Predictors of treatment satisfaction among older adults with anxiety in a primary care psychology program

Increasing numbers of patients are treated in integrated primary care mental health programs. The current study examined predictors of satisfaction with treatment in patients from a randomized clinical trial of late-life generalized anxiety disorder (GAD) in primary care. Higher treatment satisfaction was associated with receiving CBT rather than enhanced usual care. Treatment credibility, treatment expectancies, social support, and improvements in depression and anxiety symptoms predicted higher treatment satisfaction in the total sample. In the CBT group, only credibility and adherence with treatment predicted satisfaction. This suggests that older patients receiving CBT who believe more strongly in the treatment rationale and follow the therapist's recommendations more closely are likely to report satisfaction at the end of treatment. In addition, this study found that adherence mediated the relationship between treatment credibility and treatment satisfaction. In other words, patients’ perceptions that the treatment made sense for them led to greater treatment adherence which then increased their satisfaction with treatment.     

The impact of the family on diabetes adjustment: A developmental perspective

This study investigated how pubertal development may influence the relation between aspects of the family environment and diabetes adjustment. Subjects were 49 youngsters with newly diagnosed insulin-dependent diabetes mellitus (IDDM) and their parents. Pearson correlations between aspects of the family environment and diabetes adjustment revealed many significant findings for the total sample and separately by pubertal development. Tests of differences between these correlations revealed support for our hypotheses in expected directions. These results suggest the adoption of a developmental perspective when considering how family life is related to a youngster's diabetes adjustment.     

Sexual Portrait of Couples Seeking Relationship Therapy

This study sought to provide information about the sexual well‐being of 298 mixed‐sex couples seeking relationship therapy and determined the extent to which problems with sexual functioning and dyadic adjustment of both partners are associated with sexual satisfaction. Partners completed measures of dyadic adjustment, sexual satisfaction, and sexual functioning. Thirty percent of couples reported a clinically significant sexual problem. Compared to their male partners, the women were more likely to report a sexual problem as well as lower dyadic adjustment, sexual satisfaction, and overall sexual functioning. Path analysis indicated that relationship adjustment uniquely predicted individuals' own sexual satisfaction; problems in sexual functioning uniquely predicted own and partner sexual satisfaction. Findings underscore the need to address sexual problems in relationship therapy.     

Dyadic Adjustment and Community Involvement in Same-Sex Couples

This study examines the effects of age and involvement in the gay, lesbian, and bisexual community on dyadic adjustment in 62 male and 54 female same-sex couples. Participants completed the Dyadic Adjustment Scale (Spanier, 1976) and scales of political and social involvement in the gay, lesbian, and bisexual community based on Peplau and Cochran (1981). Those in midlife (35 years and older) had significantly lower conflict in matters of affection and sex than those younger (less than 35 years old). Political involvement interacted significantly with gender and age in predicting dyadic consensus scores: Among younger women, greater political involvement was associated with higher dyadic consensus. Inter-partner differences in social involvement were significantly associated with greater dyadic conflict in sex and affection. Inter-partner dyadic adjustment and community involvement scores were positively correlated, in general. Findings support the importance of age in the study of same-sex couples. The implications for conceptualizations of the gay, lesbian, and bisexual communities and dyadic adjustment are discussed.     

Pressure to Attend Therapy,Dyadic Adjustment,and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

In this study we examine the role that pressure to attend therapy, dyadic adjustment, and adverse childhood experiences (ACEs) play in developing the therapeutic alliance. A total of 351 couples received treatment as usual at three family therapy training clinics. Participants rated predictor variables at intake and alliance at the fourth session. Results of a path analysis indicate that each partner's dyadic adjustment is directly associated with the quality of her or his own alliance. In addition, when male partners report more ACEs and pressure to attend treatment, their own alliance scores decrease. Additionally, when one partner reports feeling pressure to attend therapy, the other partner's alliance decreases. Finally, for males, there is an indirect effect of dyadic adjustment on alliance through pressure to attend therapy. These results suggest that clinicians should routinely assess relationship adjustment, how pressured each partner is feeling to attend treatment, and ACEs; as these may impact alliance quality.     

Flemish Foster Mothers’ Perceptions of Support Needs Regarding Difficult Behaviors of Their Foster Child and Their Own Parental Approach

Family foster care is a valuable, but vulnerable type of out-of-home placement. Adequate support of foster parents is an important factor for placement success. This requires an accurate assessment of the support needs of foster parents. This paper focuses on the support needs of foster mothers concerning difficult behavior of the child and their own parenting behavior. Data were gathered from 282 foster mothers. 46 % of the foster mothers needed support on at least one behavior of the child, 40 % on at least one parenting behavior. Foster mothers, who felt less competent to deal with the child, expressed a higher support need on both areas. A high support need concerning difficult behaviors was further predicted by the foster mother’s age, the type of foster care, and the number of biological children. A high support need concerning parenting was further predicted by the quality of support by the foster care worker and the number of foster children. Careful monitoring of all types of foster care situations with special attention to problem behaviors and how to handle them could make this type of out-of-home-placement more effective.     

