No abstract

Two samples of family caregivers (Study 1: N = 169; Study 2: N = 145) of cognitively impaired older adults were used to revise, extend, and evaluate a measure of perceived self-efficacy for caregiving tasks. The Revised Scale for Caregiving Self-Efficacy measures 3 domains of caregiving self-efficacy: Obtaining Respite, Responding to Disruptive Patient Behaviors, and Controlling Upsetting Thoughts. The 3 subscales show strong internal consistency and adequate test-retest reliability. Construct validity is supported by relationships between these 3 facets of perceived caregiving efficacy and depression, anxiety, anger, perceived social support, and criticism expressed in speech samples. The Revised Scale for Caregiving Self-Efficacy has potential uses for both research and clinical purposes.

There is active debate regarding whether diagnosable depression exists on a continuum with subthreshold depressive symptoms or represents a categorically distinct phenomenon. To address this question, multiple indexes of dysfunction (psychosocial difficulties, mental health treatment history, and future incidence of major depression and substance abuse/dependence) were examined as a function of the extent of depressive symptoms in 3 large community samples (adolescent, adult, and older adult; N = 3,003). Increasing levels of depressive symptoms were associated with increasing levels of psychosocial dysfunction and incidence of major depression and substance use disorders. These findings suggest that (a) the clinical significance of depressive symptoms does not depend on crossing the major depressive diagnostic threshold and (b) depression may best be conceptualized as a continuum. Limitations of the present study are discussed.

Depressed outpatients received treatment focusing on either interpersonal skills, cognitions, or pleasant events. In each treatment modality, approximately half of the patients received immediate treatment and half received delayed treatment. Patients were assessed at four intervals to determine response to treatment and follow-up status. Results indicated that all treatment modalities significantly alleviated depression. However, no treatment modality had specific impact on the variables most relevant to its treatment format. Instead, all patients improved on most dependent variables, regardless of whether the variables were directly addressed in treatment. Results are discussed in terms of Bandura's self-efficacy model.

Physical disease is commonly considered a risk factor for depression among older adults. However, this pattern is not consistently supported, and a theoretical framework for understanding such a relationship has not been articulated. P.M. Lewinsohn, H. Hoberman, L. Teri, and M. Hautzinger's (1985) integrative model of depression predicts that disease will be a risk factor for depression only when disease results in functional impairment, and that impairment in the absence of disease is also a risk factor for depression. The authors tested these predictions in a community-based sample of older adults followed longitudinally and found that functional impairment was a significant risk factor for depression, regardless of disease status. Disease was not a significant predictor of major depression, nor did it interact with impairment to predict depression.

A paradigm was developed to investigate the influence of success and failure experiences on subsequent selective attention to information about the self. College students were assigned to success, failure, or control experiences on an achievement task ostensibly testing intellectual ability. Half also expected further testing, and half expected no further testing. Immediately after the achievement task subjects had available positive and negative personality information about themselves as well as information about the task. They could choose to attend, or not attend, to any of the information in any order for 10 minutes. Successful subjects attended more to their personality assets, and less to liabilities, than did subjects who failed or had a control experience. The latter two groups did not differ. These effects were strongest when there was no expectancy for further testing. The discussion analyzed the theoretical bases for the effects of positive experiences (e.g., success) on subsequent self-regulatory patterns. In addition, main effects and interactions with individual differences on the Repression-Sensitization Scale indicated that sensitizers were more likely to attend to their liabilities and repressers were more likely to attend to their assets; these effects of individual differences were strongest in control conditions, and were nullified when treatment effects were powerful, in accord with theoretical expectations.

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation's largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA's efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients.

National training in and implementation of CBT-D within the VA health care system is associated with significant, positive therapist training outcomes, as evidenced by increases in CBT core competencies. The implementation of the protocol by newly trained CBT-D therapists is associated with significantly improved patient outcomes, as evidenced by large decreases in depression and improvements in quality of life.