at the Menninger Clinic from 1988 to 1994. During this period. median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents.