Confirmatory factor analysis of Beck Depression Inventory-II with two American Indian samples.

The Beck Depression Inventory-II (BDI-II) is used to assess depression with people from many cultures and ethnicities; however, the scale has been validated with very few populations other than the majority (Gray et al., 2016). Secondary analysis of data included two-factor confirmatory factor analyses (CFA) of the BDI-II with two independent American Indian samples, which were compared with the results in the BDI-II Manual (Beck et al., 1996). Sample 1 included 527 adult American Indians recruited from seven tribal communities, and Sample 2 included a community sample of 440 American Indian adults. The results of both CFA matched the original factor structure reported in Beck et al. (1996) supporting the construct validity of the BDI-II in Northern Plains American Indians. The internal consistency of the BDI-II was very high in Sample 1 (r = .94) but somewhat lower in Sample 2 (r = .72). Measures of convergent validity and discriminant validity were below acceptability for both Sample 1 and Sample 2. The results of this study support the construct validity of the BDI-II in Northern Plains American Indians. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Diet Quality and Depression in a Cohort of American Indians: The Strong Heart Family Study.

Diet quality has been shown to be inversely associated with depression, but this has not been studied in American Indians (AIs). We examined the prospective association of diet quality and probable depression in a family-based cohort of rural AIs. Using data from the Strong Heart Family Study, we included 1,100 AIs ≥14 years old who were free of probable depression at baseline. We defined probable depression as the presence of moderate or severe depressive symptoms on the Center for Epidemiologic Studies Depression Scale or current use of antidepressant medications. We calculated baseline diet quality from food frequency questionnaires using the Alternative Healthy Eating Index-2010 (AHEI). We used GEE-based multivariate logistic regression to estimate the odds ratio of probable depression at follow up associated with a 10-point higher AHEI score at baseline, adjusted for demographic, psychosocial, and health factors. At follow up, 19% (n = 207) of the sample reported probable depression. Diet quality was not associated with report of probable depression at follow up (OR = 1.16, 95% CI [0.96, 1.39]). Research is needed to examine other temporal dimensions of this relationship and unique aspects of rural AI diets and psychosocial factors that may influence depression.

The three sisters garden: A cultural approach to cultivating American Indian/Alaska Native (AI/AN) psychological service providers.

Less than 300 practicing Native American (NA) psychologists are available to support over 5.2 million American Indian and Alaska Natives (AI/AN) who reside in the U.S., according to the 2010 census (2010; Society of Indian Psychologists [SIP], 2016). The Three Sisters Model represents a training approach for NA behavioral health students to help address the need for culturally competent behavioral health services for individuals living in Indian country. The model utilizes a socially relevant approach including culture, spirituality, and education as key components to successful recruitment, retention, and training of NA behavioral health professionals. By incorporating culturally informed approaches and a culturally inclusive environment, this model provides a supportive, nurturing and affirming approach to help AI/AN students overcome challenges and complete their degrees. Upon completion, students are culturally proficient in skills which can be applied to Native communities in utilizing the Indigenous lens which can be used with tribes in the Midwestern U.S., but with local cultural adaptation it could be used in other regions. The 15 programs of the Three Sisters Model provide the steps for students to manage the completion of the steps (e.g., from high school to college) toward licensure while managing and balancing Western and Indigenous approaches to proficiency of care. The model includes supports to address barriers which have inhibited past AI/AN from reaching education and professional goals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Rumination and quality of life among Northern Plains Indians.

