Ninety female gamblers identified barriers to gambling treatment. These data suggest that the women in this study are a homogeneous group: middle aged (M = 47 years), Caucasian (86%), married or living with their partner (46%), had children (77%), completed a post secondary education (53%), employed full or part-time (67%), with personal incomes less that $35,000 (61%), and household incomes between $35,000 to $79,999 (51%). Moreover, most were recruited by referral from the GA conferences or GA members (70%) and were living in Ontario, Canada (37%). The Gamblers Anonymous 20 Questions and the South Oaks Gambling Screen were the two instruments used in this study to measure gambling severity. The average score on the GA20 was 17 and the SOGS was 13. Almost the entire sample (99% for the GA20 and 98% for the SOGS) can be considered to be compulsive or probable pathological gamblers. The majority (81%) of women in this study received some type of formal help for their gambling problem. Forty-three percent received outpatient treatment, 41% received crisis help, and 27% received residential or in-patient treatment. All but one woman accessed informal help, including 91% who sought help from Gamblers Anonymous and 38% received help from the Internet support group CGHub. Eighty-four percent reported feeling seriously depressed; 74% related their depression to gambling. Thirty-three percent reported having attempted suicide; 57% related their suicide attempt to gambling. Almost half (47%) received treatment in adulthood for a mental health or addictive disorder other than gambling, of which 60% were treated for depression. Barriers to treatment were identified within 3 broad domains: individual, socio-environmental and programmatic issues. Correlations among the three barriers subscales were positive and statistically significant. Individual barrier items were identified most often and programmatic barriers were identified least often. The barrier item gamble to deal with the stress of daily life was most frequently endorsed. Respondents who received formal treatment reported statistically more barriers and had higher individual and socio-environmental barrier subscale scores than non-formal treatment seekers. These findings suggest that women gamblers in this study have sought help from both formal and informal help systems. Key barriers to treatment are psychological and emotional issues. The women disclose turbulent personal and family histories and significant issues of comorbidity and concurrent life stressors, which may have important clinical implications in providing appropriate and effective treatment to women addicted to gambling.

The United States has the highest unintended pregnancy rate relative to other Western countries (Division of Reproductive Health, 2002). Mothers and children of unintended births face increased risk of substantial physical and social problems (Brown & Eisenberg, 1995; Gold, 2001). The high unintended pregnancy rate in the U.S. is primarily due to the lack of consistent contraceptive use by many individuals who are at risk for unintended pregnancy (Piccinino & Mosher, 1998). Due in part to the NASW position on family planning, social workers are in a key position for providing family planning information to clients. This study investigates the barriers that social workers face in providing family planning information to their clients through the use of a survey questionnaire. The questionnaire includes a modified version of the Bardis Religion Scale (1961), and items related to Banduras social cognitive theory (1986) with a focus on family planning knowledge, comfort, self-efficacy, perceived social worker roles, and moral attitudes toward providing information on family planning to clients. A section for respondent characteristics was also included. A sample of 800 respondents, with a final sample of 203 respondents, was randomly selected and surveyed from the 2007 roster of Pennsylvania licensed social workers. Findings revealed that greater religiosity, conservative political beliefs, a tendency to vote for Republicans, and a pro-life abortion stance were associated with reported increased barriers in providing family planning information. Participation in family planning coursework or training, and practicing in an urban area were found to be related to lower reported barriers, regardless of religiosity. Years of experience and work function had no significant effect on providing family planning information. Moral objection ranked low as compared to other barriers. Lack of workplace incentive and issues related to lack of family planning training and knowledge were of greater importance in understanding barriers. Furthermore, many social workers lack accurate family planning information, especially related to emergency contraception. These results suggest need for family planning training within social work professional education and continuing education, as well as an urgent need to address policies that undermine social work clients' access to family planning information and services.

