Ruth Cronkite

• PhD, MS
• Consultant at VA Palo Alto Health Care System & Stanford University

Although mental health is a major factor in couple relations, little is known on how depression might be transmitted within couples over long periods of time. This study sought to examine mutual influences of depressive symptoms across 23 years between women with clinical depression and their partners. A longitudinal, observational design employed...

Background Although studies have examined how depressed patients’ baseline characteristics predict depression course, still needed are studies of how depression course is associated with modifiable long-term outcomes. Aims This study examined six outcomes of three groups representing distinct depression courses (low baseline severity, rapid declin...

Background: Depression is a debilitating condition that affects the individual and the family. Objective: This study sought to identify potential reciprocal influences between family arguments and depressive symptoms among clinically depressed patients over a 23-year span. Methods: The present study employed a longitudinal, observational desig...

Despite the considerable racial, ethnic, religious, and cultural diversity among the U.S. patient and health provider populations, the community of researchers who study these populations lack diversity. Indeed, few health services investigators are members of traditionally underrepresented racial, ethnic, linguistic, and/or cultural backgrounds. I...

1 Background Depression is the leading cause of disability and represents a significant challenge to stable employment and professional success. Importantly, employment may also operate as a protective factor against more chronic courses of depression as it can function as a form of behavioral activation and scaffold recovery by facilitating commun...

Humanism in medicine is defined as health care providers' attitudes and actions that demonstrate respect for patients' values and concerns in relation to their social, psychological and spiritual life domains. Specifically, humanistic clinical medicine involves showing respect for the patient, building a personal connection, and eliciting and addre...

Purpose: Limited empirical attention to date has focused on best practices in advanced research mentoring in the health services research domain. The authors investigated whether institutional incentives for mentoring (e.g., consideration of mentoring in promotion criteria) were associated with mentors' perceptions of mentoring benefits and costs...

Background In large health care systems, decision regarding broad implementation of psychotherapies for inpatients with psychosis require substantial evidence regarding effectiveness and feasibility for implementation. It is important to recognize challenges in conducting research to inform such decisions, including difficulties in obtaining consen...

Historically, mentorship has been conceived of as a dyadic relationship between a senior mentor and an early-career investigator. Models involving multiple mentors have gained favor in recent years, but empirical research on multiple-mentor models has been lacking. The current work aims to fill this gap by describing a long-standing health services...

Purpose: To evaluate the academic advancement and productivity of Department of Veterans Affairs Health Services Research and Development (HSR&D) Career Development Award (CDA) program recipients, National Institutes of Health (NIH) K awardees in health services research (HSR), and Agency for Healthcare Research and Quality (AHRQ) K awardees. Met...

Background Few longitudinal studies describe the relationship between somatic symptoms and family disagreements. We examined changes over time in somatic symptoms, family disagreements, their interrelationships, and whether these patterns differed between individuals treated for depression (depression group) and individuals from the same community...

Objectives: To examine associations between coping strategies at baseline and adverse outcomes 13 years later, and whether gender and age moderated these associations. Method: Participants (N = 651) completed a survey on demographic characteristics, coping strategies, and psychosocial outcomes (negative life events, alcohol consumption, drinking...

Objective: Telemedicine has potential value for monitoring individuals with SCI/D, especially for prevention and early detection and management of secondary conditions, by allowing remote assessments and corresponding rehabilitation opportunities in a home setting. We determined the accuracy of telemedicine for assessment of transfer mobility - per...

Although Al-Anon Family Groups (Al-Anon) is the most common source of help for people concerned about someone else's drinking, only 16% of members are men. To identify gender differences, we compared demographics, reasons for attendance, health status, and personal functioning, and drinker characteristics of 174 men and women attending Al-Anon. Men...

Background Although higher rates of depression and lower rates of social behaviors (i.e., social support and activities) and physical activities are associated with mortality, the independent contribution of each of these factors needs examination. Methods A prospective sample of 848 individuals (55% female) was used; half were clinically depresse...

