The Challenges of Working With Men Who Perpetrate Partner Violence: Perspectives and Observations of Experts Who Work With Batterer Intervention Programs

Batterer intervention programs (BIPs) constitute the primary treatment for perpetrators of intimate partner violence (IPV). Systematic evaluations of BIPs, however, have yielded modest results in terms of these programs' ability to reduce perpetration. Descriptive studies, which can provide information on the contexts and process associated with BIPs, can provide insights into the underlying mechanisms that might promote change among BIP clients, and as such are important to improving efficacy measures for BIPs. To date, however, limited research exists on what challenges BIPs encounter in working with clients, and how those challenges present barriers to behavioral change among perpetrators at the intervention level. As part of a 2-year ethnographic study, we conducted 36 individual semistructured interviews with professionals working with BIPs. We identified six themes related to challenges to promoting behavioral change among men who perpetrate violence: (a) social acceptance of IPV, (b) hypermasculine attitudes, (c) emotional problems, (d) childhood exposure to violence, (e) co-morbid mental health issues, and (f) denial, minimization, and blame. Our results have implications for thinking about some of the contextual factors that may impede BIPs ability to produce desired outcomes and for identifying areas in which programs can be tailored to improve the overall client experience. Our results also point to the need for a more coordinated community response to IPV, and in particular to helping provide resources that support BIPs sustained, safe, and as effective as possible work.

Key Components of the Batterer Intervention Program Process: An Analysis of Observational Data From Two Community-Based BIPs

Qualitative research on batterer intervention programs (BIPs) has primarily consisted of interview-based studies of clients and facilitators. To date, no research has utilized observational data to understand how BIPs "work," or the processes occurring in BIPs that promote prosocial behavioral change. Forty-four observations of BIP group sessions were conducted. Two key processes were found: "facilitator processes" (e.g., managing group dynamics and engaging clients in learning) and "client processes" (e.g., mutual aid, help-seeking, and support). More observational research on BIPs is needed to uncover the full range of processes occurring during BIPs and that can link group processes to client outcomes.

Male IPV Perpetrators' Perspectives on Facilitation of Batterer Intervention Program: Results From a 2-Year Study

As part of a two-year ethnographic study of batterer intervention programs (BIPs) we interviewed 76 male perpetrators of intimate partner violence (IPV) on their perspectives regarding BIP facilitators. Participants endorsed a number of characteristics of facilitators that helped to reduce their resistance to the group process and assisted in engaging them in the learning process, including facilitators who were invested in the program and its mission, and displayed a non-judgmental demeanor. At the same time, they also endorsed facilitators who were honest with them and challenged them on their behavior, and who exhibited a high degree of experience in IPV. Additionally, participants endorsed the need to have a female facilitator as part of the group to further promote engagement and learning. This study has implications for thinking about what components of BIP facilitation might be important for reducing some of the resistance that may lead to client attrition, and how BIPs can better engage clients in prosocial behavioral changes.

Human Services Utilization Among Male IPV Perpetrators: Relationship to Timing and Completion of Batterer Intervention Programs

Limited information exists on the extent to which male perpetrators of Intimate Partner Violence (IPV) are engaged in the use of human services for co-occuringpsychosocial and health issues. The current analysis uses administrative data from one batterer intervention program (BIP) and data from the local Department of Human Services to explore perpetrators' engagement with human services, and the relationship of that use to timing and completion of the BIP. Data for 330 adult male clients referred to the participating BIP from 2010 to 2015 were collected. A majority (63%) had engaged in at least one human service program. The most common kind of service was mental health (46%). The most specific service engagement was child welfare as a parent (41%). Engagement largely concluded prior to beginning the BIP. BIP completers had less service use overall. Future work should explore how these services could be utilized to improve the success of BIPs and reduce perpetration.

The Operational Challenges for Batterer Intervention Programs: Results From a 2-Year Study

Batterers intervention programs (BIPs) constitute a primary intervention for perpetrators of intimate partner violence (IPV). There is little understanding as to what operational, or program-level, challenges BIPs face that can impede their effectiveness and adherence to state standards. As part of a 2-year ethnographic study, we conducted 36 individual semistructured interviews with professionals working with BIPs and identified five themes related to program-level challenges for BIPs: (a) information barriers, (b) safety issues, (c) facilitator retention and training, (d) the need for monitoring, and (e) funding constraints. We conclude that continued work needs to be done at both the state and local level, and in coordination with community judicial, mental health, human services, and other agencies to help provide resources that support BIPs in sustained, safe, and as effective as possible work.

