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Biomedical subjects

Rudolf H Moos

Publications and source records attributed to Rudolf H Moos.

At least 55 records · Page 3Linked to original sources
PubMed2004

Posttraumatic stress disorder and health status among female and male medical patients.

Posttraumatic stress disorder (PTSD) is associated with objective health problems in specific populations, such as Vietnam veterans. Less is known about PTSD and health among medical samples, especially PTSD patients with different etiologic traumas. This study examined PTSD and health in medical patients within the Department of Veterans Affairs healthcare system. A total of 134 patients completed an interview and questionnaires. Data on physician-diagnosed illnesses were gathered from medical records. PTSD diagnosis and symptoms were associated with a higher likelihood of circulatory and musculoskeletal disorders. In addition, PTSD symptoms were associated with more medical conditions. PTSD symptoms and diagnoses were also associated with poorer health related quality of life. Most of these findings remained significant after controlling for comorbid depressive, generalized anxiety disorder, and panic attack symptoms. Overall, gender did not moderate the relationship between PTSD and poorer health.

Comorbidity↗
PubMed2004

VA practice patterns and practice guidelines for treating posttraumatic stress disorder.

Little is known about how recent ISTSS practice guidelines (E. B. Foa, T. M. Keane, & M. J. Friedman, 2000) compare with prevailing PTSD treatment practices for veterans. Prior to guideline dissemination, clinicians in 6 VA medical centers were surveyed in 1999 (n = 321) and in 2001 (n = 271) regarding their use of various assessment and treatment procedures. Practices most consistent with guideline recommendations included psychoeducation, coping skills training, attention to trust issues, depression and substance use screening, and prescribing of SSRIs, anticonvulsants, and trazodone. PTSD and trauma assessment, anger management, and sleep hygiene practices were provided less consistently. Exposure therapy was rarely used. Additional research is needed on training, clinical resources, and organizational factors that may influence VA implementation of guideline recommendations.

Depression↗
PubMed2004

Long-term influence of duration and frequency of participation in alcoholics anonymous on individuals with alcohol use disorders.

This study examined the influence of the duration and frequency of a baseline episode of participation in Alcoholics Anonymous (AA) among 473 individuals with alcohol use disorders on 1-year and 8-year outcomes and the effect of additional participation and delayed participation on outcomes. Compared with individuals who did not participate, individuals who affiliated with AA relatively quickly, and who participated longer, had better 1-year and 8-year alcohol-related outcomes. Individuals who continued to participate, and those who continued longer, had better alcohol-related outcomes than did individuals who discontinued participation, but individuals who delayed participation in AA had no better outcomes than those who never participated. In general, the frequency of participation was independently associated only with a higher likelihood of abstinence.

Adult↗
PubMed2004

Unipolar depression, life context vulnerabilities, and drinking to cope.

This study followed baseline samples of 424 unipolar depressed patients and 424 community controls across 10 years to investigate the association between depression and alcohol-related coping and to examine how life context vulnerabilities underlie the risk for depressed individuals to rely on drinking to cope. Findings supported all hypotheses. Depressed patients engaged in more drinking to cope than did community controls. Within individuals, more negative life events and less family support were associated with more drinking to cope across the 4 observations. Depressed patients experienced more negative life events and less family support than did community controls. These underlying life context vulnerabilities explained the relationship between depressed patient status and drinking to cope.

Adaptation, Psychological↗
PubMed2004

Posttraumatic stress disorder, anger and hostility, and physical health status.

Accumulating evidence suggests that posttraumatic stress disorder (PTSD) is linked to both objective and subjective indices of poorer health. Less is known about processes that may explain this association. This study examined anger/hostility as a possible mediator and moderator of PTSD and health status among a sample of 134 medical patients. Participants completed a structured interview of PTSD and questionnaires assessing health perceptions and anger and data on physician-diagnosed illnesses were gathered from computerized databases. Trait anger and anger-in partially explained the association between PTSD and poorer general health perceptions. There was a significant association between anger-in and the presence of a circulatory disorder only in patients with PTSD.

Anger↗
PubMed2004

Ten-year patterns of alcohol consumption and drinking problems among older women and men.