This study's purpose was to identify distinct publishing trajectories among 442 participants in three prominent mentored health services research career development programs (Veterans Affairs, National Institutes of Health, and Agency for Healthcare Research & Quality) in the 10 years after award receipt and to examine awardee characteristics assoc...

This case study documents organizational factors that affected implementation of the ATHENA-Hypertension (ATHENA-HTN) clinical decision support system (CDSS) at five medical centers within the U.S. Department of Veterans Affairs (VA). The ATHENA-HTN implementation occurred during a system-wide reorganization of the VA’s Office of Information & Tech...

Background and Objectives Despite Al-Anon's widespread availability and use, knowledge is lacking about the drinkers in attendees' lives. We filled this gap by describing and comparing Al-Anon newcomers' and members' reports about their “main drinker” (main person prompting initial attendance).Methods Al-Anon's World Service Office mailed a random...

Objective: Empirical knowledge is lacking about Al-Anon Family Groups (Al-Anon), the most widely used form of help by people concerned about another's drinking, partly because conducting research on 12-step groups is challenging. Our purpose was to describe a new method of obtaining survey data from 12-step group attendees and to examine influence...

Background: Life stressors and personal and social resources are associated with depression in the short-term, but little is known about their associations with the long-term course of depression. The current paper presents results of a 23-year study of community adults who were receiving treatment for depression at baseline (N=382). Methods: Se...

Objectives To compare the 1-year survival for different age strata of intensive care unit (ICU) patients after receipt of packed red blood cell (PRBC) transfusions. Background Despite guidelines documenting risks of PRBC transfusion and data showing that increasing age is associated with ICU mortality, little data exist on whether age alters the tr...

To examine the associations between predisposing and need factors and receipt of mental health care and to examine age as a moderator of these associations. Participants (N=521) were surveyed as part of a larger study on health and adaptation. Obtaining mental health care was predicted by more reliance on approach coping, and more depressive and me...

Background: Suicidal ideation predicts suicide behaviors; however, research is needed on risk factors for suicidal ideation in adults, a common developmental period for first suicide attempts. Aims: To examine childhood and concurrent predictors of suicidal ideation among 340 adult offspring of depressed and matched control parents. Method: Pa...

Background Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems. Methods We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to whic...

Home telehealth can improve clinical outcomes for conditions that are common among patients with spinal cord injury (SCI). However, little is known about the costs and potential savings associated with its use. We developed clinical scenarios that describe common situations in treatment or prevention of pressure ulcers. We calculated the cost impli...

The Veterans Health Administration (VHA) is implementing the patient-centered medical home (PCMH) model of primary care which emphasizes patient-centered care and the promotion of healthy lifestyle changes. Motivational Interviewing (MI) is effective for promoting various health behaviors, thus a training protocol for primary care staff was impleme...

This exploratory study investigated organizational factors associated with receipt of military sexual trauma (MST) screening during an early timeframe of the Veterans Health Administration's (VHA) implementation of the universal MST screening policy. The sample consisted of all VHA patients eligible for MST screening in fiscal year 2005 at 119 VHA...

This study examined the association of hematocrit (Hct) levels measured upon intensive care unit (ICU) admission and red blood cell transfusions to long-term (1-year or 180-day) mortality for both surgical and medical patients. Administrative and laboratory data were collected retrospectively on 2393 consecutive medical and surgical male patients a...

We examined whether patient subgroups with differing substance use disorders (SUDs) and psychiatric severity levels varied on engagement in continuing care and abstinence outcomes, the association of continuity of care practices to engagement, and the association of engagement to abstinence. Staff in 28 Veterans Affairs SUD treatment programs used...

Development of clinical decision support systems (CDSs) has tended to focus on facilitating medication management. An understanding of behavioral medicine perspectives on the usefulness of a CDS for patient care can expand CDSs to improve management of chronic disease. The purpose of this study is to explore feedback from behavioral medicine provid...