Objective: Maternal depression in low-income women is a significant problem because of its negative consequences both to mothers and their children. Although the direct influence of economic problems on maternal depression has been previously noted, there is a more limited base of support that explains potential mechanisms that could explain this association. One theory suggests that economic difficulties could erode perceived social support; a model known as the social support deterioration model. This research tests this social support deterioration model by examining the direct as well as indirect impact by which economic hardship is associated with depressive symptoms. Methods: A sample of 336 mothers with children in mental health treatment was analyzed. Structural equation modeling was used to examine the hypothesized paths depicted by the deterioration model and relevant demographic variables. Results: First, economic hardship positively predicted depressive symptoms. Second, economic hardship negatively predicted perceived social support. Third, social support negatively predicted depressive symptoms. Finally, social support was found to partially mediate the relationship between economic hardship and depressive symptoms. Being married and working outside the home were also found to have benefits to mothers. Conclusions: Low levels of perceived social support were found to be one mechanism that explains the elevated depressive symptoms of mothers who maintain high levels of economic hardship. Economic hardship also maintained a direct impact on maternal depressive symptoms in mothers with children in mental health treatment. Future research should consider social support and economic hardship as potential targets for prevention and intervention of maternal depression.

Objective: Managed care practices that limit access to and duration of treatment conflict with established standards of care for patients with anorexia nervosa (AN). However, there is little information about how abbreviated lengths of hospitalization relate to the need for rehospitalization, one indicator of unfavorable outcome. This dissertation describes the demographic and clinical features of patients who require multiple psychiatric hospitalizations for treatment of AN and identifies patient characteristics that predict both likelihood of and time to readmission in the current care environment. Method: One-hundred-forty-seven patients with a primary diagnosis of AN and hospitalized on a specialized eating disorders psychiatric unit completed self-report questionnaires measuring eating disorders symptoms, mood, and personality functioning at admission and discharge. Medical record reviews yielded demographic, historical, and inpatient course of treatment information. Medical records were later reviewed to determine which of the 147 patients had been readmitted to the same facility within 3 years of their index admission. Multivariate logistic regression analysis was used to evaluate prediction of readmission status. Cox regression survival techniques were used to evaluate prediction of time to readmission. Parallel analyses were conducted on the full sample (n = 147) and on a subsample of patients (n=107) who were not discharged against medical advice (i.e., received an adequate dose of treatment). Results: Twenty-seven percent of the full sample and 31% of the subsample were readmitted within 3 years of their discharge. Body dissatisfaction and mood disorder diagnosis at discharge best predicted the likelihood of both readmission and time to readmission for the group of patients who received an adequate dose of inpatient treatment. Discussion: The observed predictors differ from those typically associated with readmission in patients with AN. The findings highlight the centrality of psychopathological aspects of AN and comorbid mood disorder, and they suggest a need to refine inpatient treatment interventions to more specifically target the psychological distress associated with body image disturbances and mood disorder. More broadly, the findings suggest the need to further evaluate the extent to which the managed care treatment environment is affecting treatment outcomes.

This cross-sectional study of 163 women with a mean age of 48 examined service utilization before and after gastric bypass surgery. Time since surgery ranged from 12 months to over 6 years. Service use prior to surgery, specifically extended dietary counseling and attendance at bariatric support groups, was associated with a higher sense of coherence and better postsurgical dietary adherence. Attendance at groups after surgery was mildly associated with better exercise adherence. Postsurgical depression was significantly related to postsurgical weight gain and worse quality of life outcomes. A 9-item eating assessment designed for the study was used to examine pre and postsurgical dietary adherence. The measure detected a significant improvement in eating behaviors for the majority of participants. A path analysis indicated that postsurgical dietary adherence, sense of coherence, and BMI accounted for 59% of the variance in postsurgical quality of life.

