Testing the Assumption of Measurement Invariance in the SAMHSA Mental Health and Alcohol Abuse Stigma Assessment in Older Adults

This study examined the assumption of measurement invariance of the SAMSHA Mental Health and Alcohol Abuse Stigma Assessment. This is necessary to make valid comparisons across time and groups. The data come from the Primary Care Research in Substance Abuse and Mental Health for Elderly trial, a longitudinal multisite, randomized trial examining two modes of care (Referral and Integrated). A sample of 1,198 adults over the age of 65 who screened positive for depression, anxiety, and/or at-risk drinking was used. Structural equation modeling was used to assess measurement invariance in a two-factor measurement model (Perceived Stigma, Comfort Level). Irrespective of their stigma level, one bias indicated that with time, respondents find it easier to acknowledge that it is difficult to start treatment if others know they are in treatment. Other biases indicated that sex, mental quality of life and the subject of stigma had undue influence on respondents' feeling people would think differently of them if they received treatment and on respondents' comfort in talking to a mental health provider. Still, in the present study, these biases in response behavior had little effect on the evaluation of group differences and changes in stigma. Stigma decreased for patients of both the Referral and Integrated care group

The Role of Positive Alcohol Expectancies in Underage Binge Drinking Among College Students

Objective: This study explored associations between positive alcohol expectancies, and demographics, as well as academic status and binge drinking among underage college students. Participants: A sample of 1,553 underage college students at 3 public universities and 1 college in the Southeast who completed the Core Alcohol and Drug Survey in the Spring 2013 semester. Methods: A series of bivariate analyses and logistic regression models were used to examine associations between demographic and academic status variables as well as positive alcohol expectancies with self-reported binge drinking. Positive alcohol expectancies were examined in multivariable models via 2 factors derived from principal component analyses. Results: Students who endorsed higher agreement of these 2 emergent factors (sociability, sexuality) were more likely to report an occurrence of binge drinking in the past 2 weeks. Conclusions: Study results document associations between positive alcohol expectancies and binge drinking among underage students; implications for prevention and treatment are discussed

Elevated Movement Path Tortuosity in Voluntary Outdoor Ambulation in Community-Dwelling Veterans With a History of Traumatic Brain Injury

Objective: In comparison to veterans without a history of traumatic brain injury (TBI), we hypothesized that veterans with past TBI would have slower walking speed and more path tortuosity, TBI symptoms, problems with spatial orientation, and poorer executive function. Setting: Community nonclinical. Participants: Seventeen males (mean age of 37.2 years) reporting prior TBI and 20 non-TBI (mean age of 42.9 years). The number of years separating date of discharge and testing was 10.8 and 15.4 for the TBI and non-TBI groups, respectively. Design: Small 2 groups without random assignment. Main Measures: Brief Traumatic Brain Injury Screen, Trail Making Test-B, Clock Drawing Test, walking speed, and distance and path tortuosity in 30 minutes of voluntary outdoor walking wearing a small Global Positioning Systems recorder. Results: Those with TBI reported 4 Brief Traumatic Brain Injury Screen symptoms versus 0.4 for controls (F = 49.1; df = 1,35; P \u3c .001) but did not differ on Trail Making Test-B or the Clock Drawing Test. Veterans with TBI walked shorter distances, 2.33 km versus 2.84 km (F = 4.8; df = 1,35; P \u3c .05), and had greater path tortuosity (fractal D of 1.22 vs 1.15; F = 3.5; df = 1,35; P \u3c .05) but did not differ on travel speed or time spent walking. Conclusions: Traumatic brain injury has persistent symptomatic effects and significantly affects ambulation and spatial orientation years after the event. These findings corroborate and extend observations linking cognitive impairment and ambulation

Six-month longitudinal patterns of mental health treatment utilization by older adults with depressive symptoms

