B Christopher Frueh

Honolulu University, Honolulu, Hawaii, United States

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Publications (245)692.98 Total impact

  • Jon D. Elhai · B. Christopher Frueh
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    ABSTRACT: The mental health field has seen a trend in recent years of the increased use of information technology, including mobile phones, tablets, and laptop computers, to facilitate clinical treatment delivery to individual patients and for record keeping. However, little attention has been paid to ensuring that electronic communication with patients is private and secure. This is despite potentially deleterious consequences of a data breach, which are reported in the news media very frequently in modern times. In this article, we present typical security concerns associated with using technology in clinical services or research. We also discuss enhancing the privacy and security of electronic communication with clinical patients and research participants. We offer practical, easy-to-use software application solutions for clinicians and researchers to secure patient communication and records. We discuss such issues as using encrypted wireless networks, secure e-mail, encrypted messaging and videoconferencing, privacy on social networks, and others. © Copyright 2015 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 10/2015; DOI:10.4088/JCP.14r09506 · 5.50 Impact Factor
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    ABSTRACT: Treatment non-response among high-risk, psychiatric patients exposes those suffering to suicidal risk as well as persistent social and occupational difficulties. Strategies for identification of treatment non-response are limited. Diagnostic efficiency of a self-report, cross-cutting symptom measure was assessed as a marker of treatment non-response. 835 inpatients at a specialist psychiatric hospital completed the Patient Health Questionnaire - Depression (PHQ-9) at admission and every two weeks during hospitalization. For patients admitted with severe depression (PHQ-9 ≥ 20), results indicated good accuracy of 2-week PHQ-9 change score in identifying treatment non-response (AUC = 0.80, SE = 0.04, p < .0001; sensitivity = 85%; specificity = 73%; OR = 14.91). The search for predictors of non-response to psychiatric treatment has a long and generally unfulfilled history. The PHQ-9 change score holds promise as a cost-effective test with comparable diagnostic characteristics to other medical tests. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 09/2015; 68:114-119. DOI:10.1016/j.jpsychires.2015.06.018 · 3.96 Impact Factor
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    ABSTRACT: This study examined the effectiveness of telemedicine to provide psychotherapy to women with posttraumatic stress disorder (PTSD) who might be unable to access treatment. Objectives were to compare clinical and process outcomes of PTSD treatment delivered via videoteleconferencing (VTC) and in-person (NP) in an ethnically diverse sample of veteran and civilian women with PTSD. A randomized controlled trial of Cognitive Processing Therapy, an evidence-based intervention for PTSD, was conducted through a noninferiority design to compare delivery modalities on difference in posttreatment PTSD symptoms. Women with PTSD, including 21 veterans and 105 civilians, were assigned to receive psychotherapy delivered via VTC or NP. Primary treatment outcomes were changes in PTSD symptoms in the completer sample. Improvements in PTSD symptoms in the VTC condition (n = 63) were noninferior to outcomes in the NP condition (n = 63). Clinical outcomes obtained when both conditions were pooled together (N = 126) demonstrated that PTSD symptoms declined substantially posttreatment (mean = -20.5, 95% CI -29.6 to -11.4) and gains were maintained at 3- (mean = -20.8, 95% CI -30.1 to -11.5) and 6-month followup (mean = -22.0, 95% CI -33.1 to -10.9. Veterans demonstrated smaller symptom reductions posttreatment (mean = -9.4, 95% CI -22.5 to 3.7) than civilian women (mean = -22.7, 95% CI -29.9 to -15.5. Providing psychotherapy to women with PTSD via VTC produced outcomes comparable to NP treatment. VTC can increase access to specialty mental health care for women in rural or remote areas. © 2015 Wiley Periodicals, Inc.
