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Nadine J Kaslow

Publications and source records attributed to Nadine J Kaslow.

At least 19 recordsLinked to original sources
PubMed2006

A descriptive study of pathways to care among hospitalized urban African American first-episode schizophrenia-spectrum patients.

BACKGROUND: Studying pathways to care, or contacts made during the period of time from the onset of illness until the first initiation of treatment, is critical for understanding how to improve the early recognition and treatment of mental disorders. However, little is known about pathways to care among patients with first-episode psychosis in the United States. The objectives of this study were to examine the pathways to care and number of help contacts prior to hospitalization in first-episode patients, and to ascertain the frequency of contact with primary care providers and police. METHOD: Pathways to care, including all contacts for help from the onset of prodromal symptoms until first hospital admission, were assessed in 25 urban African American patients. Other measures were obtained as part of an ongoing study of predictors of the duration of untreated psychosis. RESULTS: The median durations from the onset of illness to hospital admission and from the emergence of positive psychotic symptoms to hospital admission were 128.0 weeks (range 0.6-476.9) and 32.9 weeks (range 0.4-337.7), respectively. Of the 83 total contacts, 17 were with police, whereas only four were with primary care providers. While the number of contacts per patient ranged from one to eight, 16 of the 25 patients were admitted within 1 week of their first contact for help. CONCLUSIONS: The findings indicate that pathways to care in this population are highly variable, and there is a need for additional research to better understand the nature and determinants of these pathways. Such investigations may provide insights into service enhancements that can promote early detection and intervention, thus improving illness outcomes.

Adolescent↗
PubMed2006

Coping variables that mediate the relation between intimate partner violence and mental health outcomes among low-income, African American women.

Coping variables that mediate the relation between intimate partner violence (IPV) and mental health outcomes among African American women were investigated. The study sample included 143 economically disadvantaged African American women ranging in age from 21 to 64 years old who were receiving services at an urban public health system. Sixty-five had experienced IPV within the past year and 78 had never experienced IPV. Results indicated that (a) the IPV status-depressive symptoms link was mediated by multiple ways of coping, spiritual well-being, and social support; (b) the IPV status-anxiety symptoms link was mediated by multiple ways of coping, social support, and ability to access resources; and (c) the IPV status-parenting stress link was mediated by multiple ways of coping, spiritual well-being, and social support. Implications of these findings for clinical practice with abused women are discussed.

Adaptation, Psychological↗
PubMed2006

Stages of change as a correlate of mental health symptoms in abused, low-income African American women.

The current study aims to further our understanding of the applicability of the transtheoretical model (TM) to intimate partner violence (IPV), with particular focus on mental health symptoms (depression, posttraumatic stress disorder symptomatology, suicidal ideation) in a sample of low-income African American women seeking medical services at an inner city emergency department. Results revealed that of the 121 abused African American women, the majority (95%) were in the precontemplation and contemplation stages of the change process. Further, contrary to predictions, bivariate analyses revealed those at further stages of change endorsed more severe mental health symptoms. However, a multivariate analysis of variance examining differences in level of mental health symptoms between women high and low on stages of change was inconclusive due to the small number of women at the higher stages of the TM model. These findings contribute to the growing body of literature supporting the TM as applied to IPV. Results are discussed in terms of applicability to intervention design.

Adult↗
PubMed2006

Determinants of health plan membership among patients in routine U.S. psychiatric practice.

This study utilized a large clinical dataset of patients representative of those in routine U.S. psychiatric practice to assess the influence of sociodemographic variables and diagnostic class on health plan membership (public or private). Data on patients with schizophrenia or other psychotic disorders (n=288) and patients with mood or anxiety disorders (n=1304) were obtained from a cross-sectional practice-based survey conducted by the American Psychiatric Institute for Research and Education. The likelihood of health plan membership was lower among males and among those from a minority race/ethnicity. Health plan membership was also affected by educational attainment and employment status. Even after controlling for these sociodemographic determinants of health plan membership, individuals with schizophrenia/other psychotic disorders were significantly less likely to belong to a health plan than those with mood/anxiety disorders.

Adult↗
PubMed2006

Intimate partner violence and mental health symptoms in African American female ED patients.