Male Intimate Partner Violence Perpetrators' Perceptions of the Positives and Negatives of Peer Interactions in Group Batterer Intervention Programs

Seventy-six adult male perpetrators of intimate partner violence enrolled in a batterer intervention program (BIP) were interviewed on their perspectives of the intra-BIP group peer interactions. A majority of participants endorsed positives aspects of working with peers in the group context. Only one negative aspect arose, namely, other group members who disrupted the BIP process in some way. More importantly, a minority of participants expressed indifference toward the group process. This study has implications for training of BIP facilitators and for future research on BIPs that helps to tailor the approaches these groups use to maximize client engagement.

Developing a Community-Based Tailored Exercise Program for People With Severe and Persistent Mental Illness

BACKGROUND

People with severe and persistent mental illness (SPMI) are at a greater risk of medical issues compared with the general population. Exercise has a positive effect on physical and mental health outcomes among this population in community settings.

OBJECTIVES

To describe community-based participatory research (CBPR) methods used to tailor an exercise program among people with SPMI, demonstrate its impact, and present lessons learned for future research.

METHODS

The partnership developed a project to explore the feasibility of implementing a physical activity program at a community agency among clients with SPMI.

LESSONS LEARNED

Data showed improved trends in mood, social support, and physical and mental health outcomes. Facilitators and barriers must be carefully considered for recruitment and retention.

CONCLUSIONS

A gender-specific, group-based, tailored exercise intervention developed through collaboration with a community agency serving people with SPMI using CBPR methods is feasible.

Effect of food service nutrition improvements on elementary school cafeteria lunch purchase patterns

BACKGROUND

Schools can play a major role in prevention and intervention for childhood obesity. We describe changes in elementary school cafeteria lunch sales patterns resulting from nutritional improvements in menu offerings that were part of a community-wide focus on health.

METHODS

Elementary school lunch sales data were collected for 1 week in each of 7 years in a district serving a predominantly poor, rural, and Caucasian student population, with high rates of obesity. Post hoc data analyses described lunch sales patterns and related food service costs over the project years.

RESULTS

The percentage of high calorie/low nutrition foods sold decreased from 22% of all sales in 2005 to 0% in 2011. High-calorie snack purchases decreased from 535 items to 0 items. The sale of fresh fruits increased by 12%. There was only a slight decline in the percentage of children who purchased cafeteria lunches over the years and a 15.2% cost increase for purchasing healthier food supplies.

CONCLUSIONS

Elementary school children purchased healthier lunches when healthier menu items were offered and when less healthy foods were eliminated from the menu. There was no significant decline in the number of students who purchased lunches as nutritional improvements were made.

Prenatal smoking cessation intervention and gestational weight gain

BACKGROUND

Quitting smoking is often associated with weight gain and prenatal cessation may lead to increased gestational weight gain (GWG). Although previous reports have suggested a link between prenatal smoking cessation and GWG, no studies have examined the relationship between cessation and guideline-recommended GWG, and there is little information about the relationship between the timing of prenatal cessation and GWG. Thus, we examine GWG among women in a community prenatal smoking cessation program and assess the relationship between the timing of prenatal cessation GWG.

METHODS

Pregnant women from care clinics serving economically disadvantaged women who participated in a smoking cessation intervention offered free of charge, self-reported weight, and provided biochemical verification of smoking. Relationships between duration of cessation and GWG were evaluated in t-tests and regression models. GWG was calculated from self-reported weight before pregnancy and self-reported weight at the last visit before delivery.

FINDINGS

Women who quit earlier during pregnancy had greater GWG (16.9 ± 7.5 kg) than did those who never quit (13.6 ± 8.9). After adjusting for timing of weight assessment and prepregnancy body mass index, however, GWG was not different between women who did and did not quit.

CONCLUSION

Quitting earlier in pregnancy is associated with greater GWG, but women who do and do not quit do not differ on total GWG. Despite increased GWG with early cessation, the maternal and fetal health benefits of prenatal smoking cessation outweigh risks of potential risks of excessive GWG.

