Biomedical subjects

Terry L Schell

Publications and source records attributed to Terry L Schell.

11 recordsLinked to original sources

PubMed2007

Problem drinking among Cambodian refugees in the United States: how big of a problem is it?

OBJECTIVE: The present study assesses current drinking behavior in a representative sample of Cambodian refugees. Earlier estimates of alcohol use in this population suggest that Cambodian refugees are at elevated risk for alcohol-use problems, but these studies have relied on convenience samples and may not reflect current consumption patterns. METHOD: A cross-sectional, face-to-face interview was conducted in Khmer on a household probability sample of Cambodian refugees residing in the largest such community in the United States. The overall response rate was 87% and yielded 490 respondents in the current analyses. RESULTS: Rates of consumption and alcohol-use problems were low in this population. Few participants (26%) reported any alcohol consumption in the 30 days preceding the interview, and only 2% reported any heavy drinking in the last 30 days. Multivariate analyses indicated that younger participants and men were more likely to report any recent drinking, and men were more likely to report any heavy drinking. Notably, recent consumption was not related to degree of trauma exposure or extent of psychiatric distress when controlling for age and gender. CONCLUSIONS: These data contrast dramatically with the widespread belief that Cambodian refugees are at elevated risk for problem drinking. Findings highlight the pitfalls of drawing population-based conclusions from data based on nonrepresentative samples or from nonstandard measures of alcohol consumption.

Adult↗

PubMed2006

The role of hyperarousal in the manifestation of posttraumatic psychological distress following injury.

The authors examined the temporal relation among posttraumatic stress disorder symptom clusters, using data derived from a longitudinal study of survivors of orofacial injury (N = 264). They conducted cross-lagged panel analyses, with self-reported symptom data collected at 1, 6, and 12 months postinjury. Results demonstrate that hyperarousal was a potent predictor of subsequent symptoms of reexperiencing and avoidance as well as hyperarousal. By contrast, neither reexperiencing nor avoidance was significantly related to other symptom clusters other than themselves over time. These findings underscore the distinctive nature of hyperarousal in the manifestation of posttraumatic psychological distress over time. Implications for theory, clinical intervention, and future research are discussed.

Adult↗

PubMed2006

Barriers to mental health care utilization for U.S. Cambodian refugees.

Asian Americans encounter barriers to mental health care, some of which are structural, whereas others may be cultural. Using data from a probability sample (N = 490) drawn from the largest Cambodian refugee community in the United States, the authors assessed the extent to which structural and cultural barriers were experienced. Surprisingly, a relatively small proportion endorsed commonly cited cultural barriers such as distrust of Western care (4%) and greater confidence in alternative care (5%), whereas most endorsed structural barriers such as high cost (80%) and language (66%). Among those with a probable diagnosis, a similar pattern was found. Findings suggest that structural, not culturally based, barriers are the most critical obstacles to care in this U.S. Cambodian refugee community.

Adult↗

PubMed2006

Socio-environmental influences on adolescents' alcohol outcome expectancies: a prospective analysis.

AIMS: To investigate the prospective influence of social influence and social bonding variables on the development of alcohol outcome expectancies among adolescents with and without drinking experience. DESIGN: Longitudinal data from students in the control schools of a field trial designed to evaluate a school-based drug prevention program. SETTING: A total of 19 middle schools in South Dakota, USA. MEASUREMENTS: An alcohol outcome expectancy scale administered to 1410 students in grades 8 and 9. After using confirmatory factor analysis (CFA) to develop an expectancies measure, multiple-group (grade 8 drinkers versus grade 8 non-drinkers) path analysis was used to model 9th grade alcohol expectancies. Grade 8 social influence and bonding variables were used as predictors, controlling for grade 8 expectancies. FINDINGS: At the bivariate level, peer and adult influences and social bonding variables were related consistently to alcohol outcome expectancies among drinkers and non-drinkers. A bivariate relationship between alcohol advertising and alcohol expectancies was found among drinkers only. In the multivariate model, greater alcohol use by important adults predicted independently increased alcohol positivity among drinkers; greater perceived approval of alcohol use by parents and peers predicted diminished perceived potency of alcohol among non-drinkers. Advertisement exposure and social bonding variables were not independent predictors of alcohol expectancies in the multivariate model. CONCLUSIONS: These findings suggest that attempts to alter adolescents' alcohol expectancies are likely to fail unless they address the influence of immediate social models on these beliefs.

Adolescent↗

PubMed2006

Rates and correlates of seeking mental health services among Cambodian refugees.

