Biomedical subjects

Kate B Carey

Publications and source records attributed to Kate B Carey.

At least 37 records · Page 2Linked to original sources

PubMed2004

Reducing HIV-risk behavior among adults receiving outpatient psychiatric treatment: results from a randomized controlled trial.

This study investigated the efficacy of a 10-session, HIV-risk-reduction intervention with 221 women and 187 men receiving outpatient psychiatric care for a mental illness. Patients were randomly assigned to the HIV intervention, a structurally equivalent substance use reduction (SUR) intervention, or standard care; they were assessed pre- and postintervention and at 3- and 6-month follow-ups. Patients receiving the HIV-risk-reduction intervention reported less unprotected sex, fewer casual sex partners, fewer new sexually transmitted infections, more safer sex communications, improved HIV knowledge, more positive condom attitudes, stronger condom use intentions, and improved behavioral skills relative to patients in the SUR and control conditions. Patients receiving the SUR intervention reported fewer total and casual sex partners compared with control patients. Exploratory analyses suggested that female patients and patients diagnosed with a major depressive disorder were more likely to benefit from the HIV-risk-reduction intervention.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Effects of alcohol and expectancies on HIV-related risk perception and behavioral skills in heterosexual women.

This experiment tested the effects of alcohol and expectancies on determinants of safer sex according to the information-motivation-behavioral skills model. Sixty heterosexual women attended 2 sessions. During Session 1, participants completed a set of descriptive measures; during Session 2 they were randomly assigned to 1 of 4 beverage conditions: control, alcohol-low (.35 gm alcohol/kg body weight), alcohol-moderate (.70 gm alcohol/kg body weight), or placebo. After beverage consumption, all participants completed measures of motivation to engage in risky sex and condom use negotiation skills. Results showed that the higher dose of alcohol and stronger alcohol expectancies were associated with greater motivation to engage in risky sexual behavior. However, perceived intoxication, rather than actual alcohol consumption or expectancies, was the best predictor of condom use negotiation skills. Integration of the findings with past research and their implication for the design of HIV-prevention programs are discussed.

Adult↗

PubMed2004

Lability and impulsivity synergistically increase risk for alcohol-related problems.

This study examined two aspects of affect dysregulation as risk factors for alcohol-related problems. From a sample of 592 undergraduates, 442 alcohol users were examined on measures of impulsivity, lability, alcohol use, and alcohol-related problems. As expected, affect lability and impulsivity significantly increased risk for alcohol problems even after controlling for gender and lifetime-use frequency. Impulsivity was further examined as a vulnerability factor, potentially enhancing the relations between use frequency and problems and affect lability and problems. Impulsivity did not moderate the use frequency-problems relationship. However, the relationship between affect lability and problems was greatest among participants with higher degrees of impulsivity. The results demonstrate that individual differences in affect dysregulation are associated with alcohol-related problems in young adults.

Adolescent↗

PubMed2004

Brief alcohol interventions with mandated or adjudicated college students.

This article summarizes the proceedings of a symposium presented at the 2003 RSA Meeting in Ft. Lauderdale, Florida, organized and chaired by Nancy Barnett. The purpose of the symposium was to present information and efficacy data about approaches to brief intervention with students who get into trouble on their campuses for alcohol and as a result are required to attend alcohol education or counseling. Presentations were (1) Differences Between Mandated College Students and Their Peers on Alcohol Use and Readiness to Change, by Tracy O'Leary Tevyaw; (2) An Effective Alcohol Prevention Program for Mandated College Students, by Kim Fromme; (3) Two Brief Alcohol Interventions for a Referred College Population, by Kate Carey; and (4) Brief Motivational Intervention With College Students Following Medical Treatment or Discipline for Alcohol, by Nancy Barnett. The data presented in this symposium indicated that students who are evaluated or disciplined for alcohol use are on average heavy drinkers who drink more heavily than their closest peers. Brief intervention approaches described by the speakers included group classroom sessions, individual motivational intervention, individual alcohol education, and computerized alcohol education. Reductions in consumption and problems were noted across the various intervention groups. Brief motivational intervention as a general approach with mandated students shows promise in that it reduced alcohol problems in a group of mandated students who were screened for being at risk (in the Borsari and Carey study) and increased the likelihood that students would attend further counseling (in the Barnett study).

Adolescent↗

PubMed2004

HIV risk behavior among psychiatric outpatients: association with psychiatric disorder, substance use disorder, and gender.