We examined change in family support and depressive symptoms over the course of 23 years and included the potential moderators of gender and participation in treatment. A sample of 373 depressed individuals provided data in five waves, with baseline, 1-year, 4-year, 10-year, and 23-year follow-ups. Multilevel modeling was used to evaluate longitudi...

Although abuse victimization and dual diagnosis are associated with poor functioning across numerous domains, their impact on attendance and involvement in mutual-help groups (MHGs) is not well understood. This study examined the impact of physical or sexual abuse victimization on MHG attendance and involvement and the influence of abuse on the ass...

There has been considerable focus on the burden of mental illness (including post-traumatic stress disorder, PTSD) in returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, but little attention to the burden of medical illness in those with PTSD. (1) Determine whether the burden of medical illness is higher in women and me...

We examined military-related sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans. Of 125 729 veterans who received Veterans Health Administration primary care or mental health services, 15.1% of the women and 0.7% of the men reported military sexual trauma when screened. Military sexual trauma was associated...

We examined whether parents' stressors and avoidance coping when offspring were children helped to explain associations between parent depression at baseline and offspring's avoidance coping and depression in adulthood. Self-report data were collected at baseline and 1 year from parents (N = 326) and at 23 years from adult offspring (N = 326). Asso...

While considerable research exists on the role of physical illness in initiating depressive reactions, the role of depression in the onset of physical illness is much less studied. Moreover, whereas almost all previous research on depression and incident physical illness has involved specific physical illnesses, the present study examines the link...

This study examined whether having a depressed parent intensifies the secondary deficits that often co-occur with offspring's depression symptoms. The sample was adult offspring of parents who had been diagnosed with depression 23 years earlier (N = 143) and demographically matched nondepressed parents (N = 197). Respondents completed mailed questi...

The reliability and validity of assessments and diagnoses made via home telehealth was measured in 42 patients with spinal cord injury. Two telehealth modalities were investigated: telephone-only contact and videoconferencing. The results were compared with a reference (gold-standard) method, the in-person assessment and diagnosis of skin integrity...

Background: A significant burden of illness associated with the mental health effects of Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq is now a key focus of the Veteran Health Administration (VHA). The issue of sexual trauma has received scant attention in the discussion of deployment-related stressors an...

Although speculation suggests that continuity of care predicts abstinence following substance-use disorder (SUD) treatment, models examining staff's continuity of care practices and engagement in continuing care and whether they mediate or moderate the association between patient and treatment factors and abstinence are lacking. In this study, we a...

Our aim was to compare adults who were depressed or nondepressed offspring of depressed or matched nondepressed parents on functioning. Participants were adult children of depressed (n=143) or nondepressed (n=197) parents who participated in a larger study. They completed self-report measures of depression symptoms, medical conditions and pain, fam...

This study examined the role of 2 central aspects of family life—income and social support—in predicting concurrent happiness and change in happiness among 274 married adults across a 10-year period. The authors used hierarchical linear modeling to investigate the relationship between family income and happiness. Income had a small, positive impact...

Determine the relative impact of chronic hepatitis C (CHC) and co-morbid illnesses on health-related quality of life (HRQoL) in 3023 randomly selected veterans with known hepatitis C virus antibody (anti-HCV) status who previously completed a veteran-specific HRQoL questionnaire (SF-36V). Multiple regression analyses were performed to measure the r...

Although lifetime physical and sexual abuse are common among substance use disorder (SUD) patients, few studies have examined the impact of abuse on treatment outcomes, particularly for men. Men with lifetime physical (n = 49), sexual (n = 49), or no abuse (n = 117) history were assessed at entry to outpatient SUD treatment and at 6 and 12 months p...

We compared adult offspring of depressed or control parents who were followed for 23 years. Comparisons were on depression symptoms, physical functioning and disability, social functioning, and utilization of help and coping. Also examined was whether the parent's course of depression (stably remitted, partially remitted, non-remitted) was associat...

