Bulletin of the Menninger Clinic最新文献

Research suggests that racial/ethnic minoritized individuals have elevated risk for experiencing trauma and developing posttraumatic stress disorder (PTSD) but are less likely to utilize mental health treatment compared to their non-Hispanic White counterparts. However, possessing health insurance may mitigate these disparities. We investigated this issue using a subsample of data obtained from the National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 2,339), to estimate the likelihood of utilizing PTSD-specific and general mental health treatment among a racially/ethnically diverse sample of individuals diagnosed with PTSD. Insurance status was included as a moderating factor. Across racial/ethnic groups, insured individuals had more than twice the odds of utilizing PTSD-specific and general treatment than those without insurance. Black, Hispanic, and Asian/Native Hawaiian/Pacific Islander participants were significantly less likely to utilize PTSD-specific and general mental health treatment regardless of insurance status. These findings can inform targeted public health interventions to address mental health care disparities.

Cultural competence is crucial for achieving health equity in mental health care, as systemic barriers and sociocultural factors significantly impact access, diagnosis, and treatment. This paper examines cultural competence and related concepts, including cultural humility, cultural safety, and structural competence, while addressing critiques and misconceptions. We examine its applications at micro, meso, and macro levels, emphasizing its role in diverse clinical settings. In mental health assessment, frameworks like the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision's (DSM-5-TR) Outline for Cultural Formulation and the Contextual Formulation highlight the importance of understanding patients' cultural identities and values. In psychotherapy, cultural adaptations, including mindfulness-based interventions such as acceptance and commitment therapy (ACT), can enhance effectiveness. At the systemic level, we advocate for inclusive organizational practices, ongoing training, and policies that address structural inequities. Integrating cultural competence into mental health care enables clinicians and institutions to better serve diverse populations.

Objectives: The Five Facet Mindfulness Questionnaire - Short Form (FFMQ-15) measures the tendency to be mindful and is proposed as an alternative to the original 39-item version. This study examines the psychometric properties of the FFMQ-15 in a clinical sample to provide further support for a short-form version.

Method: Participants (N = 244; M_age = 29.68) included in the study completed the FFMQ-39 and FFMQ-15, the Brief Experiential Avoidance Questionnaire (BEAQ), and the Adult ADHD Self-Report Scale - Part A (ASRS). A confirmatory factor analysis (CFA) examined the structure of the FFMQ-15.

Results: The FFMQ-15 demonstrates moderate to excellent internal consistency. The FFMQ-15 showed significant correlations in predicted directions with the FFMQ-39, the BEAQ, and the ASRS. The CFA supports a four-factor hierarchical model, excluding the Observing subscale.

Conclusion: Results indicate reasonable psychometric properties of the FFMQ-15 but suggest further examination of the Observing subscale.

Exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD). While previous literature supports the effectiveness of higher levels of specialized ERP-based care for OCD (i.e., partial hospital, residential), little is known about how outcomes for these levels of care compare to each other, or who is accessing different levels of specialized care. The present study compared treatment outcomes and baseline demographic, clinical, and prior treatment characteristics between adults with OCD or a related disorder accessing a virtual partial hospital program (VPHP; n = 63) or a residential (n = 128) program. Analyses revealed no significant clinical differences between the programs at either baseline or across treatment. Programs significantly differed on whether patients had children or not. Findings suggest that both VPHP and residential treatment for OCD are effective forms of care, and future research should consider how demographic factors may influence treatment access and preferences.

Medical-legal partnerships (MLPs) address social determinants of health by integrating legal services into health care settings. This study examines associations between health-harming legal needs (HHLNs) and mental health quality among family medicine clinic patients screened for MLP referral. A retrospective cohort of 475 patients completed an HHLN screening instrument, including a measure of mentally unhealthy days (MUDs). Zero-inflated negative binomial models assessed associations between HHLNs and MUDs, adjusting for demographics. Patients with any HHLN had 65% lower odds of reporting zero MUDs. Worrying about housing instability was the strongest independent predictor of increased MUDs, associated with a 56% increase. Black race was associated with greater odds of reporting zero MUDs. Housing concerns are a key driver of mental health quality, highlighting the need for targeted legal interventions. Integrating MLP screening into primary care may help identify and address legal issues impacting patient mental health.