People living with a mental illness are disproportionately vulnerable to human immunodeficiency virus. The current study sought to examine the influence of psychiatric disorder, substance use disorder, and gender on risky sexual behavior in this vulnerable population. Participants were 228 female and 202 male outpatients (66% mood disorder, 34% schizophrenia), each of whom took part in a Structured Clinical Interview for the DSM-IV and a comprehensive assessment of sexual risk behavior. Univariate and multivariate analyses tested a priori hypotheses. The results indicated that risk behavior was more frequent among patients diagnosed with a mood disorder (compared with those diagnosed with schizophrenia) or a substance use disorder (compared with those without a comorbid disorder) or both. We recommend routine human immunodeficiency virus risk screening and risk reduction programs for this vulnerable population.

Adult↗

PubMed2004

Temporal stability of the timeline followback interview for alcohol and drug use with psychiatric outpatients.

OBJECTIVE: The purpose of this study was to evaluate the test-retest reliability of the Timeline Followback (TLFB) interview for assessing daily alcohol and drug use with adults living with a severe mental illness. METHOD: Participants were 132 psychiatric outpatients (64% men) with a confirmed schizophrenia-spectrum (52%) or major mood disorder (48%) and a lifetime history of substance use disorder. They completed a 90-day TLFB twice, separated by a mean of 5 days, and represented 55% of the participants who originally consented to be in the study. RESULTS: Test-retest reliability coefficients ranged from 0.73 to 1.00 (rounded) for 30-day TLFB and from 0.77 to 1.00 (rounded) for the 90-day TLFB. Within-subject comparisons of means across the three 30-day windows revealed no significant differences, and no degradation of the magnitude of the reliability coefficients was observed with increasingly distant assessment periods. CONCLUSIONS: The TLFB is a reliable method of assessing alcohol and drug use in outpatients diagnosed with severe mental illness.

Adult↗

PubMed2003

Prevalence and correlates of areca nut use among psychiatric patients in India.

OBJECTIVES: To estimate the prevalence and identify the correlates of areca nut use among men and women being treated for a major psychiatric disorder in India. METHODS: Inpatients (N=988) admitted to the adult psychiatry department of the National Institute of Mental Health and Neuro Sciences in India were interviewed regarding their use of the areca nut, tobacco, alcohol, and other drugs. Medical records were reviewed to obtain psychiatric diagnosis and history. RESULTS: About 24% of the sample reported recent areca nut use, and 10% reported severe use suggesting dependence. Common reasons for use include to improve mood (31% of users), socialization (31%), digestion (22%), or performance (7%) and to decrease aches and pains (6%). Predictors of current areca nut use included less education, diagnosis of bipolar disorder, and current tobacco use. Predictors of severe use were older age, female gender, less education, and current tobacco use. CONCLUSION: Areca nut use occurs commonly among Indian psychiatric patients, and deserves further investigation.

Adult↗

PubMed2003

Relationships between binge drinking and substance-free reinforcement in a sample of college students: a preliminary investigation.

Heavy episodic drinking is a relatively common phenomenon among college students, and students who engage in binge drinking are at increased risk for a variety of adverse consequences. This paper investigates relationships between substance use and reinforcement derived from specific categories of substance-free activities among a sample of 256 college undergraduates. Data from a standardized behavioral inventory were used to compare the frequency, pleasure, and reinforcement potential of substance-free events and activities experienced by binge drinkers and a comparison group. Binge drinkers reported significantly lower scores across a variety of substance-free activity categories and, in the majority of the cases, the relationship between binge drinking and decreased reinforcement density remained significant after accounting for the effects of the use of other drugs and demographic variables. These results are consistent with a growing body of evidence linking substance use to deprivation of substance-free reinforcement.

Adolescent↗

PubMed2003

Personal strivings and marijuana use initiation, frequency, and problems.

This study examined relations between perceived conflict/utility of marijuana use in achieving valued personal goals and marijuana use initiation, marijuana use frequency, and marijuana-related problems. Personal strivings are higher order goals that may influence marijuana use to the extent that they are congruent or incongruent with use. Participants were 592 young adults who generated lists of personal strivings independent of the substance use assessment. They then evaluated their 10 most important strivings with regard to the perceived conflict/utility of several levels of marijuana use in achieving their most important strivings. Less marijuana use-striving conflict was positively associated with use initiation and frequency. A significant gender interaction emerged in the prediction of use frequency; marijuana use-striving conflict was more strongly associated with use frequency for men than women. The relationship between use-striving conflict and marijuana-related problems was mediated fully by use frequency.

Adolescent↗

PubMed2003

Predictors of HIV risk among men seeking treatment for substance abuse in India.