    Depression and Anxiety 08/2015; DOI:10.1002/da.22397 · 4.41 Impact Factor
  • B Christopher Frueh
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    ABSTRACT: Technology is the key to solving mental healthcare access problems in the twenty-first century. Perhaps the greatest challenge we face in harnessing the possibilities of information technology in healthcare today is to ensure that we do it in a manner that is clearly evidence-based. This means innovations must be evaluated in a variety of contexts, using designs to ensure they are feasible and acceptable to our patients, are effective in treating the symptoms and disorders for which they are applied, and ultimately are structured to have the best possible balance of increasing access, minimising costs, and maximising clinical outcomes. As a service delivery medium, telemedicine, or telepsychology, offers a viable means of delivering high quality, specialised mental health services to people with significant access-to-care barriers, such as those living in remote or rural areas, lacking in transportation, or experiencing ambulatory problems such as many elderly people do. Randomised controlled trials have demonstrated the clinical efficacy of telemedicine for specific populations with discrete psychiatric disorders. Going forward we must discover how to best integrate telemedicine with in-person care and other forms of communications technology, including the Internet, mobile technology and its “apps”, social media, virtual reality, “smart homes,” and wearable monitoring devices. It is also imperative that we better integrate these approaches with primary medical care so that “mental healthcare” does not continue to be viewed as independent from physical health.
    Australian Psychologist 08/2015; 50(4). DOI:10.1111/ap.12140 · 0.61 Impact Factor
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    ABSTRACT: Many older adults with major depression, particularly veterans, do not have access to evidence-based psychotherapy. Telemedicine could increase access to best-practice care for older adults facing barriers of mobility, stigma, and geographical isolation. We aimed to establish non-inferiority of behavioural activation therapy for major depression delivered via telemedicine to same-room care in largely male, older adult veterans. In this randomised, controlled, open-label, non-inferiority trial, we recruited veterans (aged ≥58 years) meeting DSM-IV criteria for major depressive disorder from the Ralph H Johnson Veterans Affairs Medical Center and four associated community outpatient-based clinics in the USA. We excluded actively psychotic or demented people, those with both suicidal ideation and clear intent, and those with substance dependence. The study coordinator randomly assigned participants (1:1; block size 2-6; stratified by race; computer-generated randomisation sequence by RGK) to eight sessions of behavioural activation for depression either via telemedicine or in the same room. The primary outcome was treatment response according to the Geriatric Depression Scale (GDS) and Beck Depression Inventory (BDI; defined as a 50% reduction in symptoms from baseline at 12 months), and Structured Clinical Interview for DSM-IV, clinician version (defined as no longer being diagnosed with major depressive disorder at 12 months follow-up), in the per-protocol population (those who completed at least four treatment sessions and for whom all outcome measurements were done). Those assessing outcomes were masked. The non-inferiority margin was 15%. This trial is registered with ClinicalTrials.gov, number NCT00324701. Between April 1, 2007, and July 31, 2011, we screened 780 patients, and the study coordinator randomly assigned participants to either telemedicine (120 [50%]) or same-room treatment (121 [50%]). We included 100 (83%) patients in the per-protocol analysis in the telemedicine group and 104 (86%) in the same-room group. Treatment response according to GDS did not differ significantly between the telemedicine (22 [22·45%, 90% CI 15·52-29·38] patients) and same-room (21 [20·39%, 90% CI 13·86-26·92]) groups, with an absolute difference of 2·06% (90% CI -7·46 to 11·58). Response according to BDI also did not differ significantly (telemedicine 19 [24·05%, 90% CI 16·14-31·96] patients; same room 19 [23·17%, 90% CI 15·51-30·83]), with an absolute difference of 0·88% (90% CI -10·13 to 11·89). Response on the Structured