B Christopher Frueh

Honolulu University, Honolulu, Hawaii, United States

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Publications (238)627.66 Total impact

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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 · 5.14 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
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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 · 4.82 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: 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 01/2015; 25(1):104-7. · 0.92 Impact Factor
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    ABSTRACT: Background: 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. Methods: 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. Results: 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. Conclusions: 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: 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: 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: 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 · 2.26 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 · 3.18 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 · 1.99 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
  • Jeffrey Allen Smith, Kristi L Masuhara, B Christopher Frueh
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    ABSTRACT: We have little understanding of the increased active duty military suicide rates found in the United States, and little understanding of what is historically normative for combatants. Therefore, we examined historical records on suicides among the British Army during the Crimean War for the years 1854-1856. There were 18 documented suicides in the British Army during this period. Calculating an accurate annual suicide rate per 100,000 is impossible because it is unclear how many of the 111,313 military personnel were in country for each of the 2 years of the war. However, the range is conservatively estimated between 8 and 16 per 100,000, with the likely answer somewhere near the middle. This suggests the possibility that increasing suicide rates among active duty military may be a modern U.S. phenomenon.
    Military medicine 07/2014; 179(7):721-723. DOI:10.7205/MILMED-D-13-00547 · 0.77 Impact Factor
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    ABSTRACT: Little is known about the psychometric properties and clinical utility of the Beck Depression Inventory-II (BDI-II) among adult clinical inpatients, a group at high risk for major depressive disorder (MDD). Data from 1,904 adult inpatients were analyzed using confirmatory factor analysis (CFA), Cronbach's alpha, and Pearson's correlations. Receiver operating characteristic (ROC) analyses evaluating MDD diagnostic performance were conducted with a subsample (n = 467) using a structured diagnostic interview for reference. CFA of 3 previous 2-factor oblique solutions, observed in adolescent and older adult inpatient clinical samples, and 3 corresponding bifactor solutions indicated that BDI-II common item variance was overwhelmingly accounted for by 1 general factor specified to all items, with minor additional variance contributed by 2 specific factors. Analyses revealed high internal consistency (Cronbach's α = .93) and significant (p < .01) intercorrelations between the BDI-II total scale and Behavior and Symptom Identification Scale-24's Depression/Functioning (r = .79) and Overall (r = .82) subscales. ROC analyses generated low area under the curve (.695; 95% confidence interval [.637, .752]) and cutoff scores with poor sensitivity/specificity balance. BDI-II use as a screening instrument for overall depressive symptomology was supported, but MDD diagnostic performance was suboptimal. Clinicians are advised to use the BDI-II to gauge severity of depression and measure clinical changes to depressive symptomology over time but to be mindful of the limitations of the BDI-II as a diagnostic tool for adult inpatients. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychological Assessment 06/2014; DOI:10.1037/a0036998 · 2.99 Impact Factor
  • Nancy Wolff, Jessica Huening, Jing Shi, B Christopher Frueh
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    ABSTRACT: Trauma exposure and trauma-related symptoms are prevalent among incarcerated men, suggesting a need for behavioral health intervention. A random sample of adult males (N = 592) residing in a single high-security prison were screened for trauma exposure and posttraumatic stress disorder (PTSD) symptoms. Trauma was a universal experience among incarcerated men. Rates of current PTSD symptoms and lifetime PTSD were significantly higher (30 to 60 %) than rates found in the general male populations (3 to 6 %). Lifetime rates of trauma and PTSD were associated with psychiatric disorders. This study suggests the need for a gender-sensitive response to trauma among incarcerated men with modification for comorbid mental disorders and type of trauma exposure. Developing gender-sensitive trauma interventions for incarcerated men and testing them is necessary to improve the behavioral health outcomes of incarcerated men who disproportionately return to urban communities.
    Journal of Urban Health 05/2014; 91(4). DOI:10.1007/s11524-014-9871-x · 1.94 Impact Factor
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    ABSTRACT: Objective: To compare clinical and process outcomes of cognitive processing therapy-cognitive only version (CPT-C) delivered via videoteleconferencing (VTC) to in-person in a rural, ethnically diverse sample of veterans with posttraumatic stress disorder (PTSD). Method: A randomized clinical trial with a noninferiority design was used to determine if providing CPT-C via VTC is effective and "as good as" in-person delivery. The study took place between March 2009 and June 2013. PTSD was diagnosed per DSM-IV. Participants received 12 sessions of CPT-C via VTC (n = 61) or in-person (n = 64). Assessments were administered at baseline, midtreatment, immediately posttreatment, and 3 and 6 months posttreatment. The primary clinical outcome was posttreatment PTSD severity, as measured by the Clinician-Administered PTSD Scale. Results: Clinical and process outcomes found VTC to be noninferior to in-person treatment. Significant reductions in PTSD symptoms were identified at posttreatment (Cohen d = 0.78, P <.05) and maintained at 3- and 6-month follow-up (d = 0.73, P <.05 and d = 0.76, P <.05, respectively). High levels of therapeutic alliance, treatment compliance, and satisfaction and moderate levels of treatment expectancies were reported, with no differences between groups (for all comparisons, F < 1.9, P >.17). Conclusions: Providing CPT-C to rural residents with PTSD via VTC produced outcomes that were "as good as" in-person treatment. All participants demonstrated significant reductions in PTSD symptoms posttreatment and at follow-up. Results indicate that VTC can offer increased access to specialty mental health care for residents of rural or remote areas. (C) Copyright 2014 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 05/2014; 75(5):470-476. DOI:10.4088/JCP.13m08842 · 5.14 Impact Factor
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    ABSTRACT: Gender differences in prevalence rates of Borderline Personality Disorder (BPD) may reflect true differences between groups or may reflect some form of gender bias in diagnostic criteria. The detection of differential item functioning (DIF) using item response theory methods provides a powerful method of evaluating whether gender differences in prevalence rates of BPD reflect true mean differences or criterion bias. The aim of the current study was to evaluate gender-based DIF in DSM BPD criteria. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis II Personality Disorders (SCID-II: First, Spitzer, Gibbon, Williams, & Benjamin, 1994) was administered to 747 adult inpatients. Results indicated DIF for 2 BPD criteria (impulsivity and uncontrolled anger), such that it was easier for these items to be endorsed for men compared with women at the same level of latent trait. At the level of the test, men were expected to be rated slightly higher than women on the SCID-II at the same level of latent BPD liability. Implications of these results for research and clinical assessment are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Abnormal Psychology 02/2014; 123(1):231-6. DOI:10.1037/a0035637 · 4.86 Impact Factor
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    ABSTRACT: Purpose: Major depressive disorder (MDD) is a common mental disorder (U.S. lifetime prevalence rate = 16.5%) associated with severe clinical consequences (e.g., functional impairment and suicide). For providers seeking to screen clients for MDD, the well-established Beck Depression Inventory (BDI-I) has been widely utilized due to its demonstrated psychometrics across multiple clinical subpopulations. Yet, the psychometric properties and clinical utility of the revised BDI-II among adult psychiatric inpatients, a group at elevated risk for MDD, is largely unknown; a gap in the literature this paper sought to address. Methods: Psychiatric inpatient participants (N= 1,904) recruited from a non-profit psychiatric hospital in Texas completed the BDI-II and the Behavior and Symptom Identification Scale (BASIS-24) upon admission. BDI-II reliability was examined via Cronbach’s alpha and construct validity via inter-item correlations and BDI-II total score correlations with BASIS-24 subscales. Factor analyses (exploratory and confirmatory) evaluated BDI-II factor structure. Diagnostic utility was explored using receiver operating characteristic (ROC) analyses of a 575 participant subsample assessed for MDD using the Structured Clinical Interview for DSM Disorders (SCID). Results: The BDI-II sample mean was 24.93 (SD=13.20), indicating that on average, participants experienced moderate depression at admission. Analyses of psychometric properties yielded Cronbach’s alpha of .93, and significant (p<0.01) BDI-II correlations with the BASIS-24 Depression (r=.79) and Overall subscales (r=.81). BDI-II factorial structure was explored by splitting the sample into two random halves. Maximum likelihood estimation extraction with direct oblimin rotation conducted on one random half decomposed the items into three factors with eigenvalues greater than one (8.57, 1.51, 1.20) although scree plot and principal components parallel analyses supported a two factor model (i.e., Cognitive and Affective/Anhedonia) that accounted for 48.03% of variance. The pattern and structure matrices indicated all items loaded onto one of the two factors (>.35); inter-factor correlation was -.68. Generalized least squares with bootstrapping confirmatory factor analysis (CFA) was conducted on the second random half due to non-normality of data; factors were correlated, correlated errors were not permitted. Chi-square tests were significant (p<0.001) due to the large sample size (Hoelter’s critical N=285). The RMSEA=.06, SRMR=.06, GFI=.93, and Adjusted GFI=.91 indicated good model fit. As the RMSEA of the null model was lower than .158 (RMSEA=.07), incremental indices of fit such as TLI and CFI were not valid. ROC analyses on the SCID subsample (72% prevalence rate of major depression) revealed low AUC (95% CI) = .65 (.61 - .71) for the BDI-II and produced cutoff scores with poor balance between sensitivity/specificity. Implications: This large-scale psychometric investigation of the BDI-II with psychiatric inpatients revealed good internal consistency and convergent validity but suboptimal MDD diagnostic performance. Factor analyses decomposed the BDI-II into two factors (Cognitive and Affective/Anhedonia), mirroring the Cognitive and Somatic/Affective factors previously reported for psychiatric outpatients by the instrument authors. Study findings support BDI-II utility as an inpatient screening measure of depressive symptomology but call into question its diagnostic capabilities. Social workers within inpatient settings are recommended to use the BDI-II to assess depression severity but to consider alternative screening methods for MDD.
    The Society for Social Work and Research 2014 Annual Conference; 01/2014