Aims of the study were to describe behavioral health treatment utilization patterns of community-dwelling older adults with depressive symptoms over a six-month period and to identify factors associated with treatment use, guided by a theoretical model emphasizing the dynamic nature of treatment use patterns over time and social context. A total of 144 participants ≥65 years old with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes at each follow-up included the use of antidepressants or counseling. Covariates included personal and social context variables. Approximately half of the participants (N=70, 48%) received no formal treatment (antidepressant prescription or counseling). Treatment use or nonuse did not change for most participants. More participants with severe symptoms received antidepressants (25%-37%) than did those with milder symptoms (10%-14%), although more participants in the latter group started (milder, 62%,versus severe, 49%) and stopped (milder, 77%, versus severe, 26%) antidepressant treatment at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, treatment use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new treatment at baseline, and receipt of advice to seek treatment. Over a six-month period, most older adults with depressive symptoms in this study continued their use or nonuse of mental health treatment. Demographic, need, attitudinal, and social variables were related to treatment use over time. Addressing intentions and providing advice may facilitate treatment seekin

Screening and Brief Intervention for Substance Misuse Among Older Adults: The Florida BRITE Project

Objectives. We developed and examined the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a 3-year, state-funded pilot program of screening and brief intervention for older adult substance misusers

Six-Month Longitudinal Patterns of Mental Health Treatment Utilization by Older Adults With Depressive Symptoms

Aims of the study were to describe behavioral health treatment utilization patterns of community-dwelling older adults with depressive symptoms over a six-month period and to identify factors associated with treatment use, guided by a theoretical model emphasizing the dynamic nature of treatment use patterns over time and social context. A total of 144 participants ≥65 years old with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes at each follow-up included the use of antidepressants or counseling. Covariates included personal and social context variables. Approximately half of the participants (N=70, 48%) received no formal treatment (antidepressant prescription or counseling). Treatment use or nonuse did not change for most participants. More participants with severe symptoms received antidepressants (25%-37%) than did those with milder symptoms (10%-14%), although more participants in the latter group started (milder, 62%,versus severe, 49%) and stopped (milder, 77%, versus severe, 26%) antidepressant treatment at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, treatment use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new treatment at baseline, and receipt of advice to seek treatment. Over a six-month period, most older adults with depressive symptoms in this study continued their use or nonuse of mental health treatment. Demographic, need, attitudinal, and social variables were related to treatment use over time. Addressing intentions and providing advice may facilitate treatment seekin

Peer Support as a Strategy for Reducing Hospital Readmissions Among Older Adults with Chronic Medical Illness and Depression

Reducing hospital readmissions has become a national priority, and there has been a strong push to identify strategies that reduce the number of hospital readmissions for high-risk patients. Recent evidence suggests adding peer support to Care Transitions Interventions may reduce hospital readmissions among older adult patients; however there is a dearth of research examining mechanisms through which added peer support may impact outcomes. This paper qualitatively examined the mechanisms through which peer support impacts outcomes after hospitalization from the perceptions of diverse older adults (N=11) recently discharged from the hospital living with a chronic illness and co-occurring clinical depression. Participants were recruited from Tampa General Hospital located in Tampa Florida in the United States. Through thematic analysis, we identified three mechanisms through which peer support may impact hospital readmissions: increased self-efficacy in self-management of disease, connection to community resources and improved mental health literacy. This study suggests that peer support is a valuable approach towards enhancing the benefit and reach of evidence-based Care Transitions Programs

Peer Support as a Strategy for Reducing Hospital Readmissions Among Older Adults with Chronic Medical Illness and Depression

Reducing hospital readmissions has become a national priority, and there has been a strong push to identify strategies that reduce the number of hospital readmissions for high-risk patients. Recent evidence suggests adding peer support to Care Transitions Interventions may reduce hospital readmissions among older adult patients; however there is a dearth of research examining mechanisms through which added peer support may impact outcomes. This paper qualitatively examined the mechanisms through which peer support impacts outcomes after hospitalization from the perceptions of diverse older adults (N=11) recently discharged from the hospital living with a chronic illness and co-occurring clinical depression. Participants were recruited from Tampa General Hospital located in Tampa Florida in the United States. Through thematic analysis, we identified three mechanisms through which peer support may impact hospital readmissions: increased self-efficacy in self-management of disease, connection to community resources and improved mental health literacy. This study suggests that peer support is a valuable approach towards enhancing the benefit and reach of evidence-based Care Transitions Programs