Clinical Interview for DSM-IV, clinician version, also did not differ significantly (39 [43·33%, 90% CI 34·74-51·93] patients in the telemedicine group and 46 [48·42%, 90% CI 39·99-56·85] in the same-room group), with a difference of -5·09% (-17·13 to 6·95; p=0·487). Results from the intention-to-treat population were similar. MEM analyses showed that no significant differences existed between treatment trajectories over time for BDI and GDS. The criteria for non-inferiority were met. We did not note any adverse events. Telemedicine-delivered psychotherapy for older adults with major depression is not inferior to same-room treatment. This finding shows that evidence-based psychotherapy can be delivered, without modification, via home-based telemedicine, and that this method can be used to overcome barriers to care associated with distance from and difficulty with attendance at in-person sessions in older adults. US Department of Veterans Affairs. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet Psychiatry 08/2015; 2(8):693-701. DOI:10.1016/S2215-0366(15)00122-4
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    ABSTRACT: This study examined changes in health-related quality of life in adult inpatients with serious mental illness engaged in a 6- to 8-week intensive treatment program. Admission and discharge assessment with the MOS 36-item Short-Form Health Survey was completed (June 2010-June 2012) for 410 adults aged 18-68 years. Paired t tests and effect size estimates were calculated for the overall sample, and reliable change index scores and clinical significance were calculated to estimate individual-level response and recovery rates. Hierarchical stepwise regression analyses were conducted to explore patient pretreatment characteristics, including total number of DSM-IV-TR diagnoses, that influence treatment response. Large effect size improvements were demonstrated for the Mental Component Summary score (Cohen d = 1.5), including subjective ratings of vitality (Cohen d = 1.1), social functioning (Cohen d = 1.3), role-emotional functioning (Cohen d = 1.3), and mental health (Cohen d = 1.3). Equivocal findings for change in physical health were demonstrated, with the majority of patients demonstrating no significant change in function (t409 = 0.14, P = .89) but approximately equal numbers of patients demonstrating improvement and deterioration. The pretreatment characteristic of a tendency to be interpersonally distant, cold, and disengaged was predictive of a poorer outcome on Mental Component Summary treatment response (P < .001). In light of a heavy burden of illness and high psychiatric comorbidity of this sample, treatment response was generally positive for improvement in mental health functioning. This study adds to a growing body of evidence indicating robust treatment response even for those with serious mental illness when treatment is intensive and multimodal. © Copyright 2015 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 05/2015; 76(5):e632-e638. DOI:10.4088/JCP.14m09041 · 5.50 Impact Factor
  • Jeffrey A Smith · B Christopher Frueh · Jennifer Campbell · Leonard Egede
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    ABSTRACT: Diabetes is the seventh leading cause of death in the United States and disproportionately affects ethnic minorities. While research examining health disparities is well-established, an historical understanding of how the disparities evolved over time may be warranted. This article examined racial differences in prevalence of diabetes and associated mortality in Blacks and Whites during the US Civil War. Data were extracted from the Medical and Surgical History of the War of Rebellion, 1861-1865, representing segregated White and Black Union Forces who served during the war. Data were collapsed by war theater (Atlantic, Central, Pacific). Results by race show that, from 1861 to 1866, the rates of Whites diagnosed with diabetes ranged overall from 0% to .11% and was distributed throughout the war theaters as: Atlantic 0.3% to .05%; Central 0.3% to .08%, and Pacific 0% to .11%. For Blacks, Atlantic ranged from .02% to .07% and Central .03% to .06%. None were reported for Pacific. Mortality was approximately .01% for both Blacks and Whites. These data suggest no racial differences in diabetes prevalence and mortality existed between Blacks and Whites during this time, implying that disparities may have evolved more recently.