Ethnic and racial socialization of internationally and/or transracially adopted children has been widely recognized as a viable and important social work practice area in the adoption community. Increasingly, adoption social work professionals and adoption agencies advocate for the importance of connecting children who have been adopted internationally and/or transracially to their birth culture. However, awareness of what constitutes good social work practice in this area is minimally informed by research evidence. The primary purpose of this study was to identify developmental contextual factors, such as adoptive parents' support of ethnic and racial socialization and neighborhood characteristics, and examine how such factors affect transracially adopted Asian children's ethnic identity development and psychological well-being. Using a web-based survey design, the study recruited 100 Asian adoptees, between the ages of 14-26 from adoption family support groups on various Internet e-mail "listservs". The results showed that while ethnic socialization was directly and negatively associated with adoptees' psychological well-being, the effect of racial socialization was positive. The finding suggests that parental efforts for socializing children to their ethnic culture facilitate adoptees' ethnic identity development, which in turn, decrease adoptees' sense of marginality and, thereby increase adoptees' self-esteem.

Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need mental health services from seeking care. Individuals suffering from mental health symptoms who can benefit from mental health treatment choose not to pursue services, or begin treatment but drop out prematurely, to avoid the label of 'mentally ill,' as well as the stereotypes, prejudice and discrimination associated with bearing such a label. Empirical investigation suggests that the stigma of having a mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental health diagnosis. There is, however, a dearth of research that examines the way in which stigma influences attitudes toward seeking mental health services among aging populations and racial/ethnic minorities. This mixed methods study examined the impact of stigma on racial differences in treatment seeking attitudes and behaviors among older adults with depression. Results indicate that older adults with depression have high levels of public stigma and do not intend to seek, nor are they currently engaged in mental health treatment. Results also suggest that African American older adults endorse higher internalized stigma and less positive attitudes toward seeking mental health treatment than their white counterparts. In addition, high level of internalized stigma was related to negative attitudes toward seeking treatment and partially mediated the relationship between race and attitudes toward treatment. Older African Americans in the current study identified a number of experiences living in the black community that impacted their treatment seeking attitudes and behaviors, which led to their identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its' influence on attitudes and intentions toward seeking mental health services among older adults, particularly African American elders. Additionally, findings from this study provide impetus for a number of practice implications and suggestions for future research.

What is the meaning of homelessness and how does it translate into a better understanding of what the experience of homelessness represents? Exploring the experiences of those who are homeless and the meaning of those experiences is essential when attempting to gain insight and improve service response to those who are homeless. Narrative inquiry is used in this dissertation to tell a story of homelessness from social and personal perspectives. Ultimately, my own understanding of the social and personal dictate the story of homelessness presented in this narrative. It provides an opportunity to better understand what it means to be homeless, why individuals seek shelter, and what can happen when individuals living a homeless experience are called upon to experience their lives in their own words. What is revealed through the personal stories suggest a need for sanctuary. Sanctuary in this narrative represents respite, security, a place to decide next steps, and ultimately, for a few, a place for transition. An emergency shelter program for the homeless comes to represent sanctuary for the twenty participants in this study. It is during this experience of sanctuary that participants come to confirm, resist, and eventually maintain or transform the accepted norm (Richardson, 2001, p. 37) of what it means to live in a homeless circumstance. The internalized cultural self (Swandt, 1999) emerges as the dominant influence in telling the story of homelessness, both on the part of study participants and that of the author. Sanctuary emerges as a key theme from the personal stories, but the act of self-reflection when telling ones story becomes the catalyst for a new thinking about how participants view their homeless circumstance and their life experiences. That self-reflection proves to be an unexpected invitation to the reconstruction of ones personal story of homelessness, and an invitation for me to consider a different kind of service response. It is in this narrative, the beginning of an alternative model for emergency shelter services, where opportunties for sanctuary or respite are discussed as key needs for participants of this study. In addition, a proposed sanctuary model of service intervention is presented, where traditional emergency services are available, but with a caveat of service support that elicits the personal stories of those who are willing to reconstruct their life experiences and begin the process of narrating a different experience that holds transitional implications for their current homeless circumstance.

