Leadership Styles Experienced During Military Service Predict Later Anhedonic Depressive Symptoms and Self-Efficacy in Veterans With Alcohol Use Disorder.

INTRODUCTION: Lifetime and past-year alcohol use disorder (AUD) prevalence is significantly higher in US Armed Services Veterans than in non-veterans across adulthood. This study examined the associations of perceived transformational leadership styles (TLS) experienced during military service and anhedonic depression and self-efficacy related to confidence to abstain or reduce alcohol consumption in Veterans seeking treatment for AUD. The ramifications of perceived leadership styles on multiple aspects of follower psychiatric functioning, including depressive and PTSD symptomatology, during and after military service, may be substantial and enduring. Higher anhedonic depression and lower abstinence self-efficacy are related to increased risk of relapse after treatment. We predicted Veterans, in treatment for AUD, who reported higher perceived levels of transformational leadership during military service, demonstrate lower anhedonic depressive symptoms and higher alcohol abstinence self-efficacy. MATERIALS AND METHODS: Veterans with AUD (n = 60; 50 ± 14 years of age) were recruited from residential treatment at the VA Palo Alto Health Care System. All procedures were approved by the VA Palo Alto Health Care System and Stanford University institutional review boards. A series of mediation analyses were completed with The Multifactor Leadership Questionnaire measures of TLS (average across leadership measures [transformational leadership average; TLS average]) as predictor and the Alcohol Abstinence Self-Efficacy Scale, Mood and Anxiety Symptom Questionnaire, anhedonic depression subscale, as dependent measures. PTSD Checklist for DSM-5 score was tested as a mediator variable. RESULTS: Higher reported perceived TLS average during military service was significantly related to lower anhedonic depressive symptoms. Higher TLS average was related to higher self-efficacy to resist alcohol use in contexts involving experience of physical issues and withdrawal/cravings and urges. These relationships were not mediated by PTSD symptomatology or duration of military service, age, education, time since military service, military branch, combat exposure, or current psychiatric diagnosis. CONCLUSIONS: The significant associations of perceived TLS during military service with anhedonic depression and alcohol use self-efficacy are clinically relevant because these measures are associated with relapse risk after AUD treatment. Further study of the implications of perceived TLS during military service for AUD and other substance use disorder treatment outcome is warranted in Veterans.

Exploring the Motivation to Lead in a Demanding Environment: The Role of Achievement Values, Grit, and Psychological Capital.

As leaders across organizational contexts continue to face volatile and often stressful environments, a greater understanding of the psychological underpinnings of the motivation to lead (MTL) in challenging circumstances is needed. Based on a sample of 242 cadets holding leadership positions in a military college, we utilized a distal and proximal conceptualization of MTL to test achievement values, grit, and psychological capital (PsyCap) as antecedents to the three factors of MTL. Controlling for gender, prior leadership positions, and leader tenure, regression modeling revealed grit and achievement values to be positively associated with affective/identity MTL, while PsyCap was positively associated with all three MTL factors. In addition, PsyCap mediated the relation between grit and all three MTL factors. Our findings suggest that PsyCap plays a critical proximal role in MTL in demanding environments, and further implications for research and practice are discussed.

Combat Experiences Link With Posttraumatic Growth Among Veterans Across Conflicts: The Influence of PTSD and Depression.

Research has established posttraumatic growth as a potential outcome of highly stressful experiences such as combat. However, a deeper understanding of this relationship is needed to provide practical implications for clinical work and to influence new research directions. We examined the relation between combat experiences and posttraumatic growth along with its subscales, as well as the influence of posttraumatic stress disorder and depression symptom severity. The study contained a sample of 130 combat veterans representing a variety of deployment locations. Regression analysis revealed combat experiences to be associated with posttraumatic growth beyond the effect of age (ß = 0.21; p = 0.014). In addition, the association between combat experiences and posttraumatic growth was most evident among those endorsing low levels of depression symptom severity (partial η squared = 0.07; p = 0.009). These results highlight the need to consider negative cognitions and other depressive symptoms as potential barriers to posttraumatic growth.

Refining the metamemory in adulthood questionnaire: a 20-item version of change and capacity designed for research and clinical settings.

Objective: Subjective memory concerns (SMCs) might be an early indicator of future cognitive decline and conversion to dementia. However, a rich history of mixed findings, moderating factors, and heterogenous methods preclude the usefulness of SMCs in both research and clinical settings. The present study aimed to review some of the factors that might cause mixed results and propose a revised version the Metamemory in Adulthood (MIA) Questionnaire that can be easily implemented to more consistently derive estimates of SMCs.Method: We used factor analysis and regression to investigate the utility of a revised 20-item version of the MIA Change and Capacity subscales.Results: Based on two samples of older adults (N = 382 and N = 221), the revised scale showed strong internal reliability and a two-factor structure. Regression analyses supported the incremental validity of the MIA-Revised Change scale in predicting performance on the Rivermead Behavioural Memory Test.Conclusions: By establishing a revised version of a well-known and previously validated questionnaire to assess SMCs, research and clinics can better implement a psychometrically sound measure quickly and easily. Moreover, the revised Change and Capacity subscales provide sufficient divergence to be sensitive to different facets of SMCs in a community dwelling older adult sample.