    Ethnicity & disease 03/2015; 25(1):104-7. · 1.00 Impact Factor
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    ABSTRACT: Recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) conceptualize personality disorders (PDs) as categorical constructs, but high PD co-occurrence suggests underlying latent dimensions. Moreover, several borderline PD criteria resemble Criterion A of the new DSM-5 Section III general criteria for personality pathology (i.e., self and interpersonal dysfunction). We evaluated a bifactor model of PD pathology in which a general factor and several specific factors of personality pathology (PD 'g' and 's' factors, respectively) account for the covariance among PD criteria. In particular, we examined the extent to which the borderline PD criteria would load exclusively onto the g-factor versus on both the g- and one or more s-factors. A large (N = 966) sample of inpatients were interviewed for six DSM-IV (American Psychiatric Association, 1994) PDs using the (Structured Clinical Interview for Personality Disorders (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1994) with no skip-outs. We ran a series of confirmatory, exploratory, and bifactor exploratory factor analyses on the rated PD criteria. The confirmatory analysis largely replicated the DSM PDs, but with high factor correlations. The "standard" exploratory analysis replicated four of the DSM PDs fairly well, but nearly half the criteria cross-loaded. In the bifactor analysis, borderline PD criteria loaded only on the general factor; the remaining PDs loaded either on both the general and a specific factor or largely only on a specific factor. Results are interpreted in the context of several possibilities to define the nature of the general factor. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Journal of Abnormal Psychology 03/2015; 124(2). DOI:10.1037/abn0000033 · 4.86 Impact Factor
  • Nancy Wolff · M Gregory Chugo · Jing Shi · Jessica Huening · B Christopher Frueh
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    ABSTRACT: Trauma exposure is overrepresented in incarcerated male populations and is linked to psychiatric morbidity, particularly posttraumatic stress disorder (PTSD). This study tests the feasibility, reliability, and validity of using computer-administered interviewing (CAI) versus orally administered interviewing (OAI) to screen for PTSD among incarcerated men. A 2 × 2 factorial design was used to randomly assign 592 incarcerated men to screening modality. Findings indicate that computer screening was feasible. Compared with OAI, CAI produced equally reliable screening information on PTSD symptoms, with test-retest intraclass correlations for the PTSD Checklist (PCL) total score ranging from .774 to .817, and the Clinician-Administered PTSD scale and PCL scores were significantly correlated for OAI and CAI. These findings indicate that data on PTSD symptoms can be reliably and validly obtained from CAI technology, increasing the efficiency by which incarcerated populations can be screened for PTSD, and those at risk can be identified for treatment.
    Criminal Justice and Behavior 02/2015; 42(2):219-236. DOI:10.1177/0093854814551601 · 1.71 Impact Factor
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    ABSTRACT: Substance abuse is highly comorbid with major psychiatric disorders. While the neural underpinnings of drug abuse have been studied extensively, most existing studies compare drug users without comorbidities and healthy, non-user controls. Such studies do not generalize well to typical patients with substance abuse disorders. Therefore, we studied a population of psychiatric inpatients (n = 151) with a range of mental illnesses. Psychiatric disorders were diagnosed via structured interviews. Sixty-five percent of patients met criteria for at least one substance use disorder. Patients were recruited for resting state functional connectivity (RSFC) and diffusion tensor imaging (DTI) experiments to examine the interhemispheric connectivity between brain regions hypothesized to be involved in drug addiction, namely: the inferior, medial, and superior frontal gyri; insula; striatum; and anterior cingulate cortex. The World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHOA) questionnaire was used to further assess drug use. An association between use of tobacco, alcohol, cocaine, sedatives, and hallucinogens with increased insular interhemispheric connectivity was observed. In addition, increased inferior frontal gyrus interhemispheric connectivity was associated with amphetamine and inhalant use. Our results suggest that increased inter-hemispheric insula connectivity is associated with the use of several drugs of abuse. Importantly, psychiatric inpatients without a history of drug dependence were used as an ecologically valid control group rather than the more typical comparison between "mentally ill vs. healthy control" populations. We suggest that dysfunction of interhemispheric connectivity of the insula and to a lesser extent of the inferior frontal gyrus, are related to drug abuse in psychiatric populations. Copyright © 2014. Published by Elsevier Ltd.