AIMS: This study focused on changes in 10-year patterns of alcohol consumption among older women and men, late-life and life history predictors of drinking problems, and gender differences in these predictors. DESIGN, SETTING, PARTICIPANTS: A sample of late-middle-aged community residents (N = 1291) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 1 year, 4 years and 10 years later. MEASUREMENTS: At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems and health-related and life context factors. Participants also provided information about their life history of drinking. RESULTS: Over the 10 years, the proportion of individuals who consumed alcohol declined. Among individuals who continued to drink, women and men showed comparable declines in alcohol consumption, minor concomitants of alcohol consumption and drinking problems. In addition to the amount of alcohol consumption, smoking, friends' approval of drinking and avoidance coping consistently predicted late-life drinking problems. With respect to life history factors, heavy drinking, drinking problems and increased drinking in response to life events were related to a higher likelihood of late-life drinking problems; obtaining help from family members and friends and, among men, participation in Alcoholics Anonymous, were related to a lower likelihood of problems. CONCLUSION: Older women and men show comparable declines in alcohol consumption and drinking problems. Specific late-life social context and coping variables, and life history indices, are risk factors for late-life drinking problems among both women and men.

Age Factors↗
PubMed2004

High-risk alcohol consumption and late-life alcohol use problems.

OBJECTIVES: We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems. METHODS: A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later. RESULTS: Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals. CONCLUSION: Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.

Aged↗
PubMed2003

Coping and coping styles in personality and treatment planning: introduction to the special series.

Coping is a complex process. It is variously described as a situational and as a trait-like response, as a response to stress and as a disposition to respond to change. In this article, we review the current research on coping within the context of considering the contributions of the articles presented in this series. We present two broad views of coping, the more general one under the title of "coping response" defines coping as containing emotional, behavioral, and cognitive qualitites. It is generally considered to be a stress-specific pattern by which an individual's perceptions, emotions, and behaviors prepare for adapting and changing. The more narrow view of coping is described here as "coping style" and represents a more observable but general style of interacting. In this usage, coping is a trait-like variable that is activated when an environment changes in some way. It resembles other personality qualities and describes dispositions to respond in certain ways. In this article, we consider the implications and extant knowledge about coping within these two definitions, with special consideration to the prediction of treatment processes and outcomes. The articles in this series are discussed both in terms of extant research on these two views of coping and in terms of their contributions to the available literature on coping and coping responses.

Adaptation, Psychological↗
PubMed2003

Coping, treatment planning, and treatment outcome: discussion.

The articles presented in this issue are discussed within the context of the general literature on coping and coping style. The focus of this special issue was to determine if these articles are both consistent with extant research and advance the field. We identify at least two general definitions of coping, as used in these articles. We refer to one definition as reflecting one's "coping style." This is largely a descriptive concept and closely related to one's enduring behavioral traits. It is closely related to other personality characteristics such as introversion-extroversion, stability, etc. The other definition of "coping" in the literature is much more specific to stressful environments and to the changes noted in one's behavior and cognitions during times of stress, than the first definition. We refer to this broad stress response as one's "coping response." Coping response, unlike coping style, includes both a cognitive and an affective component. We conclude that it may be advantageous to differentiate between these two broad definitions in future research. We also conclude that the articles in this issue provide information that advances the field's understanding of coping styles and coping responses.

Adaptation, Psychological↗
PubMed2003

Dispositional and contextual perspectives on coping: toward an integrative framework.

The clinical disciplines have witnessed a rapidly growing literature on the conceptualization and measurement of coping and on the role of coping in confronting stressful life circumstances and maintaining adaptive functioning. This literature has spawned a diversity of concepts and contrasting perspectives on the determinants and effects of coping. To address this complexity, we comment on dispositional and contextual perspectives on the coping process, describe the domains of coping styles and coping skills, and review some measures of these constructs. Next, we present a conceptual framework that integrates key aspects of these constructs and use the framework to guide a selective review of the linkages between personal and social resources, coping skills, and adaptive functioning. We then consider applications of the framework to clinical practice.

Adaptation, Psychological↗
PubMed2003

Outcomes at 1 and 5 years for older patients with alcohol use disorders.

