The Psychometric Properties of the Drug Abuse Screening Test

Low Levels of HIV Stigma Among Transgender Women Receiving HIV Care

Despite the prevalence of HIV among transgender women (TGW), gaps exist in understanding the impact of HIV-related stigma (HRS) on TGW with HIV. This is a small cross-sectional pilot study examining HRS in TGW (n=18) with HIV in Miami, FL, who completed a survey during an HIV clinical visit. In contrast with previous studies, results demonstrated low levels of HRS and suggest the potential of increasing acceptance of TGW with HIV as a contributing factor. Larger studies are needed to explore factors underlying HRS with the aim of further reducing stigma among TGW with HIV.

Clinical Predictors of Engagement in Teleintegrated Care and Telereferral Care for Complex Psychiatric Disorders in Primary Care: a Randomized Trial

BACKGROUND

Telepsychiatry Collaborative Care (TCC) and Telepsychiatry/Telepsychology Enhanced Referral (TER) expand the reach of specialty mental health services to underserved populations.

OBJECTIVE

Assess clinical predictors of treatment engagement for complex psychiatric conditions in TCC-in which remote specialists consult with primary care teams via an onsite care manager who also provides brief psychotherapy-and TER, in which remote specialists provide direct telehealth treatment.

DESIGN

A randomized pragmatic trial from twenty-four primary care clinics without onsite psychiatrists or psychologists.

PARTICIPANTS

A total of 1,004 adult patients screened positive for posttraumatic stress disorder (PTSD)and/or bipolar disorder were randomized to receive TCC or TER for 1 year.

MAIN MEASURES

Psychotherapy engagement was measured by the number of sessions completed, and pharmacotherapy engagement by the medication adherence item from the Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ).

KEY RESULTS

Engagement in TCC psychotherapy visits was greater compared to TER. There was no association between the PTSD symptom severity and treatment engagement. The internal state scale (ISS) activation subscale, an indicator of mania, was associated with reduced odds of initiating psychotherapy (odds ratio [OR] = 0.70; 95% CI, 0.59 to 0.84) but not the number of sessions attended once psychotherapy started. The Drug Abuse Screening Test-10(DAST-10) score was associated with receipt of fewer psychotherapy sessions (incidence ratio rate [IRR] = 0.88; 95% CI, 0.81 to 0.95). The number of physical health comorbidities was associated with greater engagement in psychotherapy (IRR = 1.11, 95% CI, 1.03 to 1.19) and pharmacotherapy (OR = 1.54; 95% CI, 1.27 to 1.87). None of the findings varied by intervention group.

CONCLUSIONS

Both teleintegrated and telereferral care offer an opportunity to treat patients with complex psychiatric conditions. While there was no difference in clinical characteristics predicting engagement, onsite care managers engaged patients in more psychotherapy sessions than remote therapists.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02738944.

Underlying pathway of factors leading to mental health in Iranian young adolescents: A structural equation modeling

Background:

The present study aimed to provide a field-tested model of constituting factors affecting mental health in young Iranian adolescents.

Materials and Methods:

In this cross-sectional study, a conceptual model was proposed based on an extensive literature review. A total of 254 young adolescents aged 11–14 years were recruited from north, south, east, and west regions of Tehran megacity by a random cluster sampling procedure, of whom 244 adolescents participated. The adolescents and their mothers altogether completed eight questionnaires pertaining to the proposed conceptual model: (1) Strengths and Difficulties Questionnaire (SDQ), (2) Childhood Experience of Care and Abuse Questionnaire, (3) Child Exposure to Domestic Violence Scale, (4) Drug Abuse Screening Test-10, (5) Baumrind Parenting Style Questionnaire, (6) Conflict Behavior Questionnaire, (7) General Health Questionnaire-28, and (8) Garmaroodi Socioeconomic Status Questionnaire. The statistical analysis was performed using structural equation modeling.

Results:

This study demonstrated that parent mental health (b = −0.111), experience of father's care (b = −1.112), conflict with mother (b = 0.309), conflict with father (b = 0.135), and exposure to domestic violence (b = 0.217), as well as age (b = 0.93) and gender (b = 0.139), had direct effect on adolescent mental health (all P < 0.05). Further, the results showed that exposure to domestic violence and conflict with mother had the greatest direct impact on adolescent mental health among all other family-related factors, followed by conflict with father and parent mental health. Conflict with mother and conflict with father also affected adolescent mental health indirectly through experience of domestic violence and had a mediating effect for the influence of several other factors on adolescent mental health, thus playing an important role in the pathway leading to young adolescent mental health status in the Iranian population.

Conclusion:

Overall, the final model proved to be fit and the factors constituting the final model were able to predict 88% of the variations in the mental health of Iranian adolescents. This model can guide clinical psychologists, psychiatrists, and other mental health workers in a more realistic and effective prevention or treatment planning for their young clients. Moreover, it may help in arriving at a comprehensive preventive policymaking for mental health policymakers.