    Neuropharmacology 01/2015; 92. DOI:10.1016/j.neuropharm.2014.12.030 · 5.11 Impact Factor
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    ABSTRACT: A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n=230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n=142) or by preference (n=88) to receive SS or M-TREM, with a waitlist group of (n=93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD and addiction problems. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Journal of Anxiety Disorders 01/2015; 30C:66-80. DOI:10.1016/j.janxdis.2014.10.009 · 2.96 Impact Factor
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    ABSTRACT: Impaired capacity for emotion regulation is associated with a broad spectrum of psychiatric disturbances; however, little is known about treatment response in emotion regulation functioning among patients with severe mental illness. This study examined treatment response and the role that experiential avoidance plays in mediating the relationship between attachment anxiety/avoidance and change in emotion regulation. Difficulties in emotion regulation were assessed at admission and at discharge, and rates of improvement and deterioration in emotion regulation were calculated. Attachment anxiety and avoidance were assessed in conjunction with experiential avoidance at baseline in a large cohort (N = 493) of adults admitted to a specialized adult psychiatric hospital. Inpatient treatment was associated with clinically significant improvement in emotion-regulation capacities for 49 percent of patients completing at least four weeks of treatment. Fifty-six percent of patients attained a status of recovery. Greater attachment avoidance and anxiety were related to positive change in emotion regulation at discharge. Experiential avoidance fully mediated the relationship between insecure attachment and change in emotion-regulation capacities. Contrary to expectation, greater attachment insecurity (anxiety and avoidance) as well as greater experiential avoidance predicted improvement in emotion regulation. These counterintuitive findings add to a growing evidence base indicating that severity of psychopathology is associated with greater improvement in hospitalized patients. Results of the mediation analysis suggest that targeting experiential avoidance may be an effective augmentation in the treatment of impaired emotion regulation functioning.
    12/2014; 1(19). DOI:10.1186/2051-6673-1-19
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    ABSTRACT: Although support for Internet-based interventions (IBIs) has grown significantly in the past decade, few interventions are designed specifically for veterans with posttraumatic stress disorder and other mental health problems. Additionally, research guiding IBI development is limited. We solicited feedback from providers familiar with the needs and preferences of Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) veterans with mental health problems to inform the development of an IBI. Thematic interviews were conducted with 17 Veterans Affairs providers to (a) gain insight into the unique problems and needs of OIF/OEF veterans, (b) obtain feedback on the content and presentation of the IBI, and (c) generate suggestions regarding the effective delivery of the IBI. Providers were receptive to the use of IBIs and were vocal in their need for novel approaches and tools to address the mental health needs of their patients. They noted several advantages to IBIs such as their ability to circumvent access-to-care barriers and their ease of use and likely appeal to OIF/OEF veterans. They also noted challenges associated with IBIs, including obtaining sufficient motivation and buy-in from veterans given the distal nature of IBIs. Finally, providers offered several recommendations regarding the content and design of the IBI, as well as strategies for effective marketing and dissemination. Provider feedback was valuable in the development of an IBI that is responsive to the mental health needs of OIF/OEF veterans and in learning about how best to promote IBIs. Similar approaches can be used by stakeholders interested in developing IBIs for novel populations and settings. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
    Psychological Trauma Theory Research Practice and Policy 11/2014; 6(6):624-631. DOI:10.1037/a0035772 · 2.31 Impact Factor
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    ABSTRACT: Objective This study investigated predictors of therapeutic outcomes for veterans who received treatment for dysregulated anger.Method Data are from a randomized controlled trial investigating the effectiveness of video teleconferencing compared to in-person delivery of anger management therapy (AMT) among 125 military veterans. Multilevel modeling was used to assess 2 types of predictors (demographic characteristics and mental health factors) of changes in anger symptoms after treatment.ResultsResults showed that while veterans benefited similarly from treatment across modalities, veterans who received two or more additional mental health services and who had longer commutes to care showed the greatest improvement on a composite measure of self-reported anger symptoms.Conclusion Results highlight that veterans with a range of psychosocial and mental health characteristics benefited from AMT, while those receiving the most additional concurrent mental health services had better outcomes.