Nutrition knowledge of low-income parents of obese children

Minority and low-income children are overrepresented among obese US children. Lack of basic nutrition knowledge among parents may contribute to this disparity. The purpose of this study is to measure nutrition knowledge of parents of Medicaid-insured obese children using a simple low-literacy tool. Parents, recruited from pediatric clinics, demonstrated their nutrition knowledge by placing food stickers into cells on a printed grid with food groups displayed in columns and three nutrition categories displayed in rows. In general, parents (n = 135; 74.8 % black; 79.2 % income of ≤$25,000/year) correctly identified food groups (median = 90.5 % correct). Nutritional categories were more commonly misidentified (median = 67 % correct), with parents mostly believing foods were healthier than they were. Multivariable linear regression revealed black race (p = 0.02), no college education (p = 0.02) and income of <$15,000 (p = 0.03) independently predicted misidentification of nutritional categories. Parents' understanding of food's nutritional value is variable. Black race, less education, and very low income are associated with poorer nutrition knowledge.

Giving residents tools to talk about behavior change: a motivational interviewing curriculum description and evaluation

OBJECTIVE

To determine whether a motivational interviewing (MI) curriculum is effective in teaching internal medicine residents core MI skills and the empathic, nonjudgmental MI style.

METHODS

Nineteen third-year residents met for 12 h with a faculty instructor. Teaching methods included lecture, written exercises, a simulated patient exercise, and discussion of residents' behavior change issues.

RESULTS

Residents' adoption of MI skills was evaluated before and after the course with the Helpful Responses Questionnaire. Residents decreased use of closed-ended questions (from a score of 1.13 to 0.37, p=0.036) and MI roadblocks (4.00-1.08, p<0.001), and increased the use of reflections (1.87-4.87, p<0.001), and use of MI strategies (0.45-0.97, p=0.017). Residents' use of open-ended questions decreased from 1.97 to a mean of 1.05, p=0.023. Residents' ratings of the course on a 5-point scale varied from 3.7 for written exercises to 4.6/5 for the simulated patient exercise. After the course, residents rated behavior change counseling skills as more important.

DISCUSSION AND CONCLUSION

A 12-h course increased residents' use of core MI communication skills in a written measure, and was highly rated.

PRACTICE IMPLICATIONS

Future work should examine whether teaching of the empathic, collaborative MI stance impacts patient outcomes.

In person versus computer screening for intimate partner violence among pregnant patients

OBJECTIVE

To compare in person versus computerized screening for intimate partner violence (IPV) in a hospital-based prenatal clinic and explore women's assessment of the screening methods.

METHODS

We compared patient IPV disclosures on a computerized questionnaire to audio-taped first obstetric visits with an obstetric care provider and performed semi-structured interviews with patient participants who reported experiencing IPV.

RESULTS

Two-hundred and fifty patient participants and 52 provider participants were in the study. Ninety-one (36%) patients disclosed IPV either via computer or in person. Of those who disclosed IPV, 60 (66%) disclosed via both methods, but 31 (34%) disclosed IPV via only one of the two methods. Twenty-three women returned for interviews. They recommended using both types together. While computerized screening was felt to be non-judgmental and more anonymous, in person screening allowed for tailored questioning and more emotional connection with the provider.

CONCLUSION

Computerized screening allowed disclosure without fear of immediate judgment. In person screening allows more flexibility in wording of questions regarding IPV and opportunity for interpersonal rapport.

PRACTICE IMPLICATIONS

Both computerized or self-completed screening and in person screening is recommended. Providers should address IPV using non-judgmental, descriptive language, include assessments for psychological IPV, and repeat screening in person, even if no patient disclosure occurs via computer.

Understanding turning points in intimate partner violence: factors and circumstances leading women victims toward change

OBJECTIVE

When counseling women experiencing intimate partner violence (IPV), healthcare providers can benefit from understanding the factors contributing to a women's motivation to change her situation. We wished to examine the various factors and situations associated with turning points and change seeking in the IPV situation.

METHODS

We performed qualitative analysis on data from 7 focus groups and 20 individual interviews with women (61 participants) with past and/or current histories of IPV.

