Triple jeopardy for HIV: substance using Severely Mentally Ill Adults

Severely Mentally Ill (SMI) adults have disproportionately high HIV seroprevalence rates. Abuse of alcohol and other substances (AOD) and lifetime exposure to trauma by others are particularly potent risk factors, which, in combination with psychiatric disabilities, create triple jeopardy for HIV infection. This study examined the predictive utility of demographic characteristics; history of physical, emotional, or sexual abuse; extent of drug and alcohol abuse; knowledge about HIV/AIDS; sexual self-efficacy; and condom attitudes toward explaining the variance in a composite of HIV high-risk behavior among 188 SMI women and 158 SMI men. History of sexual abuse, engaging in sexual activities while high on substances, and lower cannabis use were the most significant predictors of HIV sexual risk behaviors. Given the triple jeopardy for HIV risk in this population, a triple barreled approach that simultaneously addresses multiple health risks within an integrated treatment setting is warranted.     

Schizophrenia, AIDS and the decision to prescribe HAART: results of a national survey of HIV clinicians

Individuals with schizophrenia are at risk of developing HIV and are known to experience barriers to optimal medical care. Our goal was to determine, among a cohort of HIV clinicians, whether or not the diagnosis of schizophrenia affected the clinical decision to offer highly active antiretroviral therapy (HAART) to AIDS patients. This is a cross-sectional study of a random, national sample of HIV experts drawn from the membership of the American Academy of HIV Medicine. Participants were mailed a self-administered questionnaire with a case vignette of a new onset AIDS patient and were specifically asked whether or not they would recommend HAART treatment. Vignettes were randomly assigned to include a diagnosis of schizophrenia or not. We located 649 clinicians (93%); 347 responded (53.4%). Responders and non-responders did not differ in demographics or work characteristics. Recommendation of antiretroviral treatment did not differ between those who received a case vignette with schizophrenia versus those who did not(95.8% vs. 96.6%, p=0.69). Compared to those who received a case vignette without schizophrenia, those who received vignettes with schizophrenia were more likely to avoid prescribing efavirenz, a medication with known neuropsychiatric side effects(17.7% vs. 45.5%, p < 0.01), more likely to agree to be helped by a specialist(34.5% vs. 12.9%, p < 0.01), and more likely to recommend directly observed therapy (20% vs.10%, p = 0.01). HIV clinicians recognize the importance of recommending HAART treatment to individuals with schizophrenia and AIDS and avoid using antiretroviral medication with known neuropsychiatric side effects.     

Unsafe sex: do feelings matter?

The purpose of this study was to investigate the relationships among self-efficacy for condom use during distress (SE-Condom Distress), self-efficacy related to general HIV prevention skills (SE-HIV), and HIV risk behaviors, attitudes, and knowledge. Two hundred and twenty two adolescents with psychiatric disorders between 13 and 18 years-old participated. Participants completed measures related to HIV Self-Efficacy, HIV Attitudes, and Sexual Behaviors. Self-efficacy for condom use during distress (SE-Condom Distress) was significantly associated with more HIV protective behaviors. Controlling for observed covariates, SE-Condom Distress was the only variable significantly associated with consistent condom use in a multiple logistic regression (OR=2.43). Self-efficacy regarding condom use during affective arousal is closely associated with HIV-related attitudes and behaviors. Clinicians need to be alert to subtle signs of distress as adolescents contemplate safer sexual behavior.     

Schizophrenia,AIDS and the Decision to Prescribe HAART

SUMMARY

Individuals with schizophrenia are at risk of developing HIV and are known to experience barriers to optimal medical care. Our goal was to determine, among a cohort of HIV clinicians, whether or not the diagnosis of schizophrenia affected the clinical decision to offer highly active antiretroviral therapy (HAART) to AIDS patients.

