Joshua Fogel, PhD 

Medscape Psychiatry & Mental Health.  2006;11(2) ©2006 Medscape

Introduction

The American Psychological Association held its 114th Annual Convention in New Orleans, Louisiana, on August 10-13, 2006. Below are summaries on several highlights of this year's meeting:

Alcoholism Treatment

Margaret E. Mattson, PhD, Health Scientist Administrator, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, Maryland, described the background and rationale for the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study.^[1] The COMBINE study focused on understanding what combinations of behavioral and pharmacologic treatments are effective for treating those with alcohol dependence.^[2] The medications studied were naltrexone and acamprosate. The behavioral treatments studied were less intensive medication management (MM) and moderately intensive combined behavioral therapy (CBI).

Stephanie O'Malley, PhD, Professor, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, discussed the methodology and results of COMBINE.^[3] Men and women aged 21 years and older with current alcohol dependence were included. Severe mental illness (eg, schizophrenia) and drug dependence (except for nicotine or marijuana) were two of the exclusion criteria. There were 9 possible treatment options in total and 4 possible medication combinations:

In 4 of the groups, everyone received MM plus one of the 4 medication combinations. Another 4 groups received CBI in addition to MM, plus one of the 4 medication combinations. Those in the ninth group received only CBI, without MM or medication. The medications were provided over 16 weeks with a naltrexone dosage of 100 mg daily and an acamprosate dosage of 3000 mg daily. The behavioral treatments were manual-guided; the CBI intervention provided up to 20 individual sessions over a 4-month duration. There were 1383 individuals randomized to one of the 9 treatment options. Primary outcomes were percentage of days abstinent (PDA) and time to first heavy drinking day.

Overall, as expected, there were great reductions in drinking. PDA tripled from 25% to 76%, and total drinking decreased from 66 to 13 drinks per week (an 80% reduction). Unlike other studies showing benefits for acamprosate, the COMBINE study did not find this drug to be more effective than placebo for any of the primary outcomes. Naltrexone, on the other hand, significantly reduced craving and had increased PDA (80.6%) compared with placebo (75.1%) without CBI. Also, naltrexone had a hazard ratio of 0.72, indicating less risk for relapse compared with placebo. There was significant improvement for the primary outcomes for those in the group receiving CBI, MM, and placebo. However, combining treatments did not further improve outcomes. More specifically, treatment outcomes were not improved by combining (1) acamprosate with CBI, (2) acamprosate with naltrexone, or (3) naltrexone with CBI. Also, either naltrexone or CBI improved outcomes when used with MM.

Joseph LoCastro, PhD, Associate Professor, Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, discussed the impact of including a placebo in the study.^[4] He emphasized that trials of behavior therapy for alcoholism are typically not compared with medication treatments and are never compared with an additional medication placebo.

Dr. LoCastro reported that there were overall significant differences (P = .0002) for PDA after 16 weeks of treatment between MM and placebo (73%); CBI, MM, and placebo (80%); and CBI alone (67%). These significant differences remained in post hoc pairwise comparisons. Also, there was significantly more relapse to heavy drinking in the CBI-alone group compared with those receiving CBI, MM, and placebo (P = .05). There were no significant differences between the CBI-alone group and the MM and placebo group (P = .46). He discussed possible reasons for the observed placebo effects, including the psychological expectancy of taking medication, and that there was more concrete, extra clinical attention received as part of the MM meetings.

Dennis M. Donovan, PhD, Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, discussed the 1-year study follow-up.^[5] He reported that PDA declined overall in all of the groups. There was no main effect for either naltrexone or acamprosate. There was a trend (P = .08) for those receiving CBI to have a higher PDA than those not receiving CBI, regardless of medication condition. Also, more individuals had at least 1 heavy drinking day. Only those taking naltrexone had less risk of returning to heavy drinking (P = .04). There was also a trend (P = .08) for those receiving CBI to have less risk for relapse to return to heavy drinking than those not receiving CBI.

