Biomedical subjects

Robert A Steer

Publications and source records attributed to Robert A Steer.

At least 19 recordsLinked to original sources

PubMed2006

Cognition checklist for mania-revised.

The Cognitive Checklist for Mania-Revised (CCL-M-R), which measures the severity of maladaptive beliefs and cognitions associated with mania, was administered to 35 inpatients with a major depressive disorder, 20 inpatients with a schizoaffective disorder, and 45 inpatients with a bipolar I disorder to determine whether cognitions associated with mania differentiate patients who have most recently experienced either manic, mixed, or depressive episodes. The CCL-M-R is composed of four subscales assessing (a) exaggerated beliefs about self-worth (Myself), (b) grandiose beliefs about interpersonal relationships (Relationships), (c) erroneous beliefs about needing excitement from engaging in high risk situations (Pleasure/Excitement), and (d) unrealistic beliefs about having high energy levels for undertaking goal-driven activities (Activity). As hypothesized, the mean CCL-M-R total, Myself, Relationships, and Activity scores of the 26 patients with manic episodes were higher than those for either the 17 patients with mixed episodes or the 57 with depressive episodes. The CCL-M-R was discussed as a reliable and valid instrument for measuring the severity of maladaptive cognitions associated with mania in psychiatric patients.

Adult↗

PubMed2006

A follow-up study of a multisite, randomized, controlled trial for children with sexual abuse-related PTSD symptoms.

OBJECTIVE: To ascertain whether the differential responses that previously have been found between trauma-focused, cognitive-behavioral therapy (TF-CBT), and child-centered therapy (CCT) for treating posttraumatic stress disorder (PTSD) and related problems in children who had been sexually abused would persist following treatment and to examine potential predictors of treatment outcome. METHOD: A total of 183 children 8 to 14 years old and their primary caregivers were assessed 6 and 12 months after their posttreatment evaluations. RESULTS: Mixed-model repeated analyses of covariance found that children treated with TF-CBT had significantly fewer symptoms of PTSD and described less shame than the children who had been treated with CCT at both 6 and 12 months. The caregivers who had been treated with TF-CBT also continued to report less severe abuse-specific distress during the follow-up period than those who had been treated with CCT. Multiple traumas and higher levels of depression at pretreatment were positively related to the total number of PTSD symptoms at posttreatment for children assigned to the CCT condition only. CONCLUSIONS: Children and caregivers assigned to TF-CBT continued to have fewer symptoms of PTSD, feelings of shame, and abuse-specific parental distress at 6- and 12-month assessments as compared to participants assigned to CCT.

Caregivers↗

PubMed2006

Mean Beck Depression Inventory-II total scores by type of bipolar episode.

The 1996 Beck Depression Inventory-II was administered to 120 outpatients diagnosed with DSM-IV-TR bipolar I disorders who had recently experienced manic, mixed, or depressed episodes. A focused contrast supported the hypothesis that the mean Beck-II total score for the 40 patients with depressed episodes (M=34.1, SD = 13.2) was higher than the mean Beck-II total score for the 40 patients with mixed episodes (M=25.9, SD= 13.6) which was, in turn, higher than the mean Beck-II total score for the 40 patients with manic episodes (M= 11.7, SD=7.8, p<.001). The Beck Depression Inventory-II appears to be useful for measuring self-reported depression in patients with bipolar I disorders.

Adolescent↗

PubMed2006

When does the daily hazard rate for committing suicide stabilize in psychiatric outpatients?

To ascertain whether the daily hazard risk rate for committing suicide by psychiatric outpatients stabilizes over time, a parametric survival analysis was calculated for the 6891 outpatients who were followed by Brown, Beck, Steer, and Grisham. Approximately 3 1/4 years after a patient's initial evaluation, the daily hazard rate leveled off and dropped below the hazard rate that would occur if a constant (exponential) daily hazard rate were assumed. The cost-effectiveness of conducting follow-up studies to identify suicidal risk factors in psychiatric outpatients beyond three years was questioned.

Adolescent↗

PubMed2006

Patient confidentiality vs disclosure of inheritable risk: a survey-based study.

