The Barriers to Mental Health Services Scale Revised: Psychometric Analysis Among Older Adults.

OBJECTIVES: Older adults underutilize mental health services suggesting that significant barriers are operating. This study presents reliability and validity data for a revised version of the self-report Barriers to Mental Health Services Scale (BMHSS) designed to quantify 10 barriers to mental health service use, so that barriers can be examined collectively. METHODS: The Barriers to Mental Health Services Scale Revised (BMHSS-R) was revised to improve its reliability and validity, including adding items, eliminating poor items, and balancing the number of items across subscales. A sample of 100 older adults (M age = 72.1 years, SD = 17.8 years) completed the BMHSS-R, the Beliefs Toward Mental Illness Scale, and the Willingness to Seek Help Questionnaire. RESULTS: Internal consistency for the 10 subscales of the BMHSS-R ranged between .63 and .87, with 8 of the 10 values greater than .70. Correlational analyses indicated that many of the subscales overlap considerably but are still distinct. Convergent validity of the BMHSS-R subscales of help-seeking and stigma was partially supported, although correlations were modest. CONCLUSION: Revisions to the BMHSS resulted in improved reliability estimates for use as a measure of perceived barriers to mental health services. We recommend when using the BMHSS-R to combine results with other information (e.g., service utilization data) to characterize a profile of barriers. We discuss directions for future research and further refinement of the BMHSS-R.

Motivational and cognitive pathways to medical help-seeking for Alzheimer's disease: a cognitive impairment response model.

OBJECTIVES: Relationships among cognitive and motivational factors in predicting medical help-seeking for Alzheimer's disease (AD) symptoms were tested. METHOD: Community residents awaiting jury service (N = 280) completed questionnaires, including responses to a vignette depicting prototypical early symptoms of AD in a hypothetical mother. Cognitive responses to the vignette included AD symptom identification and AD attribution. Affective-motivational responses to vignettes were symptom impact and behavior appraisals. General knowledge of AD was assessed. Intention to seek medical help was the dependent variable. RESULTS: The impact and identification of AD symptoms, appraisals of risk, and attribution of the scenario to AD were modest, yet all contributed to prediction of medical-help-seeking intentions. The best fitting model had distinct but interrelated cognitive and motivational paths explaining 49% of the variability in medical help-seeking. Motivational variables had particularly important direct and indirect effects on help-seeking. DISCUSSION: Findings are interpreted as evidence of the importance of motivational as well as cognitive aspects of perceptions of illness behavior in another person. The substantial impact of the tested variables on the desired outcome of medical help-seeking may suggest options for public health efforts to enhance early medical help-seeking for AD that sets the stage for early intervention.

Utility of the SLUMS as a cognitive screening tool among a nonveteran sample of older adults.

OBJECTIVES: To investigate the concurrent validity of the Saint Louis University Mental Status examination (SLUMS) by comparing the ability of the Mini-Mental State Examination (MMSE) and the SLUMS to predict performance on standard neuropsychological measures of memory and executive functioning. DESIGN: Cross-sectional. SETTING: University-based research clinic. PARTICIPANTS: Community-dwelling adults (N = 170) age 60 years and older (Mage = 73.08; SD = 8.18). MEASUREMENTS: The Trail Making Test (TMT), Rey Auditory Verbal Learning Test, Wisconsin Card Sorting Test (WCST), MMSE, and SLUMS. RESULTS: The distributional properties of the SLUMS and the MMSE were directly compared. The SLUMS showed statistically a smaller mean, lower rank scores, and less skewness than the MMSE. Comparisons of the correlations of the screening tests with the neuropsychological measures indicated that the SLUMS demonstrated stronger relationships with the TMT compared with the MMSE. Multiple regression analyses were conducted to determine the ability of the SLUMS and the MMSE to predict scores on common neuropsychological tests after controlling for demographic variables. Results demonstrated that the SLUMS significantly predicted performance across all measures over the MMSE and demographic variables, with the exception of the WCST's perseverative errors. However, the MMSE does not add to the prediction of neuropsychological functioning over the SLUMS. CONCLUSION: Although the SLUMS and the MMSE are strongly correlated, the SLUMS significantly adds to the prediction of neuropsychological measures beyond the MMSE scores. Our findings suggest that the SLUMS may be an appropriate measure to use as a screening tool among older adults and may have fewer ceiling effects than the MMSE.

A longitudinal study of administrative segregation.

The use of administrative segregation for inmates with and without mental illness has generated considerable criticism. Segregated inmates are locked in single cells for 23 hours per day, are subjected to rigorous security procedures, and have restricted access to programs. In this study, we examined whether inmates in segregation would show greater deterioration over time on psychological symptoms than would comparison offenders. The subjects were male inmates, with and without mental illness, in administrative segregation, general population, or special-needs prison. Subjects completed the Brief Symptom Inventory at regular intervals for one year. Results showed differentiation between groups at the outset and statistically significant but small positive change over time across all groups. All groups showed the same change pattern such that there was not the hypothesized differential change of inmates within administrative segregation. This study advances the empirical research, but replication research is needed to make a better determination of whether and under what conditions harm may or may not occur to inmates in solitary confinement.

