Confidentiality Uncovered: Why Peer Supporters Need Protection

The concept of confidentiality arises from legal recognition given to the expectations of parties in a relationship. The party conveying the information has an expectation of privacy and the party hearing the information has an obligation not to disclose. More importantly, the concept of privilege arises when legal recognition is given to those communications. Privilege prevents compelled disclosure in legal settings. There is currently no recognized privilege protection for communications made to researchers absent a Certificate of Confidentiality. With the few exceptions that we will discuss, there is also no recognized privilege for communications made to peer supporters. Peer supporters are becoming increasingly more important in clinical and research settings. For the purposes of this brief, peer supporters are defined as individuals with a history of mental illness or substance abuse who are providing services and/or supports to others diagnosed with a similar illness. The increasing use of peer supporters is largely due to research findings and transformation efforts that suggest that peers are able to easily build effective relationships with clients and help promote recovery. Peers have been shown to have the ability to act as positive role models with personal experiences to share, and are often more empathetic than non-peers. Unfortunately peers may not be protected from the consequences of compelled disclosure of information they gain. In Massachusetts, peers can be subpoenaed by a court to repeat any information they obtain from clients/research subjects. The authors will discuss strategies which could protect peers under these circumstances

Exploring the Concept of “Young Carer” in Families Living with Parental Mental Illness

Background Information: The concept of “young carers” has been framed in the literature as children providing care and assuming household responsibilities when parents have physical and/or mental disabilities (Aldridge & Becker, 2003). In the United Kingdom, young carers have been studied extensively, leading to increased access to services and supports (Dearden & Becker, 2004). Our goal is to explore the concept of young carers in the U.S. Aims: 1) To describe the care giving and household responsibilities of children and youth living with parents with mental illnesses, how often they are performed, and the feelings of children and youth about these responsibilities. In addition, we are exploring the daily activities and interactions of children and youth; and 2) To assess the feasibility and usefulness of certain measures for use with younger children. Methods: Data were obtained in baseline interviews conducted with children and youth participating in the Family Options study. Interview data were obtained from 47 children and youth between the ages of 8 and 16 years at the time of entry into the study. The sample is balanced in terms of gender. The majority of the children are white. About half had ever had an IEP. Over two thirds had ever had any emotional/behavioral problems. The majority had been involved with child protection services. Interviews included questions from a structured measure used in previous research on young carers (Aldridge & Becker, 1993) and open-ended interview items from the Behavioral and Emotional Rating Scale-2nd Ed. (BERS-2; Mooney, Epstein, Ryser, & Pierce, 2005). Results: Most of the children and youth reported having responsibilities such as helping to provide care for their mother (82%), helping mom get ready to go out (58%), and helping mom to get up in the morning (50%). Children also reported doing chores such as washing dishes (60%), helping with laundry (69%), and helping with sweeping, vacuuming or dusting (84%). Most children (95%) said the amount of work they had to do around the house seemed fair to them and that they felt appreciated for this work (91%). Ninety-four percent of children and youth indicated they spend time “doing things they like.” Also, about half (51%) indicated they would like to be doing more of these activities. Almost ninety percent (89%) reported they spend time playing or hanging out with friends. Interviewers noted that children’s ages may have affected their interpretation of some of the questions. Also, parents were often nearby while children were being interviewed, which may have influenced children’s responses. Discussion: While children perform care giving and other responsibilities in the home, these responsibilities seem to be balanced with engagement in personal activities and friendships. Further research might explore children’s attitudes about their responsibilities in relation to their parents’ illnesses and their relationships with their parents, as well as their perceptions of the balance between these responsibilities and their personal activities. Recommendations for the future include interviewing children without their parents present and providing additional clarification for younger children on the meaning of questions regarding care giving and household responsibilities

A prospective examination of sex differences in posttraumatic autonomic functioning

BACKGROUND: Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning. METHODS: 192 participants were recruited from emergency departments following trauma exposure ( RESULTS: 2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR levels. Two-week HF-HRV was significantly lower in women, and a sex by PTSD interaction suggested that women with PTSD demonstrated the lowest HF-HRV levels. Skin conductance response in the emergency department was associated with 2-week HR and HF-HRV only among women who developed PTSD. CONCLUSIONS: Our results indicate that there are notable sex differences in autonomic functioning among trauma-exposed individuals. Differences in sympathetic biomarkers (BP and HR) may have implications for cardiovascular disease risk given that sympathetic arousal is a mechanism implicated in this risk among PTSD populations. Future research examining differential pathways between PTSD and cardiovascular risk among men versus women is warranted

Prospective Associations between Emotion Dysregulation and Fear-Potentiated Startle: The Moderating Effect of Respiratory Sinus Arrhythmia

