Yookyung Kim

Complicated grief in survivors of suicide.

Complicated grief is a newly defined and distinctive psychiatric disorder that occurs in response to a significant loss through death. New findings suggest that survivors who were close to the deceased are at heightened risk for complicated grief. Little is known about whether close kinship (spouses, parents, children, siblings, vs. in-laws, aunts/uncles, nieces/nephews, friends, or coworkers) to a suicide victim also represents a heightened risk for complicated grief. Assessing for complicated grief is important, especially with survivors of suicide, because of the potential for associated health risks. This report contains preliminary data from an exploratory, descriptive pilot study examining complicated grief in adult survivors of suicide. Sixty bereaved subjects, within one month after the suicide of a family member or significant other, were assessed for complicated grief symptoms. Statistically significant differences, as measured with the Inventory of Complicated Grief, were noted between closely related and distantly related survivors of the suicide victim. These preliminary results indicate that health care professionals assessments and interventions for complicated grief should take into consideration the bereaveds familial and/or social relationship to the deceased. The closely related survivors of suicide had higher levels of complicated grief and could be at risk of developing physical and/or mental health problems, including suicidal ideation, in the future.

The Impact of Staffing on Patient Outcomes Across Specialty Units

Objective Determine the relationships between nursing staffing and specific nurse-sensitive outcomes (central line blood-associated infection, pressure ulcer, fall, medication error, and restraint application duration rates) across specialty units (cardiac and noncardiac intensive care, cardiac and noncardiac intermediate care, and medical–surgical). Background A number of hospital-level studies have demonstrated that lower staffing levels are associated with higher adverse patient outcomes. However, insufficient insight into unit-level staffing relationships is available. Further unit-level inquiry is necessary to fully explicate the relationships between staffing and outcomes and to provide assistance to nurse administrators as they seek to develop blueprints for staffing plans that are linked to quality outcomes. Methods Secondary analysis of prospective, observational data from 95 patient care units (cardiac intensive care, n = 15; noncardiac intensive care, n = 7; cardiac intermediate care, n = 18; noncardiac intermediate care, n = 12, and medical–surgical, n = 43) across 10 acute care hospitals. Results No statistically significant relationships were found between central line infection and pressure ulcer rates and staffing across specialty units. Significant inverse relationships were present between staffing and falls in cardiac intensive care, medication errors in both cardiac and noncardiac intensive care units, and restraint rates in the medical–surgical units. Conclusions Results from this study suggest that the impact of staffing on outcomes is highly variable across specialty units; however, when present, the relationships are inversely related with lower staffing levels, resulting in higher rates of all outcomes.

Perceived stress in survivors of suicide: Psychometric properties of the Perceived Stress Scale

The purpose of this study was to evaluate the psychometric properties of three versions of the Perceived Stress Scale (PSS; American Sociological Association) in adults who had survived the death of a family member or significant other by suicide. Reliability and validity were examined. Exploratory factor analysis was conducted to assess dimensionality of the underlying constructs. All three versions of the PSS demonstrated acceptable reliability. Two shorter versions retained good psychometric properties and demonstrated convergent and concurrent validity with measures of posttraumatic stress symptoms and mental health quality of life. Factor analysis provided further evidence of their usefulness as brief and valid measures of perceived stress in acutely bereaved adult survivors of suicide. In a sub-sample of closely related survivors, the psychometric properties of the 4-item version of the PSS were retained.

EFFECTS OF A SOCIAL SUPPORT INTERVENTION ON HEALTH OUTCOMES IN RESIDENTS OF A DOMESTIC VIOLENCE SHELTER: A PILOT STUDY

This pilot study tested the feasibility and effectiveness of a social support intervention with women (n = 24) while they were in a domestic violence shelter. Health outcomes were examined pre and postintervention using a randomized control design. The intervention group had greater improvement (p = .013) in psychological distress symptoms and greater improvement in perceived availability of social support (p = .016) than the control group. The intervention group showed less health care utilization (p = .032) than the control group. Social support interventions for women in shelters are effective in improving health outcomes. Further research should be aimed at testing the effectiveness of different types of interventions on health and abuse outcomes in women who experience interpersonal violence.

Differential functioning of the Beck Depression inventory in late-life patients: Use of item response theory.

The present analyses examined age-related measurement bias in responses to items on the revised Beck Depression Inventory (BDI) in depressed late-life patients versus midlife patients. Item response theory (IRT) models were used to equate the scale and to differentiate true-group differences from bias in measurement in the 2 samples. Baseline BDI data (218 late life and 613 midlife) were used for the present analysis. IRT results indicated that late-life patients tended to report fewer cognitive symptoms, especially at low to average levels of depression. Conversely, they tended to report more somatic symptoms, especially at higher levels of depression. Adjusted cutoff scores in the late-life group are provided, and possible reasons for age-related differences in the performance of the BDI are discussed.