BACKGROUND: Intimate partner violence (IPV) victims often seek care in the ED, whether for an injury from abuse or other sequelae such as mental health symptoms. OBJECTIVES: The objective of the study was to assess whether depressive symptoms, posttraumatic stress disorder (PTSD), and suicidality were associated with physical, sexual, or emotional IPV in African American female ED patients and to determine if experiencing multiple types of abuse was associated with increased mental health symptoms. METHODS: All eligible African American female patients were approached in the ED waiting room during study periods. Patients participated in the screening process via a computer kiosk. Questions regarding IPV and mental health symptoms were asked using validated tools. RESULTS: In this prospective cohort, 569 participated and 36% of those in a relationship in the past year (n=461) disclosed that there were victims of IPV in the past year. In the past year, 22% experienced recent physical abuse, 9% recent sexual abuse, and 32% recent emotional abuse. A Pearson correlation was conducted and showed that all mental health symptoms were positively correlated with each type of IPV and each type of mental health symptom category. Mental health symptoms increased significantly with amount of abuse: depression (odds ratio [OR], 5.9 for 3 types of abuse), PTSD (OR, 9.4 for 3), and suicidality (OR, 17.5 for 3). CONCLUSIONS: Emotional, sexual, and physical IPV were significantly associated with mental health symptoms. Each type of abuse was independently associated with depression, suicidality, and PTSD. Experiencing more than 1 type of abuse was also correlated with increased mental health symptoms.

Adult↗
PubMed2006

Relational disorders and relational processes in diagnostic practice: introduction to the special section.

The special section addresses a number of salient issues that will arise as the revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM) unfolds and the role of relational processes in mental health is considered. This collection of articles, which emphasize historical, conceptual, and empirical contributions to the discussion, is intended to stimulate debate in the field and to serve as a resource for individuals charged with proposing new diagnostic guidelines. Jointly, the articles make it clear that the authors can improve on the current treatment of relational processes in the DSM and that there is a solid foundation of family research that can inform any discussion on this topic.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

Describing relationship problems in DSM-V: toward better guidance for research and clinical practice.

The authors provide a description of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) and its limitations, as well as empirical connections between relational processes and mental health. Four types of relational processes are identified, with each type clearly distinguished in terms of its pattern of association with psychopathology. For illustrative purposes, examples are provided along with suggestions of how each might be accommodated in the DSM-V. In view of the importance and complexity of the connections between relational processes and mental health, the authors argue that reliable and standardized assessments of relational processes are needed and suggest 6 possible approaches for providing better coverage of relational processes and relational disorders in the DSM-V. The article concludes with a discussion of potential concerns about expansion of attention to relational processes in the DSM-V.

Adult↗
PubMed2006

The mediating role of parenting stress in the relation between intimate partner violence and child adjustment.

This study examined the role of maternal parenting stress in the relation between intimate partner violence (IPV) and children's emotional and behavioral problems among 139 African American children between the ages of 8 and 12 years. Structural equation modeling was used to investigate a mediational model examining maternal reports of IPV and parenting stress and both mother and child reports of child adjustment. Results suggest that parenting stress helps explain the link between IPV and child emotional and behavioral problems. Findings from this study highlight the importance of parenting stress in outcomes of children from low-income African American families who experience IPV.

Adaptation, Psychological↗
PubMed2005

Utilization of services by abused, low-income African-American women.

BACKGROUND: Little is known about health care and service utilization patterns among low-income African-American women, particularly those who report intimate partner violence (IPV). OBJECTIVES: (1) Identify utilization patterns among low-income African-American women. (2) Demonstrate utilization differences by IPV status. PARTICIPANTS: One hundred and fifty-three African-American women from medical care clinics at a large inner-city public hospital. DESIGN: Case-control study. Predictor variable IPV assessed by the Index of Spouse Abuse. Outcome variables, health care, and service utilization, determined using the Adult Service Utilization Form. RESULTS: Of the 153 participants, 68 reported high IPV levels. The mean age was 32 years, majority were poor and unemployed, and 15.7% were homeless. The overall utilization rates were low. When controlled for homelessness and relationship status, high IPV levels were associated with greater psychiatric outpatient utilization. We found differences in the use of other medical or community services by IPV group. CONCLUSIONS: Women reporting high IPV levels are more likely to receive mental health services than women reporting low IPV levels, but may not have access to other needed services. Primary care providers should assess the mental health, legal, and social service needs of abused women, which will facilitate receipt of services.

Adult↗
PubMed2005

The associations between substance use disorders, schizophrenia-spectrum disorders, and Axis IV psychosocial problems.

