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This paper aims to compare mental and physical health, cognitive functioning, and selected biomarkers of aging reflecting metabolic pathology and inflammation, in outpatients with schizophrenia from two residential settings: residential care facilities (RCFs) and living with someone in a house/apartment. This cross-sectional study examined community-dwelling adults with schizophrenia either in RCFs (N = 100) or in a house/apartment with someone (N = 76), recruited for two NIH-funded studies in San Diego. Assessments included measures of mental/physical health, cognitive function, and metabolic (glycosylated hemoglobin, cholesterol) and inflammatory (C-Reactive Protein, Tumor Necrosis Factor-alpha, Interleukin-6) biomarkers of aging. General logistic models were used to analyze factors associated with residential status. RCF residents had several indicators of worse prognosis (never being married, higher daily antipsychotic dosages, increased comorbidities and higher Framingham risk for coronary heart disease) than individuals living with someone. However, RCF residents had better mental well-being and lower BMI, as well as comparable biomarkers of aging as those living with someone. While the cross-sectional nature of the study does not allow us to infer causality, it is possible that the supportive environment of RCFs may have a positive impact on mental and physical health of persons with schizophrenia. Longitudinal follow-up studies are needed to test this hypothesis.

Background and objectives Posttraumatic stress disorder (PTSD) is a chronic, disabling, and prevalent mental health disorder among Veterans. Despite the availability of empirically supported psychotherapies, many Veterans remain symptomatic after treatment and/or prefer to seek complementary and integrative health approaches, including yoga, to manage PTSD. The randomized controlled trial (RCT) described herein will evaluate the efficacy of a manualized yoga program as compared to nonaerobic exercise in reducing PTSD severity among Veterans. A secondary aim of this study is to better understand the mechanisms of change. Methods Veterans (N = 192) with PTSD will be randomized to hatha yoga or nonaerobic physical activity control; both groups consist of 12 weekly, 60-min group or online training sessions with 15–20 min of daily at-home practice. Outcome measures will be administered at baseline, mid-treatment, posttreatment, and 12-week follow-up. Projected outcomes This study will evaluate changes in PTSD severity (primary outcome) as well as depression, anxiety, anger, sleep problems, and psychosocial disability (secondary outcomes). We will also use multiple mediation to examine two potential models of the mechanisms of clinical effect: the Attention Model (i.e., yoga increases attentional control, which reduces PTSD symptoms), the Coping Model (i.e., yoga increases distress tolerance, which improves coping, which reduces PTSD symptoms), and the combination of these models. This aspect of the study is innovative and important given the absence of an existing, comprehensive model for understanding yoga's impact on PTSD. Ultimately, we hope to develop guidelines for application of yoga to PTSD recovery., Highlights • Many Veterans with PTSD remain symptomatic after treatment or prefer alternatives. • Yoga is a promising PTSD treatment, but evidence is mixed and of limited quality. • This study is a large randomized controlled trial of yoga vs. nonaerobic exercise. • Treatment effects may be driven by change in attentional control and coping. • COVID-19 necessitated changes, creating an opportunity to examine remote delivery.

Background Previous literature suggests that better cognitive ability and insight are associated with greater lifetime risk of suicide attempts in schizophrenia, counter to the direction of association in the general population. However, the conjoint association between distinct cognitive domains, insight, and suicidality has not been assessed. Method In a cross-sectional study, 162 adults with schizophrenia or schizoaffective disorder completed cognitive testing via the MATRICS battery, symptom and cognitive insight assessments, along with the Columbia Suicide Severity Rating Scale. We then contrasted participants based on history of suicidality by cognitive domains and insight measures and conducted multivariate analyses. Results Although a history of any passive ideation was not associated with cognitive ability or insight, verbal learning was positively associated with a greater history of suicidal attempt and prior ideation with a plan and intent. Higher cognitive insight, and the self-reflectiveness subscale insight, was also associated with history of passive or active suicidal ideation. Cognitive insight and cognitive ability were independent from each other, and there were no moderating influences of insight on the effect of cognitive ability on suicide related history. Exploratory analyses revealed that history of planned attempts were associated with greater verbal learning, whereas histories of aborted attempts were associated with poorer reasoning and problem-solving. Implications Although cross-sectional and retrospective, this study provides support that greater cognitive ability, specifically verbal learning, along with self-reflectiveness, may confer elevated risk for more severe suicidal ideation and behavior in an independent fashion. Interestingly, poorer problem-solving was associated with aborted suicide attempts.