Changes in type 1 diabetes health indicators from high school to college

ABSTRACT

Objective: Evaluate trajectories of type 1 diabetes health indicators from high school through the first year of college. Participants: Seventy-four students with type 1 diabetes who maintained pediatric endocrinology care during the first year of college. Methods: Hemoglobin A_1c (HbA1c), blood glucose monitoring frequency, body mass index (BMI), and clinic attendance data were collected via retrospective medical chart review in spring 2012. Group-based trajectory models evaluated diabetes-related health indicators over time and identified distinct growth trajectory groups. Results: BMI increased and clinic attendance decreased in the first year of college. Trajectories for other health indicators were heterogeneous and stable over time; 69% of students were classified as having stable good glycemic control. Racial minority youth and youth on conventional insulin regimens were disproportionally represented in higher-risk groups. Conclusions: Diabetes health indicators are stable or decline upon college entrance. Results signal the need for targeted support for college students with type 1 diabetes.     

Freud,Grafenberg, and the neglected vagina: Thoughts concerning an historical omission in sexology

Because similarity between partners has been thought to be related to relationship quality, this study assessed similarities between partners in 44 married, 35 heterosexual cohabiting, 50 gay, and 56 lesbian couples on demographic characteristics, appraisals of relationship quality, and factors predictive of relationship quality. With regard to demographic characteristics: Partners' age was correlated for each type of couple; partners' income, education, and job prestige were correlated only for heterosexual cohabiting couples; and gay partners had the largest discrepancies in age, income, and education. With regard to appraisals of relationship quality: Partners' scores were correlated for each type of couple on relationship satisfaction but for only gay and lesbian couples on love for partner; partners across all couples differed in their assessments of relationship quality. With regard to the predictors of relationship quality: Partner scores were correlated for each type of couple only on shared decision making; these predictor scores were most frequently correlated for lesbian partners; differences between partners were least for lesbian couples on attractions to the relationship and perceived family support and greatest for cohabiting couples on dyadic attachment. Relationship quality was not related to discrepancies between partners' demographic variables but was negatively related to discrepancies in partners' dyadic attachment. In conclusion, partner homogamy was most pervasive in lesbian couples, and for all couples homogamy on dyadic attachment was related to relationship quality.     

An Exploration of Adjustment Needs and Efforts of Persons with Dementia After Relocation to a Residential Care Facility

This study examined the adjustment needs and efforts of individuals with dementia after relocation to a residential care facility. This was a qualitative prospective study that involved in-depth face-to-face interviews with 16 individuals with dementia and their family caregivers at 2 and 6 months post-relocation. In their efforts to recreate a sense of home, individuals with dementia had to meet three major highly interrelated and overlapping categories of needs to settle in, fit in, and find meaning in this transition. The satisfactory fulfillment of these adjustment needs resulted in a sense of comfort, connection, and continuity associated with feeling at home. Participants’ efforts to place themselves in their new living environments created a simultaneous need to integrate relocation into their overall sense of self. The results support earlier research indicating that place making is a critical process in the overall psychosocial adjustment to old age. The findings inform supportive interventions to assist individuals with dementia to reconstruct home in a residential care environment.     

Two‐Year Follow‐Up of the Efficacy of the PREP Training on Iranian Newlyweds

The aim of the present study was to replicate the efficacy of the Prevention and Relationship Education Program (PREP) training on marital satisfaction and dyadic adjustment among a group of Iranian newlyweds. One hundred and sixty heterosexual couples (N = 320 participants) were randomly assigned to an experimental or a wait list control group. Data from one hundred and forty‐eight couples were analyzed. Participants completed the ENRICH Marital Satisfaction Scale (The Family Journal, 1, 1993, 196–207) and Dyadic Adjustment Scale (The Journal of Sex Research, 39, 1976, 190–196) at pretest, posttest, 1‐year follow‐up, and 2‐year follow‐up. Results indicated that mean marital satisfaction and dyadic adjustment scores between the experimental and control groups were significantly different at posttest. Therefore, PREP training improved marital satisfaction and dyadic adjustment of couples at posttest. The data suggests that PREP training program can be introduced as an effective relationship education program for Iranian newlyweds.     