Background: Emotion dysregulation has been implicated in the negative outcomes following trauma exposure. A proposed biomarker of emotion dysregulation, respiratory sinus arrhythmia (RSA), has demonstrated associations with trauma-related phenomena, such as the fear-potentiated startle (FPS) response. The current study aimed to examine the prospective association between emotion dysregulation and RSA and FPS several years following trauma exposure. Methods: Participants were 131 women exposed to a campus mass shooting on February 14, 2008. Pre-shooting emotion dysregulation was assessed in 2006-2008. Startle response, measured by orbicularis oculi electromyography (EMG), and RSA were gathered during an FPS paradigm conducted from 2012-2015. Results: No significant associations among emotion dysregulation, RSA, and FPS emerged among the full sample. However, emotion dysregulation predicted FPS during both acquisition ( = .54, p = .03) and extinction ( = .75, p <.01), but only among individuals with high resting RSA. Conclusions: Findings suggest that pre-shooting emotion dysregulation is a potent predictor of FPS several years following potential trauma exposure, and this association varies by RSA level. Results emphasize the importance of examining autonomic regulation in the association between emotion dysregulation and recovery from trauma exposure

Mothers with Mental Health Disorders: Mental Health Promotion in the Context of Parenting

Parenting is a meaningful role for the majority of American women, including those with mental health disorders. Success in this role, particularly for women with mental health disorders, would seem to be intimately related to mental health promotion, the recovery process, and successful functioning in other major life domains (e.g., employment, community living, and personal health and well-being). The achievement of maximum social participation for women with mental health disorders may hinge on addressing the challenges they face as parents

An Observational Descriptive Study of IRB Decision Making

Background: Institutional Review Boards (IRBs) are the primary organizations designed to protect research subjects from harm and assure that they participate voluntarily. At the same time, many researchers feel that they intrude into the research process without making research safer. Goals: • Identify which issues about applications are the focus of IRB attention; e.g., the scientific validity of a protocol, issues of risk, informed consent • Clarify how, if at all, the occupants of different roles (chair, community member, attorney, scientific expert, etc.) differ in their discussion of applications • Describe how IRB members identify problems in applications; what information resources they use and how they use them • Identify how IRBs organize the work of application review through the use of staff, pre-meeting review, and formatl meeting

Extinction of Fear Memory Attenuates Conditioned Cardiovascular Fear Reactivity

Post-traumatic stress disorder (PTSD) is characterized by a heightened emotional and physiological state and an impaired ability to suppress or extinguish traumatic fear memories. Exaggerated physiological responses may contribute to increased cardiovascular disease (CVD) risk in this population, but whether treatment for PTSD can offset CVD risk remains unknown. To further evaluate physiological correlates of fear learning, we used a novel pre-clinical conditioned cardiovascular testing paradigm and examined the effects of Pavlovian fear conditioning and extinction training on mean arterial pressure (MAP) and heart rate (HR) responses. We hypothesized that a fear conditioned cardiovascular response could be detected in a novel context and attenuated by extinction training. In a novel context, fear conditioned mice exhibited marginal increases in MAP (∼3 mmHg) and decreases in HR (∼20 bpm) during CS presentation. In a home cage context, the CS elicited significant increases in both HR (100 bpm) and MAP (20 mmHg). Following extinction training, the MAP response was suppressed while CS-dependent HR responses were variable. These pre-clinical data suggest that extinction learning attenuates the acute MAP responses to conditioned stimuli over time, and that MAP and HR responses may extinguish at different rates. These results suggest that in mouse models of fear learning, conditioned cardiovascular responses are modified by extinction training. Understanding these processes in pre-clinical disease models and in humans with PTSD may be important for identifying interventions that facilitate fear extinction and attenuate hyper-physiological responses, potentially leading to improvements in the efficacy of exposure therapy and PTSD–CVD comorbidity outcomes

Fear-Potentiated Startle and Fear Extinction in a Sample of Undergraduate Women Exposed to a Campus Mass Shooting

Posttraumatic stress disorder (PTSD) is a common psychological disorder that affects a substantial minority of individuals. Previous research has suggested that PTSD can be partially explained as a disorder of impaired fear inhibition. The current study utilized a previously validated fear acquisition and extinction paradigm in a sample of 75 undergraduate women who were exposed to a campus mass shooting that occurred in 2008. We used a protocol in which conditioned fear was first acquired through the presentation of one colored shape (reinforced conditioned stimulus, CS+) that was paired with an aversive airblast to the larynx (unconditioned stimulus, US) and a different colored shape that was not paired with the airblast (non-reinforced conditioned stimulus, CS-). Fear was extinguished 10 min later through repeated presentations of the CSs without reinforcement. Number of clinically significant posttraumatic stress symptoms (PTSS) immediately following the mass shooting were positively associated with fear-potentiated startle (FPS) to the CS+ and CS- during late periods of acquisition. During early periods of fear extinction, PTSS was positively associated with FPS to the CS+. Results from the current study suggest that PTSS is related to altered fear inhibition and extinction during an FPS paradigm. In line with similar research, women with greater PTSS demonstrated a greater “fear load,” suggesting that these women experienced elevated fear to the CS+ during extinction after conditioned fear was acquired