Aging and Work

Coping Strategies

Lindsey M. Young, MA, PhD candidate, Department of Psychology, Wayne State University, Detroit, Michigan, discussed the interplay of aging and work-family issues.^[6] Older employees engage in certain coping behaviors at work, such as avoiding tasks or delegating responsibility when the project interferes with family life. They also use the selection, optimization, and compensation approach to reduce stressors^[7]:

Employed Elder-Care Providers

Ms. Young also addressed the issue of elder care for family members, a common concern facing older workers, whether the individual who is being cared for is a spouse or parent. She stated that more than half of employed elder-care providers miss an average of 9 hours of work each month. These employees experience stress and frustration^[8] and have lower productivity and higher work-site accident rates.^[9]

Men vs Women: Differences in Elder Care

There are gender differences in how elder care is addressed. Men reduce the elder care provided, whereas women reduce their work commitments.^[10] Men tend to provide instrumental assistance, such as lawn mowing and financial assistance, whereas women provide assistance with activities of daily living, such as feeding and bathing. Ms. Young emphasized that many organizations view elder care as an individual problem; however, organizations would, in theory, retain and attract older employees if they created programs and considered policies that provided work-family balance.

Work and Self-esteem

Harvey L. Sterns, PhD, Professor, Department of Psychology, University of Akron, Akron, Ohio, discussed the relationship of work-life conflict (WLC) with self-esteem.^[11] He mentioned 2 types of self-esteem:

He also described 2 types of WLC:

Dr. Sterns surveyed 263 middle-aged full-time and part-time college faculty. Women reported more WLCs for leisure demands than men. For both the full-time and part-time faculty, an increase in GSE was associated with:

Similarly, full-time faculty, with increased OBSE, had decreased overall WLC, decreased WLC due to relationship demands, and decreased WLC due to leisure demands. However, for part-time faculty, increased OBSE was only significantly associated with decreased WLC due to relationship demands. Additional analyses including both GSE and OBSE in the model revealed that for full-time faculty, only OBSE was significantly related to each of the WLC outcomes, whereas for part-time faculty, only GSE was significantly related to WLC outcomes. Dr. Sterns suggested that increased self-esteem is associated with better WLC coping, and the type of self-esteem that improves coping strategies in the work setting may depend on whether someone works full- or part-time.

Work Status and Depression

Jacquelyn B. James, PhD, Director of Research, Boston College Center for Work & Family, Boston, Massachusetts, discussed the relationship of work status to depressive symptoms over a 12-year time period.^[12] She used data from the 7 waves of the Health and Retirement Survey Data collected from 1992 to 2004.^[13] This sample consisted of individuals aged 51-61 at the first wave -- 79% white, 17% black, and 4% other race/ethnicity.

Dr. James identified 6 different cluster patterns for the data.^[12] Of these 6 clusters, those with the highest depression at baseline (n = 509) had depressive symptoms increasing over time in the shape of an inverted U curve. These individuals were retired and had the following characteristics:

The cluster with the lowest depression at baseline (n = 3647) had very little increases in depression over time. These individuals were:

Dr. James concluded that depressive symptoms change over time in different ways for different individuals. The depression extremes are influenced by socioeconomic status and show the effects of cumulative disadvantage or advantage. She stated that the ability to work, good health, and marriage are important buffers for preventing depressive symptoms among the elderly.

Psychological Adjustment Among Older Workers

David L. Blustein, PhD, Professor, Department of Counseling, Developmental, and Educational Psychology, Boston College, Boston, Massachusetts, discussed the interface of the psychology of working and aging.^[14] He emphasized that the current generation often has the ability to choose careers, something that many of their parents did not do and that even today, those from many regions of the world still cannot do.

Dr. Blustein proposed that there are 3 different needs to be addressed for successful psychological adjustment among older workers:

Immigration and Asian Americans

David Takeuchi, PhD, Professor, Department of Sociology and School of Social Work, University of Washington, Seattle, spoke about how the immigration experience affects the mental health of Asian Americans.^[15] He discussed 4 types of immigration patterns. The 1.50 generation includes those who arrived in the United States between 0 and 12 years of age. School is their principal area of socialization. They are more like native-born Americans, and it is hypothesized that they will have similar opportunities as native-born individuals to engage in risky behaviors. The 1.25 generation includes those who arrived between 13 and 17 years of age. They have coethnic peers and may be different from Americans with regard to values and lifestyle. There is often a "push and pull" between the American and Asian cultures. The 1.0a generation includes those who arrived between 18 and 39 years of age. Their education did not occur in the United States, and this can constrain their upward mobility. The 1.0b generation includes those who arrived after age 40. They have difficulty finding jobs that match their educational levels.