    Journal of Clinical Psychology 10/2014; 70(10). DOI:10.1002/jclp.22095 · 2.12 Impact Factor
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    ABSTRACT: We investigated potential mechanisms of action for anger symptom reductions, specifically, the roles of anger regulation skills and therapeutic alliance on changes in anger symptoms, following group Anger Management Treatment (AMT) among combat veterans with posttraumatic stress disorder (PTSD). Data were drawn from a published randomized controlled trial of AMT conducted with a racially diverse group of 109 veterans with PTSD and anger symptoms residing in Hawaii. Results of latent growth curve models indicated that gains in calming skills predicted significantly larger reductions in anger symptoms at post-treatment, while the development of cognitive coping and behavioral control skills did not predict greater symptom reductions. Therapeutic alliance had indirect effects on all outcomes mostly via arousal calming skills. Results suggest that generalized symptom reduction may be mediated by development of skills in calming physiological arousal. In addition, arousal reduction skills appeared to enhance one's ability to employ other anger regulation skills.
    Journal of Anxiety Disorders 10/2014; 28(7). DOI:10.1016/j.janxdis.2014.07.001 · 2.96 Impact Factor
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    ABSTRACT: Background This study compared a dimensional, trait domain approach to characterizing personality pathology with the traditional polythetic approach with respect to their associations with interpersonal functioning and personality traits from the five factor model. Methods Psychiatric inpatients (N = 1,476) were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Dimensional representations of trait domains were derived from reorganizing DSM-IV criteria into personality trait domains from DSM-5 Alternative Model. Dimensional scores and personality disorder (PD) total criterion scores served as independent variables in predicting interpersonal profile clusters, as well as extraversion, agreeableness conscientiousness, neuroticism and openness from the five factor model traits. Results Trait domain scores and PD criteria totals were significantly correlated with submissive interpersonal style yet none proved significant in regression analyses. Avoidant and Borderline PD total criteria were negatively associated with a normative interpersonal style. Combined trait domain of detachment and Avoidant PD total criteria predicted a hostile/withdrawn interpersonal style. The trait domain of detachment was negatively associated with five factor traits of extroversion, whereas Borderline PD total criteria was negatively associated with conscientiousness. Avoidant and Borderline PD total criteria were positively associated with neuroticism. Conclusions The cross-cutting dimensional approach provided useful information in predicting a hostile/withdrawn interpersonal style as well as extroversion. Importantly, PD criterion scores and dimensional trait scores combined to predict this interpersonal style providing support to the alternative model of personality diagnosis in DSM-5. Clinicians are encouraged to assess dimensions of personality traits as these are related to interpersonal problems frequently encountered in psychiatric settings. While potentially useful, the dimensional approach articulated here did not yield substantial prediction of behavior.
    Comprehensive Psychiatry 09/2014; 56. DOI:10.1016/j.comppsych.2014.09.001 · 2.25 Impact Factor
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    ABSTRACT: The purpose of this paper is to cast a vision for the next generation of behavioral health and criminal justice interventions for persons with serious mental illnesses in the criminal justice system. The limitations of first generation interventions, including their primary focus on mental health treatment connection, are discussed. A person–place framework for understanding the complex factors that contribute to criminal justice involvement for this population is presented. We discuss practice and research recommendations for building more effective interventions to address both criminal justice and mental health outcomes.
    International Journal of Law and Psychiatry 09/2014; 37(5):427-438. DOI:10.1016/j.ijlp.2014.02.015 · 1.19 Impact Factor
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    ABSTRACT: Objective: Persons admitted for inpatient psychiatric care often present with interpersonal difficulties that disrupt adaptive social relations and complicate the provision of treatment. Whereas domains of psychosocial functioning in this population demonstrate clear growth in response to intervention, the impact of treatment on more complex patterns of interpersonal behavior has been largely overlooked within the existing literature. Interpersonal profiles characteristic of psychiatric inpatients were identified in the current study to determine rates of transition to adaptive functioning following hospitalization. Methods: Personality disturbance was assessed in 513 psychiatric inpatients using the Inventory of Interpersonal Problems. Scores were analyzed within a series of latent profile models to isolate unique interpersonal profiles at admission and at discharge. Longitudinal modeling was then employed to determine rates of transition from dysfunctional to adaptive profiles. Relationships with background characteristics, clinical presentation, and treatment response were explored. Results: Normative, Submissive, and Hostile/Withdrawn profiles emerged at both admission and discharge. Patients in the Normative profile demonstrated relatively moderate symptoms. Submissive and Hostile/Withdrawn profiles were related to known risk factors and elevated psychopathology. Approximately half of the patients who had been identified as Submissive or Hostile/Withdrawn transitioned to the Normative profile by discharge. Transition status evidenced modest associations with background characteristics and clinical presentation. Treatment engagement and reduction of clinical symptoms were strongly associated with adaptive transition. Conclusion: Maladaptive interpersonal profiles characteristic of psychiatric inpatients demonstrated categorical change following inpatient hospitalization. Enhanced therapeutic engagement and overall reductions in psychiatric symptoms appear to increase potential for interpersonal change.
