Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study.

BACKGROUND: Early intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. In the latter category, are teams ('First-episode Services' or FES) that integrate several empirically supported treatments and adapt their delivery to younger patients and caregivers. There is an urgent need to hasten access to established FES in the U.S. Despite improved outcomes for those in treatment, these FES routinely engage patients a year or more after psychosis onset. The Scandinavian TIPS study was able to effectively reduce DUP in a defined geographic catchment. The guiding questions for this study are: can a U.S. adaptation of the TIPS approach to ED substantially reduce DUP and improve outcomes beyond existing FES? METHODS/DESIGN: The primary aim is to determine whether ED can reduce DUP in the US, as compared to usual detection. ED will be implemented by one FES (STEP) based in southern Connecticut, and usual detection efforts will continue at a comparable FES (PREP(R)) serving the greater Boston metropolitan area. The secondary aim is to determine whether DUP reduction can improve presentation, engagement and early outcomes in FES care. A quasi-experimental design will compare the impact of ED on DUP at STEP compared to PREP(R) over 3 successive campaign years. The campaign will deploy 3 components that seek to transform pathways to care in 8 towns surrounding STEP. Social marketing approaches will inform a public education campaign to enable rapid and effective help-seeking behavior. Professional outreach and detailing to a wide variety of care providers, including those in the healthcare, educational and judicial sectors, will facilitate rapid redirection of appropriate patients to STEP. Finally, performance improvement measures within STEP will hasten engagement upon referral. DISCUSSION: STEP-ED will test an ED campaign adapted to heterogeneous U.S. pathways to care while also improving our understanding of these pathways and their impact on early outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02069925 . Registered 20 February 2014.

The effects of change in spousal power on intimate partner violence among Chinese immigrants.

This study explored how changes in power relations within couples after immigrating from more patriarchal societies contribute to intimate partner violence (IPV). Both subjective decision-making power and objective power bases were examined in Chinese immigrant couples. Batterers and nonviolent men both experienced loss of decision-making power in favor of their spouses postimmigration. For the batterers, this loss appeared materialized by lower gains in education and lack of significant gains in income compared to their spouses. However, it was subjective power loss that was related to the batterers' attitudes toward IPV. The study highlights the significance of understanding changes in power dynamics postimmigration among immigrants and the importance of distinguishing between subjective and material power to better capture power imbalance within couples.

Hostile attributional bias, early abuse, and social desirability in reporting hostile attributions among Chinese immigrant batterers and nonviolent men.

This study examined differences in reporting hostile attributional bias (HAB) between court-referred Chinese immigrant batterers and a nonviolent community sample. It measured social desirability (SD) in their reporting of HAB by including an SD measure and a covert indirect measure of HAB. Further, it explored the relationship between HAB and childhood exposure to violence. The batterers scored lower on the overt measure but higher on the covert measure of HAB. Their scores on the overt measure were negatively correlated with their SD scores. Childhood exposure to violence was positively correlated with HAB among the batterers but not among the nonviolent men. The role of HAB in intimate partner violence needs more research, and future studies and batterer interventions need to consider SD in assessing and addressing HAB.