OBJECTIVES: We assessed the rates and correlates of seeking mental health services among a probability sample of Cambodian refugees who needed such services. METHODS: Interviewers conducted face-to-face interviews with a representative sample drawn from the largest US community of Cambodian refugees. The analytic sample included 339 persons who met past 12-month criteria for posttraumatic stress disorder, major depression disorder, or alcohol use disorder. Respondents described contact with service providers for psychological problems during the preceding 12 months. We examined bivariate and multivariate predictors of seeking services. RESULTS: Respondents reported high rates of contact with both medical care providers (70%) and mental health care providers (46%). Seeking services from both types of providers was associated with lack of English-speaking proficiency, unemployment, 3 or fewer years of preimmigration education, and being retired or disabled. Women, individuals with health insurance, and persons receiving government assistance also were more likely to seek services. CONCLUSIONS: Cambodian refugees with mental health problems had high rates of seeking service for psychological problems during the preceding 12 months. Research is needed to examine the effectiveness of services received by Cambodian refugees.

Adult↗

PubMed2005

Predicting DUI recidivism: Personality, attitudinal, and behavioral risk factors.

AIMS: To predict DUI recidivism using personality, attitudinal, and behavioral factors. DESIGN: We conducted cross-sectional analyses of survey data. Covariance structure modeling was used to identify unique predictors of driving after drinking (DAD), alcohol consumption, and high-risk driving. PARTICIPANTS: Two hundred and eighty individuals with multiple DUI convictions, predominately male and Hispanic. Participants were surveyed in the Rio Hondo Courthouse, Los Angeles County, California. MEASUREMENTS: The survey included measures of past year frequency of DAD, socially desirable response bias, sensation seeking, trait hostility, high-risk driving style, alcohol expectancies, and alcohol consumption. FINDINGS: DAD was positively related with frequency of drinking and with positive alcohol expectancies. It was negatively associated with socially desirable response bias. Measures of high-risk driving and the personality variables were highly negatively associated with socially desirable response bias. CONCLUSIONS: Individuals who believe that they are affected positively by alcohol intoxication are not responding to the standard penalties for DUI and persist in driving after drinking. These beliefs may serve as an important point of intervention for programs designed to reduce drunk driving. The current research also suggests that self-report measures of DAD, as well as many hypothesized risk factors, are highly correlated with socially desirable response biases. Failure to control for such biases may be a significant threat to the validity of research in this field.

Adult↗

PubMed2005

Mental health of Cambodian refugees 2 decades after resettlement in the United States.

CONTEXT: Little is known about the long-term mental health of trauma-exposed refugees years after permanent resettlement in host countries. OBJECTIVE: To assess the prevalence, comorbidity, and correlates of psychiatric disorders in the US Cambodian refugee community. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, face-to-face interview conducted in Khmer language on a random sample of households from the Cambodian community in Long Beach, Calif, the largest such community in the United States, between October 2003 and February 2005. A total of 586 adults aged 35 to 75 years who lived in Cambodia during the Khmer Rouge reign and immigrated to the United States prior to 1993 were selected. One eligible individual was randomly sampled from each household, with an overall response rate (eligibility screening and interview) of 87% (n = 490). MAIN OUTCOME MEASURES: Exposure to trauma and violence before and after immigration (using the Harvard Trauma Questionnaire and Survey of Exposure to Community Violence); weighted past-year prevalence rates of posttraumatic stress disorder (PTSD) and major depression (using the Composite International Diagnostic Interview version 2.1); and alcohol use disorder (by the Alcohol Use Disorders Identification Test). RESULTS: All participants had been exposed to trauma before immigration. Ninety-nine percent (n = 483) experienced near-death due to starvation and 90% (n = 437) had a family member or friend murdered. Seventy percent (n = 338) reported exposure to violence after settlement in the United States. High rates of PTSD (62%, weighted), major depression (51%, weighted), and low rates of alcohol use disorder were found (4%, weighted). PTSD and major depression were highly comorbid in this population (n = 209; 42%, weighted) and each showed a strong dose-response relationship with measures of traumatic exposure. In bivariate analyses, older age, having poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty were also associated with higher rates of PTSD and major depression. Following multivariate analyses, premigration trauma remained associated with PTSD (odds ratio [OR], 2.08; 95% CI, 1.37-3.16) and major depression (OR, 1.56; 95% CI, 1.24-1.97); postmigration trauma with PTSD (OR, 1.65; 95% CI, 1.21-2.26) and major depression (OR, 1.45; 95% CI, 1.12-1.86); and older age with PTSD (OR, 1.76; 95% CI, 1.46-2.13) and major depression (OR, 1.47; 95% CI, 1.15-1.89). CONCLUSION: More than 2 decades have passed since the end of the Cambodian civil war and the subsequent resettlement of refugees in the United States; however, this population continues to have high rates of psychiatric disorders associated with trauma.