BACKGROUND: Substance abuse among individuals with schizophrenia-spectrum disorders (SSDs) is associated with a range of adverse psychosocial outcomes in the areas of occupational functioning, housing stability, economic independence, access to health care, and involvement with the legal system. The aim of this study was to estimate the effects of substance use disorders (SUDs), SSDS, and dual diagnosis with both disorders on the risk for six important Axis IV psychosocial problems. This was accomplished using a large dataset of patients who are representative of individuals in routine US psychiatric practice. METHOD: Weighted data from the 1999 Study of Psychiatric Patients and Treatments from a practice-based research network of the American Psychiatric Institute for Research and Education were analyzed. Some 615 US psychiatrists provided detailed clinical, psychosocial, and health services information on 1,843 patients, including 285 patients with one or more SUDs without an SSD, 180 patients with a diagnosis of an SSD without substance abuse comorbidity, and 68 dually diagnosed patients. Logistic regression models were used to determine effect estimates (adjusted odds ratios), and corresponding 95% confidence intervals were calculated. RESULTS: After adjusting for sociodemographic variables and for SSD diagnosis, SUD diagnosis was independently associated with increased risk for five of the Axis IV psychosocial problems of interest (occupational problems, housing problems, economic problems, problems with access to health care services, and problems related to interaction with the legal system/crime) when compared to all other psychiatric patients (n=1,310). After adjusting for the sociodemographic variables and for SUD diagnosis, SSD diagnosis (compared to all other psychiatric diagnoses) was associated with Axis IV economic problems, but not with the other five psychosocial problems of interest. The presence of both an SUD and an SSD diagnosis (dual diagnosis) was associated with a greater risk for four of the six Axis IV psychosocial problems studied, compared to the risks associated with either diagnosis alone. Limiting the substance of abuse to alcohol resulted in similar findings. CONCLUSIONS: Although SUDs are associated with increased risk for poor social adjustment, the comorbidity of SUDs and SSDs is associated with greatly compounded psychosocial burdens. These findings, from a large sample of representative US psychiatric patients, demonstrate the ongoing need for improved services and policies for those specially burdened patients with the dual diagnosis of both an SSD and substance abuse or dependence.

Adult↗
PubMed2005

Predictors of psychiatrist-reported treatment-compliance problems among patients in routine U.S. psychiatric care.

Characteristics associated with psychiatrist-reported treatment-compliance problems were investigated using the 1999 Study of Psychiatric Patients and Treatments from the Practice Research Network of the American Psychiatric Institute for Research and Education (n=1,843). Logistic regression was used to study characteristics associated with compliance problems as perceived by treating psychiatrists. Among the 22 potential predictors of interest, all but three (age, gender, and problems with primary support group) were found to be significantly associated with treatment-compliance problems in bivariate analyses. A predictive model was developed consisting of eight independently significant predictors from diagnostic, clinical, psychosocial, and treatment-history domains. These predictors included substance use disorder diagnosis, medication side effects, moderate to severe psychotic symptoms, personality disorder diagnosis, economic problems, prior hospitalization, current Global Assessment of Functioning scale score, and duration of treatment with current psychiatrist. This predictive model correctly identified the presence or absence of treatment-compliance problems in 91% of patients in a sample randomly drawn from the dataset before model construction. These findings may be useful to clinicians, researchers, and program planners interested in addressing the important issue of treatment-compliance problems in psychiatric care settings.

Adult↗
PubMed2005

Self-reported psychotic symptoms predict impulsivity among African-American patients in an urban non-psychiatric medical setting.

A variety of epidemiological studies have documented self-reported psychotic symptoms among individuals in the general population. Research has not been conducted on the associations between self-reported psychotic symptoms and enduring personality characteristics, such as impulsivity, among participants in non-psychiatric settings. We hypothesized that impulsivity scores, as measured by the Barratt Impulsiveness Scale (BIS-11), would be predicted partly by the presence of one or more of a variety of positive psychotic experiences, determined by the revised Symptom Checklist-90. The sample consisted of 100 African-American men and women seeking care in medical clinics in an urban public sector hospital. The sample was divided into those participants endorsing one or more of six psychotic symptoms and those not reporting psychotic symptoms. Multiple linear regression models examined predictors of impulsivity (as measured by the BIS-11 total score and the two derived subscales), including the effect of self-reported positive psychotic symptoms. The presence of psychotic symptoms was predictive of the total impulsivity score and the ideo-motor impulsivity subscale score, even after adjustment for the effects of other correlates of impulsivity, including gender, homelessness, history of conviction for a misdemeanor or felony, and history of past treatment or hospitalization for psychiatric or substance abuse problems. The findings suggest that there is an important link between the presence of self-reported psychotic symptoms and impulsivity, especially ideo-motor impulsivity, in a general sample of low-income African-American men and women seeking ambulatory medical care. Further research on self-reported psychotic symptoms in non-psychiatric populations is needed, as well as research on the personality correlates of such symptoms, including impulsivity.

