Psychiatric correlates of medical care costs among veterans receiving mental health care

Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether DESNOS severity was associated with greater nonmental health medical care costs in veterans receiving mental health care. Participants were 106 men and 105 women receiving VA outpatient mental health treatment. A standardized interview assessed DESNOS severity. The dependent variables consisted of primary and specialty medical treatment costs. Sequential zero-inflated negative binomial regression was used to evaluate the variance in medical costs accounted for by DESNOS severity, controlling for PTSD severity and established predisposing, enabling, and need-based health care factors. Contrary to our hypothesis, in fully adjusted models, DESNOS severity independently added a significant amount of variance to lower specialty medical care costs, whereas PTSD did not consistently account for significant variance in medical care costs. Greater DESNOS severity appears to be associated with lower specialty medical care costs but not primary care costs. These findings may indicate that patients with DESNOS symptoms are at risk for being underreferred for specialty care.     

Positive Personal Identification of Human Remains Based on Thoracic VertebralMargin Morphology

Abstract: Radiography has long been used by anthropologists to establish positive personal identification of human remains in forensic cases. These methods have been largely ad hoc and depend upon specific congenital or pathological bone markers. Court rulings, such as Daubert and Mohan have, however, pushed the discipline toward more statistically supportable methods of identification. This study describes the use of normal morphological variation of the thoracic vertebrae to identify human remains. Radiographs from healthy, male individuals, aged 18–55 were examined to identify normally varying features of vertebral morphology. The frequency of occurrence of these features was calculated, tested, and found to be stable in the given sample. The frequencies were compared to establish which sets of traits varied independently of one another. Finally, unknown radiographs were compared to known samples to test the applicability of this method in determining positive identification, with 21 of 24 (87.5%) unknown radiographs positively identified.     

Constitutional Comparisons by A Supranational Court in Flux: The Privy Council and Caribbean Bills of Rights

This article examines how the Judicial Committee of the Privy Council makes constitutional comparisons between ‘related’ constitutions that are or were within its jurisdiction, deploying its own precedents, as a pragmatic method of resolving idiosyncratic questions that arise across multiple constitutions. In particular, it considers the Committee's approach to the longstanding question of the interpretation of the opening section of Caribbean constitutional bills of rights, which has far reaching implications for the scope of constitutional protection of human rights. The JCPC's answer over time to this question reveals the fault lines for this supranational constitutional court as its jurisdiction peters out yet remains. The gaze of comparativism is very harsh as older constitutions are evaluated in light of newer ones and also as fossilised constitutional interpretations presented in earlier JCPC cases where the Committee no longer has jurisdiction are given new life in contemporary cases.     

Observing Environmental Destruction Stimulates Neural Activation in Networks Associated with Empathic Responses

The negative impacts of environmental disruption disproportionately affect marginalized and underprivileged communities; thus, the degree to which society is complicit in allowing unchecked environmental destruction to occur has important social justice applications. Although decades of research have sought to understand factors which determine acceptance of environmental destruction, most of this research has been based on self-report surveys. In the present work, we used neuroimaging techniques to examine the neural correlates of environmental concern. To do this, we compared responses to observing suffering dogs with responses to observing suffering ecosystems. Our results extend previous findings which had shown largely overlapping neural response patterns to observing animal and human suffering. Critically, we found activation in regions previously identified as active in empathy processes in response to viewing harm to ecosystems (i.e., without any animals present in the images). We also found relative differences in response patterns between the two types of stimuli: witnessing harm to environments (vs. dog suffering) led to reduced activation in some regions, but similar activation in others. We discuss these findings in terms of their potential implications for behavioral interventions and possibilities for continued neuroimaging research examining neural responses to environmental ecosystems and other nonhuman entities.     

Sex differences in depression across the high school to college transition

Although adolescent and adult females have consistently been found to experience depression at twice the rate of males, the college population has represented a notable exception, with equal rates of depression reported for males and females. Using a cross-sectional design with equivalent measures, we explored the nature of these shifting population statistics by the following: (a) examining whether college females were reporting lower levels of depression, or college males were reporting higher levels of depression, relative to same-sex high school peers; and (b) exploring a number of relevant psychological and psychosocial/environmental variables that might explain these shifts. Replicating previous findings on the presence or absence of gender differences in depression in adolescent vs. college subjects, our data also indicated that this shift could be accounted for by lower levels of depression reported by college, relative to high school, females. Moreover, although psychological variables were the best overall predictors of females' depression levels, differences between high school and college females were best explained by psychosocial/environmental variables. Results are discussed in terms of the contextual features associated with the college environment that might protect women against depression and account for differential depression levels.Graduate student in the Ph.D. program in clinical psychologyResearch interests include cognitive, interpersonal, and social-environmental factors associated with depression.Received Ph.D. from Northwestern University. Research interests include cognitive and developmental aspects of depression. This research was supported, in part, by a faculty grant from Emory University to Linda Koenig.     

Discussion's Impact on Political Allocations: An Experimental Approach

In this study, we unite two experimental traditions to examinethe impact of discursive processes on political decision making.We directly manipulate the presence and timing of discussionin the "divide-the-dollar" game to assess the effects of discussionon participants' allocations and perceptions of the game's legitimacy.To investigate the influence of structure, we also manipulatethe presence of a majority/minority cleavage among participants.The dependent measures in all instances are the players' allocations,the outcome of the game, and psychometric indicators of legitimacyperceptions. Results indicate that the presence of discussioncan generate outcomes that are perceived as more equitable andfair in some circumstances—namely, when a cleavage ispresent. These findings establish the utility of this paradigm,as well as an important baseline for assessing the probableimpacts of proposals to integrate deliberation into politicaldecision making.     

Administrative Failure and the International NGO Response to Hurricane Katrina

The devastation caused by Hurricane Katrina and the subsequent failure of government agencies and public administrators elicited an unprecedented response by international nongovernmental organizations (INGOs) to a disaster in the United States. This paper focuses on why so many INGOs were compelled to provide humanitarian assistance and relief in the United States for the first time and the administrative barriers they faced while doing so. What does such a response reveal about administrative failures in the wake of Katrina, and what might the implications be for reconceptualizing roles for nonprofit and nongovernmental organizations in disaster relief? The authors answer these questions using data from interviews with INGO representatives, organizational press releases and Web sites, news articles, and official reports and documentation.