Correlates of Psychosocial Adjustment in Adolescents From Divorced Families

The study was designed to identify the factors which predict psychological adjustment among 15 to 18-year-old adolescents whose parents have divorced. Psychosocial adjustment was assessed by the Youth Self Report (Achenbach, 1978, 1991). Predictors included the type of custody arrangement, the psychological adjustment of the custodial parent, factors affecting the adolescent's relationship with the non-custodial parent, demographic characteristics, stressful life events during the two years following the divorce, availability of social support, and family adaptability and cohesion. New York City high school students from divorced (n = 221) and intact (n = 215) families completed the survey instrument. Results indicated that the adjustment of adolescents from divorced families was related positively to the psychological adjustment of the custodial parent, the availability of social support, and family adaptability and cohesion. Adolescent adjustment was related negatively to the degree to which the parents displayed anger or physical abuse before and after the separation, and to the number of stressful life changes following the divorce. The factors predicting the adjustment of adolescents from intact families were similar.     

Behavioral adjustment of Chinese adoptees: The role of pre-adoption experiences

PurposeIn the current study we examined associations between children's pre-adoption experiences (type of pre-adoption care and early deprivation) and their adaptive and maladaptive behavioral adjustment. Associations with prosocial behavior, attention problems, internalizing and externalizing behavioral problems were investigated.MethodsParental ratings of pre-adoption experiences and behavioral adjustment of 891 adopted Chinese girls aged between 4 and 12 year were obtained. The children were adopted from institutional care (n = 595), foster care (n = 66) or a combination of institutional and foster care (n = 228). Prosocial behavior was assessed using the Strengths and Difficulties Questionnaire (SDQ). Attention problems, internalizing and externalizing behavioral problems were assessed using the Child Behavior Checklist for ages 4–18 (CBCL). In addition to the main effects of pre-adoption experiences, we tested interaction effects between pre-adoption experiences and age at adoption, controlling for several family and child background variables.ResultsHierarchical regression analyses revealed that type of pre-adoption care was not associated with behavioral adjustment. Early deprivation, on the other hand, was negatively associated with prosocial behavior, and positively associated with attention problems, internalizing and externalizing problems. Interaction analyses revealed no significant associations.ConclusionsThe results showed that pre-adoption deprivation increased the risk for less optimal behavioral adjustment. The effects however were small, leaving room for other explaining factors both in the pre- and post-adoption environment of the child.     

Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

The Course of Dyadic Adjustment and Depressive Symptoms During and After Couples Therapy: A Prospective Follow-up Study of Inpatient Treatment

A clinical sample of adult patients suffering from relational distress and concurrent psychiatric symptoms was followed from admission, through residential couple therapy, to 1-year follow-up. At follow-up, 9.8% were separated. The remaining couples showed significant improvement in dyadic adjustment at posttreatment. However, at 1-year follow-up, a subgroup of 25% of the positive treatment responders had deteriorated to below their admission levels of dyadic adjustment. Contrary to expectation, the deteriorated group had showed significantly less distress both in depressive symptoms and in one early maladaptive schema domain—Impaired Autonomy—at admission, when compared with the rest of the sample, which suggests the need for further research and possible replication in this area.     

Stability in the Social Support Networks of Homeless Families in Shelter: Findings From a Study of Families in a Faith-Based Shelter Program

The following article outlines a longitudinal study tracking changes of the social support networks of 28 homeless families in shelter. Weekly changes in support networks of homeless mothers were tracked including 482 dyadic ties between mothers and supportive persons. Findings suggested that informal social support and persons who provided emotional support were significantly more stable forms of support in the mothers' lives throughout their shelter stay. Time was found to be a significant predictor of financial well-being and housing stability at shelter exit, but characteristics of the supportive ties were not. Implications for family social work and research practice are presented.     

Approaching ADHD as a chronic condition: implications for long-term adherence

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic conditions of childhood. Although evidence-based treatments for ADHD, including stimulant medication and behavior modification, have long been established, and guidelines for care of ADHD in primary care settings have been developed, adherence to long-term therapy is poor among youth with ADHD. This article proposes use of the Chronic Care Model for Child Health, the purpose of which is to develop informed, activated patients who will interact with a prepared, proactive health care team. Six "pillars" make up the model: decision support, delivery system design, clinical information systems, family and self-management support, community resources and policies, and health care organizations. Each of these is discussed, and an individual example is described. Adopting the Chronic Care Model for Child Health has the potential to improve the quality of care for ADHD.     

The Longitudinal Influence of Coparenting Conflict on Parental Negativity and Adolescent Maladjustment

This study addresses two limitations of coparenting research: first, little research on coparenting has been conducted with families of adolescents, and second, there is little understanding regarding the child and family contexts in which coparenting is most salient. The longitudinal relation of coparenting conflict to parenting and adolescent maladjustment across 3 years was investigated among 516 2-parent, 2-adolescent families. Coparenting conflict predicted as much or more unique variance in parenting and adolescent adjustment as did marital quality and disagreement together. After controlling for stability, coparenting conflict predicted mothers' and fathers' negativity and adolescent antisocial behavior (but not depression). Importantly, the influence of coparenting conflict in all cases varied as a function of family type, adolescent gender, or initial level of antisocial behavior, or all. The implications of these results for family processes in different relational and developmental contexts are discussed.     

