Avoidant coping partially mediates the relationship between patient problem behaviors and depressive symptoms in spousal Alzheimer caregivers

OBJECTIVE: Caring for a loved one with Alzheimer disease is a highly stressful experience that is associated with significant depressive symptoms. Previous studies indicate a positive association between problem behaviors in patients with Alzheimer disease (e.g., repeating questions, restlessness, and agitation) and depressive symptoms in their caregivers. Moreover, the extant literature indicates a robust negative relationship between escape-avoidance coping (i.e., avoiding people, wishing the situation would go away) and psychiatric well-being. The purpose of this study was to test a mediational model of the associations between patient problem behaviors, escape-avoidance coping, and depressive symptoms in Alzheimer caregivers. METHODS: Ninety-five spousal caregivers (mean age: 72 years) completed measures assessing their loved ones' frequency of problem behaviors, escape-avoidance coping, and depressive symptoms. A mediational model was tested to determine if escape-avoidant coping partially mediated the relationship between patient problem behaviors and caregiver depressive symptoms. RESULTS: Patient problem behaviors were positively associated with escape-avoidance coping (beta = 0.38, p < 0.01) and depressive symptoms (beta = 0.26, p < 0.05). Escape-avoidance coping was positively associated with depressive symptoms (beta = 0.33, p < 0.01). In a final regression analysis, the impact of problem behaviors on depressive symptoms was less after controlling for escape-avoidance coping. Sobel's test confirmed that escape-avoidance coping significantly mediated the relationship between problem behaviors and depressive symptoms (z = 2.07, p < 0.05). CONCLUSION: Escape-avoidance coping partially mediates the association between patient problem behaviors and depressive symptoms among elderly caregivers of spouses with dementia. This finding provides a specific target for psychosocial interventions for caregivers.

Making Life Choices Program: A psychoeducational intervention for promoting critical cognitive and affective competencies in adolescents at-risk for problem behaviors

The long term goal of the work described is to contribute to the emerging literature of prevention science in general, and to school-based psychoeducational interventions in particular. The psychoeducational intervention reported in this study used a main effects prevention intervention model. The current study focused on promoting optimal cognitive and affective functioning. The goal of this intervention was to increase potential protective factors such as critical cognitive and communicative competencies (e.g., critical problem solving and decision making) and affective competencies (e.g., personal control and responsibility) in middle adolescents who have been identified by the school system as being at-risk for problem behaviors. The current psychoeducational intervention draws on an ongoing program of theory and research (Berman, Berman, Cass Lorente, Ferrer Wreder, Arrufat, & Kurtines 1996; Ferrer Wreder, 1996; Kurtines, Berman, Ittel, & Williamson, 1995) and extends it to include Freire's (1970) concept of transformative pedagogy in developing school-based psychoeducational programs that target troubled adolescents. The results of the quantitative and qualitative analyses indicated trends that were generally encouraging with respect to the effects of the intervention on increasing critical cognitive and affective competencies. ^

A test of Jessor's problem behavior theory in a Eurasian and a Western European developmental context.

PURPOSE: The current study tested the applicability of Jessor's problem behavior theory (PBT) in national probability samples from Georgia and Switzerland. Comparisons focused on (1) the applicability of the problem behavior syndrome (PBS) in both developmental contexts, and (2) on the applicability of employing a set of theory-driven risk and protective factors in the prediction of problem behaviors. METHODS: School-based questionnaire data were collected from n = 18,239 adolescents in Georgia (n = 9499) and Switzerland (n = 8740) following the same protocol. Participants rated five measures of problem behaviors (alcohol and drug use, problems because of alcohol and drug use, and deviance), three risk factors (future uncertainty, depression, and stress), and three protective factors (family, peer, and school attachment). Final study samples included n = 9043 Georgian youth (mean age = 15.57; 58.8% females) and n = 8348 Swiss youth (mean age = 17.95; 48.5% females). Data analyses were completed using structural equation modeling, path analyses, and post hoc z-tests for comparisons of regression coefficients. RESULTS: Findings indicated that the PBS replicated in both samples, and that theory-driven risk and protective factors accounted for 13% and 10% in Georgian and Swiss samples, respectively in the PBS, net the effects by demographic variables. Follow-up z-tests provided evidence of some differences in the magnitude, but not direction, in five of six individual paths by country. CONCLUSION: PBT and the PBS find empirical support in these Eurasian and Western European samples; thus, Jessor's theory holds value and promise in understanding the etiology of adolescent problem behaviors outside of the United States.