This is a cross-sectional study of a random, national sample of HIV experts drawn from the membership of the American Academy of HIV Medicine. Participants were mailed a self-administered questionnaire with a case vignette of a new onset AIDS patient and were specifically asked whether or not they would recommend HAART treatment. Vignettes were randomly assigned to include a diagnosis of schizophrenia or not. We located 649 clinicians (93%); 347 responded (53.4%). Responders and non-responders did not differ in demographics or work characteristics. Recommendation of antiretroviral treatment did not differ between those who received a case vignette with schizophrenia versus those who did not (95.8% vs. 96.6%, p = 0.69). Compared to those who received a case vignette without schizophrenia, those who received vignettes with schizophrenia were more likely to avoid prescribing efavirenz, a medication with known neuropsychiatric side effects (17.7% vs. 45.5%, p < 0.01), more likely to agree to be helped by a specialist (34.5% vs. 12.9%, p < 0.01), and more likely to recommend directly observed therapy (20% vs.10%, p = 0.01). HIV clinicians recognize the importance of recommending HAART treatment to individuals with schizophrenia and AIDS and avoid using antiretroviral medication with known neuropsychiatric side effects.     

HIV prevention services for adults with serious mental illness in public mental health care programs

Despite well-documented need, little is known about the HIV prevention services provided to adults with serious mental illness in the public mental health system. This study examined the types, frequency, and client-level correlates of HIV prevention services provided to a representative sample of clients in five public mental health care programs. Although results indicate that HIV prevention care is infrequent, clients identified as being at higher risk for HIV infection reported receiving prevention interventions more frequently. However, both the clients' gender and the service setting influenced the types and frequency of services that clients received.     

Associations Between Caregiver Support, Bullying, and Depressive Symptomatology Among Sexual Minority and Heterosexual Girls: Results from the 2008 Boston Youth Survey

Although sexual minority (SM) youth are at an increased risk for being bullied and experiencing depression, it is unclear how caregiver support is interrelated with those variables. Therefore, we sought to assess: (a) the prevalence of nonphysical bullying, depressive symptomatology, and caregiver support among heterosexual and SM girls, (b) the association between caregiver support and bullying in both groups, and (c) whether sexual orientation moderates the interactive effect of caregiver support and bullying on depressive symptoms. Data come from a survey of students in 22 Boston public high schools; 99 of the 832 girls in the analytic sample were SM. We used chi-square statistics to examine group differences, and multiple regression to estimate the association between the caregiver support, sexual orientation, being bullied, and depressive symptomatology. SM girls reported similar levels of caregiver support as heterosexual girls, but reported higher levels of depressive symptomatology. They were also more likely to report nonphysical bullying. Tests for interactions were not statistically significant, suggesting that bullying, caregiver support, and sexual orientation are independently associated with depressive symptomatology.     

Depressive Symptoms in Low-Income,Urban Adolescents: Cognitive and Contextual Factors

This study examined the relationships among cognitive variables, family immigration history, negative life events, and depressive symptoms in a sample of 306 low-income, urban fifth- and sixth-grade children. Explanatory style and negative automatic thoughts were the cognitive variables examined. There were three key findings. First, children who were immigrants reported significantly more depressive symptoms, more negative life events, and more negative automatic thoughts than children who were not immigrants. Second, both explanatory style and negative automatic thoughts were significantly associated with depressive symptoms above and beyond the effects of child immigration history and negative life events. Finally, negative automatic thoughts mediated the relationship between child immigration history and depressive symptoms. We discuss the clinical and research implications of these findings.     

Community-level HIV prevention for persons with severe mental illness living in supportive housing programs: a pilot intervention study

Individuals with severe mental illness (SMI) are at risk for HIV/AIDS. Despite the availability of supportive community programs for those with SMI, there have been no published evaluations of community-level HIV prevention trials among this population. A pilot intervention trial was conducted to determine the feasibility of such an intervention in supportive housing programs (SHPs). A multi-component community-level trial was implemented in two SHPs with a total of 28 residents. Participants completed assessments at three time points: prior to the intervention (baseline), following skills training (post-assessment), and following the 4-month community intervention (follow- up). Results demonstrated significant improvements in psychosocial risk factors at both post- and follow-up assessments, with indications of sexual behavior change at follow-up. The community-level intervention appeared to reduce the risk of HIV among persons with SMI living in SHPs, and supports the importance of conducting larger scale intervention trials.     

