Papers by Rosemarie Wolfe
Clinical Rehabilitation, 2003
Objective: To examine variability in ‘uptime’ (the amount of time spent in the upright position).... more Objective: To examine variability in ‘uptime’ (the amount of time spent in the upright position).Design: An observational study. Setting: The community (i.e., homes and schools in the Melbourne metropolitan area).Subjects: Normal children between 8 and 15 years of age (18 girls and 8 boys).Equipment: An ‘uptimer’, a lightweight, battery-operated remote monitor, was used to record uptime.Procedure: Each child in the
The British Journal of Psychiatry, 2015
Individuals with severe mental illnesses such as schizophrenia, bipolar disorder and major depres... more Individuals with severe mental illnesses such as schizophrenia, bipolar disorder and major depression are more likely to experience trauma over their lifetime than people in the general population. 1,2 This trauma exposure has been linked to a wide range of negative outcomes, including more severe symptoms and distress, more impaired functioning and higher utilisation of acute care services. The high rate of trauma, and its associated clinical correlates, has drawn attention to the need for treatments to reduce the consequences of trauma in this population. Post-traumatic stress disorder (PTSD) is a common consequence of trauma exposure. Surveys indicate elevated rates of PTSD in people with severe mental illness, with most studies reporting current rates between 25 and 48%. 1 These rates are clearly higher than the average estimated prevalence of 3.5% for past year PTSD in the general population. 5 Effective interventions have been established for PTSD in the general population, with most research focusing on individuals exposed to specific types of trauma (for example combat, sexual assault) or to the broader range of traumatic events in community samples (such as accidents). Less attention has been paid to tailoring treatments to meet the unique needs of people with severe mental illness and PTSD, such as high sensitivity to stress, psychotic symptoms and cognitive limitations. As noted by Spinazzola et al, 7 'true advancement of the field will require a deliberate process of evaluation and adaptation of efficacious treatments with less restricted, more clinically representative PTSD samples' . To address this need, we developed an individual 12-to 16-session cognitive-behavioural therapy (CBT) programme for PTSD in people with severe mental illness, with simplified educational and worksheet materials to facilitate learning in people with cognitive and other challenges, and clinical guidelines to accommodate a wide range of clinical symptoms (such as psychosis, severe depression). 8 The first three sessions of the CBT programme involve teaching breathing retraining as a skill for reducing anxiety, and education about PTSD -both common components of PTSD treatment programmes in the general population. 9 The remaining 8-12 sessions focus on cognitive restructuring (i.e. identifying, evaluating and changing inaccurate and distressing thoughts, including trauma-related beliefs). We chose to focus on cognitive restructuring as the main active ingredient for the programme on the basis of research in the general population showing that cognitive restructuring and prolonged exposure therapy are of comparable efficacy with each other and are more effective than other approaches, 10-12 clinical experience using cognitive restructuring in the treatment of severe mental illness (such as schizophrenia, bipolar disorder, borderline personality disorder), 13-16 and because we anticipated it would be more acceptable to patients and less stressful than exposure therapy.
Schizophrenia research, 2010
Clinical investigators have argued that the experience of a recent onset of psychosis is an event... more Clinical investigators have argued that the experience of a recent onset of psychosis is an event of such severity that it can lead to posttraumatic stress disorder (PTSD), or at least to PTSD symptoms. The traumagenic elements of the psychotic experience may relate to the distressing nature of psychotic symptoms, components of treatment, or both. However, this hypotheses has not been fully empirically evaluated. In particular, the importance of the DSM-IV A1 (perception of threat) and A2 (negative emotion at time of event) criteria for a traumatic event due to a psychotic episode has not been assessed. To address this question, 38 clients in treatment for recent onset of psychosis were interviewed to identify distressing experiences related to the episode, with PTSD assessed (including A1/A2 criteria) related to those events. More than one-half of the participants reported intense distress related to psychotic symptoms or treatment experiences, with 66% meeting symptom criteria for...