Subjective organization, verbal learning, and forgetting across the life span: from 5 to 89.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Previous tests of the relationship between subjective organization during encoding, aging, and recall have produced inconsistent findings. The present study investigates subjective organization and the acquisition and recall of verbal material across the life span (from 5 to 89 years of age) using two measures, the intertrial repetition paired frequency (PF) measure and the unidirectional subjective organization (SO) measure. METHODS: Participants (N = 2656) were administered a version of the Rey Auditory Verbal Learning Test, including a delayed recall trial. Analyses of variance (ANOVAs) were performed to examine the relationship between age and subjective organization and between age and recall. Mediation and growth curve analyses were performed to further examine the relationship between age, verbal acquisition, and subjective organization. RESULTS: Subjective organization was not predictive of verbal forgetting. Deficits in verbal acquisition and subjective organization were detected among children and elderly adults. Mediational analyses showed that age affected the number of words recalled as well as subjective organization, and that subjective organization affected the number of words recalled in children, young adults and elderly. Latent growth curve modeling suggests that increases in subjective organization over time are related to increases in recall over time for each age group. CONCLUSION: Subjective organization is predictive of recall, and both subjective organization and recall are lowest among children and elderly individuals. Age has direct effects on recall but this effect is partially mediated by subjective organization. Brain imaging studies showing increased prefrontal cortex activation during encoding of remembered words bolster our findings that age affects the relationship between verbal learning and organization of material during encoding.

Analysis of the psychometric properties of the Interpersonal Needs Questionnaire (INQ) among community-dwelling older adults.

OBJECTIVES: This study evaluated the structure and validity of the use of the 18-item Interpersonal Needs Questionnaire (INQ-18), a measure of thwarted belongingness (TB) and perceived burdensomeness (PB), among older adults. METHOD: Community-dwelling older adults (N = 284; mean age = 73 years; age range = 64-96 years; 56% women) anonymously completed a questionnaire packet. RESULTS: Principal axis factor analysis indicated that two factors should be retained. Items in the first factor reflected the concept of TB, whereas items in the second factor were consistent with the concept of PB. Both factors had medium-to-large positive correlations with hopelessness, depression, suicide ideation, and low meaning in life, providing evidence for convergent validity. CONCLUSIONS: Findings from this study support the use of the INQ-18 among community-dwelling older adults.

Prevalence of ADHD and its subtypes in male and female adult prison inmates.

There are few published studies of attention-deficit/hyperactivity disorder (ADHD) in adult inmates, and even fewer studies that have considered ADHD in adult inmates by gender. The present study examined the prevalence of ADHD, its subtypes, and associated psychological and neuropsychological comorbidity as a function of gender in a sample of 3,962 inmates (3,439 men and 523 women; mean age = 33.6 years, range 17-73) who had completed the 250-item, self-report, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (Text Revision) (DSM-IV-TR)-aligned Coolidge Correctional Inventory (CCI). The overall ADHD prevalence rate found was 10.5%, which is substantially higher than the rate among adults in the general population (2-5%). The female inmate ADHD prevalence rate (15.1%) was higher than the male inmate ADHD rate (9.8%), consistent with some previous studies. The most prevalent ADHD subtype for both genders was the hyperactive-impulsive subtype. The combined and inattentive ADHD subtypes had higher levels of comorbid psychopathology than the hyperactive-impulsive ADHD subtype. As the presence of ADHD and associated gender differentials may impact the success of rehabilitation and educative programs with inmates, the assessment of ADHD and comorbid psychopathology should be a priority in initial inmate screening and evaluation.

Age effects on emotion recognition in facial displays: from 20 to 89 years of age.

UNLABELLED: BACKGROUND/STUDY CONTEXT: An emotion recognition task that morphs emotional facial expressions from an initial neutral expression to distinct increments of the full emotional expression was administered to 482 individuals, 20 to 89 years of age. METHODS: Participants assessed six basic emotions at 25%, 50%, 75%, and 100% of the full facial expression. RESULTS: Participants in the three oldest age groups (60s, 70s, and 80s) demonstrated decreased performance for the recognition of the fear, anger, and sad emotions. Increased age was associated with increased recognition rates for the disgust expression, whereas no age effect was detected for the happy and surprise expressions. Covariate analyses revealed age effects were reduced by processing speed, but were unaffected by decision-making ability. The effects of age on individual emotions and levels of presentation are discussed. CONCLUSION: These findings suggest that age has the greatest impact on the recognition of the sad emotion and the greatest age effect at the 50% level of presentation across the adult life span.

Psychometric properties of the Coolidge Correctional Inventory in a sample of 3,962 prison inmates.

The present study reports on the preliminary psychometric characteristics of a new personality and neuropsychological, 250-item, self-report measure, the Coolidge Correctional Inventory (CCI), in an archival de-identified sample of 3,962 prison inmates. The median internal reliability for the 33 CCI scales and subscales was alpha = .79 (range: alpha = .49 to .93). A prevalence estimate, based on the polythetic criteria in DSM-IV-TR, of at least one personality disorder was 61% of the entire sample, and the prevalence of ADHD was estimated to be 16%. Drug and alcohol problems were also highly prevalent (60%). These results appear to support the preliminary reliability and validity of the CCI and also reveal a high rate of psychopathology and neuropsychological dysfunction among prison inmates.

Multiphase mixed-effects models for repeated measures data.

Behavior that develops in phases may exhibit distinctively different rates of change in one time period than in others. In this article, a mixed-effects model for a response that displays identifiable regimes is reviewed. An interesting component of the model is the change point. In substantive terms, the change point is the time when development switches from one phase to another. In a mixed-effects model, the change point can be a random coefficient. This possibility allows individuals to make the transition from one phase to another at different ages or after different lengths of time in treatment. Two examples are reviewed in detail, both of which can be estimated with software that is widely available.