Therapeutic mechanisms targeting multiple mental health disorders are key for providing treatment services with high-disparity, low-resource populations. Rumination, a cognitive response style, is a well-recognized transdiagnostic factor across disorders in the general population (Arditte et al., 2016; Nolen-Hoeksema, 1991). This study explored the influence of rumination, and mediational effect of mental health disorder, on Quality of Life among a sample of 585 Northern Plains Indian (NPI) women and men. Using secondary data from a Mood Disorder Assessment Validation study, parallel mediation path analyses indicated rumination did not have a direct influence on quality of life. However, rumination indicated higher anxiety (R² = .38, p < .001), depression (R² = .60, p < .001), and substance use symptoms (R² = .14, p < .001). As rumination increased, significant increases occurred in severity of symptoms reported for women and men for all diagnoses- but lower perceived quality of life occurred only in the presence of depressive symptoms (women, B = -28.19, p < .001; men, B = -20.15, p < .001). Significant differences arose between NPI women and men, with women reporting higher rumination, anxiety, and depression and men reporting higher substance use. Based on these results, rumination is useful as a transdiagnostic factor for NPIs, as rumination helped uncover maladaptive coping mechanisms among NPIs in the sample. In addition, quality of life assessments can help target maladaptive coping in treatment by taking a holistic view of well-being that accounts for risk factors while supporting traditional views of healing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric evaluation of the Substance Abuse Subtle Screening Inventory-3 with Northern Plains American Indians.

The efficacy of the Substance Abuse Subtle Screening Inventory-3 (SASSI-3) was assessed among northern plains American Indians (AIs). The current study examined the efficacy of the SASSI-3 for identification of substance abuse in AIs. Northern plains AIs from 7 reservations participated in the study. The participants were either a clinical sample receiving substance abuse (SA) or mental health diagnoses from behavioral health clinicians and receiving outpatient treatment services or a community sample that had no substance abuse or mental health diagnoses and were not currently in treatment (no diagnosis). The internal consistency for Face Valid Alcohol (FVA), Face Valid Other Drugs, and Symptoms (SYM) subscales were excellent, and the consistency for the other subscales was moderate, ranging from .21 to 73. The results of the study suggest that the SASSI-3 has good positive predictive power (PPP) and negative predictive power (NPP), particularly when the criterion group substance abuse is larger in the sample. Additionally, the PPP and NPP varied depending on the decision rules. For the analysis that included individuals with just SA, the clinical group scored significantly higher than the no diagnosis group on all measures of the SASSI-3, except for Defensiveness. When the SA group included all individuals with the diagnosis (regardless of the comorbid diagnosis), the clinical group scored significantly higher than the no diagnosis group for all the SASSI-3 subscales. A discriminant examination of the standardized function coefficients indicated that the FVA and SYM subtests contributed the most to the function. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluating Ceftriaxone 80 mg/kg Administration by Rapid Intravenous Infusion-A Clinical Service Evaluation.

In pediatric ambulatory care, the speed of medication infusion can have major impact on healthcare staff workload and the number of children able to be treated by services designed to reduce inpatient length of stay. In many regions of the world, local and supraregional guidelines allow ceftriaxone infusions of ≥50 mg/kg in infants and children up to 12 years of age to be given over 10 minutes. The generic European summary of product characteristics for ceftriaxone does not state a specific infusion time for this dose range, although 1 manufacturers' summary of product characteristics in the United Kingdom states a 30-minute minimum infusion time. We conducted a formal service evaluation of a change in practice at a large UK pediatric children's hospital and demonstrated the clinical feasibility, safety, and high parent satisfaction of 10-minute ceftriaxone infusions for prescribed doses ≥50 mg/kg. This approach can improve patient flow within hospital-based ambulatory services as well as by community nursing teams administering antibiotics at home.

Suicidal behaviors among American Indian/Alaska Native firefighters: Evidence for the role of painful and provocative events.