The purpose of this study was to investigate the prevalence and correlates of HIV risk among men receiving treatment for substance abuse in India. Consecutive inpatients from the major substance abuse hospital in southern India were screened using a structured interview and standardized measures to obtain demographic, psychiatric, sexual behavior, and substance use data at the time of admission. Seventy-seven percent of the 352 men who were screened reported that they were sexually active during the past year, and 13% reported that they had engaged in sexual practices associated with greater risk. The most common risk practices in the past year included having multiple sexual partners (7%), paying for sex (5%), and having unprotected anal sex (4%). Engaging in risky sexual practices was associated with the presence of a co-occurring psychiatric disorder and higher scores on a drug abuse screening measure. Assessing HIV risk in substance abuse settings can help to identify patients who may benefit from HIV-risk reduction programs.

Adult↗

PubMed2003

Smoking among psychiatric outpatients: relationship to substance use, diagnosis, and illness severity.

To understand the elevated smoking rates among psychiatric patients, the authors investigated whether psychiatric diagnosis, illness severity, and other substance use predicted smoking status in a diverse sample (N=2774) of psychiatric outpatients. Results indicated that 61% smoked daily and that 18% smoked heavily. Smoking was related to psychiatric diagnosis and illness severity as well as caffeine consumption and substance abuse. Diagnoses of bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking status, an association that was most pronounced among persons treated at clinics serving more impaired patients. Thus, diagnosis and illness severity contribute to elevated smoking rates, even after controlling for other substance use. Cessation programs are needed to reduce tobacco use in this vulnerable population.

Adult↗

PubMed2003

Self-reported drinking-game participation of incoming college students.

Drinking games are associated with excess alcohol use and alcohol-related problems, yet it is unclear whether they are unique to the college environment or whether students come to college familiar with such games. The authors queried 1,252 students attending voluntary summer orientation programs about their experiences with drinking games. A majority (63%) indicated they had played drinking games and viewed them as a means to get drunk quickly and to socialize, control others, or get someone else drunk. Logistic regression analyses revealed that familiarity with drinking situations was associated with a greater likelihood of playing drinking games. Students who reported drinking more frequently and consuming greater quantities of alcohol than others, having lifetime marijuana use, and initiating alcohol consumption between the ages of 14 and 16 years were significantly more likely to have participated in drinking games. These findings demonstrate the importance of considering students' participation in drinking games when campus officials address alcohol use.

Adolescent↗

PubMed2003

Correlates of substance use disorder among psychiatric outpatients: focus on cognition, social role functioning, and psychiatric status.

This study compared psychiatric outpatients who were never, former, and current substance abusers on psychiatric, social, and cognitive functioning. Fifty-six outpatients with schizophrenia spectrum and bipolar disorders volunteered to complete diagnostic and social role function interviews, self-report inventories, and neuropsychological tests. Multinomial logit regression analyses indicated that current and former abusers reported greater subjective feelings of distress than those who never abused. Contrary to expectations, however, both groups of substance abusers performed better on nonverbal cognitive tests compared with those who never abused. Differences in social functioning were also observed: former abusers demonstrated better instrumental role functioning than those who never abused. This pattern of findings challenges assumptions about additive effects of comorbid disorders on cognitive and social functioning.

Adult↗

PubMed2003

HIV risk behaviour among psychiatric inpatients: results from a hospital-wide screening study in southern India.

The study was carried out to investigate the prevalence and correlates of sexual risk behaviour among psychiatric inpatients in India. Consecutive inpatients (n = 618) were assessed using a structured interview and standardized measures. Women were more likely to be sexually active (50%) than men (36%), but equally likely (6% vs 5%) to engage in risky behaviour. Common risk behaviours included having a risky partner, having multiple partners, and exchanging money for sex. Being sexually active was associated with younger age, being married, being diagnosed with a disorder other than schizophrenia, and a history of drug use problems. Engaging in risky sexual behaviour was associated with being male, using tobacco and screening positive for either drug use or alcohol problems. Screening psychiatric patients for HIV risk behaviour can identify those who may benefit from risk reduction programmes.

Adolescent↗

PubMed2003

A cry from the darkness: women with severe mental illness in India reveal their experiences with sexual coercion.