Correlates of Depressive Symptom Severity in Problem and Pathological Gamblers in Couple Relationships

Problem and pathological gamblers (PPG) often suffer from depressive symptoms. Gambling problems have negative consequences on multiple aspects of gamblers’ lives, including family and marital relationships. The objectives of the current study were to (1) replicate the results of studies that have suggested a stronger and more significant relationship between gambling and depression in PPG than in non-problem gamblers (NPG) and (2) explore specific correlates of depressive symptom severity in PPG in couple relationships. Variables demonstrated to be significantly correlated with depressive symptoms in the general population were selected. It was hypothesized that gender, age, gambler’s mean annual income, perceived poverty, employment status, clinical status (i.e., problem or pathological gambler versus non-problem gambler), trait anxiety, alcoholism, problem-solving skills, and dyadic adjustment would be significant predictors of depressive symptoms. Sixty-seven PPG were recruited, primarily from an addiction treatment center; 40 NPG were recruited, primarily through the media. Results revealed that PPG reported significantly greater depressive symptoms than did NPG. Further, elevated trait anxiety and poor dyadic adjustment were demonstrated to be significant and specific correlates of depressive symptom severity in PPG. These findings contribute to the literature on depressive symptomatology in PPG in relationships, and highlight the importance of the influence of the couple relationship on PPG.     

Structural and Dynamic Process Family Risk Factors: Consequences for Holistic Adolescent Functioning

This study utilized a dynamic cumulative family risk model to explain changes in adolescent functioning. We used a person‐centered approach to detect patterns of academic, emotional, and behavioral functioning and the stability of these patterns using two waves of the National Longitudinal Study of Adolescent Health (N= 10,173). Four adjustment profiles emerged at both time points. Although most (91%) adolescents remained in the same classifications at both waves, some experienced shifts in functioning. Changes in family process risk factors predicted these shifts in adjustment, whereas changes in structural risk factors predicted stable adjustment. We concluded that even short‐term changes in family processes are significant sources of risk for some adolescents.     

Diabetes education program for people with type 2 diabetes: An international perspective

BackgroundIn the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range.ObjectiveThis study aimed at measuring the effect of diabetes educational intervention program for patients suffering from type 2 diabetes attending the Diabetes Clinic in Tulkarim Directorate of Health.MethodsA short duration observational study involving pre- and post-test educational intervention program was carried out on a relatively small number of type 2 diabetes patients at the Diabetes Clinic in Tulkarim Directorate of Health. In total, 215 patients attended a group-based 4 h educational intervention session about diabetes. The program included explaining diabetes mellitus-symptoms, risk factors, types, treatment and complications and main aspects of self-care of the disease (foot care, eye care, and blood glucose monitoring), main aspects of dietary management, weight reduction, blood pressure, smoking cessation, periodic investigations, home monitoring and importance of physical activity. Knowledge evaluation questionnaire were evaluated pre- and post-study. Anthropometric measurements such as body weight (WT), body mass index (BMI) and laboratory tests such as fasting blood glucose (FBG), hemoglobin A1C (HbA1c), cholesterol (Chol), and triglycerides (TG) were measured both at the beginning and at the end of the study. Significance of the results was assessed by paired t-test at 95% confidence interval.ResultsThe participant’s mean age was 51.07 that ranged between 31 and 70 years. For a total of 215 participants, 41.4% were males and 58.6% were females. The mean weight before educational intervention was 80.81 ± 14.95 kg (82.6 kg for males and 79.5 kg for females) that decreased to 78.9 ± 14.33 kg (81.1 kg for males and 77.3 kg for females) after educational intervention program. The BMI also decreased significantly after educational intervention. The mean fasting blood sugar was 188.65 ± 71.45 mg/dL before educational intervention that decreased to 177.7 ± 66.11 mg/dL after the educational intervention (p = 0.049). The mean glycosylated hemoglobin was 8.57 ± 1.21 before educational intervention that decreased to 7.95 ± 1.42 after educational intervention. The mean value of cholesterol before educational intervention was 183.27 ± 37.74 mg/dL that decreased to 169.57 ± 34.23 mg/dL after educational intervention. The mean triglycerides value decreased after educational intervention from 209.85 ± 171.04 mg/dL to 183.28 ± 152.4 mg/dL (p = 0.025). The mean score of knowledge questionnaire before educational intervention was 60.6 ± 20.65 that increased to 78.1 ± 13.4 after conducting educational intervention.ConclusionsDiabetes education was found to be effective on BMI, FBG, HbA1c, Chol, TG, and knowledge.RecommendationsDiabetes education is a cornerstone in the management and care of diabetes and should be an integral part of health planning involving patient’s family, diabetes care team, community, and decision makers in the education process.