Beliefs about mental illness and willingness to seek help: a cross-sectional study.

Evidence indicates that older adults underutilize mental health services, but little is known empirically about the perceptions older adults have about mental illness and their attitudes about seeking professional help for psychological problems. The present study examined beliefs about mental illness and willingness to seek professional help among younger (n=96; M age=20.6 years; range=17-26 years) and older (n=79; M age=75.1 years; range=60-95 years) persons. Participants completed the Beliefs Toward Mental Illness Scale and the Willingness to Seek Help Questionnaire. Older adults had generally similar perceptions of mental illness as younger adults except that older adults were more likely to perceive the mentally ill as being embarrassing and having poor social skills. Older adults also did not report a lower willingness to seek psychological help. Correlational analyses showed that, among older adults, increases in negative attitudes about mental illness (specifically, the view that the mentally ill have poor interpersonal skills) are associated with decreases in willingness to seek psychological services. An implication is that negative stereotypes about mental illness held by some older adults could play a role in their underutilization of mental health services. Other barriers to mental health care are also discussed.

A comparison of suicidal thinking and reasons for living among younger and older adults.

A cross-sectional design was used to examine age-related differences in suicidal thinking and reasons for living among younger (n = 82; M age = 21) and older (n = 82; M age = 68) adults. Volunteers anonymously completed the Beck Scale for Suicide Ideation and the Reasons for Living Inventory. Findings indicated that older adults do not manifest suicidal ideation differently than younger adults. However, there does appear to be some age-related differences in reasons for not committing suicide. Compared to the younger group, the older group reported moral objections and child-related concerns as stronger reasons for not committing suicide. An implication is that the identification of specific reasons that deter individuals from committing suicide may be clinically useful and provide some assistance in suicide prevention efforts.

Personality disorders and coping among anxious older adults.

This study examined the interrelationships among anxiety, personality disorders, and coping strategies in anxious older adults (n = 28; age range = 55-89; mean = 66.0), nonanxious older adults (n = 100, age range = 55-79, mean = 64.6 ), and anxious younger adults (n = 132; age range = 17-30; mean = 20.2). Younger participants were college students and older participants were community-based family members of the students or recruits from local senior centers. Participants completed the Coolidge Axis II Inventory, the Coping Orientations to Problems Experienced scale, and the Brief Symptom Inventory. Results indicated that the prevalence of generalized anxiety states was relatively low and similar in both older and younger groups and dependent on measurement scale and criterion. At least one personality disorder was found in 61% of the older persons group; obsessive-compulsive, schizoid, and avoidant were the most frequently assigned personality disorders. Anxious older adults had elevated rates of dependent and avoidant personality disorder compared with nonanxious older adults. Younger anxious persons were found to have significantly greater personality dysfunction compared with older anxious persons. Finally, coping differences existed between older anxious and older nonanxious adults and between older anxious and younger anxious adults. Implications for diagnosis and treatment of anxiety in older adults were discussed.

Evolution of personality disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.

This article reviews the history and evolution of the diagnosis of personality disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) from its first edition in 1952 through its fourth edition in 1994. The article also traces the earliest origins of personality disorders (e.g., Hippocrates) through the modern foundational works of Pritchard, Schneider, and Horney. Analysis of the changes across the editions of the DSM suggest slow but steady progress in the clarification and classification of personality disorders, although formidable challenges remain. A call for future research as to reliability and validity of personality disorders is made, and suggestions for research are offered.

Relationship between the Millon Clinical Multiaxial Inventory-II and Coolidge Axis II Inventory in chronically mentally ill older adults: a pilot study.

The purpose of this study was to investigate the relationship between two self-report measures of personality disorders in older chronically mentally ill inpatients. A random sample of 30 chronically mentally ill (DSM-III-R schizophrenia, schizoaffective disorder, recurrent major depression) inpatients aged 55 and older completed the Millon Clinical Multiaxial Inventory-II (MCMI-II) and the Coolidge Axis II Inventory (CATI). The personality inventories were concurrently administered in counterbalanced fashion to assess concurrent validity of the CATI and MCMI in this older adult group. Data were submitted for correlational analysis. Median concurrent validity (raw score sums) between the CATI and MCMI-II for the 13 personality disorder scales was moderate (r = .55). Individual scale correlations ranged from -.13 for schizoid disorder to .88 for borderline disorder. Individual scale correlations were somewhat lower than previously reported values, but were above .54 for 7 of 13 disorders. Findings provide preliminary support for use of the CATI and MCMI with chronically mentally ill elders. Suggestions for future research are offered.