An Examination of the Reliability,Data Screening Procedures,and Extreme Response Patterns for the Youth Risk Behavior Surveillance Survey

Abstract

This article explores psychometric characteristics of the Youth Risk Behavior Surveillance Survey (YRBS), one of the most widely used instruments to assess the prevalence of violent and other high-risk behaviors in secondary school settings. Response patterns were analyzed for a subset of 414 youths who indicated that they had carried a weapon to school six or more times during the preceding 30 days, and were compared to a matched sample of youths randomly selected from the 13,610 participants in the 2001 national administration of the YRBS. Results indicated that extreme responders to the weapon-carrying item were considerably more likely than their counterparts to respond in an extreme fashion to all YRBS items, including risk items pertaining to school (e.g., physical fights on school property) and outside school (e.g., alcohol consumption) factors, as well as positive health behaviors (e.g., healthy eating habits). Overall, the results suggest an ex-treme response bias among some participants that may impact the validity of the YRBS instrument. More specifically, presence of this response bias may inflate estimates of the prevalence of school violence and related concerns. These findings are discussed in light of the need to carefully examine individual response patterns on future administrations of the YRBS in an effort to ensure maximum instrument utility.     

Bystander Intervention,Bullying, and Victimization: A Multilevel Analysis of New Zealand High Schools

This study examines the association between schools and student bullying behaviors and victimization among a nationally representative sample (N = 9,107) of New Zealand high school students. In particular, the study sought to explore the role of characteristics of schools and school culture with respect to bystander behavior, while controlling for individual student factors related to victimization and bullying behaviors. Results indicated that a total of 6% of students report being bullied weekly or more often and 5% of students reported bullying other students at least weekly. Results of multilevel analyses suggested that schools characterized by students taking action to stop bullying were associated with less victimization and less reported bullying among students. In contrast, in schools where students reported teachers take action to stop bullying, there was no decline in victimization or bullying. Overall, these findings support whole-school approaches that aid students to take action to stop bullying.     

University and Community Resources for Sexual Assault Survivors: Familiarity With and Use of Services Among College Students

Scholars have highlighted the prevalence of sexual assault on college campuses. Universities are generally equipped to address victimization through a range of resources, including counseling and psychological services. These resources are instrumental for posttrauma recovery, but students must be aware of and willing to use available services. This study used a sample of 505 survey responses collected at a mid-sized, public, Southern university regarding community and campus resource knowledge, familiarity, and service use. The majority of participants were unaware of resources. Females reported increased community resource familiarity compared to males. Multivariate models revealed distress disclosure, sexual victimization history, and race were significant predictors of service use but criminal justice major and law enforcement career plans were not significant. Implications are discussed.     

Developing a Tripartite Prevention Program for Impoverished Young Women Transitioning to Young Adulthood: Addressing Substance Use,HIV Risk,and Victimization by Intimate Partners

Little is known about the transition to adulthood for adolescent females and young women who are impoverished and homeless. Co-occurrence of drug use and abuse, HIV risk, and victimization is notable among homeless women, highlighting the need for comprehensive interventions. Unfortunately, evidence-based prevention approaches addressing these inter-related problems among impoverished women transitioning into adulthood are lacking. To address this gap, we designed an innovative prevention program by utilizing open- and closed-ended interview data from impoverished women (n = 20), focus groups with community experts and providers (2 groups; n = 9), and a theoretical framework to direct the research. Information provided by our focus groups and interviews with women supported our theoretical framework and highlighted the importance of addressing normative information, providing skills training, and utilizing a non-confrontational approach when discussing these sensitive issues.     

Alcohol Use and Violence Among Adolescents in a Multiethnic Setting

Abstract

This study compares the prevalence of drinking behaviors and violence (fighting, weapon carrying, being threatened and feeling unsafe) among Hawaiian, other Asian American and Pacific Islander (AAPI), and Caucasian students, using data collected from the Youth Risk Behavior Survey in Hawaii in 1997 and 1999 (N = 2,146). Native Hawaiians and Caucasians were more likely than other AAPIs to have had a drink and to binge drink. Drinking behavior was a predictor for all violence behaviors, increasing its likelihood as much as ten-fold. Violent behaviors differed by ethnicity. The findings highlight the need to develop culturally sensitive strategies for violence prevention and to explore risk factors among AAPI subgroups.     