Firefighters represent a group at elevated suicide risk. Identifying segments of the fire service at increased risk may facilitate the targeted provision of suicide prevention initiatives. Among the general population, American Indian/Alaska Native (AI/AN) individuals report higher rates of suicide attempts. This study sought to examine suicide attempt rates among AI/AN firefighters and to determine if greater exposure to painful and provocative events and/or fearlessness about death explains the relationship between AI/AN identity and suicidal behaviors. A total of 917 US firefighters completed a web-based mental health survey (6.2% AI/AN). Participants completed a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form, the Painful and Provocative Events Scale, and the Acquired Capability for Suicide Scale-Fearlessness About Death scale. Bootstrap mediation analyses were conducted, controlling for years of service as a firefighter. Although AI/AN firefighters accounted for only 6.2% of the sample, they accounted for 34.4% of the career suicide attempts. AI/AN firefighters were 16.31 (95% CI = 7.96, 33.42) times more likely to report a career suicide attempt history than non-AI/AN firefighters, adjusting for years of service as a firefighter. Painful and provocative events, but not fearlessness about death, was a statistically significant mediator of the relationship between AI/AN identity and suicide attempts. Firefighters identifying as AI/AN represent a subgroup within the fire service at increased risk for suicide. Findings suggest that greater exposure to painful and provocative events among AI/AN firefighters may explain the elevated suicide risk among this population.

Wac'inyeya: Hope Among American Indian Youth.

This article examines what gives American Indian youth hope. The project included 56 rural tribal youth in focus groups across a Northern Plains reservation. The participants completed a Youth Personal Balance Tool to provide perspective on the balance according to a medicine wheel model of their lives. The focus groups asked questions from a strengths-based perspective about what gives them hope and how they could show others they were hopeful. The project culminated with the youth developing creative representations of hope and presenting these projects to family and community.

Psychometric evaluation of depression measures with Northern Plains Indians.

Numerous psychometric measurements are used to assess for mental health problems in Native American and Alaskan Native (AI/AN) populations; however, few studies have been carried out to assess their validity and reliability within these populations. This study was designed to assess the validity and reliability of numerous measures among the Northern Plains Indians. This article is a partial report, focused on the psychometric measures directed at detecting depression, namely the Beck Depression Inventory (BDI) II, the Center for Epidemiologic Studies Depression (CES-D) Scale, the Tri-Ethnic Depression Scale (TEDS), the Beck Hopelessness Scale (BHS), the Beck Anxiety Inventory (BAI), and the Symptom Checklist-90-Revised (SCL-90-R). Results revealed moderate to strong correlation across all measures, alpha coefficients that exceeded published alphas for the general population, and overall indicated their validity and reliability of these measures, and a 2-factor solution for the BDI-II. While there were limitations to the study, analysis of the results supports the use of each measure with the Northern Plains Indians (NPI) subpopulation, that the NPI subpopulation scored similar to the general population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Assessment of anxiety among Northern Plains Indians.

This study is an examination of the reliability and validity of the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) in a sample of NPIs (N = 529). Validity was assessed by comparing BAI scores among 3 different diagnostic categories in a clinical sample (anxiety disorder, mood disorder, and comorbid anxiety/mood disorder diagnostic groups) and a community sample of participants with no self-reported mental health diagnoses. The BAI was also compared with depression, quality of life, and anxiety measures to assess validity. Support toward the validity of the BAI was demonstrated through high correlations with similar measures of anxiety, as well as higher scores among the clinical samples compared to the control sample. The BAI also demonstrated strong internal consistency (α = .95). An exploratory factor analysis indicated the presence of 3 factors: (a) fear, (b) cardiorespiratory, and (c) body instability symptoms. The BAI was unable to accurately differentiate between mood disorder and anxiety disorder groups. Results of this study indicate that the BAI may be a useful instrument in the assessment of anxiety with NPIs; however, the BAI is potentially unsuited to differentiating between mood disorders and anxiety disorders with this population. (PsycINFO Database Record

Suicide terrorism and post-mortem benefits.

Lankford claims that suicide terrorists are suicidal, but that their suicidal tendencies are often frustrated by injunctive social norms. Martyrdom represents a solution, and terrorist organizations exploit this. In this commentary, we claim that this argument has not been fully made and that such ideation in itself does not explain a willingness to engage in punitive actions against an enemy. We suggest the psychology of kinship as a possible missing factor.

Growing our own: building a native research team.