People have much to gain from regular exercise, such as improved sleep, increased cognitive function, and reduced risk for cardiovascular disease, and these benefits may be particularly important for people experiencing deficits in these areas due to depressive symptoms (Kubesch et al., 2003; Lett et al., 2004; Rethorst et al., 2013). Moreover, regular exercise can be an effective treatment for depression (Babyak et al., 2000; Dunn et al., 2005; Mather et al., 2002; Mota-Pereira et al., 2011; Rethorst, Wipfli, & Landers, 2009). Despite the myriad benefits of regular exercise, adults with depressive symptoms have lower exercise levels than other adults (Patten, Williams, Lavorato, & Eliasziw, 2009; Roshaneai-Moghaddam, Katon, & Russo, 2009) and those with depressive symptoms who initiate a regular exercise regimen are more likely than others to discontinue it (DiMatteo, Lepper, & Croghan, 2000; Teixeira et al., 2004). Therefore, it is important to understand the reasons why people with depressive symptoms have difficulty initiating and maintaining regular exercise. Models of health behavior change, such as the Health Action Process Approach, Theory of Planned Behavior, and Social Cognitive Theory, emphasize the role of self-efficacy in successful behavior change (Ajzen, 1991; Bandura, 1997; Schwarzer, 1992). Self-efficacy is a person’s belief in his or her own ability to execute a specific behavior (Bandura, 1997), and it is central to behavior change because it guides what behaviors people choose to engage in and how people respond to obstacles and challenges in changing their behaviors (Bandura, 1997). Self-efficacy is known to be a predictor of successful initiation and maintenance of regular exercise (Rodgers, Hall, Blanchard, McAuley, & Munroe, 2002; Williams et al., 2008). Low self-efficacy may be one reason why people with depressive symptoms have difficulties initiating and maintaining regular exercise. People with depressive symptoms report lower self-efficacy than people without depressive symptoms across various behaviors (Bandura, 1998; Robinson-Smith, Johnston & Allen, 2000; Sacco et al., 2005). However, to date, it is unclear how depressive symptoms affect people’s self-efficacy while they attempt to initiate regular exercise. Self-efficacy beliefs are based on perceptions of ability to execute the relevant behavior, as well as perceptions of specific task demands and situational circumstances. Self-efficacy is theorized to stem from four sources: personal experience, vicarious experience, social persuasion (e.g., verbal encouragement), and physiological factors (e.g., arousal such as increased heart rate can lead to perceived inefficacy). Among these different sources, personal experience in executing the relevant behavior is the strongest source of self-efficacy perceptions (Bandura, 1997). Consistent with the proposition that personal experience is the strongest source of self-efficacy, exercise self-efficacy has been shown to significantly increase following participation in exercise. This has been observed after individual bouts of exercise (McAuley, 1995; McAuley et al., 2011) and long-term interventions for regular exercise (Marcus, Selby, Niaura, & Rossi, 1992; McAuley, 1995). This pattern of self-efficacy increases following the execution of exercise is consistent across the literature among healthy adults (Keller, Fleury, Gregor-Holt, & Thompson, 1999). In contrast, self-efficacy has been shown to decrease when individuals do not adhere to regular exercise, especially during the initiation of regular exercise as a new behavior (Parschau, Richert, Koring, Lippke, & Schwarzer, 2012). These findings all demonstrate that perceptions of self-efficacy are sensitive to whether people are successfully engaging in exercise or not. However, Bandura (1997) emphasized that it is not simply objective task execution that influences self-efficacy, but also the subjective perceptions and interpretations associated with the behavior. Subjective perceptions can be influenced by personal factors, such as differences in affective and cognitive processing. Depressive symptoms may be a personal factor that moderates the path between personal experience with exercise and self-efficacy. Depression is characterized by negative interpretations of experiences that are influenced by rumination, negative cognitions, and negative recall bias (Beck, 1991). The result of these negative interpretations is a tendency to minimize successes and exaggerate failures (Bandura, 1997). There is evidence to suggest that depressive symptoms influence self-efficacy to exercise regularly, but the evidence does not specifically address how this occurs. For example, older adults with depressive symptoms who enrolled in a 10-week progressive resistance-training program did not report increases in self-efficacy despite regular participation in exercise and objective gains in physical capability (Singh et al., 1997). This finding suggests the possibility that people with depressive symptoms have difficulties deriving self-efficacy from successfully performing exercise. This would be consistent with evidence that depressive symptoms are associated with a tendency to minimize successes (Bandura, 1997; Beck, 1991). Alternatively, Conroy and colleagues (2007) analyzed cross-sectional data one year after an exercise intervention in order to understand lapses (i.e., two weeks of failed adherence) during the initiation of a regular exercise regimen. They found that participants with high depressive symptoms were more likely than other participants to never return to regular exercise after a lapse to inactivity. This suggests that not exercising for two weeks was more detrimental to regular exercise behavior for participants with high depressive symptoms than those with low symptoms. One possible explanation is that participants with depressive symptoms may have experienced greater decreases in self-efficacy when they did not exercise regularly. This would be consistent with evidence that depressive symptoms can also be associated with a tendency to exaggerate failures (Bandura, 1997; Beck, 1991). However, this possibility was not directly examined. If depressive symptoms moderate the relation between exercise and self-efficacy, the moderation effect could be manifest in two different ways. First, depressive symptoms may dampen an increase in self-efficacy when people exercise (e.g., self-efficacy is lower for people with high depressive symptoms than those with low symptoms on days they exercise). Second, depressive symptoms may amplify a decrease in self-efficacy when people do not exercise (e.g., self-efficacy is lower for people with high depressive symptoms than those with low symptoms on days they do not exercise). Current evidence is unclear as to whether either or both effects occur for people with depressive symptoms (Singh et al., 1997; Conroy et al., 2007). Elucidating how these effects unfold on a daily basis would help specify why people with depressive symptoms have difficulties initiating regular exercise. Self-efficacy and exercise both have unique features that would benefit from daily examination over time. First, self-efficacy is not a static construct; it varies according to a person’s experiences (Shiffman et al., 2000). Second, the first days and weeks of initiating regular exercise are a sensitive period in both the formation of self-efficacy (Bandura, 1997) and establishing regular exercise (Dishman, Ickes, & Morgan, 1980), thus it is likely that exercise self-efficacy will be particularly sensitive to daily influences during this critical phase. Third, regular exercise is a health behavior that does not necessitate daily adherence, unlike other health behaviors such as smoking cessation or medication adherence. Indeed, public health guidelines for physical activity recommend activity on most but not all days of the week (USDHHS, 2008). Consequently, for people initiating regular exercise, there will routinely be days on which they exercise and days on which they do not. Distinguishing between experiences that occur on days of exercise and days of no exercise is relevant to understanding the daily psychological processes that occur during the initiation phase of regular exercise.