Problem behavior of dementia patients predicts low-grade hypercoagulability in spousal caregivers

Low-grade hypercoagulability might be one pathway to explain how the chronic stress of dementia caregiving increases cardiovascular disease risk, but the specific aspects of caregiver stress that elicit hypercoagulability are elusive. We hypothesized that dementia patients' problem behaviors and negative reactions of caregivers to these behaviors would relate to hypercoagulability in caregivers.

Learning Data-Driven Models of Non-Verbal Behaviors for Building Rapport Using an Intelligent Virtual Agent

There is a growing societal need to address the increasing prevalence of behavioral health issues, such as obesity, alcohol or drug use, and general lack of treatment adherence for a variety of health problems. The statistics, worldwide and in the USA, are daunting. Excessive alcohol use is the third leading preventable cause of death in the United States (with 79,000 deaths annually), and is responsible for a wide range of health and social problems. On the positive side though, these behavioral health issues (and associated possible diseases) can often be prevented with relatively simple lifestyle changes, such as losing weight with a diet and/or physical exercise, or learning how to reduce alcohol consumption. Medicine has therefore started to move toward finding ways of preventively promoting wellness, rather than solely treating already established illness. Evidence-based patient-centered Brief Motivational Interviewing (BMI) interven- tions have been found particularly effective in helping people find intrinsic motivation to change problem behaviors after short counseling sessions, and to maintain healthy lifestyles over the long-term. Lack of locally available personnel well-trained in BMI, however, often limits access to successful interventions for people in need. To fill this accessibility gap, Computer-Based Interventions (CBIs) have started to emerge. Success of the CBIs, however, critically relies on insuring engagement and retention of CBI users so that they remain motivated to use these systems and come back to use them over the long term as necessary. Because of their text-only interfaces, current CBIs can therefore only express limited empathy and rapport, which are the most important factors of health interventions. Fortunately, in the last decade, computer science research has progressed in the design of simulated human characters with anthropomorphic communicative abilities. Virtual characters interact using humans’ innate communication modalities, such as facial expressions, body language, speech, and natural language understanding. By advancing research in Artificial Intelligence (AI), we can improve the ability of artificial agents to help us solve CBI problems. To facilitate successful communication and social interaction between artificial agents and human partners, it is essential that aspects of human social behavior, especially empathy and rapport, be considered when designing human-computer interfaces. Hence, the goal of the present dissertation is to provide a computational model of rapport to enhance an artificial agent’s social behavior, and to provide an experimental tool for the psychological theories shaping the model. Parts of this thesis were already published in [LYL+12, AYL12, AL13, ALYR13, LAYR13, YALR13, ALY14].

Learning data-driven models of non-verbal behaviors for building rapport using an intelligent virtual agent

There is a growing societal need to address the increasing prevalence of behavioral health issues, such as obesity, alcohol or drug use, and general lack of treatment adherence for a variety of health problems. The statistics, worldwide and in the USA, are daunting. Excessive alcohol use is the third leading preventable cause of death in the United States (with 79,000 deaths annually), and is responsible for a wide range of health and social problems. On the positive side though, these behavioral health issues (and associated possible diseases) can often be prevented with relatively simple lifestyle changes, such as losing weight with a diet and/or physical exercise, or learning how to reduce alcohol consumption. Medicine has therefore started to move toward finding ways of preventively promoting wellness, rather than solely treating already established illness.^ Evidence-based patient-centered Brief Motivational Interviewing (BMI) interventions have been found particularly effective in helping people find intrinsic motivation to change problem behaviors after short counseling sessions, and to maintain healthy lifestyles over the long-term. Lack of locally available personnel well-trained in BMI, however, often limits access to successful interventions for people in need. To fill this accessibility gap, Computer-Based Interventions (CBIs) have started to emerge. Success of the CBIs, however, critically relies on insuring engagement and retention of CBI users so that they remain motivated to use these systems and come back to use them over the long term as necessary.^ Because of their text-only interfaces, current CBIs can therefore only express limited empathy and rapport, which are the most important factors of health interventions. Fortunately, in the last decade, computer science research has progressed in the design of simulated human characters with anthropomorphic communicative abilities. Virtual characters interact using humans’ innate communication modalities, such as facial expressions, body language, speech, and natural language understanding. By advancing research in Artificial Intelligence (AI), we can improve the ability of artificial agents to help us solve CBI problems.^ To facilitate successful communication and social interaction between artificial agents and human partners, it is essential that aspects of human social behavior, especially empathy and rapport, be considered when designing human-computer interfaces. Hence, the goal of the present dissertation is to provide a computational model of rapport to enhance an artificial agent’s social behavior, and to provide an experimental tool for the psychological theories shaping the model. Parts of this thesis were already published in [LYL+12, AYL12, AL13, ALYR13, LAYR13, YALR13, ALY14].^