Following a baseline sample of 184 married couples over 10 years, the present study develops a broadened conceptualization of linkages in spouses' functioning by examining similarity in coping as well as in depressive symptoms. Consistent with hypotheses, results demonstrated (a) similarity in depressive symptoms within couples across 10 years, (b)...

Patients in intensive SUD programs who subsequently participate in continuing care for a longer interval have better outcomes than those who participate for a shorter interval. We sought to identify patient and program factors associated with duration of engagement in SUD continuing care after residential/inpatient treatment. Patients (n=3032) at 1...

To determine the relative impact of chronic hepatitis C (CHC) and comorbid psychiatric illness on the health-related quality of life (HRQoL). Psychiatric conditions are more common among patients with CHC but their relative influence on HRQoL is not well understood. We identified 864 veterans who had previously completed a veteran-specific HRQoL qu...

Epidemiological research examining the relationship between physical activity and depression has been conducted almost exclusively with community samples. We examined associations between physical activity, exercise coping, and depression in a sample of initially depressed patients, using four waves of data spanning 10 years. A cohort (n=424) of de...

To evaluate Breslau's 7-item screen for posttraumatic stress disorder (PTSD) for use in primary care. One hundred and thirty-four patients were recruited from primary care clinics at a large medical center. Participants completed the self-administered 7-item PTSD screen. Later, psychologists blinded to the results of the screen-interviewed patients...

Substance use disorder (SUD) patients who engage in more continuing care have better outcomes, but information on practices associated with greater patient engagement and retention in continuing care remains elusive. The objectives of this study were to determine if staff's continuity of care practices predict patients' engagement in continuing car...

Accumulating evidence suggests that posttraumatic stress disorder (PTSD) is linked to both objective and subjective indices of poorer health. Less is known about processes that may explain this association. This study examined anger/hostility as a possible mediator and moderator of PTSD and health status among a sample of 134 medical patients. Part...

The purpose of this article is to describe the development and psychometric properties of parallel program-level and individual-level versions of the Continuity of Care Practices Survey (CCPS-P and CCPS-I), a measure that assesses four dimensions of continuity of care practices in substance use disorder (SUD) treatment programs. CCPS subscales asse...

This study examined the relationship between depression and Stressors in depressed patients and community controls using data from a 10-year longitudinal study. The first aim was to examine the role of unipolar depression as an antecedent to various Stressors over varying durations of time. The results provide support for the hypothesis that depres...

This study followed baseline samples of 424 unipolar depressed patients and 424 community controls across 10 years to investigate the association between depression and alcohol-related coping and to examine how life context vulnerabilities underlie the risk for depressed individuals to rely on drinking to cope. Findings supported all hypotheses. De...

Posttraumatic stress disorder (PTSD) is associated with objective health problems in specific populations, such as Vietnam veterans. Less is known about PTSD and health among medical samples, especially PTSD patients with different etiologic traumas. This study examined PTSD and health in medical patients within the Department of Veterans Affairs h...

This study examined drinking to cope with distress and drinking behavior in a baseline sample of 412 unipolar depressed patients assessed 4 times over a 10-year period. Baseline drinking to cope operated prospectively as a risk factor for more alcohol consumption at 1-, 4-, and 10-year follow-ups and for more drinking problems at 1- and 4-year foll...

This study examined drinking to cope with distress and drinking behavior in a baseline sample of 412 unipolar depressed patients assessed 4 times over a 10-year period. Baseline drinking to cope operated prospectively as a risk factor for more alcohol consumption at 1-, 4, and 10-year follow-ups and for more drinking problems at 1- and 4-year follo...

This study reports on 122 families with a depressed parent at baseline and matched nondepressed control families. The 10-year course of depression in parents was characterized as stably-, partially-, or non-remitted. At the 10-year follow-up, children of stably-remitted parents had more psychological distress, physical problems, and disturbance tha...