Preoccupied Attachment and Emotional Dysregulation: Specific Aspects of Borderline Personality Disorder or General Dimensions of Personality Pathology?

Emotional dysregulation and impaired attachment are seen by many clinical researchers as central aspects of borderline personality disorder (BPD). Alternatively, these constructs may represent general impairments in personality that are nonspecific to BPD. Using multitraitmultimethod models, the authors examined the strength of associations among preoccupied attachment, difficulties with emotion regulation, BPD features, and features of two other personality disorders (i.e., antisocial and avoidant) in a combined psychiatric outpatient and community sample of adults. Results suggested that preoccupied attachment and difficulties with emotion regulation shared strong positive associations with each other and with each of the selected personality disorders. However, preoccupied attachment and emotional dysregulation were more strongly related to BPD features than to features of other personality disorders. Findings suggest that although impairments in relational and emotional domains may underlie personality pathology in general, preoccupied attachment and emotional dysregulation also have specificity for understanding core difficulties in those with BPD.

Inventory of Interpersonal Problems Personality Disorder Scales: Operating Characteristics and Confirmatory Factor Analysis in Nonclinical Samples

Research involving clinical samples has demonstrated the utility of a 28-item personality disorder (PD) screening measure (Inventory of Interpersonal Problems-Personality Disorder scale [IIP-PD]) culled from the IIP in the prediction of the presence or absence of a PD (Pilkonis, Kim, Proietti, & Barkham, 1996). This article extends these diagnostic efficiency findings to nonclinical samples and presents additional data regarding the factor structure of the 28 IIP-PD items. Diagnostic efficiency statistics for the IIP-PD scale, calculated using both interview and self-report methods, support the utility of the IIP-PD scale as a screening tool for the presence or absence of a PD. High specificity estimates indicate that individuals who do not exceed Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) symptom thresholds rarely exceed the IIP-PD cutoff. Furthermore, a high negative predictive power (NPP) estimate derived using an interview-based diagnostic standard suggests that the IIP-PD scale accurately screens out individuals who do not have a PD. Finally, cross-validated confirmatory factor-analytic results involving items composing the 5 IIP PD subscales identified in previous research (Kim, Pilkonis, & Barkham, 1997) suggest that a measurement model with a single second-order factor (general PD) and 5 first-order factors (one representing each PD subscale) provided the best fit to the observed data compared to 2 other competing models.

Comparing three theories in predicting reproductive health behavioral intention in adolescent women with diabetes

Background: Understanding factors that affect decision‐making in using preconception planning is important to reduce the rate of unplanned pregnancies and pregnancy‐related complications in all women with diabetes. Previously, there were no studies of reproductive health‐related beliefs, attitudes, or behaviors of adolescent women with diabetes. Constructs from social cognitive models, such as, the health belief model (HBM), theory of reasoned action, and social cognitive theory, are factors that can influence these behavioral outcomes.

Clinically relevant behaviors in elderly hip fracture inpatients

Objective: To examine the range of behaviors documented by inpatient rehabilitation staff and the association of these behaviors with functional outcome, in elderly persons undergoing rehabilitation after hip fracture. Method: Subjects were 137 patients, aged 60 and older, admitted to a rehabilitation hospital after a hip fracture, defined as having either a good or poor rehabilitation outcome based on change in Functional Independence Measure motor subscale scores during the course of their admission. Their charts were systematically reviewed for nursing and therapy staff documentation of behaviors. Prevalence of behaviors was compared between good and poor rehabilitation outcome groups. Results: Disturbances in cognition and rehabilitation participation were common and were associated with poorer rehabilitation outcome. Behaviors reflective of depression and anxiety were relatively uncommon and not associated with rehabilitation outcome. Conclusions: Rehabilitation staff frequently detect and document disturbances in cognition and participation that are associated with poorer rehabilitation outcome. It is recommended that staff observations be routinely added to mental health evaluations. Additionally, routine mental health screening and required staff documentation of behaviors would improve case detection rate.

PSYCHOMETRIC QUALITIES OF THE COPING RESPONSE INVENTORY-YOUTH FORM

This study examined the psychometric qualities of the Coping Response Inventory-Youth (CRI-Y) form. Participants were 376 females and 248 males (age 15.9 + 1.0 year) recruited from four rural high schools in Western Pennsylvania who completed the CRI-Y as part of the instrument battery of a longitudinal study. Exploratory factor analysis was conducted to examine the factorial validity of the CRI-Y scale, and reliability coefficients were examined to address the reliability of the scale. The eight subscales of CRI-Y exhibited low to moderate reliability coefficients (from .47 to .70). The approach, avoidance, cognitive, and behavioral coping domains and total CRI-Y showed good reliability coefficients (.81, .87, .85, .84, and .91, respectively). Factor analysis of CRI-Y subscales exhibited a unidimensionality of the subscales with a one-factor solution explaining 28%–40% of the total variance.