    Psychiatry Interpersonal & Biological Processes 09/2014; 77(3):247-262. DOI:10.1521/psyc.2014.77.3.247 · 3.05 Impact Factor
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    ABSTRACT: Objective: The authors previously demonstrated an 82.3% reduction in seclusion and restraint use at an inpatient psychiatric facility, largely attributable to changes to the physical environment. This study investigated whether the reduction was sustained over time. Methods: This follow-up study examined archival data by using a longer preintervention baseline phase and examined the sustainability of intervention gains in the absence of a research agenda. Over ten years, 3,040 seclusion and restraint incidents were analyzed across 254,491 patient-days. Results: The extended baseline phase (N=38 months) exhibited a linear trend upward in seclusion and restraint use, and the formal intervention period and subsequent follow-up periods (N=82 months) showed a stabilization effect (p<.001). Conclusions: The findings suggest that reduction in seclusion and restraint use is sustainable, and judicious use of seclusion and restraint can become the new normative practice-even in the face of potentially disruptive administrative and environmental changes.
    Psychiatric services (Washington, D.C.) 07/2014; 65(10). DOI:10.1176/appi.ps.201300383 · 2.41 Impact Factor
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    ABSTRACT: Patient satisfaction is increasingly used as an indicator of health care quality. Few measures are available to assess characteristics unique to inpatient psychiatric hospitals, especially those that provide longer-term care. Furthermore, there is limited guidance on how to utilize patient satisfaction data to guide quality improvement initiatives. The authors developed the 20-item, Menninger Quality of Care measure at The Menninger Clinic in Houston, Texas. Psychometric analyses were based on responses from 337 adult inpatients. The measure has excellent internal reliability (Cronbach α = 0.92) with adequate concurrent and construct validity. We present a methodology to identify targeted quality improvement efforts by (1) highlighting the perspective of patients who are generally satisfied but had at least some reservations regarding the care they received and (2) highlighting areas of concern that are most associated with overall quality of care. We discuss our findings in light of national health care quality trends.
    Quality management in health care 07/2014; 23(3):178-187. DOI:10.1097/QMH.0000000000000034

Publication Stats

6k Citations
692.98 Total Impact Points


  • 2010–2015
    • Honolulu University
      Honolulu, Hawaii, United States
  • 2008–2015
    • Baylor College of Medicine
      • • Department of Neuroscience
      • • Department of Psychiatry & Behavioral Sciences
      • • Veterans Affairs Medical Center
      Houston, Texas, United States
  • 2007–2015
    • University of Hawaiʻi at Hilo
      • Department of Psychology
      Hilo, Hawaii, United States
  • 2013–2014
    • The Menninger Clinic, Inc.
      Houston, Texas, United States
  • 2007–2013
    • University of Hawai'i System
      Honolulu, Hawaii, United States
  • 1994–2011
    • Medical University of South Carolina
      • Department of Psychiatry and Behavioral Sciences
      Charleston, SC, United States
  • 2003
    • New York State
      New York City, New York, United States
    • Nova Southeastern University
      • Center for Psychological Studies
      Florida, NY, United States
  • 1999
    • University of Arkansas
      Fayetteville, Arkansas, United States
  • 1994–1996
    • College of Charleston
      Charleston, South Carolina, United States