Schizophrenia is a severe and persistent mental illness that results in substantial burden and disability for the individuals who suffer from it, their families, and society. Social disability, in particular, is one of the most crippling aspects of the disorder that dramatically limits functioning and quality of life. Recently, social-cognitive impairments in emotional intelligence have shown to be promising potential contributors to social disability in schizophrenia, and consequently might serve as effective targets for treatment. However, measurement in this area has been limited, and no study has examined the longitudinal relationship between emotional intelligence and social disability in schizophrenia within an experimental context. This study makes use of baseline and 1 year follow-up data from an outpatient sample of individuals in the early course of schizophrenia (n = 57 at baseline, n = 47 at year 1) participating in a randomized-controlled trial of Cognitive Enhancement Therapy to investigate the psychometric properties of a promising new measure of emotional intelligence, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), and elucidate its longitudinal relations with social disability in this population. A comprehensive psychometric analysis was used to examine the reliability, discriminant validity, and factor structure of the instrument with individuals with schizophrenia; and general linear modeling, including hierarchical linear regression, was used to examine the cross-sectional and longitudinal relations between MSCEIT performance and social disability after accounting for demographic, clinical, and cognitive confounds. Psychometric results generally supported the reliability and discriminant validity of the MSCEIT when applied to individuals with schizophrenia, but also revealed a potential shift in the latent factor structure of the instrument in this population. Analyses of relations with social disability indicated little to no cross-sectional associations between MSCEIT performance and social disability, and modest longitudinal associations between changes in these domains. In particular, significant relationships were observed between longitudinal improvements in emotion regulation and reductions in overall social disability (r = -.31) and household/family relationship problems (r = -.34). These relationships persisted after adjusting for demographic characteristics, neurocognitive function, and psychopathology. Tentative evidence from mediator analyses pointed to the possibility of longitudinal improvements in emotion regulation to serve as a mechanism by which Cognitive Enhancement Therapy achieves its beneficial effects on social disability, although reverse mediation could not be ruled out. Together these findings suggest that changes in emotion regulation may be uniquely associated with changes in social disability in schizophrenia. Future research will need to replicate these findings with larger and more heterogeneous samples, and focus on the development of additional measures to study broader domains of social cognition, beyond emotional intelligence, that may also bear relevance to social disability.

ABSTRACT Background: Psychotherapy treatment specificity is the degree to which therapists utilize specific factors and not others of an intended treatment during therapy sessions. In Interpersonal psychotherapy (IPT), increased specificity has been associated with greater efficacy. IPT, however, is a dyadic intervention, and little is known about the relationship between patients pre-treatment characteristics and IPT specificity. Understanding patient characteristics that predict treatment specificity is crucial for treatment optimization. Methods: Subjects meeting DSM-IV criteria for Major Depressive Disorder were randomly assigned to IPT or escitalopram. Data from a small sub-set of subjects were examined: 20 patients (8 males, 12 females), randomized to receive IPT from one of four study therapists. Subjects remitted with IPT alone. The following predictors were hypothesized to be associated with higher treatment specificity: a) treatment preference match (patients indicating a preference for psychotherapy) as opposed to non-match (patients indicating a preference for medication or no preference); b) lower baseline scores on anxiety spectrum assessments; and, c) higher severity baseline depression scores. Patient/ therapist gender match (female patient matched with female therapist) in comparison to non-gender match (male patient with female therapist) were predicted to produce negligible results. Results: Higher baseline depressive severity predicted higher IPT specificity. Higher baseline depressive severity and preference for no therapy were highly correlated. However, patient treatment preference, therapist/ patient gender match, and anxiety spectrum scores were not related to treatment specificity. Implications: Results suggest that specificity may act as mediator between baseline depressive severity and outcome. Further studies with larger samples are needed.