RESULTS

The turning points women identified fell into 5 major themes: (1) protecting others from the abuse/abuser; (2) increased severity/humiliation with abuse; (3) increased awareness of options/access to support and resources; (4) fatigue/recognition that the abuser was not going to change; and (5) partner betrayal/infidelity.

CONCLUSIONS

Women experiencing IPV can identify specific factors and events constituting turning points or catalyst to change in their IPV situation. These turning points are dramatic shifts in beliefs and perceptions of themselves, their partners, and/or their situation that alter the women's willingness to tolerate the situation and motivate them to consider change. When counseling women experiencing IPV, health providers can incorporate understanding of turning points to motivate women to move forward in their process of changing their IPV situation.

The Pittsburgh STOP program: disseminating an evidence-informed intervention for low-income pregnant smokers

PURPOSE

Prenatal smoking is a preventable risk factor for poor perinatal outcomes and is more prevalent in pregnant smokers of low socioeconomic status (SES). We describe the intervention model and factors associated with quitting from the Pittsburgh STOP Program, an evidence-informed dissemination intervention for low-SES pregnant smokers.

SETTING

STOP is delivered in community health care clinics serving economically disadvantaged women.

PARTICIPANTS

Participants were 856 pregnant women who were current smokers (93%) and recent quitters (7%). Most were white (59%) or black (35%), single (74%), young (mean age = 25), and experiencing an unplanned pregnancy (84%); 90% were insured by Medicaid/uninsured.

METHODS

An evidence-informed intervention for community pregnant women was delivered individually in a single-group pre-post evaluation design. Measures were demographics, participation and retention, smoking status, satisfaction, and cost. Analyses included descriptive statistics and logistic regression.

RESULTS

Participants attended an average of 4.7 sessions. Dropout rate after the first session was 5%. Over 11% of smokers quit; 48% of preenrollment spontaneous quitters remained abstinent. Factors significantly associated with quitting included race, mother's age, nicotine dependence, and number of sessions attended.

LIMITATIONS

STOP is a community program with self-selected participants and no control group.

CONCLUSION

Low-income pregnant smokers will engage in an evidence-informed cessation program tailored for this group, with quit rates that compare to controlled research results.

Partner violence screening in mental health

OBJECTIVE

To study a mental health sample to assess (1) the prevalence of physical, sexual and emotional intimate partner violence (IPV) victimization and perpetration, (2) the extent this sample reported being asked about IPV by mental health clinicians and (3) how prevalence and screening rates varied by gender.

METHOD

Women and men receiving services at a large psychiatric facility completed anonymous written questionnaires.

RESULTS

A total of 524 adults were approached for study participation, and 428 (158 men, 270 women) completed a survey. Over half (51%) of participants experienced some form of IPV; 63% of women and 32% of men reported IPV victimization. Experience of IPV was more likely if participants were women and had diagnoses of posttraumatic stress disorder, anxiety disorder or bipolar disorder. Both women (33%) and men (16%) reported perpetrating IPV. The reported IPV screening rate by mental health providers was 44% for the whole sample (women: 55%; men: 27%).

CONCLUSION

IPV victimization and perpetration is a prevalent problem among women and men receiving mental health services. Clinicians are missing opportunities to screen for IPV as part of mental health evaluation and treatment.

Adapting pediatric obesity treatment delivery for low-income families: a public-private partnership

OBJECTIVE

The objective was to evaluate the feasibility of delivering a pediatric weight management intervention adapted for low-income families. Academic researchers, a Medicaid health plan, a State Medicaid agency, and community pediatric providers partnered in the project.

METHODS

Participants were 48 families with 52 overweight/obese children aged 4 to 12 recruited from Medicaid health plan and providers' offices. Elements of efficacious pediatric obesity interventions were modified for low literacy and implemented in person and telephonically with parents.

RESULTS

Families report ents in food shopping and preparation, and child eating and activity habits. The retention rate was 88%. Children grew significantly taller (F = 7.1; P = .012) but did not gain significant weight (F = 0.91; P = .35), with a trend toward decreased BMI ( F = 3.2; P = .08).

CONCLUSIONS

The authors demonstrate the feasibility of delivering an adapted pediatric obesity intervention with low-income families. They also discuss implications for public-private partnerships among key stakeholders to address pediatric obesity in this high-risk population.