Adult↗

PubMed2005

Measuring developmental changes in alcohol expectancies.

The goal of this study was to measure shifts in alcohol expectancies from childhood into adolescence while controlling for changes in the psychometric properties of the instrument. One thousand nine hundred ninety-three 4th-grade and 1,632 9th-grade students from South Dakota rated the likelihood that 23 outcomes would result from alcohol use. These expectancies were modeled using a 2-factor confirmatory factor analysis. After differences in the psychometric properties of the instrument were controlled, the cohorts were distinguished by a large difference in Alcohol Positivity, with older participants viewing alcohol's effects more positively. Additionally, older participants displayed greater Alcohol Potency, believing that alcohol has a larger impact on all outcomes. There were also significant differences in the interpretation of the alcohol expectancies items across cohorts.

Adolescent↗

PubMed2005

Dynamic effects among patients' treatment needs, beliefs, and utilization: a prospective study of adolescents in drug treatment.

OBJECTIVE: To document the prospective, reciprocal relationships among substance use problems, utilization of drug treatment, and predisposing beliefs thought to increase treatment utilization. DATA SOURCE: Persistent Effects of Treatment Study-Adolescent (PETS-A), conducted by the Center on Substance Abuse Treatment. This was a longitudinal study of youths originally participating in one of two CSAT studies; one sample included 476 youths receiving residential drug treatment, and the other included 519 youths receiving outpatient treatment. STUDY DESIGN: This study uses five waves of data collected over a 12-month period to examine the temporal relationships among four variables: treatment dose, substance use problems, drug resistance self-efficacy, and perceived need for treatment (PNT). Data from this longitudinal study were analyzed using cross-lagged panel models, and structural equation modeling techniques were used to estimate the prospective, reciprocal relationships among these four variables in each of the two samples, while controlling for several covariates. PRINCIPAL FINDINGS: Both PNT and low drug resistance self-efficacy led to higher levels of subsequent treatment. However, low self-efficacy presaged increases in drug problems while PNT predicted decreases. CONCLUSIONS: Understanding the role of psychological variables in the utilization of health services is complicated for psychological disorders because beliefs that affect treatment can also influence the disorder itself. Efforts to keep adolescents in drug treatment should focus on convincing youth that treatment can help them with their problems, rather than convincing them that they cannot resist drugs on their own. While both messages increase treatment utilization, the latter belief undermines the effects of treatment.

Adolescent↗

PubMed2004

All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress.

This 3-wave longitudinal study examined the natural course of posttraumatic stress disorder symptoms using data collected from young adult survivors of community violence. Three key findings emerged. 1. Mean levels of distress for each symptom cluster decreased over time, with reexperiencing decreasing most rapidly. 2. Cross-lagged panel analysis revealed that hyperarousal strongly influences, but is not generally influenced by, other symptoms clusters. 3. Trajectory analysis demonstrated that respondents for whom hyperarousal was the most pronounced baseline symptom showed lower overall symptom improvement relative to trauma exposed counterparts for whom hyperarousal was a less prominent early symptom. Implications for theory, research, and clinical practice are discussed.

Adult↗

PubMed2002

Reappraising the link between peritraumatic dissociation and PTSD symptom severity: evidence from a longitudinal study of community violence survivors.

Cross-lagged panel analysis of longitudinal data collected from young adult survivors of community violence was used to examine the relationship between recall of peritraumatic dissociation and posttraumatic stress disorder (PTSD) symptom severity. Recollections of peritraumatic dissociation assessed within days of exposure differed from recollections measured at 3- and 12-month follow-up interviews. Peritraumatic dissociation was highly correlated with PTSD symptoms within each wave of data collection. Baseline recollections of peritraumatic dissociation were not predictive of follow-up PTSD symptom severity after controlling for baseline PTSD symptom severity. This pattern of results replicates previous work demonstrating a correlation between peritraumatic dissociation and subsequent symptom severity. However, findings are not consistent with the prevailing view that peritraumatic dissociation leads to increased PTSD symptom severity.

Adolescent↗