BACKGROUND: As the field of genetic medicine advances and more tests for genetic diseases become available, a dilemma of legal and ethical importance will be increasingly encountered by family physicians. Protecting the confidentiality of a patient with a genetic disease when the patient's family is at risk for inheriting the disease is a conflict that more and more physicians will be forced to address. METHODS: In March 2003, osteopathic family physicians in New Jersey were given a vignette in which a patient reveals that he has a genetic disease and demands that the information be kept confidential. The physicians were then given a 33-item questionnaire asking their opinions about disclosing an untreatable and a treatable disease to each of the patient's children and their mother, a former spouse. Also, physicians' opinions on larger issues were gathered, such as potential legal consequences of their actions and state laws in this area. Correlations between physicians' opinions and their demographic characteristics were also explored. Data were analyzed using Pearson product moment correlations and repeated-measures analyses of variance. RESULTS: Physicians tended to agree that adult children should be told if the disease were treatable, and these physicians were willing to accept responsibility for deciding whom to tell. With regard to the characters in the vignette, physicians felt comfortable telling the 22-year-old daughter, were unsure about telling the 17-year-old son, and would not tell either a former spouse or the 12-year-old son. The respondents agreed that state laws should permit disclosure rather than require it, and they did not think state laws should forbid it. CONCLUSION: The authors recommend that states draft a definitive public policy about when, how, and whether to disclose pertinent medical information to those at risk for inheriting a genetic disease.

Adult↗

PubMed2005

Are there any gender differences in frequency of self-reported somatic symptoms of depression?

BACKGROUND: The purpose of this study was to evaluate whether self-reported somatic symptoms of depression, as measured by the Beck Depression Inventory-II (BDI-II), are more frequent in women than in men with major depressive disorder. METHODS: A sample of 105 male and 105 female adult psychiatric outpatients diagnosed with major depressive disorder was classified according to endorsed changes in appetite, changes in sleeping pattern, and fatigue (i.e., "somatic depression") symptoms on the BDI-II. RESULTS: The female to male ratio of somatic symptoms was approximately 2:1. Subsequent analyses found that change in appetite robustly distinguished between women and men and that fatigue partially distinguished between women and men. LIMITATIONS: The sample was largely Caucasian and composed of patients with high rates of comorbidity who presented to a service known for specializing in cognitive therapy. CONCLUSIONS: In outpatients with major depressive disorder, the higher prevalence of "somatic depression" in women is largely attributable to changes in appetite.

Adult↗

PubMed2005

Screening for obsessive and compulsive symptoms: validation of the Clark-Beck Obsessive-Compulsive Inventory.

The 25-item Clark-Beck Obsessive-Compulsive Inventory (CBOCI) was developed to assess the frequency and severity of obsessive and compulsive symptoms. The measure uses a graded-response format to assess core symptom features of obsessive-compulsive disorder (OCD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria and current cognitive-behavioral formulations. Revisions were made to the CBOCI on the basis of psychometric and item analyses of an initial pilot study of clinical and nonclinical participants. The construct validity of the revised CBOCI was supported in a subsequent validation study involving OCD, nonobsessional clinical, and nonclinical samples. A principal-factor analysis of the 25 items found 2 highly correlated factors of Obsessions and Compulsions. OCD patients scored significantly higher on the measure than nonobsessional anxious, depressed, and nonclinical samples. The questionnaire had strong convergent validity with other OCD symptom measures but more modest discriminant validity.

Adult↗

PubMed2005

Content-specificity of dysfunctional cognitions for patients with bipolar mania versus unipolar depression: a preliminary study.