The process of change for victims of intimate partner violence: support for a psychosocial readiness model

Intimate partner violence (IPV) victimization is a women's health problem that imposes a significant health and health care cost burden. Although IPV victims cannot change the perpetrator's behavior, they can take actions to reduce exposure to the partner's abuse. The process of change for IPV victims has been described using the transtheoretical model (TTM), among others. We report results of a qualitative study with current and past IPV victims to 1) explicate the process of safety-seeking behavior change for female victims of IPV and 2) explore the fit of the TTM for explaining this process. Based on the results, we propose the psychosocial readiness model to describe the process of change for female victims of IPV. This model considers readiness as a continuum that ranges from robustly defending the status quo on 1 end to being ready to take action toward change on the other. Movement toward and away from change along the continuum results from a dynamic interplay of both internal factors and external interpersonal and situational factors.

Understanding behavior change for women experiencing intimate partner violence: mapping the ups and downs using the stages of change

OBJECTIVE

For women who are experiencing intimate partner violence (IPV), making changes toward safety is often a gradual process. When providing counseling and support, health care providers may benefit from better understanding of where women are in their readiness to change. Our objective was to apply the transtheoretical model's stages of change to the experiences of women who experienced IPV and map their experiences of change as they moved toward increased safety.

METHODS

A multi-disciplinary team designed a qualitative interview process with 20 women who had current or past histories of IPV in order to explore their experiences.

RESULTS

The women in our study (1) moved through stages of readiness generally in a nonlinear fashion, with varying rates of progression between safe and nonsafe situations, (2) were able to identify a "turning-point" in their situations, (3) attempted multiple "action" steps and (4) were influenced by internal and external factors.

CONCLUSIONS

Our study suggests that focusing on the transtheoretical model to develop stage-based interventions for IPV may not be the most appropriate given the nonsequential movement between stages and influence of external factors.

PRACTICE IMPLICATIONS

The "change mapping" technique can be used as an educational and counseling tool with patients, as well as a training tool for health care providers.

Accessing adult smokers in the pediatric setting: What do parents think?

The anticipation of negative parental reaction is cited by pediatricians as a common barrier to intervening with parents who smoke. In an effort to clarify perceived versus actual parent reaction, the present study investigated the reactions of a diverse parent sample toward pediatricians addressing parental smoking in the outpatient setting. This study represents a descriptive cross-sectional in-person survey of 906 parents interviewed exiting four geographically diverse pediatric practices. Only 3% of the sample felt their smoking status was not the pediatrician's business, 89% stated they believe it is an important part of a pediatrician's job to ask about their smoking status, and 8% stated it wouldn't matter if the pediatrician asked. Demographic characteristics were associated with a positive attitude about being asked. Compared with nonsmokers, fewer smokers had positive attitudes (81% vs. 91%, p = .0002); and more highly educated parents were more strongly positive about being asked (91% vs. 83%, p = .006). Among 187 smokers, 177 (95%) would appreciate or feel okay about the physician's concern if advised to quit and 57% reported wanting some kind of smoking cessation help from the pediatrician's office. In a heterogeneous sample of parents, strong support exists for pediatricians addressing parental smoking at pediatric office visits. This finding is encouraging for pediatricians who are concerned about negative parental reaction.

Health care interventions for intimate partner violence: What women want

OBJECTIVE

We sought to determine what women want from health care interventions for intimate partner violence (IPV) and understand why they found certain interventions useful or not useful.

METHODS

We conducted interviews with 21 women who have a past or current history of intimate partner violence. Participants were given cards describing various IPV interventions and asked to perform a pile sort by placing cards into three categories ("definitely yes," "maybe," and "definitely no") indicating whether they would want that resource available. They were then asked to explain their categorizations.

RESULTS

The pile sort identified that the majority of participants supported informational interventions and individual counseling. Only 9 of 17, however, felt couple's counseling was a good idea with seven reporting it was definitely not useful. Half wanted help with substance use and treatment for depression. Interventions not well regarded included "Receiving a follow-up telephone call from the doctor's office/clinic" and "Go stay at shelter" with only 7 and 5 of the 21 women placing these cards in the "definitely yes" pile. "Health provider reporting to police" was the intervention most often placed in the "definitely no" pile, with 9 of 19 women doing so. The women described several elements that affected their likelihood of using particular IPV interventions. One theme related stages of "readiness" for change. Another theme dealt with the complexity of many women's lives. Interventions that could accommodate various stages of "readiness" and helped address concomitant issues were deemed more useful. Characteristics of such interventions included: 1) not requiring disclosure or identification as IPV victims, 2) presenting multiple options, and 3) preserving respect for autonomy.