Adolescent↗
PubMed2005

Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: self-esteem, social support, and religious coping.

There is a dearth of research on risk/protective factors for posttraumatic stress disorder (PTSD) among low-income African American women with a history of intimate partner violence (IPV), presenting for suicidal behavior or routine medical care in a large, urban hospital. We examined self-esteem, social support, and religious coping as mediators between experiences of child maltreatment (CM) and IPV and symptoms of PTSD in a sample (N = 134) of low-income African American women. Instruments used included the Index of Spouse Abuse, the Childhood Trauma Questionnaire, the Taylor Self-Esteem Inventory, the Multidimensional Profile of Social Support, the Brief Religious Coping Activities Scale, and the Davidson Trauma Scale. Both CM and IPV related positively to PTSD symptoms. Risk and resilience individual difference factors accounted for 18% of the variance in PTSD symptoms over and above IPV and CM, with self-esteem and negative religious coping making unique contributions. Both variables mediated the abuse-PTSD symptom link. In addition, we tested an alternate model in which PTSD symptoms mediated the relationship between abuse and both self-esteem and negative religious coping.

Adaptation, Psychological↗
PubMed2005

Social environment factors associated with suicide attempt among low-income African Americans: the protective role of family relationships and social support.

BACKGROUND: Suicide and suicide attempts are important public health concerns, and recent decades have witnessed a rising rate of suicide among African Americans. A history of prior attempts is a leading risk factor for completed suicide. Further research is needed into the social environment risk factors for suicide attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor--depressive symptoms. METHOD: Data were obtained from a case-control study of 200 African American men and women aged 18-64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for suicide attempt among the cases and controls. The role of depressive symptoms was also studied. RESULTS: Lower levels of family adaptability and family cohesion increased the relative rate of suicide attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of suicide attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models. CONCLUSIONS: Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with suicide attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for suicide attempts and suicide, appears to mediate the association between social environment factors and suicide attempt.

Adolescent↗
PubMed2005

Protective factors against suicide attempt risk among African American women experiencing intimate partner violence.

Protective factors (hope, spirituality, self-efficacy, coping, social support-family, social support-friends, and effectiveness of obtaining resources) against suicide attempts were examined in economically, educationally, and socially disadvantaged African American women (100 suicide attempters, 100 nonattempters) who had experienced recent intimate partner violence. Significant positive associations were found between all possible pairs of protective factors. Bivariate logistic regressions revealed that higher scores on each of the seven protective factors predicted nonattempter status; multivariate logistic regressions indicated that higher scores on measures of hope or social support-family showed unique predictive value for nonattempter status. Further, the multivariate model accurately predicted suicide attempt status 69.5% of the time. Partial support was found for a cumulative protective model hypothesizing a linear relationship between the number of protective factors endorsed and decreased risk for suicide attempts. Implications of these findings for community-based preventive intervention efforts and future research are discussed.

Adaptation, Psychological↗
PubMed2005

Incorporating community mental health into local bioterrorism response planning: experiences from the DeKalb County Board of Health.

Following a brief introduction to response planning for terrorism and other disasters, the authors present their experiences in developing a grassroots, interdisciplinary group charged with incorporating a mental health response component into the bioterrorism response plan for the metropolitan Atlanta area. This group was organized and supported by the Center for Public Health Preparedness at the DeKalb County Board of Health. Various viewpoints of key participating agencies are presented. Recommendations are provided for other localities and stakeholders who plan to incorporate a community mental health component into local disaster response plans.

Bioterrorism↗
PubMed2005

Training in family psychology: a competencies-based approach.

After providing an overview of the family psychology landscape and the competencies-based movement in professional psychology, attention is paid to eight family-specific competencies in the following areas: the application of scientific knowledge to practice, psychological assessment, psychological intervention, consultation and interprofessional collaboration, supervision, professional development, ethics and legal issues, and individual and cultural diversity. Effective strategies for providing family-focused education and training to psychology trainees at the doctoral, internship, and postdoctoral levels and to psychologists through continuing professional education in these core competency domains are provided.

Clinical Competence↗