Multideterminação do comportamento alimentar em humanos: um estudo de caso

Tradicionalmente o estudo da anorexia nervosa vem sendo pautado nos critérios diagnósticos trazidos dos manuais como o DSM, que priorizam a descrição topográfica dos comportamentos-problema, em que pouca ou quase nenhuma atenção se dá a sua funcionalidade nos contextos em que ocorrem. Humanos podem parar de comer sob o controle dos mais variados eventos, de modo que uma caracterização nosológica de caráter nomotético pode não ser suficiente na análise do fenômeno. O estudo de caso de um paciente do sexo masculino de 12 anos ilustra e elucida o debate, por apresentar características diagnósticas diferentes das usualmente relatadas na literatura.

The effects of adolescent cannabis use on educational attainment: a review

This paper reviews research examining the link between cannabis use and educational attainment among youth. Cross-sectional studies have revealed significant associations between cannabis use and a range of measures of educational performance including lower grade point average, less satisfaction with school, negative attitudes to school, increased rates of school absenteeism and poor school performance. However, results of cross-sectional studies cannot be used to determine whether cannabis use causes poor educational performance, poor educational performance is a cause of cannabis use or whether both outcomes are a reflection of common risk factors. Nonetheless, a number of prospective longitudinal studies have indicated that early cannabis use may significantly increase risks of subsequent poor school performance and, in particular, early school leaving. This association has remained after control for a wide range of prospectively assessed covariates. Possible mechanisms underlying an association between early cannabis use and educational attainment include the possibility that cannabis use induces an 'amotivational syndrome' or that cannabis use causes cognitive impairment. However, there appears to be relatively little empirical support for these hypotheses. It is proposed that the link between early cannabis use and educational attainment arises because of the social context within which cannabis is used. In particular, early cannabis use appears to be associated with the adoption of an anti-conventional lifestyle characterized by affiliations with delinquent and substance using peers, and the precocious adoption of adult roles including early school leaving, leaving the parental home and early parenthood.

Sobrecarga vivenciada por familiares cuidadores de pacientes esquizofrénicos e sua relação com a depressão