Background: Adolescents admitted as acute inpatients are a particularly vulnerable psychosocial population. This study aimed to examine their level of personality functioning in an acute psychiatric treatment setting.

Methods: We evaluated personality functioning in 62 adolescents using the Level of Personality Functioning-Questionnaire 12-18 (LoPF-Q 12-18) from a patient perspective and the Level of Personality Functioning Scale (LPFS) completed by clinicians.

Results: Adolescent patients exhibited a relatively high level of impaired personality functioning, with females tending to show partly higher levels of impairment than males. The agreement between self-reported and clinician reported impairment of personality functioning was low. Biopsychosocial mental health was a strong predictor of self-reported and clinician-reported levels of personality functioning, in contrast to nonsuicidal self-injurious behavior and suicidality.

Conclusion: Our findings identify important characteristics of adolescents in acute psychiatric inpatient units. The LoPF-Q may serve as a valuable screening tool for diagnostics and treatment.

Greater therapist experience is not necessarily associated with superior treatment outcomes, but some data suggest that experience with a specific disorder or treatment protocol is helpful. This study conducted a secondary analysis of one such finding, in which therapists with previous experience treating trichotillomania (TTM) achieved better outcomes than did TTM-novice therapists in a randomized controlled trial of the Comprehensive Behavioral (ComB) model. Sixty session recordings from this trial were randomly selected for coding on rationally-selected dimensions of therapist competence, of which seven proved sufficiently reliable for between-groups analysis. Sessions conducted by experienced therapists were superior in management of session time and most indicators tapping complex ComB-specific skills, whereas they were inferior to novice therapists on addressing patient nonadherence. Discussion focused on possible explanations for these results and proposed testing a sequence in which TTM therapists could begin with less complex interventions and implement ComB only after developing improved expertise.

Intolerance of uncertainty (IU) is a cognitive factor linked to various mental health disorders, especially anxiety, in children and adolescents. This study aimed to adapt and validate the Intolerance of Uncertainty Index-A for Children (IUI-A-C) into Turkish. A sample of 552 participants aged 10 to 19 years (M = 13.84, SD = 2.29) completed the Turkish version of the IUI-A-C and measures of anxiety. The study assessed confirmatory factor analysis, internal consistency reliability, criterion validity, item discrimination, and test-retest reliability. The adapted scale showed good psychometric properties, with confirmatory factor analysis indicating a good fit to the data. Internal consistency reliability was adequate (Cronbach's α = .73), and criterion validity was supported by a moderate positive correlation with anxiety measures. Item discrimination analysis demonstrated the scale's ability to differentiate between high and low levels of IU, and test-retest reliability was excellent (intraclass correlation coefficient = .92). Thus, the Turkish IUI-A-C is a valid and reliable tool for assessing IU in children and adolescents.

Since borderline personality disorder was identified as a distinct psychiatric syndrome in the 1970s, it has been recognized as a disorder marked by disturbance in interpersonal functioning. Understanding the borderline patient's characteristic modes of relating to self and others is therefore of significant theoretical and clinical importance. This article seeks to examine multiple facets of borderline personality disorder believed to contribute to interpersonal dysfunction, including: common communication patterns observed in borderline patients, such as double-bind communication; the primitive or paleologic thinking that results in misperception of benign interpersonal phenomena; and the destabilizing effect of a persistent pattern of stimulation and frustration (idealization and devaluation) on human relationships. This discussion of communication dilemmas and paradoxes is believed to represent a novel contribution to the literature on borderline psychopathology. It is argued that a broader recognition of these psychodynamic processes will yield improvement in psychotherapeutic models and treatment of this severe and disabling disorder.