This study examines the ability of baseline drinking to cope to predict drinking behavior across an ensuing 10-year period. In addition, it examines whether a propensity to consume alcohol to cope with stressors strengthens the link between emotional distress and drinking behavior. The study uses survey data from a baseline sample of 421 adults (54...

Debate has ensued about whether substance use disorder (SUD) patients with comorbid posttraumatic stress disorder (PTSD) participate in and benefit from 12-step groups. One hundred fifty-nine SUD-PTSD and 1,429 SUD-only male patients were compared on participation in 12-step activities following an index episode of treatment. Twelve-step participat...

This study tested an integrative structural equation model of posttreatment functioning among 165 depressed patients followed for an average of 9 years after the end of an episode of treatment. The model examined (a) the link between life change and psychosocial resource change and (b) the role of resource change in mediating the relationship betwe...

This study tested an integrative structural equation model of posttreatment functioning among 165 depressed patients followed for an average of 9 years after the end of an episode of treatment. The model examined (a) the link between life change and psychosocial resource change and (b) the role of resource change in mediating the relationship betwe...

This study examined a broadened conceptualization of the stress and coping process that incorporated a more dynamic approach to understanding the role of psychosocial resources in 326 adults studied over a 10-year period. Resource loss across 10 years was significantly associated with an increase in depressive symptoms, whereas resource gain across...

This study examined a broadened conceptualization of the stress and coping process that incorporated a more dynamic approach to understanding the role of psychosocial resources in 326 adults studied over a 10-year period. Resource loss across 10 years was significantly associated with an increase in depressive symptoms, whereas resource gain across...

The high likelihood of a chronic course of depression underscores the need to identify at intake patients most at risk for long-term nonremission. In a naturalistic study of 313 unipolar depressed patients, potential symptom-based risk factors were assessed at treatment intake and were used to predict a chronic course of treated depression over a 1...

The current investigation described the relationship between depression and outpatient medical utilization in a sample of 424 treatment-seeking individuals diagnosed with a depressive disorder and a demographically matched community sample of 424 men and women. This relationship was assessed longitudinally from baseline (intake for the patient samp...

A 3-wave prospective panel model was used to examine the idea that depression erodes an individual's social resources and that lack of social resources contributes to depression. The data are from 313 depressed patients assessed at intake to treatment and at 1-year and 10-year follow-ups. There was little or no evidence for a social selection effec...

A 3-wave prospective panel model was used to examine the idea that depression erodes an individual's social resources and that lack of social resources contributes to depression. The data are from 313 depressed patients assessed at intake to treatment and at 1-year and 10-year follow-ups. Then was little or no evidence for a social selection effect...

A group of 313 depressed patients and 284 controls was assessed at baseline (treatment intake for the patients) and at 1-year, 4-year, and 10-year follow-ups. Stably remitted patients achieved levels of family and extrafamily resources that were comparable with those of the controls. Although partially remitted and nonremitted patients' social reso...

Previous studies have suggested that a considerable number of depressed patients suffer from sustained or repeated episodes of depressive symptoms. We developed a risk factor index based on data obtained at admission to treatment predicting sustained nonremission of depressive symptoms over 4 years for a sample of 370 unipolar depressed inpatients...

A 10-year naturalistic study of 313 patients who entered treatment for unipolar depression and a community comparison group of 284 nondepressed adults was conducted. We compared life stressors, social resources, personal resources, and coping among patients who were remitted (N = 76), partially remitted (N = 146), or nonremitted (N = 91). Compared...

A 10‐year naturalistic study of 313 patients who entered treatment for unipolar depression and a community comparison group of 284 nondepressed adults was conducted. We compared life stressors, social resources, personal resources, and coping among patients who were remitted (N = 76), partially remitted (N = 146), or nonremitted (N = 91). Compared...