In 2006, American Indian/Alaska Natives (AI/AN) made up less than 1% of the science, engineering and health doctorates in the U.S. Early introduction of AI/AN students to research and continued opportunities are necessary to develop successful AI/AN researchers who can better serve their communities. This team was developed to form a cohort of American Indian students, staff and faculty interested in research and becoming researchers. Since implementation, the program grew from one student to over 20 AI students ranging from freshmen just entering college to doctoral students working to complete their dissertations. This article highlights the team growth, increasing structure, student needs and the faculty and staff involved. It further addresses the support and educational aspects of growing an ongoing, multidisciplinary research team committed to ethical research in Native communities. The team addresses substance use prevalence, the relationship of substance abuse to other mental health diagnoses, and treatment issues. The team includes weekly team meetings, a Blackboard site on the Internet that is populated with resources and focused on sharing materials and information, a weekly journal club discussion of research articles, and collaborative discussions on each project and the barriers and challenges that need to be addressed to move forward.

Circle of strength: a case description of culturally integrated suicide prevention.

This article presents a case description of an American Indian female at high risk for suicide in effort to document the potential effectiveness of a college student suicide prevention program designed for Northern Plains American Indian students. The program is integrative and culturally grounded within the Medicine Wheel, stressing continuity of care through programming and ongoing communication across support systems. The composite case description presented illustrates the secondary prevention aspects of the model, and how utilizing the model within the framework of continuous care was helpful for a suicidal person and produced a successful outcome over the course of 6 months.

Multiple step pattern as a biomarker in Parkinson disease.

OBJECTIVE: To evaluate quantitative measures of saccades as possible biomarkers in early stages of Parkinson disease (PD) and in a population at-risk for PD. METHODS: The study sample (n=68) included mildly to moderately affected PD patients, their unaffected siblings, and control individuals. All participants completed a clinical evaluation by a movement disorder neurologist. Genotyping of the G2019S mutation in the LRRK2 gene was performed in the PD patients and their unaffected siblings. A high resolution, video-based eye tracking system was employed to record eye positions during a battery of visually guided, anti-saccadic (AS), and two memory-guided (MG) tasks. Saccade measures (latency, velocity, gain, error rate, and multiple step pattern) were quantified. RESULTS: PD patients and a subgroup of their unaffected siblings had an abnormally high incidence of multiple step patterns (MSP) and reduced gain of saccades as compared with controls. The abnormalities were most pronounced in the more challenging version of the MG task. For this task, the MSP measure demonstrated good sensitivity (87%) and excellent specificity (96%) in the ability to discriminate PD patients from controls. PD patients and their siblings also made more errors in the AS task. CONCLUSIONS: Abnormalities in eye movement measures appear to be sensitive and specific measures in PD patients as well as a subset of those at-risk for PD. The inclusion of quantitative laboratory testing of saccadic movements may increase the sensitivity of the neurological examination to identify individuals who are at greater risk for PD.

Screening mammography: does ethnicity influence patient preferences for higher recall rates given the potential for earlier detection of breast cancer?

PURPOSE: To prospectively survey the preferences of an underserved and predominantly minority population of women regarding their understanding of screening mammography, desire for recall and early detection, and willingness to continue with annual screening mammography once given a false-positive result. MATERIALS AND METHODS: A total of 1011 women who were going to undergo mammography completed a HIPAA-compliant, Institutional Review Board-approved, validated survey in one of three languages: English, Spanish, or Haitian-Creole. Data were analyzed across three groups (ie, white, black, Hispanic) by using chi(2) analysis. RESULTS: Of 911 women included in the final analysis, 378 (41%) were white, 439 (48%) were black, and 94 (10%) were Hispanic. Income and education levels varied significantly across ethnicities (P < .0001). A higher percentage of white women (40%) correctly identified the sensitivity of mammography (P < .0001), while black (42%) and Hispanic (50%) participants thought mammography to have a higher sensitivity than it truly does. After a false-positive result, only 80% of black women and 71% of Hispanic women were likely to continue with screening in the future, compared with 93% of white women (P < .0001). Only 54% of black women and 59% of Hispanic women were willing to return for a second noninvasive procedure despite the possibility of a higher cancer detection rate, compared with 76% of white women (P < .0001). Black women (53%) were also more reluctant to be recalled for invasive studies, and Hispanic women (65%) were slightly less willing to take this risk than were white women (75%) (P < .0001). CONCLUSION: Differences in ethnic background appear to influence women's understanding of mammography, compliance with recall, and preference for early detection of breast cancer.