OBJECTIVE: Dysfunctional beliefs or cognitions are considered to be fundamental to both the phenomenology and pathogenesis of depression. However, the cognitive aspects of mania have not been as thoroughly investigated. We sought to compare the maladaptive beliefs and cognitions of 23 bipolar manic or hypomanic patients, 28 patients with unipolar major depression, and 24 normal adults. METHOD: The Cognition Checklist for Mania (CCL-M) was used to assess the beliefs. This 61-item self-report instrument is scored for seven subscales measuring (a) self-importance, (b) interpersonal grandiosity, (c) inappropriate spending, (d) excitement and risk-taking, (e) interpersonal frustrations, (f) goal-driven activity, and (g) past or future outlooks on life, and also yields a total score. RESULTS: The mean CCL-M total score of the bipolar-manic patients was significantly higher than the mean CCL-M total score of the unipolar-depressed patients, and the patients' mean CCL-M total score was also higher than that of the normal adults. The mean scores of the subscales measuring excitement and past and future memories and expectations were also significantly higher for the bipolar-manic than unipolar-depressed patients. CONCLUSIONS: Bipolar-manic patients endorse with maladaptive beliefs and cognitions that are associated with mania more than do unipolar-depressed patients and normal adults. The implications for the early identification of cognitions associated with prodromal states of mania, and for psychotherapeutic interventions, are discussed.

Adult↗

PubMed2005

The internal struggle between the wish to die and the wish to live: a risk factor for suicide.

OBJECTIVE: This study attempted to assess whether an index of the difference between the wish to die and the wish to live constitutes a risk factor for suicide. METHOD: A study group of 5,814 patients, including 44 who committed suicide (0.8%), were recruited from a psychiatric outpatient clinic. Structured diagnostic interviews and clinician ratings of the wish to live and wish to die were conducted. The outcome variable was the occurrence of suicide, as indicated on death certificates. RESULTS: A dichotomized index score of the difference between the wish to live and the wish to die yielded a hazard ratio of 6.51 for suicide. This index contributed a unique risk for suicide after the authors controlled for age, psychiatric hospitalization, suicide attempts, bipolar disorder, major depressive disorder, and unemployment status. CONCLUSIONS: The difference between the wish to die versus the wish to live is a unique risk factor for suicide.

Adult↗

PubMed2004

A new instrument for measuring insight: the Beck Cognitive Insight Scale.

The clinical measurements of insight have focused primarily on patients' unawareness of their having a mental disorder and of their need for treatment ([Acta Psychiatr. Scand. 89 (1994) 62; Am. J. Psychiatry 150 (1993) 873]; etc.). A complementary approach focuses on some of the cognitive processes involved in patients' re-evaluation of their anomalous experiences and of their specific misinterpretations: distancing, objectivity, perspective, and self-correction. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate patients' self-reflectiveness and their overconfidence in their interpretations of their experiences. A 15-item self-report questionnaire was subjected to a principle components analysis, yielding a 9-item self-reflectiveness subscale and a 6-item self-certainty subscale. A composite index of the BCIS reflecting cognitive insight was calculated by subtracting the score for the self-certainty scale from that of the self-reflectiveness scale. The scale demonstrated good convergent, discriminant, and construct validity: (a) the BCIS composite index showed a significant correlation with being aware of having a mental disorder on the Scale to Assess Unawareness of Mental Disorder (SUMD; Arch. Gen. Psychiatry 51 (1994) 826) and the self-reflectiveness subscale was significantly correlated with being aware of delusions on the SUMD, (b) the composite index score of the BCIS differentiated inpatients with psychotic diagnoses from inpatients without psychotic diagnoses, and (c) in a separate study, change scores on the BCIS were significantly correlated with change scores on positive and negative symptoms. The results provided tentative support for the validity of the BCIS. Suggestions were made for further investigation of the cognitive processes involved in identifying and correcting erroneous beliefs and misinterpretations.

Adult↗

PubMed2004

A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms.

OBJECTIVE: To examine the differential efficacy of trauma-focused cognitive-behavioral therapy (TF-CBT) and child-centered therapy for treating posttraumatic stress disorder (PTSD) and related emotional and behavioral problems in children who have suffered sexual abuse. METHOD: Two hundred twenty-nine 8- to 14-year-old children and their primary caretakers were randomly assigned to the above alternative treatments. These children had significant symptoms of PTSD, with 89% meeting full DSM-IV PTSD diagnostic criteria. More than 90% of these children had experienced traumatic events in addition to sexual abuse. RESULTS: A series analyses of covariance indicated that children assigned to TF-CBT, compared to those assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuse-related attributions. Similarly, parents assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices. CONCLUSIONS: This study adds to the growing evidence supporting the efficacy of TF-CBT with children suffering PTSD as a result of sexual abuse and suggests the efficacy of this treatment for children who have experienced multiple traumas.