Federal law has prohibited the purchase and possession of firearms on the basis of mental health for nearly 50 years. The current background check system is limited by its vague policies, nonmandatory reporting standards, and low cooperation of individual states with the national background check registry. In January 2013, the Obama administration began an effort to reduce gun violence, which included proposed reform to mental health reporting standards and to the national background check system. However, there is much debate over whether people with mental illness should be included in background check databases or if their inclusion is counterproductive to the treatment of mental illness and the prevention of gun violence. The literature suggests that mental illness is not a reliable predictor of violence, rather a history of violence and current threats of violence are the best predictors of future violence. This article discusses the ethical considerations of mental health background checks for firearm ownership, with particular regard to the differing confidentiality policies of mental health professionals across states and the potential ramifications of a national mental health registry on patients' well-being. We propose that gun control regulations should implement empirically supported predictors of violence and that national inconsistencies in policies regarding confidentiality and "duty to warn" should be resolved. Language: en

The aims were to predict cognitive therapy (CT) noncompletion and to determine, relative to other putative predictors, the extent to which the patient skills in CT for recurrent major depressive disorder predicted response in a large, two-site trial.Among 523 outpatients aged 18e70, exposed to 12e14 weeks of CT, 21.6% dropped out. Of the 410 completers, 26.1% did not respond. To predict these outcomes, we conducted logistic regression analyses of demographics, pre-treatment illness characteristics and psychosocial measures, and midtreatment therapeutic alliance.The 17-item Hamilton Rating Scale for Depression (HRSD17) scores at entry predicted dropout and nonresponse. Patients working for pay, of non-Hispanic white race, who were older, or had more education were significantly more likely to complete. Controlling for HRSD17, significant predictors of nonresponse included: lower scores on the Skills of Cognitive Therapy-Observer Version (SoCT-O), not working for pay, history of only two depressive episodes, greater pre-treatment social impairment. Midphase symptom reduction was a strong predictor of final outcome.These prognostic indicators forecast which patients tend to be optimal candidates for standard CT, as well as which patients may benefit from changes in therapy, its focus, or from alternate modalities of treatment. Pending replication, the findings underscore the importance of promoting patients’ understanding and use of CT skills, as well as reducing depressive symptoms early. Future research may determine the extent to which these findings generalize to other therapies, providers who vary in competency, and patients with other depressive subtypes or disorders.

Item does not contain fulltext Physical activity (PA) interventions have a clear role in promoting mental health. Current PA guidelines directed toward specific PA intensities may have negative effects on affective response to exercise, and affective response is an important determinant of PA adherence. In this randomized trial of 67 previously inactive adults, we compared the effects of a PA prescription emphasizing the maintenance of positive affect to one emphasizing a target heart rate, and tested the extent to which the effect of the affect-guided prescription on PA is moderated by cardiorespiratory fitness (CRF). We found the effect of an affect-guided prescription was significantly moderated by CRF. At one week, for participants with lower CRF (i.e. poor conditioning), the affect-guided prescription resulted in significantly greater change in PA minutes (M = 240.8) than the heart rate-guided prescription (M = 165.7), reflecting a moderate-sized effect (d = .55). For those with higher CRF (i.e. good conditioning), the means were in the opposite direction but not significantly different. At one month, the same pattern emerged but the interaction was not significant. We discuss the implications of these findings for the type of PA prescriptions offered to individuals in need. 13 p.

Satisfaction with physical activity is known to be an important factor in physical activity maintenance, but the factors that influence satisfaction are not well understood. The purpose of this study was to elucidate how ongoing experiences with recently initiated physical activity are associated with satisfaction. Participants (n = 116) included insufficiently active volunteers who initiated a self-directed physical activity regimen and completed daily diaries about their experiences for 28 days. We used multilevel models to examine the associations between experiences with physical activity and satisfaction. Significant between-person effects demonstrated that people reporting higher average levels of positive experiences and lower levels of thinking about the negative aspects of exercise were more likely to report higher levels of satisfaction (ps