Little is known about the effects of psychosocial factors on the long-term course of unipolar depression. This article examines the 4-year stability and change in life stressors, social resources, and coping, and their effect on the course of treated unipolar depression among 352 men and women. Depressed patients were assessed at treatment intake a...

Evaluations of treatment outcome may obtain positively biased findings by failing to reassess patients who are difficult to follow and who may also be functioning more poorly than those who are successfully followed. We consider whether difficulty of follow-up is related to pre- and posttreatment functioning by reassessing 95% of a sample of 424 de...

Longitudinal data on 267 married couples are used to examine the interrelationships among predisposing factors, stress, moderating factors, and subsequent functioning. A model of the stress process that considers spouse symptoms and coping was estimated separately for three functioning criteria (depressed mood, physical symptoms, and alcohol consum...

This article focuses on gender and marital status differences in the treatment process, posttreatment experiences, and outcome of 332 alcoholic patients and explores the utility of several sex-role models in explaining the observed findings. Among men patients, being married is related to better treatment outcome, but the marital status difference...

Although used increasingly frequently, statistical analyses to explore moderating as well as main effects have not always been well-understood by researchers in the stress and coping/support field. We attempt to clarify three areas of potential confusion. First, three approaches for estimating main effects in multiple regressions with significant i...

157 community couples and 157 couples in which one of the partners was clinically depressed were studied within the framework of an expanded stress-illness paradigm that encompassed life events, ongoing strains, coping responses, family support, and depression. Ss completed the Health and Daily Living Form, Family Environment Scale, and Work Enviro...

Examined the role of stress and coping factors in depression by comparing a group of 409 Ss (over age 18) entering psychiatric treatment for unipolar depression with a sociodemographically matched group of 409 nondepressed Ss. In addition to reporting significantly more stressful events than controls, depressed Ss also experienced more severe life...

Examined the role of stress and coping factors in depression by comparing a group of 409 Ss (over age 18) entering psychiatric treatment for unipolar depression with a sociodemographically matched group of 409 nondepressed Ss. In addition to reporting significantly more stressful events than controls, depressed Ss also experienced more severe life...

This article presents a conceptual framework of potentially broad applicability in the study of spouses of persons suffering from any of a variety of impairments (e.g., alcohol abuse, heart attack, renal disease, unemployment, depression). The model is explored using path analysis and partitioning the explained variance to determine the effects of...

Presents a conceptual framework for assessing the interrelationships among pretreatment-, treatment-, and posttreatment-related variables as well as their effects on outcome (alcohol consumption, abstinence, depression, and occupational functioning) for 120 alcoholic patients 2 yrs after treatment. Results of a path analysis, Family Environment Sca...

This paper demonstrates, through the application of causal modeling, that inferences currently being drawn from research employing simulations may be incorrect, and as a result may mislead the researcher. Such faulty inferences may be made under certain conditions: (1) when the epistemic coefficients vary across situations; (2) when unintended effe...

Presents a conceptual framework for assessing the interrelationships among pretreatment-, treatment-, and posttreatment-related variables as well as their effects on outcome (alcohol consumption, abstinence, depression, and occupational functioning) for 120 alcoholic patients 2 yrs after treatment. Results of a path analysis, Family Environment Sca...

Examines the interrelationships among 5 major sets of variables (social background, intake symptoms, program type, treatment experiences, and perceptions of the environment) that are related to posttreatment functioning of alcoholic patients (alcohol consumption, rating of drinking problem, physical impairment, and occupational functioning). The sa...

This paper examines both the determinants of spouses' normative preferences for family roles and determinants of changes in these preferences over time. Both a static and a dynamic model are developed which hypothesize effects of background characteristics, socioeconomic factors and family life-cycle stages on three dimensions of normative preferen...

present a conceptual framework that encompasses psychosocial processes in the course of depression / review and integrate the theoretical and empirical literature in this area / the framework is based on an expanded evaluation paradigm, and stress and coping theory in relation to depression / use the framework to illustrate the interplay among the...