Adolescent↗

PubMed2004

Adolescent psychiatric inpatients' self-reported reasons for cutting themselves.

To ascertain (1) whether male and female adolescent (13-17 years old) psychiatric inpatients endorse comparable reasons for cutting themselves and (2) whether these reasons are correlated with selected psychosocial characteristics of the adolescents, self-reported depression, and hopelessness, the Self-Injury Motivation Scale II (SIMS-II), the Beck Depression Inventory-II, and the Beck Hopelessness Scale were administered to 19 (38%) male and 31 (62%) female adolescents who had cut themselves. Independent t tests found that none of the SIMS-II subscale scores was differentiated by sex, but the Beck Depression Inventory-II total score was significantly correlated with the SIMS-II total, Affect Modulation, Desolation, and Punitive Duality subscale scores. The results are discussed as indicating that male and female adolescent inpatients endorse comparable reasons for cutting themselves and that self-reported depression is positively associated with the number and intensity of different motivations for cutting oneself.

Adolescent↗

PubMed2003

Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide.

Among 440 psychiatric outpatients with current suicidal ideation, we examined the empirical distinction between the "plans" vs. "desire" dimensions of suicidality, focusing for conceptual and empirical reasons on a worst-point assessment strategy. Factor analyses were consistent with the distinction, but more importantly, among the current ideators included in this study, the worst-point "plans" dimension was the only predictor significantly related to both of two important indices, history of past attempt and eventual suicide. These findings bear on the trajectory of suicidal behavior over time, as well as inform the clinical assessment of suicidal patients.

Adult↗

PubMed2003

Adolescents' responses to sexual abuse evaluation including the use of video colposcopy.

PURPOSE: To examine adolescents' responses to a medical examination, which included the use of video colposcopy, conducted during an investigation of possible child sexual abuse. METHODS: Girls aged 11 to 18 years, referred for evaluation and treatment of sexual abuse at an academic medical center were eligible to participate. Demographic data and information regarding the alleged sexual abuse event(s) were obtained by medical record review. Prior to the medi- cal examination subjects were assessed regarding: anticipations of the medical examination; level of state anxiety using the State-Trait Anxiety Inventory (STAI); response to stressful situations along the dimensions of information-seeking or information-avoiding using the Miller Behavioral Style Scale (MBSS); and knowledge of reproduction and genital anatomy. Subsequently, a medical examination, which included the use of video colposcopy with a monitor for subject viewing, was completed. The examining physician provided a standardized educational intervention regarding genital anatomy and a discussion about abuse issues and sexually transmitted infections. An exit interview assessed perceptions of the medical examination and video colposcopy and reassessed anxiety using the state portion of the STAI. Follow-up interviews occurred 3 months later during which knowledge of reproduction and genital anatomy was reassessed. Measures were evaluated using paired Student's t-tests, McNemar tests for correlated proportions, correlations and independent Student's t-tests, as appropriate. RESULTS: Seventy-seven eligible girls participated; 51 returned for follow-up. The mean age of the subjects was 13.5 years (SD 1.4 years). Fifty-one percent of the sample was Caucasian, 29% African-American, 18% Hispanic, and 2% other. Seventy-nine percent of the girls chose to watch the examination on the video monitor. The girls' post-examination perceptions were significantly more positive than their pre-examination anticipations (p <.001), even though some aspects continued to be embarrassing, painful, or "scary". Anxiety, as measured by the STAI, significantly decreased from pre- to post-examination (p <.001). Pre-examination and post-examination anxiety were negatively associated with pre-examination anticipation and post-examination perceptions, respectively. Information-avoiding coping styles on the MBSS were associated with positive anticipations of the examination, but exhibited a trend toward negative associations with perceptions of video colposcopy. Scores assessing knowledge of the reproductive functions of their bodies at 3 months revealed no significant differences during the period from pre-examination assessment to three month follow-up. CONCLUSIONS; Teens generally reported that the medical examination, which included the use of video colposcopy, was beneficial. There was a significant reduction in anxiety from pre-examination to post-examination and the girls' feelings about the medical examination were significantly more positive afterwards.