RESUMO: A partir da desinstitucionalização psiquiátrica, a ênfase nas políticas públicas de saúde mental passou para os serviços comunitários e para períodos mais curtos de hospitalização. As famílias, então, tornaram-se as principais provedoras de cuidados cotidianos e de apoio aos pacientes. As dificuldades e o despreparo em assumir este novo papel têm gerado um sentimento de sobrecarga nos familiares, o que pode afetar sua saúde física e mental. Vários estudos investigaram as consequências de se tornar um cuidador de um paciente psiquiátrico, mas poucos pesquisaram o impacto na saúde mental desses cuidadores. A presente pesquisa investigou a relação entre a sobrecarga e a saúde mental dos familiares cuidadores de pacientes psiquiátricos. Participaram deste estudo 74 familiares cuidadores de pacientes com diagnóstico de esquizofrenia, atendidos no ambulatório do Serviço de Referência em Saúde Mental, da cidade de Divinópolis, MG. Os familiares participaram de uma entrevista estruturada. Nela foram aplicadas a Escala de Avaliação da Sobrecarga dos Familiares de Pacientes Psiquiátricos (FBIS-BR) e, para avaliar a saúde mental dos cuidadores, a Escala de Depressão de Beck (BDI). Foram realizadas análises estatísticas descritivas, univariadas e multivariadas. Os resultados mostraram que a maioria dos cuidadores era do sexo feminino (78,40%), pais (62,20%) e com idade média de 59,14 anos. Os cuidadores apresentaram uma média de sobrecarga global objetiva de 2,05 (DP ± 0,54), em uma escala de 1 a 5 pontos, e uma média de sobrecarga global subjetiva de 2,44 (DP ± 0,71), em uma escala de 1 a 4 pontos. Os resultados da escala BDI mostraram que 42 cuidadores poderiam ser classificados com depressão mínima (56,80%), 17 com depressão leve (23,00%), 7 com depressão moderada (9,50%) e 8 com depressão grave (10,80%). Foram encontradas correlações positivas significativas entre o grau de sobrecarga global e das subescalas e o nível de depressão. As análises multivariadas mostraram que o principal preditor de depressão dos cuidadores foi a sobrecarga global subjetiva. Outros preditores foram a obrecarga objetiva das rotinas diárias e da supervisão dos comportamentos problemáticos dos pacientes e a sobrecarga subjetiva das preocupações com o paciente. As informações levantadas mostraram o impacto do papel de cuidador na saúde mental dos familiares e apontaram para a necessidade de uma maior atenção, por parte dos gestores e profissionais da área, aos cuidadores de pacientes psiquiátricos.----------ABSTRACT: The emphasis in public policy on mental health was transferred to community services and for shorter periods of hospitalization from the psychiatric deinstitutionalization. Then the families become the first provider of daily care and support to patients. The difficulties and unprepared to assume this new role has generated a sense of overload in the relatives, which can affect your physical and mental health. Several studies have investigated the consequences of becoming a caregiver of a psychiatric patient, but few scholars have researched the impact on the mental health of caregivers. The present study has investigated the relationship between overload and mental health of family caregivers of psychiatric patients. The study included 74 family caregivers of patients with schizophrenia and outpatient clinic of the Department of Mental Health Reference, in Divinópolis, Minas Gerais, Brazil. The Rating Scale Burden of Relatives of Psychiatric Patients and the scale of Beck Depression Inventory (BDI) to assess the mental health of caregivers were applied in the interview. Descriptive statistics and univariate and multivariate analysis have performed. The results showed that the majority of caregivers were female (78.40%), parents (62.20%) and mean age of 59.14 years. The caregivers had an average burden overall objective of 2.05 (± 0.54) on a scale of 1 to 5 points, and a subjective global average burden of 2.44 (± 0.71) in a scale of 1 to 4 points. The results of the BDI showed that 42 caregivers could be classified with minimal depression (56.80%), 17 with mild depression (23.00%), 7 with moderate depression (9.50%) and 8 with severe depression (10 80%). Significant positive correlations were found between the degree of overloading and global subscales and depression levels. Multivariate analysis showed that the main predictor of caregivers' depression was the global subjective burden. Other predictors were the objective burden of daily routines and supervision of problem behaviors of patients and subjective burden of the concerns about patient. The resulting information showed the impact of caregiver role in the mental health of relatives and pointed to the need for higher attention of managers and professionals to caregivers of psychiatric patients.

Social Cognition and Behavior in Relationship Context

Social information processing (SIP; Crick & Dodge, 1994) and social-cognitive learning theories have been often used to understand children’s problem behaviors, such as aggression. According to these theories, children’s thinking guides their subsequent behaviors. Although most of us agree that social behavior and underlying thought processes are context-dependent, personality and social development researchers have usually engaged in searching for stable patterns of dispositions and behaviors, ignoring (or treating as error) the variance across different situations and relationship types. This, however, can result in erroneous conclusions and question the interpretation of previous findings. Four studies were conducted to explore the influence of relationship context on children’s social-cognitive evaluations and behavior. Samples were fourth to sixth graders from Estonia and Finland. Social cognitions were assessed by presenting children with hypothetical vignettes where the previously identified relationship partner’s behavior had a negative consequence for the child (Studies I, II, and IV), followed by questions measuring different social-cognitive processes (e.g., hostile attributions, behavioral strategies, outcome expectations and self-efficacy beliefs for aggression). In addition, in Studies II and IV, children provided information about their behavior within a specific relationship context. In Study III, an affective priming paradigm was employed where participants were presented with a short display of photographs of children’s liked and disliked classmates, and unknown peers. The results of this thesis suggest that children’s thinking and behavior are largely influenced by the affective valence of the relationship. Moreover, cognitions guide behavior within the relationship. The current findings offer a fruitful avenue for studying the heterogeneity of peer interactions.