Military Environmental Exposure Concerns, Posttraumatic Stress Disorder, and Somatic Symptoms: Their Interrelation Among Treatment-Seeking Veterans.

OBJECTIVE: Research suggests military environmental exposure concerns are associated with negative health outcomes. This study investigated the relationship among exposure concerns, Posttraumatic Stress Disorder (PTSD), and somatic symptoms to enhance post-deployment health care programs for veterans. METHODS: We analyzed intake health data from a heterogeneous sample of predominantly Operation Desert Storm/Shield and Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans (N = 247). RESULTS: Individual exposure concerns and somatic symptoms were associated with higher PTSD symptom severity. Regression modeling demonstrated total exposure concerns and PTSD symptom severity linked with total somatic symptom severity. Mediation modeling revealed PTSD symptom severity to partially explain the relation between exposure concerns and somatic symptoms. CONCLUSIONS: These findings illustrate the need for integrative treatment approaches incorporating physiological and exposure-related concerns associated with PTSD among veterans.

Memory training for adults with probable mild cognitive impairment: a pilot study.

Background & Objectives: This pilot study aimed to evaluate the efficacy of memory training and health training intervention over a 24-month period in people with probable mild cognitive impairment (MCI). Research Design & Methods: Based on the accepted criteria, and the neuropsychiatric measures used in the trial, MCI was defined as a subjective change in cognition, impairment in episodic memory, preservation of independence of functional abilities, and no dementia. Without a neurological assessment, laboratory tests, and psychometric evaluation combined, some of our participants may have had dementia that we were unable to detect through neuropsychological testing. Of the 263 total participants, 39 met criteria for a diagnosis of MCI. There were 19 adults in the memory and 20 in health training conditions. Both groups received twenty hours of classroom content that included eight hours of booster sessions at three months post intervention. Hierarchical linear models (HLM) and standardized regression-based (SBR) analyses were used to test the efficacy of the intervention on immediate recall, delayed recall, subjective memory complaints, and memory self-efficacy. Age, education, depression, racial group, ethnic group, MMSE score, and baseline performance were included as covariates. Results: Over 24 months, the MCI group in the memory training condition showed better objective and subjective memory outcomes compared with the MCI group in the health training condition. Conclusions: Senior WISE Memory training delivered to individuals with MCI was able to forestall the participants' declining cognitive ability and sustain the benefit over two years in both subjective and objective memory function.

Effects of Integrated Telehealth-Delivered Cognitive-Behavioral Therapy for Depression and Insomnia in Rural Older Adults.

BACKGROUND: We examined the effects of integrated cognitive-behavioral therapy for depression and insomnia (CBT-D + CBT-I) delivered via videoconferening in rural, middle aged and older adults with depressive and insomnia symptoms. METHOD: Forty patients with depressive and insomnia symptoms were randomized to receive either 10 sessions of CBT-D + CBT-I or usual care (UC). Patients in the integrated CBT condition were engaged in telehealth treatment through Skype at their primary care clinic. Assessments were conducted at baseline, post-treatment, and 3-month follow-up. RESULTS: CBT-D +CBT-I participants had significantly greater improvements in sleep at post-treatment and 3-month follow-up as compared to the UC participants. The time by group interaction for depression was not significant; both the CBT-D + CBT-I and UC conditions had a decrease in depressive symptoms over time. CONCLUSION: While integrated CBT benefits both depression and insomnia symptoms, its effects on depression are more equivocal. Further research should consider expanding the depression treatment component of integrated CBT to enhance effectiveness.

The role of interpersonal sensitivity, social support, and quality of life in rural older adults.

The mental health of elderly individuals in rural areas is increasingly relevant as populations age and social structures change. While social support satisfaction is a well-established predictor of quality of life, interpersonal sensitivity symptoms may diminish this relation. The current study extends the findings of Scogin et al by investigating the relationship among interpersonal sensitivity, social support satisfaction, and quality of life among rural older adults and exploring the mediating role of social support in the relation between interpersonal sensitivity and quality of life (N = 128). Hierarchical regression revealed that interpersonal sensitivity and social support satisfaction predicted quality of life. In addition, bootstrapping resampling supported the role of social support satisfaction as a mediator between interpersonal sensitivity symptoms and quality of life. These results underscore the importance of nurses and allied health providers in assessing and attending to negative self-perceptions of clients, as well as the perceived quality of their social networks.

A Randomized Controlled Trial of a Therapeutic Intervention for Nursing Home Residents With Dementia and Depressive Symptoms.