CONCLUSIONS

Women who had experienced IPV described not only what they wanted from IPV interventions but how they wished to receive these services and why they would chose to use certain resources. They advised providing a variety of options to allow individualizing according to different needs and readiness to seek help. They emphasized interventions that protected safety, privacy, and autonomy.

Relationship of birth cohort and early age at onset of illness in a bipolar disorder case registry

OBJECTIVE

Utilizing data from a previously characterized registry of subjects with bipolar illness, the authors examined age at onset of the first illness episode in cohorts of subjects born from 1900 through 1939 and from 1940 through 1959.

METHOD

Demographic and clinical characteristics at the first full episode of bipolar disorder of subjects in a diagnostically validated voluntary bipolar disorder registry (N=1,218) were reviewed and subjected to statistical analyses.

RESULTS

The median age at onset of the first episode of bipolar illness was lower by 4.5 years in subjects born during or after 1940 (median age=19 years), compared with subjects born before 1940 (median age=23.5 years). The proportion of subjects with bipolar disorder presenting with a prepubertal onset was significantly higher in the later birth-year cohort than in the earlier birth-year cohort. More than 50% of male and female subjects in both cohorts had a depressive episode as the first episode of bipolar illness. Subjects in each cohort who had a parent with major depression, bipolar disorder, or schizophrenia experienced their first episode nearly 4 to 5 years earlier than the other subjects in the cohort.

CONCLUSIONS

Prospective epidemiological studies conducted with bipolar disorder subjects are needed to either affirm or refute these data on age at illness onset. If the results are affirmed, the early recognition of prepubertal bipolar disorder will be important, so that the condition can be treated with appropriate medications and medications that could potentially worsen the illness course can be avoided. Similarly, early recognition of bipolar illness is important, especially in women, to minimize use of antidepressant monotherapy for patients with bipolar illness. Among young people presenting with major depression as the first illness episode, a parental history of major depression, bipolar disorder, or psychosis may be a useful pointer to future bipolar disorder. Early recognition and appropriate treatment of bipolar illness may prevent the development of chronicity and serious functional impairment.

Parent attitudes about pediatricians addressing parental smoking

OBJECTIVE

Pediatricians have a great opportunity to intervene in parental smoking, but few do so consistently. Pediatricians consistently cite concern about negative parental reaction as one barrier to addressing parental smoking. This study investigated parent attitudes about pediatricians addressing parental smoking at pediatric visits.

METHODS

Parents (N = 341) were interviewed immediately after a pediatric visit about their attitudes toward pediatricians addressing parental smoking. Chi-square analyses identified relevant factors in parents' responses.

RESULTS

Most parents (99%; n = 337) said that asking about smoking is a very important part of a pediatrician's job (89%; n = 302) or felt that it did not matter one way or the other (10%; n = 35). There was no difference between attitudes of smoking and nonsmoking parents on this variable (chi(2) = 5.9, df = 1, P >.05). Very few nonsmokers (1%; n = 2) or smokers (5%; n = 2) believed that pediatricians have no business asking about parental smoking. The results support recent reports from adult practice that patient satisfaction ratings are improved when physicians ask about tobacco use and advise about quitting.

CONCLUSIONS

Both smoking and nonsmoking parents strongly believe that pediatricians should address parental smoking in the context of pediatric visits.

Demographic and clinical characteristics of individuals in a bipolar disorder case registry

BACKGROUND

The goal of this analysis was to characterize a cohort of 3000 persons who self-identified as having bipolar disorder by demographic, clinical, and treatment characteristics and to document the burden that this disorder imposed on their lives.

METHOD

The Stanley Center Bipolar Disorder Registry used a variety of recruitment methods to reach people with bipolar disorder. The cohort included those currently in treatment and those active in support groups. Registrants completed an interviewer-administered questionnaire to obtain information on demographic characteristics, clinical history, and treatment history.