Epidemiological studies of childhood and adolescence headache

The main purpose of this study was to examine the changes in the prevalence, incidence, and characteristics of headache in childhood and adolescence. In addition, the predictors of the change in the occurrence of childhood headache and the association between adolescent headache and behavior were studied. The occurrence and characteristics of headache were investigated as part of a prospective follow-up study, where 6-year-old children and their families (n=1132) were followed to the age of 12-years (n=1126). The study design entailed both a cohort and case-control group. The incidence of headache and the association between headache and behavior were studied in another cohort, consisting of 11-year-old twins (n=5393), who were followed to the age of 17 (n=4159). The prevalence rates of headache increased during the follow-up, especially in boys whose mothers suffered from frequent headache. The incidence rates of frequent headache changed the most in girls between ages of 11 and 14. Early-onset migraine and tension-type headache were equal predictors of migraine at age 12. The age-related changes observed in pain localization, concurrent symptoms and triggers were considerable. Headache frequency was significantly associated with externalizing and internalizing problem behaviors and adaptive behaviors as rated by parents, but only with externalizing problem behaviors as rated by teachers. Headache both in children and adolescents is characterized by its changing nature. Its prevention and treatment should take familial, environmental and psychosocial aspects into account.

Clinician-Perceived Bridges and Barriers to Parental Implementation of Picture Exchange Communication System (PECS): An evaluation.

Picture Exchange Communication System (PECS) is an augmentative and alternative communicative system that improves communication and decreases problem behaviors in children with Developmental Disabilities and Autism. The mediator model is a validated approach that clinicians use to train parents to perform evidence-based interventions. Parental non-adherence to treatment recommendations is a documented problem. This qualitative study investigated clinician-perceived factors that influence parental adherence to PECS recommendations. Three focus groups (n=8) were conducted with Speech Language Pathologists and Behavior Therapists experienced in providing parents with PECS recommendations. Constant comparison analysis was used. In general, clinicians believed that PECS was complex to implement. Thirty-one bridges were identified to overcome complexity. Twenty-two barriers and 6 other factors also impacted parental adherence. Strategies to address these factors were proposed based on a review of the literature. Future research will be performed to validate these findings using parents and a larger sample size.

Eficacia y seguridad de la melatonina para el manejo de los trastornos del sueño en el autismo: meta-análisis

INTRODUCCIÓN: El 80% de los niños y adolescentes con trastornos del espectro autista (TEA) presenta algún trastorno del sueño, en cuya génesis al parecer intervienen alteraciones en la regulación de la melatonina. El objetivo de este metaanálisis fue determinar la eficacia y seguridad de la melatonina para el manejo de ciertos trastornos del sueño en niños con TEA. MÉTODOS: Tres revisores extrajeron los datos relevantes de los ensayos clínicos aleatorizados doble ciego de alta calidad publicados en bases de datos primarias, de ensayos clínicos, de revisiones sistemáticas y de literatura gris; además se realizó búsqueda en bola de nieve. Se analizaron los datos con RevMan 5.3. Se realizó un análisis del inverso de la varianza por un modelo de efectos aleatorios para las diferencias de medias de los desenlaces propuestos: duración del tiempo total, latencia de sueño y número de despertares nocturnos. Se evaluó la heterogeneidad interestudios con el parámetro I2 RESULTADOS: La búsqueda inicial arrojó 355 resultados, de los cuales tres cumplieron los criterios de selección. La melatonina resultó ser un medicamento seguro y eficaz para aumentar la duración total del sueño y disminuir la latencia de sueño en niños y adolescentes con TEA; hasta el momento la evidencia sobre el número de despertares nocturnos no es estadísticamente significativa. DISCUSIÓN: A la luz de la evidencia disponible, la melatonina es una elección segura y eficaz para el manejo de ciertos problemas del sueño en niños y adolescentes con TEA. Es necesario realizar estudios con mayores tamaños muestrales y comparados con otros medicamentos disponibles en el mercado.

Caracterização de programas de intervenção com crianças e/ou adolescentes

The objective was to present a descriptive analysis of interventions to prevent and/or reduce children's and/or adolescents' problem behaviors. The study reviewed 192 abstracts from journal articles published between the 1986 and June 2006, available on the following databases: Index-Psi/Periódicos, Lilacs, PsycInfo, Scielo and Medline. Categories of analysis focused on bibliography, method, and studies' results. Data-analysis showed that most of the studies focused on groups and families, and samples with more than 30 participants. Study designs were experimental and quasi-experimental, combining observation and self report or just self report for data collection. Result analysis suggests that the intervention programs contributed specially for reducing behavior problems, and improving parental practices. Discussion evaluates contributions of the study and gaps in knowledge.

Práticas educativas de professores, habilidades sociais e problemas de comportamento: um estudo comparativo, correlacional e preditivo

Pós-graduação em Psicologia do Desenvolvimento e Aprendizagem - FC