Older patients with alcohol use disorders who had gone through residential treatment were compared with matched groups of young and middle-aged patients (N = 432 in each age group) on their 1- and 5-year outcomes, use of continuing care services, and outcome predictors. Older patients had better outcomes than did young and middle-aged patients but had comparable levels of continuing substance abuse care and 12-step self-help group involvement. Similar factors predicted outcomes across the age groups. Longer duration of continuing substance abuse care and greater self-help group involvement were related to better outcomes, as were patients' attitudes and coping strategies at program discharge. The findings indicate that older patients with alcohol use disorders respond to age-integrated substance abuse treatment programs at least as well as do younger patients and are equally involved in formal and informal continuing substance abuse care.

Adult↗
PubMed2003

Social contexts: transcending their power and their fragility.

For more than four decades, my colleagues and I have examined how social contexts and individuals influence each other. To provide a perspective on this work, I describe some lessons we have learned: situational influence exemplifies both the power and fragility of social contexts; common aspects of settings underlie their power, for better and for worse; individuals' health and well-being is affected by powerful forces in eight domains; and intervention programs are powerful settings that encompass risks as well as rewards. I then note some unresolved questions, such as how to balance the risks and rewards of powerful environments, how to better understand the interplay between individuals and the social contexts they select and create, how to learn from the fact that many people overcome the power of traumatic social contexts, and how to apply our knowledge to balance the risks and rewards of individual and community contexts.

Health Status↗
PubMed2003

Models of standard and intensive outpatient care in substance abuse and psychiatric treatment.

Intensive outpatient mental health programs are proliferating rapidly. However, findings suggest that intensive treatment may be no more effective than standard treatment. This study compared standard to intensive outpatient programs, within both the psychiatric and substance abuse systems of care, on organization, staffing, and treatment orientation; clinical management practices; and services. A total of 723 (95% of those eligible) Department of Veterans Affairs programs were surveyed nationwide. Psychiatric intensive programs have responded appropriately to their more severely ill patients in terms of the amount and orientation of care, and having a rehabilitation focus. However, the relative lack of basic psychiatric services in psychiatric intensive programs, and the overall similarity of substance abuse standard and intensive programs, may explain why intensive programs have not yielded patient outcomes that are superior to those of standard programs. Mental health system planners should consider differentiating intensive programs using broader criteria and methods.

Ambulatory Care↗
PubMed2003

PTSD treatment and 5-year remission among patients with substance use and posttraumatic stress disorders.

Given the high prevalence of comorbid substance use and posttraumatic stress disorders (SUD-PTSD), how to best treat these patients is a pressing concern for SUD providers. PTSD treatment may play an important role in patients' recovery. One hundred male SUD-PTSD patients who attended SUD treatment completed 1-. 2-, and 5-year follow-ups. Outpatient treatment information was gathered from Veterans Affairs databases. PTSD treatment and 12-Step group attendance in the 1st year predicted 5-year SUD remission. Patients who received PTSD treatment in the first 3 months following discharge and those who received treatment for a longer duration in Year 1 were more likely to be remitted in Year 5. The receipt of PTSD-focused treatment immediately after SUD treatment may enhance long-term remission.

Adult↗
PubMed2003

Addictive disorders in context: principles and puzzles of effective treatment and recovery.

To consider key issues in understanding effective treatment and recovery, the author reviews selected principles and unresolved puzzles about the context of addictive disorders and the structure, process, and outcome of treatment. The principles focus on the process of problem resolution, the duration and continuity of care, treatment provided by specialist versus nonspecialist providers, alliance and the goals and structure of treatment, characteristics of effective interventions, and the outcome of treatment versus remaining untreated. The unresolved puzzles involve how to concepualize service episodes and treatment careers, connections between the theory and process of treatment effective patient-treatment matching strategies, integration of treatment and self-help, and the development of unified models to encompass life context factors and treatment within a common framework.

Community Mental Health Services↗
PubMed2003

Older and younger patients with substance use disorders: outpatient mental health service use and functioning over a 12-month interval.

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patents were initially functioning a well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses.

Adult↗