Objectives: Research on psychosocial interventions for people with serious mental illness (SMI) d... more Objectives: Research on psychosocial interventions for people with serious mental illness (SMI) demonstrates that cognitive functioning is associated with psychosocial functioning. However, cognitive impairment is more pronounced and progressive in older adults with SMI and is associated with poorer functioning. Little is known about the long-term impact of psychosocial skills training on cognitive functioning in this rapidly growing group. Design: We conducted post-hoc analyses on a previously reported randomized controlled trial to evaluate the relationship between cognitive and psychosocial functioning and the potential impact of psychosocial skills training on cognitive functioning over time. Setting and Participants: The current study was conducted using a community-dwelling sample of 183 people older than age 50 with SMI. Intervention: Half of the study sample received a psychosocial skills training and health management program, Helping Older People Experience Success, and were compared with a treatment-as-usual group. Measurements: Cognitive and psychosocial functioning were assessed at baseline and at 1-, 2-, and 3-year follow-ups. Results: Psychosocial functioning was strongly related to cognitive functioning at baseline. Participation in the Helping Older People Experience Success program was not associated with greater improvements in overall cognitive functioning; however, exploratory analyses suggested a modest improvement in executive functioning. Conclusions: Given the lack of long-term data on interventions associated with sustaining or improving executive functioning in older adults with SMI, these exploratory findings suggest that future research is warranted to establish the potential benefit of psychosocial skills training as a component of treatment aimed at enhancing longterm psychosocial and cognitive functioning. (Am J Geriatr Psychiatry 2013; 21:242e250)
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jan 6, 2013
Objectives: Research on psychosocial interventions for people with serious mental illness (SMI) d... more Objectives: Research on psychosocial interventions for people with serious mental illness (SMI) demonstrates that cognitive functioning is associated with psychosocial functioning. However, cognitive impairment is more pronounced and progressive in older adults with SMI and is associated with poorer functioning. Little is known about the long-term impact of psychosocial skills training on cognitive functioning in this rapidly growing group. Design: We conducted post-hoc analyses on a previously reported randomized controlled trial to evaluate the relationship between cognitive and psychosocial functioning and the potential impact of psychosocial skills training on cognitive functioning over time. Setting and Participants: The current study was conducted using a community-dwelling sample of 183 people older than age 50 with SMI. Intervention: Half of the study sample received a psychosocial skills training and health management program, Helping Older People Experience Success, and were compared with a treatment-as-usual group. Measurements: Cognitive and psychosocial functioning were assessed at baseline and at 1-, 2-, and 3-year follow-ups. Results: Psychosocial functioning was strongly related to cognitive functioning at baseline. Participation in the Helping Older People Experience Success program was not associated with greater improvements in overall cognitive functioning; however, exploratory analyses suggested a modest improvement in executive functioning. Conclusions: Given the lack of long-term data on interventions associated with sustaining or improving executive functioning in older adults with SMI, these exploratory findings suggest that future research is warranted to establish the potential benefit of psychosocial skills training as a component of treatment aimed at enhancing longterm psychosocial and cognitive functioning. (Am J Geriatr Psychiatry 2013; 21:242e250)
American Journal on Addictions, 2003
Psychiatric Rehabilitation Journal, 2014
Despite the large number of Latinos living in the United States, little research has evaluated th... more Despite the large number of Latinos living in the United States, little research has evaluated the effectiveness of different vocational rehabilitation programs for individuals with severe mental illness in this rapidly growing minority population. This article presents a secondary analysis of a randomized, controlled trial comparing supported employment with 2 other vocational rehabilitation programs in 3 ethnic/racial groups of participants with severe mental illness: Latinos, non-Latino African Americans, and non-Latino Whites. The data were drawn from a previously published randomized, controlled trial comparing supported employment with standard vocational rehabilitation services and a psychosocial clubhouse program in persons with severe mental illness (Mueser et al., 2004), including 64 Latinos, 91 non-Latino African Americans, and 43 non-Latino Whites. Comparisons were made between the 3 groups at baseline on demographic characteristics, clinical and psychosocial functioning, and quality of life. Within each ethnic/racial group, competitive employment and all paid employment outcomes were compared between the 3 vocational rehabilitation programs over the 2-year study period. At baseline, the Latino participants had lower levels of education and disability income, were less likely to have worked competitively over the previous 5 years, had more severe symptoms, and worse psychosocial functioning than the non-Latino African American or non-Latino White participants. Latinos randomized to supported employment had better competitive and all-paid work outcomes than those assigned to either standard services or the psychosocial clubhouse program, similar to the non-Latino consumers. Rates of competitive work for consumers in supported employment were comparable across all 3 racial/ethnic groups. Supported employment is effective at improving competitive work in Latinos with severe mental illness. Efforts should be made to increase access to supported employment in the growing population of Latinos with severe mental illness.
Suicide and Life-Threatening Behavior, 2005
In this study we examined self-reported suicide attempts and their relationship to other health r... more In this study we examined self-reported suicide attempts and their relationship to other health risk factors in a community sample of 16,644 adolescents. Fifteen percent endorsed suicide attempts (10% single; 5% multiple attempts). We hypothesized that multiple attempters would show higher prevalence of comorbid health risks than single or non-attempters. The three groups showed significant differences in ten health risk domains, on factors such as depressed mood, sexual assault, weight problems, and drug and alcohol use (ORs: 3.26-13.57). Repeated suicide attempts appear to be related to increased vulnerability and likelihood of harm in multiple domains of health risk.