Publication Stats

5k Citations
627.66 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
    • University of South Dakota
      • Department of Psychology
      Vermillion, SD, United States
  • 2007–2015
    • University of Hawaiʻi at Hilo
      • Department of Psychology
      Hilo, Hawaii, United States
    • University of Washington Seattle
      Seattle, Washington, United States
    • Creighton University
      • Department of Psychiatry
      Omaha, Nebraska, United States
    • University of North Carolina at Chapel Hill
      • Cecil G. Sheps Center for Health Services Research
      Chapel Hill, NC, United States
  • 2012–2014
    • The Menninger Clinic, Inc.
      Houston, Texas, United States
  • 2010–2013
    • 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
  • 2009
    • UConn Health Center
      Farmington, Connecticut, United States
  • 2006
    • University of Sioux Falls
      • Department of Family Medicine
      Sioux Falls, South Dakota, United States
  • 2005
    • University of Maryland, College Park
      • Department of Psychology
      College Park, MD, United States
  • 2003
    • New York State
      New York City, New York, United States
    • Nova Southeastern University
      • Center for Psychological Studies
      Florida, NY, United States
    • Boston University
      Boston, Massachusetts, United States
  • 1998
    • Rider University
      Лаурэнсвилл, New Jersey, United States
  • 1997
    • State University of New York
      New York City, New York, United States
  • 1996
    • University of Arkansas
      Fayetteville, Arkansas, United States
  • 1994–1996
    • College of Charleston
      Charleston, South Carolina, United States