RESULTS

The median age of the 2839 patients who were analyzed was 40.1 years, 64.5% were women, and over 90% were white. The median age at onset was 17.5 years, and the mean was 19.8 years. Despite the fact that over 60% completed at least some college and 30% completed college, 64% were currently unemployed. The patients' family histories point to a high prevalence of mental disorder in the families, especially mood disorders. Patients were concurrently taking multiple medications, and more than one third were taking at least 3 types of psychotropic medications. This pattern of pharmacotherapy was consistent with participants' overall mood ratings, which demonstrated how unusual it was for them to be symptom-free over a 6-month period.

CONCLUSION

Our present findings point to the chronicity and severity of bipolar disorder as experienced in the community. We still need to develop better interventions, ensure access to care consistent with current consensus guidelines, and initiate care as early as possible in the course of the condition.

Diagnostic certainty of a voluntary bipolar disorder case registry

BACKGROUND

Strategies for identifying and recruiting persons with bipolar disorder are of importance as interest in studying this relatively uncommon, but highly disabling illness increases. The development and implementation of a bipolar disorder case registry and the assessment of diagnostic certainty of the resulting sample are described.

METHODS

Eight hundred and four individuals who self-reported a history of bipolar disorder were recruited. Telephone interviewers gathered demographic information and clinical, medical and treatment history information. One hundred randomly-selected registrants completed an in-person structured diagnostic interview. Self-report of diagnosis was compared to the results of the diagnostic interview.

RESULTS

Ninety three percent of registrants interviewed met criteria for a lifetime bipolar spectrum diagnosis; of those, 76.3% were diagnosed with bipolar I disorder. Agreement between self-reported and SCID diagnoses was 93%, indicating that self-report of a bipolar diagnosis is highly reliable. Two-thirds had experienced at least one other lifetime Axis I diagnosis, with substance abuse/dependence (55.9%) and panic disorder (19.4%) the most common comorbidities.

LIMITATIONS

Since nearly all of the sample have previously been diagnosed as having bipolar disorder by a professional, the sample's representativeness of the population as a whole may be somewhat limited.

CONCLUSIONS

Persons with bipolar disorder can accurately identify themselves as having the disorder via a telephone interview, indicating that a case registry method is a useful strategy for recruiting very large samples of persons with this disorder. Such large samples will allow for further study of treatment variations among patient subgroups, of pathways to treatment, and of the effectiveness of new treatments.

The Pittsburgh study of normal sleep in young adults: focus on the relationship between waking and sleeping EEG spectral patterns

The effects of age and gender on spectral characteristics of the waking EEG were investigated in a large sample of young adult men and women. In addition, relationships between spectral characteristics of the waking and sleeping EEG within an individual were explored. The sample included 28 females and 33 males in two age groups: 20-29 years (n = 32), and 30-40 years (n = 29). Spectral analysis was used to quantify EEG frequency characteristics for waking EEG just prior to sleep onset, as well as for the entire sleep recording. Significant effects of age were seen in the waking EEG but only in the delta frequency range (0.5-4.5 Hz) with lower delta activity in the older group (F = 11.6, P = 0.001). No significant gender effects were found in the waking EEG. Independent of age and gender, spectral profiles in the delta, theta, alpha and beta frequency bands of a subject's waking EEG were found to be highly correlated with their sleep EEG. In addition, subjects with high voltage alpha profiles during waking were found to sleep significantly longer and deeper than those with low voltage records. Significant correlations between waking and sleep EEG suggest that the spectral signature of an individual's EEG may be found across sleep/wake states.

Behavioral interventions as adjunctive treatments for chronic asthma

Results of this review of the behavioral literature on asthma therapy indicate that systematic desensitization, operant interventions, and biofeedback treatments have been successful in altering pulmonary functioning, asthma symptomatology, and/or asthma-related behaviors, whereas some evidence for the limited effectiveness of relaxation training has been demonstrated. The clinical usefulness of these techniques remains open to interpretation. It cannot be said, however, that the results reported represent the definitive statement regarding the usefulness of these interventions, due to the lack of methodological sophistication evident in this body of research. Behavioral investigators currently interested in this area have the opportunity to design and implement research strategies which attend to sound methodological considerations and which may present a clearer demonstration of the efficacy of the adjunctive behavioral treatments which have been used with asthma patients for the past several decades.