THIS STUDY used qualitative research methods to investigate the problem of sexual coercion among female psychiatric patients in India. Consecutive female admissions (n = 146) to the inpatient unit of a psychiatric hospital in southern India were screened regarding coercive sexual experiences. Women who reported coercion (n = 50; 34%) participated in a semi-structured interview to learn more about their experiences. Among these women, 24 (48%) reported that the perpetrator was their spouse, 13 (26%) identified a friend or acquaintance, and 10 (20%) identified a relative such as an uncle or cousin. Most experiences occurred in the women's homes. Thirty of the 50 coerced women (60%) reported that they had not disclosed their experience to anyone, and that they had not sought help. Women revealed a sense of helplessness, fear, and secrecy related to their experiences. The problem of sexual coercion is seldom addressed in mental health care in India; the prevalence and severity of such experiences warrant immediate clinical attention and continued research.

Adolescent↗

PubMed2003

Descriptive and injunctive norms in college drinking: a meta-analytic integration.

OBJECTIVE: Many college students overestimate both the drinking behaviors (descriptive norms) and the approval of drinking (injunctive norms) of their peers. As a result, consistent self-other discrepancies (SODs) have been observed, in which self-perceptions of drinking behaviors and approval of drinking usually are lower than comparable judgments of others. These SODs form the foundation of the currently popular "social norms approach" to alcohol abuse prevention, which conveys to students the actual campus norms regarding drinking behaviors and approval of alcohol use. However, little attention has been paid to the factors that can influence the magnitude of SODs. This research was conducted to address these issues. METHOD: This meta-analytic integration of 23 studies evaluated the influence of five predictors of SODs: norm type (injunctive or descriptive), gender, reference group, question specificity and campus size. These studies rendered 102 separate tests of SODs in descriptive and injunctive forms, representing the responses of 53,825 participants. RESULTS: All five predictors were significantly related to self-other differences in the perception of norms. Greater SODs were evident for injunctive norms, estimates by women, distal reference groups and nonspecific questions, as well as on smaller campuses. CONCLUSIONS: More systematic attention should be given to how norms are assessed. In particular, SODs can be maximized or minimized, depending on the specificity of the behaviors/attitudes evaluated and the reference groups chosen for comparison.

Alcohol Drinking↗

PubMed2003

Psychometric evaluation of the alcohol use disorders identification test and short drug abuse screening test with psychiatric patients in India.

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) and the short Drug Abuse Screening Test (DAST-10) are brief self-report screens for alcohol and drug problems that have not been evaluated for use with psychiatric patients in developing countries. This study was designed to evaluate the factor structure, reliability, validity, and utility of the AUDIT and the DAST-10 in an Indian psychiatric hospital. METHOD: Consecutive inpatient admissions from April to December 2001 were sampled. Patients were diagnosed with substance use disorders or psychiatric disorders according to ICD-10 criteria. All patients completed both the AUDIT and the DAST-10 during their intake evaluation. RESULTS: Of the 2286 admissions to the hospital, 1349 were enrolled in the study (30% women); 361 patients (27%) had primary substance use disorders and 988 patients (73%) had primary psychiatric disorders. Both the AUDIT and the DAST-10 were unidimensional and internally consistent. Total scores significantly differentiated the subsamples with primary substance use from those with primary psychiatric disorders (p <.0001). Using cutoff scores of >/= 8 on the AUDIT and >/= 3 on the DAST-10, only 10% (N = 100) of the psychiatric subsample exceeded either cutoff, whereas 99% (N = 358) of the addiction treatment subsample exceeded 1 or both cutoffs. Within the psychiatric subsample, 77% (N = 65) of the patients who were identified as high risk on the AUDIT did not receive an additional alcohol use disorder diagnosis at discharge, and 59% (N = 16) of those identified as high risk on the DAST-10 did not receive an additional discharge diagnosis of drug use disorder. CONCLUSION: The AUDIT and the DAST-10 demonstrate strong psychometric properties when used in an Indian psychiatric hospital. Routine use of these brief screens can facilitate detection of substance use disorders among psychiatric patients.

Adult↗

PubMed2002

Predictors of participation and attrition in a health promotion study involving psychiatric outpatients.

Participant selection biases can reduce the generalizability of research findings and lead to misestimates of intervention effectiveness. The authors examined factors associated with study participation and attrition among psychiatric outpatients recruited for the initial phase of a health promotion trial. Medical records were reviewed to obtain HIV-risk and substance abuse data, as well as psychiatric and demographic characteristics of potential participants. Of 895 eligible outpatients, 67% (n = 601) consented to participate, among whom 69% (n = 415) completed all baseline appointments. Compared with nonconsenters, consenters were more likely to be at risk for drug problems and to receive care from clinics serving more impaired patients. Study completion was associated with older age, a psychiatric diagnosis other than adjustment disorder, and a recent sexually transmitted disease diagnosis. These findings suggest that patients who could most benefit from risk reduction interventions are more likely to participate.

Adult↗