Psychometric properties and diagnostic utility of the Beck Anxiety Inventory and the State-Trait Anxiety Inventory with older adult psychiatric outpatients.

In order to assess the psychometric properties and diagnostic utility of the Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI) with older adults, these measures were administered to 217 older adult outpatients with mixed psychiatric disorders. Both the BAI and STAI scales demonstrated high internal reliabilities. The BAI demonstrated good factorial validity, with a somatic anxiety and a subjective anxiety factor emerging. In contrast, the STAI did not evidence factorial validity, with analyses failing to support presence of state and trait anxiety factors. Both the BAI and Trait Anxiety scale of the STAI demonstrated discriminant validity in separating patients with a current anxiety disorder from patients without such a disorder. However, the State Anxiety scale of the STAI did not discriminate between these groups. When used to predict presence of an anxiety disorder, no single cutting score for either the BAI or STAI proved optimal, due to tradeoffs between sensitivity and specificity. Results suggest that both the subjective subscale and total score on the BAI can be somewhat useful as a quick screening instrument in detecting presence of a current anxiety disorder for older adult psychiatric outpatients, although results were not as strong as previous findings regarding screening tests for depression in the elderly.

Reliability of the Structured Clinical Interview for DSM-III-R: an evaluative review.

Research evaluating the reliability of the Structured Clinical Interview for DSM-III-R (SCID) is reviewed. Reliability procedures and studies are examined. Several versions of the SCID are covered, including the SCID-I (axis I disorders), SCID-II (axis II disorders), SCID-Positive and Negative Syndrome Scale (SCID-PANSS; functional-dimensional assessment for psychotic disorders), and SCID-Upjohn Version (panic disorder). The SCID has been found to yield highly reliable diagnoses for most axis I and axis II disorders. Suggestions for future research on the SCID are offered, particularly with respect to (1) the lack of studies in which SCID diagnoses are compared with diagnoses from unstructured interviews or other structured-interview formats, and (2) the need for a more natural evaluation of this instrument. Also, the importance of establishing norms and obtaining reliability data for underserved clinical populations is discussed.

Emotional processing in vocal and written expression of feelings about traumatic experiences.

The purpose of this study was to compare vocal and written expression of feeling about interpersonal traumatic and trivial events in 20-min sessions over a 4-day period. Similar emotional processing was produced by vocal and written expression of feeling about traumatic events. The painfulness of the topic decreased steadily over the 4 days. At the end, both groups felt better about their topics and themselves and also reported positive cognitive changes. A content analysis of the sessions suggested greater overt expression of emotion and related changes in the vocal condition. Finally, there was an upsurge in negative emotion after each session of either vocal or written expression. These results suggest that previous findings that psychotherapy ameliorated this negative mood upsurge could not be attributed to the vocal character of psychotherapy.

Diagnosis and assessment of substance abuse in older adults: current strategies and issues.

Alcohol and substance abuse in older adults until recently has received little empirical attention in the literature. However, in light of the increasing number of older adults in the population, clinicians and researchers alike are recognizing the importance of evaluating specific assessment and treatment strategies for such older substance abusers. Because distinctive biological, cognitive, and psychosocial variables appear to be correlated with substance abuse in older adults, evaluation and intervention methods employed with younger cohorts may be inappropriate or ineffective with individuals 55 and over. Our article, therefore, examines these characteristics as they pertain to the unique problems and service needs of the elderly. Relevant diagnostic and assessment strategies are reviewed. Finally, suggestions for future work in this area are outlined.

The rationale for controlling dietary lipids in the prevention of coronary heart disease.

Despite the acknowledged association between blood cholesterol levels and coronary heart disease, many people throughout the Americas remain uncertain about the importance of that association and available countermeasures. This article reviews the subject's historical background, results of recent studies, and current recommendations of leading expert groups in the United States. It also examines ways in which the body's cholesterol level is influenced by changes in the dietary intake of calories, saturated and unsaturated fats, and cholesterol, and recommends the adoption of specific dietary measures as a way of markedly improving public health.