Adaptation, Psychological↗

PubMed2003

Beck Depression Inventory-II items associated with self-reported symptoms of ADHD in adult psychiatric outpatients.

The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) and the Conners' Adult ADHD Rating Scale-Self-Report: Screening Version (CAARS-S:SV; Conners, Erhardt, & Sparrow, 1999) were administered to 371 (64%) female and 204 (36%) male adult (> 18 years old) outpatients who were diagnosed with various psychiatric disorders to determine whether any of the 21 items or subsets of items in the BDI-II were related to symptoms of attention deficits and hyperactivity as measured by the CAARS-S:SV DSM-IV Total ADHD Symptoms scale (attention-deficit/hyperactivity disorder [ADHD] Symptoms). Stepwise multiple-regression analyses found that the BDI-II Concentration Difficulty explained 30% of the variance in these total scores. Ratings > 1 for the BDI-II Concentration Difficulty item were discussed as being useful for ruling out possible symptoms of ADHD.

Adult↗

PubMed2003

Factorial validity of the Conners' Parent Rating Scale-revised: short form with psychiatric outpatients.

To assess the factorial validity of the 27-item Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S; Conners, 1997), 100 (50%) male and 100 (50%) female psychiatric outpatients between 5 and 16 years old were rated by a parent. A confirmatory factor analysis of the 18 item ratings from the CPRS-R:S Oppositional, Cognitive Problems, and Hyperactivity scales provided only tentative support for scoring these scales as Conners (1997) recommended. However, an exploratory principal-axis factor analysis with all 27 item ratings found 2 dimensions: 1 dimension was composed of the 6 items in the Oppositional scale, and other dimension contained the remaining 21 items. An attention deficit hyperactivity disorder (ADHD) Total Symptoms scale was constructed by summing the ratings for these 21 symptom ratings, and this scale was found to be as effective as the Hyperactivity scale was in discriminating between youth who were and were not eventually diagnosed with an ADHD. We discuss the results as providing an alternate way of scoring the CPRS-R:S to screen for an ADHD in child and adolescent psychiatric outpatients.

Adolescent↗

PubMed2003

Lack of age differences in the Beck Depression Inventory-II scores of clinically depressed adolescent outpatients.

To assess whether the mean Beck Depression Inventory-II scores of adolescents who were diagnosed with unipolar depressive disorders differed with respect to age, the inventory was administered to 144 (60%) female and 96 (40%) male outpatients between 13 and 17 yr. who were diagnosed with depressive disorders. The internal consistency of the scores was high (coefficient alpha=.89). A factorial analysis of variance was used to test for the main effects of age, sex, ethnicity, type of depressive disorder, comorbidity, and the two-way interactions of age with the other main effects. The mean scores were not differentiated by age or by the interactions of age with the other effects. The lack of age differences in this 5-year range on the mean scores of clinically depressed adolescents was discussed with respect to previous findings that have reported such differences in adolescents and adults.

Adolescent↗

PubMed2003

Mean Beck Depression Inventory-II scores of outpatients with dysthymic or recurrent-episode major depressive disorders.

The Beck Depression Inventory-II, published in 1996, was administered to 100 adult outpatients (Age M=43.1 yr., SD=15.6) who were diagnosed with a recurrent-episode Major Depressive Disorder and 100 outpatients (Age M=42.8 yr., SD=15.7) who were diagnosed with a Dysthymic Disorder. Each diagnostic group was composed of 50 men and 50 women who did not have a comorbid depressive disorder. The mean Beck Depression Inventory-II total score and the mean number of symptoms endorsed by the outpatients with a Major Depressive Disorder were significantly (ps<.001) higher than those for outpatients with a Dysthymic Disorder. The usefulness of the Beck Depression Inventory-II was discussed in helping clinicians discriminate between these two unipolar disorders.

Adult↗