Visual perception in prediagnostic and early stage Huntington's disease.

Disturbances of visual perception frequently accompany neurodegenerative disorders but have been little studied in Huntington's disease (HD) gene carriers. We used psychophysical tests to assess visual perception among individuals in the prediagnostic and early stages of HD. The sample comprised four groups, which included 201 nongene carriers (NG), 32 prediagnostic gene carriers with minimal neurological abnormalities (PD1); 20 prediagnostic gene carriers with moderate neurological abnormalities (PD2), and 36 gene carriers with diagnosed HD. Contrast sensitivity for stationary and moving sinusoidal gratings, and tests of form and motion discrimination, were used to probe different visual pathways. Patients with HD showed impaired contrast sensitivity for moving gratings. For one of the three contrast sensitivity tests, the prediagnostic gene carriers with greater neurological abnormality (PD2) also had impaired performance as compared with NG. These findings suggest that early stage HD disrupts visual functions associated with the magnocellular pathway. However, these changes are only observed in individuals diagnosed with HD or who are in the more symptomatic stages of prediagnostic HD.

Are cognitive changes progressive in prediagnostic HD?

OBJECTIVE: To characterize neurocognitive signs of disease progression in prediagnosis and early Huntington disease (HD) and compare the sensitivity of 2 disease staging classification schemes for detecting these signs. METHODS: Three hundred and six individuals at-risk for or recently diagnosed with HD completed the Unified Huntington's Disease Rating Scale, genetic testing, and a neurocognitive battery. Two schemes were used to estimate latency to onset of disease. One was based on genetic information (CAG repeat length) and the other was based on the extent of motor signs. Effect sizes were compared to assess the relative sensitivity of the 2 schemes for detecting signs of disease progression. RESULTS: CAG-expanded participants far from estimated diagnosis performed similarly to controls, whereas those near to estimated diagnosis were impaired relative to controls. Overall, the method employing genetic information yielded larger effect sizes than the motor scheme, particularly for strategic and executive function measures; the motor scheme resulted in a larger effect size for a measure of motor/psychomotor function. CONCLUSIONS: Neurocognitive function is not uniformly affected in prediagnosis and early HD; individuals near to their estimated age of diagnosis have cognitive signs similar to HD, whereas individuals far from estimated diagnosis appear cognitively normal. Classification schemes that incorporate both genetic and phenotypic information may be more sensitive for tracking neurocognitive signs of disease progression.

Specific psychiatric manifestations among preclinical Huntington disease mutation carriers.