Stress,Coping, and Black Mental Health:

Despite the fact that blacks are disproportionately exposed to social conditions considered to be antecedents of psychiatric disorder, epidemiologic studies have not conclusively demonstrated that blacks exhibit higher rates of mental illness than whites. The present paper employed a research approach which considered not only rates of psychological distress, but also the stressors that blacks face and thc various coping strategies used to adapt to those stressors. The data were obtained from the National Survey of Black Americans, the first study of a national probability sample of the adult black population. The information on mental health and coping was collected within the context of a single stressful personal problem. The analysis indicates that prayer was an extremely important coping response used by blacks especially among those making less than $10,000, above the age of 55 and women. The informal social network was used quite extensively as a means of coping with problems. This was true for all sociodemographic groups studied. The young (18-34) were less likely than those age 35 and above to seek professional help, while women were more likely than men to seek formal assistance. Income was not related to professional help seeking. With respect to the use of specific professional help sources, hospital emergency rooms, private physicians and ministers were used most frequently. The implications of these findings for research on black mental health and primary prevention are discussed.     

Chapter 14: Self-Help Group Participation Among People with Severe Mental Illness

SUMMARY

An experimental design was attempted to test the effectiveness of self-help group participation among people with severe and long-standing mental illnesses. A sample of 90 individuals was randomized to either experimental or control groups with experimentals invited to join self-help groups and given outreach to encourage participation. Control subjects were not invited to join self-help groups. Results showed low rates of 17% participation in the self-help groups for both experimental and control subjects. The small number of experimental subjects participating and the presence of cross-overs from the control group yielded a sample too small for statistical analyses and the experiment was ended. Post hoc analyses comparing subjects who participated in self-help (15), non-participating subjects (75) and a comparison group of existing self-help group members (90) showed participants to have more severe psychiatric symptoms than either non-participants or members. Participating subjects were more likely to be female, though the self-help groups had more male members. Results indicate the need for multi-site studies in self-help group research.     

Examining Adolescent Suicidal Behaviors in Relation to Gun Carrying and Bullying

Guided by the interpersonal theory of suicide, this study examines the associations between gun carrying, bullying, and suicidal behaviors among high school students. Arizona Youth Risk Behavior Surveys were completed by 2,677 students in 2011; 9.0% reported suicide attempt in the past year, 5.5% carried a gun in the past 30 days, 8.5% were involved in school bullying, and 3.9% in cyberbullying. After accounting for depressive symptoms and self-harm, multiple linear regression results demonstrate that youth who carried a gun in the past 30 days were 3.98 times more likely to attempt suicide. Bullying was not associated with suicide attempt; however, youth report being 1.55 times more likely to make a suicide plan if they were bullied in school, 1.89 times more likely if cyberbullied, and .48 less likely if a cyberbully/victim. Results support the interpersonal theory of suicide; implications for school policies on gun carrying and bullying are discussed.     

Reform,Openness and Public Health: on the economic and social determinants of HIV/AIDS in China

China's HIV/AIDS epidemic today is seen by policy-makers primarily as a biomedical problem. Yet according to many researchers this conceptualization of what causes HIV/AIDS epidemics is restricted, focussing on individual behaviour to the exclusion of the broader economic and social determinants. This paper, therefore, illustrates how considering such determinants, including income and gender inequalities, may complement our understanding of the HIV/AIDS epidemic in China. It does so by using two different examples: the development of commercial sex work and long-distance migration patterns.     

Children, women, and substance abuse: a look at recovery in a communal setting

This study explored the sense of community among women (n = 21) and women with children (n = 30) living in Oxford Houses, with emphasis on how the presence of children might affect the household. Sense of community did not vary between participants with more or less than three months residence. Residents reported very high levels of satisfaction with the home, possibly because of a ceiling effect of little room for increases in their sense of community over time. Participants reported that they were getting along with the children in the home, that mothers could count on babysitting help, and that the children had a positive effect on the household and their own recovery process. This effect did not differ between mothers and non-mothers, suggesting that non-mothers might view the children in the home with a sense of responsibility and sensitivity comparable to that of the mothers. Implications are discussed.