Dr. Takeuchi reported results from the National Latino and Asian American Study, which included 2095 Asian Americans of Chinese, Vietnamese, Filipino, and other Asian ethnicity. He reported that affective disorders increase until middle adulthood and then sharply decline in late adulthood. The one exception to this pattern is among the 1.25 generation, in which there is a steep decline for affective disorders in young adulthood, before it increases again in middle adulthood. He also reported results comparing these 4 immigration patterns to US-born individuals. All the immigrant groups had lower family support and friend support than those who were US-born. The one exception was for the 1.50 group that had similar friend support as for those who were US-born. Also, both the 1.0a and 1.0b groups had lower perceived social status compared with those who were US-born, whereas the 1.50 and 1.25 groups were similar to those who were US-born in that regard.

Summary

The following conclusions can be drawn from the 114th Annual Convention of the American Psychological Association as highlighted in the preceding summary:

Mattson ME. Background and rationale for the COMBINE study. Program and abstracts of the American Psychological Association 114th Annual Convention; August 10-13, 2006; New Orleans, Louisiana. Anton RF, O'Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence. The COMBINE study: a randomized controlled trial. JAMA. 2006;295:2003-2017. O'Malley S. COMBINE study: within treatment study outcomes. Program and abstracts of the American Psychological Association 114 Annual Convention; August 10-13, 2006; New Orleans, Louisiana. LoCastro J. Do alcoholics respond to a placebo? Results from COMBINE. Program and abstracts of the American Psychological Association 114th Annual Convention; August 10-13, 2006; New Orleans, Louisiana. Donovan DM. COMBINE study: one year posttreatment drinking outcomes. Program and abstracts of the American Psychological Association 114 Annual Convention; August 10-13, 2006; New Orleans, Louisiana. Baltes BB, Young LM. Aging and work and family issues. Program and abstracts of the American Psychological Association 114 Annual Convention; August 10-13, 2006; New Orleans, Louisiana. Baltes PB, Baltes MM. Psychological perspectives on successful aging: the model of selective optimization with compensation. In: Baltes PB, Baltes MM, eds. Successful Aging: Perspectives From the Behavioral Sciences. New York: Cambridge University Press; 1990:1-34. Orodenker S. Family caregiving in a changing society: the effects of employment on caregiver stress. Fam Community Health. 1990;12:58-70. Dellmann-Jenkins M, Bennett JM, Brahce CI. Shaping the corporate response to workers with elder care commitments: considerations for gerontologists. Educ Gerontol. 1994;20:395-405. Buffardi LC, Smith JL, O'Brien AS, Erdwins CJ. The impact of dependent-care responsibility and gender on work attitudes. J Occup Health Psychol. 1999;4:356-367. Sterns HL, Chang B, Hall RJ. Worker well-being: age, work-life conflicts, and self-esteem. Program and abstracts of the American Psychological Association 114 Annual Convention; August 10-13, 2006; New Orleans, Louisiana. James JB, Spiro A III. Role of work in trajectories of depressive symptoms. Program and abstracts of the American Psychological Association 114 Annual Convention; August 10-13, 2006; New Orleans, Louisiana. National Institute on Aging. The Health and Retirement Study. Available at: http://aspe.hhs.gov/datacncl/DataDir/racedata.htm Accessed November 18, 2006. Blustein DL, Kane KD. Psychology of working and aging: transformation and reinvention. Program and abstracts of the American Psychological Association 114 Annual Convention; August 10-13, 2006; New Orleans, Louisiana. Takeuchi D. Symposium: plenary -- emerging findings from multicultural psychiatric epidemiology. Program and abstracts of the American Psychological Association 114 Annual Convention; August 10-13, 2006; New Orleans, Louisiana.