BACKGROUND: Despite the need for significant clinical intervention owing to the psychiatric manifestations of Huntington disease (HD), there has been a paucity of studies specifically designed to evaluate these symptoms prior to disease diagnosis. OBJECTIVES: To investigate whether the Symptom Checklist 90-Revised (SCL-90-R) and the Center for Epidemiological Studies Depression Scale can be used to detect psychiatric manifestations among preclinical mutation carriers with absent or minimal motor signs of HD. DESIGN, SETTING, AND PARTICIPANTS: Individuals at risk for or recently diagnosed with HD were recruited and then evaluated at Indiana University School of Medicine, Indianapolis. All of the subjects completed a uniform clinical evaluation that included the Unified Huntington's Disease Rating Scale-99, molecular testing to determine HD mutation status, the SCL-90-R, and the Center for Epidemiological Studies Depression Scale. The sample was divided into 4 study groups: 171 individuals in the nonmutation carrier group; 29 with minimal, if any, motor signs of HD in the preclinical mutation carrier group 1; 20 with motor abnormalities suggestive of HD in the preclinical mutation carrier group 2; and 34 in the manifest HD group. MAIN OUTCOME MEASURES: Scores on the SCL-90-R and Center for Epidemiological Studies Depression Scale were compared. RESULTS: Five SCL-90-R symptom dimensions (obsessive-compulsive, interpersonal sensitivity, anxiety, paranoid ideation, and psychoticism) demonstrated a significant group effect (P < or = .04). The preclinical mutation carrier group 2 and the manifest HD group scored significantly higher on all 5 dimensions as compared with the nonmutation carrier group. The preclinical mutation carrier group 2 scored significantly higher than the nonmutation carrier group for 3 of the SCL-90-R symptom dimensions (anxiety, paranoid ideation, and psychoticism). A significant group effect was found on the Center for Epidemiological Studies Depression Scale (P = .04). The frequency of depressive symptoms was significantly higher in the manifest HD group and the preclinical mutation carrier group 2 as compared with the nonmutation carrier group. CONCLUSION: This study identified specific psychiatric symptom dimensions that differentiate nonmutation carriers from individuals in the early preclinical stages of HD who are either symptom free or have minor nonspecific motor abnormalities.

The assessment of the prognosis of musculoskeletal conditions in older adults presenting to general practice: a research protocol.

BACKGROUND: Musculoskeletal conditions represent a common reason for consulting general practice yet with the exception of low back pain, relatively little is known about the prognosis of these disorders. Recent evidence suggests that common 'generic' factors may be of value when assessing prognosis, irrespective of the location of the pain. This study will test a generic assessment tool used as part of the general practice consultation to determine prognosis of musculoskeletal complaints. METHODS/DESIGN: Older adults (aged 50 years and over) presenting to six general practices with musculoskeletal complaints will be assessed as part of the routine consultation using a generic assessment of prognosis. Participants will receive a self-completion questionnaire at baseline, three, six and 12 months post consultation to gather further data on pain, disability and psychological status. The primary outcome measure is participant's global rating of change. DISCUSSION: Prognosis is considered to be a fundamental component of scientific medicine yet prognostic research in primary care settings is currently neglected and prognostic enquiry is disappearing from general medical textbooks. This study aims to address this issue by examining the use of generic prognostic factors in a general practice setting.

Venezuelan kindreds reveal that genetic and environmental factors modulate Huntington's disease age of onset.

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease caused by a triplet (CAG) expansion mutation. The length of the triplet repeat is the most important factor in determining age of onset of HD, although substantial variability remains after controlling for repeat length. The Venezuelan HD kindreds encompass 18,149 individuals spanning 10 generations, 15,409 of whom are living. Of the 4,384 immortalized lymphocyte lines collected, 3,989 DNAs were genotyped for their HD alleles, representing a subset of the population at greatest genetic risk. There are 938 heterozygotes, 80 people with variably penetrant alleles, and 18 homozygotes. Analysis of the 83 kindreds that comprise the Venezuelan HD kindreds demonstrates that residual variability in age of onset has both genetic and environmental components. We created a residual age of onset phenotype from a regression analysis of the log of age of onset on repeat length. Familial correlations (correlation +/- SE) were estimated for sibling (0.40 +/- 0.09), parent-offspring (0.10 +/- 0.11), avuncular (0.07 +/- 0.11), and cousin (0.15 +/- 0.10) pairs, suggesting a familial origin for the residual variance in onset. By using a variance-components approach with all available familial relationships, the additive genetic heritability of this residual age of onset trait is 38%. A model, including shared sibling environmental effects, estimated the components of additive genetic (0.37), shared environment (0.22), and nonshared environment (0.41) variances, confirming that approximately 40% of the variance remaining in onset age is attributable to genes other than the HD gene and 60% is environmental.