OBJECTIVE: The purpose of this study was to conduct a randomized controlled trial of a nursing home intervention to reduce depressive symptoms in residents with dementia. METHOD: The multicomponent intervention included group activity sessions, which used question-asking-reading (QAR), reminiscence, and cognitive-behavioral therapy techniques, as well as environmental supports and individualized behavioral activity programs. Fifty-one residents from five nursing homes participated in the study. RESULTS: A significant difference in depressive symptoms was found, with residents in the QAR-Depression condition showing improvement compared with those in the treatment as usual condition. Residents in the treatment group also exhibited significantly higher levels of expressive verbalizations, engagement with materials, and laughter. Few differences in resident behavior occurring outside of the group activities were noted. DISCUSSION: Findings suggest that structured group activities can positively impact a resident's psychological well-being. In addition, the QAR structure may be suitable for older adults with cognitive impairment by distributing group tasks and providing external cognitive supports.

Pleasant Events, Hopelessness, and Quality of Life in Rural Older Adults.

PURPOSE: Rural older adults are susceptible to depression and reduced quality of life. This study explored contrasting explanations (behavioral vs cognitive route) for the relation of emotional distress with quality of life. METHODS: This retrospective study included rural older adults (N = 134) with reduced quality of life and increased psychological symptoms. Multiple mediation analysis was conducted to test the indirect effect of engagement in pleasant events and hopelessness on the emotional distress and quality of life relation. FINDINGS: Both engagement in pleasant events and hopelessness were found to partially mediate the relation between emotional distress and quality of life. CONCLUSIONS: Targeting both hopelessness and engagement in pleasant events may be helpful in improving the quality of life of vulnerable, rural older adults.

The Effect of Social Support on Quality of Life in Older Adults Receiving Cognitive Behavioral Therapy.

The current study extends the findings of Scogin et al. (2007) by exploring the role of social support in changes in quality of life resulting from home-delivered cognitive behavioral therapy (CBT). One hundred thirty-seven participants, characterized primarily as rural, low resource, and frail, were randomly assigned to either CBT or a minimal support control condition. Hierarchical regression revealed that positive change in satisfaction with social support was associated with improvement in quality of life beyond the effects of the CBT treatment. In addition, pretreatment satisfaction with social support, and change in satisfaction with social support moderated the effect of CBT on quality of life. These results suggest that bolstering social support concomitant to CBT may increase quality of life.

The "Alzheimer's type" profile of semantic clustering in amnestic mild cognitive impairment.

Impairments in learning and recall have been well established in amnestic mild cognitive impairment (aMCI). However, a relative dearth of studies has examined the profiles of memory strategy use in persons with aMCI relative to those with Alzheimer's disease (AD). Participants with aMCI, nonamnestic MCI, AD, and healthy older adults were administered the California Verbal Learning Test-II (CVLT-II). Measures of semantic clustering and recall were obtained across learning and delayed recall trials. In addition, we investigated whether deficits in semantic clustering were related to progression from healthy aging to aMCI and from aMCI to AD. The aMCI group displayed similar semantic clustering performance as the AD participants, whereas the AD group showed greater impairments on recall relative to the aMCI participants. Control participants who progressed to aMCI showed reduced semantic clustering at the short delay at baseline compared to individuals who remained diagnostically stable across follow-up visits. These findings show that the ability to engage in an effective memory strategy is compromised in aMCI, before AD has developed, suggesting that disruptions in semantic networks are an early marker of the disease. (JINS, 2014, 20, 1-11).

Efficacy and process of cognitive bibliotherapy for the treatment of depression in jail and prison inmates.

The purpose of this two-study project was to determine the effects of cognitive bibliotherapy for the treatment of depressive symptoms in jail and prison inmates. Participants in both samples were randomly assigned to either a treatment group that received the 4-week bibliotherapy program or a delayed-treatment control group. In the jail sample, which served as a pilot study for the more detailed prison study, the treatment group showed greater improvement on the A. T. Beck and R. A. Steer Beck Depression Inventory, 1993, Psychological Corporation, San Antonio, TX and the DAS (M. M. Weissman, & A. T. Beck Development and validation of the Dysfunctional Attitudes Scale: A preliminary investigation; paper presented at the meeting of the American Educational Research Association, November, 1978, Toronto, ON, Canada). In the prison sample, results indicated that the treatment group showed greater improvement on the HRSD (M. Hamilton, Development of a rating scale for primary depressive illness, British Journal of Social & Clinical Psychology, Vol. 6, 1967, pp. 278-296) and the A. T. Beck, R. A. Steer, & G. K. Brown Beck Depression Inventory (2nd ed.), 1996, Psychological Corporation, San Antonio, TX. Approximately half of the treated participants achieved clinically significant change. Analyses of the follow-up data revealed maintenance of treatment gains in the prison and jail samples. In the prison study, significant changes were also observed on a general measure of psychological distress. Overall, results suggest that cognitive bibliotherapy may be efficacious for depressed inmates.