Social Psychiatry and Psychiatric Epidemiology, 2001
Adults with depressive disorder report high rates of sub-optimal maternal care in childhood. Desp... more Adults with depressive disorder report high rates of sub-optimal maternal care in childhood. Despite the greater salience of relationships with parents earlier in life, associations with parenting style have not yet been systematically studied in adolescent onset disorder. A six-wave, 3-year study of adolescent health in 2032 Australian secondary school students provided an opportunity to undertake a two-phase study of early onset depression. Between waves 2 to 6, a self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was used to generate a first phase diagnosis of ICD-10 depressive episode. Each subject with a CIS-R-defined depressive episode was selected for second phase assessment together with two subjects from the CIS-R non-cases in each school. Second phase assessment included a second diagnostic assessment using the depression and hypomania modules of the Composite International Diagnostic Interview (CIDI) and assessment of paternal and maternal style using the Parental Bonding Instrument. A total of 1947 out of 2032 subjects in the sampling frame (95.8%) participated in the cohort study (phase 1) at least once; 406 (94%) of the 435 selected subjects completed second phase assessment. One hundred and nineteen subjects fulfilled criteria for depressive episode on the CIS-R at one or more waves. Over the 30-month study period, 69 subjects (10 male, 59 female) fulfilled both CIS-R and CIDI definitions of depression at the same wave and were classified as 'definite depressive disorder'. Low maternal and paternal care held independent associations with both definitions of depression, with the effects clearest in those in the lowest quartile of reported care. After adjusting for low parental care, the associations between high parental control and depression were small. Sub-optimal parenting is associated with depressive disorder in adolescents. Low maternal and paternal care are each associated with a two- to three-fold higher rate of depressive disorder. These findings are consistent with an effect of sub-optimal parenting on the onset rather than course of disorder. Whether sub-optimal parenting is associated with a risk for the onset of depression outside the adolescent years has yet to be clarified.
Social Psychiatry and Psychiatric Epidemiology, 1999
Computer-administered questionnaires have been little explored as a potentially effective and ine... more Computer-administered questionnaires have been little explored as a potentially effective and inexpensive alternative to pencil and paper screening tests. A self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was compared with the Composite International Diagnostic Interview (CIDI) in a two-phase study of 2032 Australian high school students (mean age 15.7 years) drawn from a stratified random sample of 44 schools in the state of Victoria, Australia. Prevalence, sensitivity and specificity were estimated using weighting to compensate for the two-phase sampling. Point prevalence estimates of depression using the CIS-R were 1.8% for males and 5.6% for females--an overall prevalence of 3.2%. Prevalence estimates for depression in the past 6 months using the CIDI were 5.2% for males and 16.9% for females--an overall estimate of 12.1%. The CIS-R had a positive predictive value (PPV) of 0.49 and negative predictive value (NPV) of 0.91 for CIDI depression in the past 6 months. Specificity was very high (0.97) but sensitivity low (0.18), indicating that a majority of those with a CIDI-defined depressive episode in the past 6 months were not recognised at a single screening using the CIS-R. Even so, the CIS-R has proved at least as good as any pencil and paper questionnaire in identifying cases for nested case-control studies of adolescent depression. Further exploration of strategies such as serial screening to enhance sensitivity is warranted.
Schizophrenia Research, 2001
Objectives: To evaluate the differences between two cohorts of patients with severe mental illnes... more Objectives: To evaluate the differences between two cohorts of patients with severe mental illness (schizophrenia-spectrum or bipolar disorder) and co-occurring substance-use disorders, living in either predominantly rural areas or urban areas. Methods: Two study groups of patients with a dual diagnosis, recruited using the same criteria, were evaluated, including 225 patients from New Hampshire and 166 patients from two cities in Connecticut. The two study groups were compared on demographic characteristics, housing, legal problems, psychiatric and substance use diagnoses, substance use and abuse, psychiatric symptoms, and quality of life. Results: Patients in the Connecticut study group had higher rates of cocaine-use disorder, more involvement in the criminal justice system, more homelessness, and were more likely to be from minority backgrounds. The Connecticut group also had a higher proportion of patients with schizophrenia and more severe symptoms, as well as lower rates of marriage, educational attainment, and work than the New Hampshire study group. Alcohol-use disorder was higher in the New Hampshire group. Subsequent analyses within the Connecticut group indicated that although African American patients had higher rates of cocaine-use disorder than white patients, cocaine disorder and not minority status was most strongly related to criminal involvement and homelessness. Conclusions: Because of the substances abused and the greater degree of psychiatric illness severity, patients with a dual diagnosis who are living in urban areas may require greater ancillary services, such as residential programs, Assertive Community Treatment, and jail diversion programs in order to treat their disorders successfully. q
Schizophrenia Research, 2010
Methods: To promote in a real setting therapy strategies that have been empirically demonstrated ... more Methods: To promote in a real setting therapy strategies that have been empirically demonstrated through the provision of regulated and quality training followed by their supervised application to clinical practice, and ascertaining limits, establishing indicators, evaluating the quality of their application and their effects, thereby obtaining essential information for their future dissemination in clinical practice. Results: the preliminary results from the mental health services of the Murcia Region are presented. The low application in clinical practice is confirmed, particularly in mental health centres, with therapy/family per year ratios ranging between 0-8. The benefits obtained where strategies have been applied are similar to experimental studies. The greatest shortcomings identified were connecting with the family and the absence of re-call sessions. The current organisation of services and overburdened staff and the need for changes on the part of professionals towards a therapy model that takes setting into account, are underlined as the greatest obstacles for their implementation. Conclusions: Additional measures are necessary, such as specific funding and professional incentives.
Schizophrenia Bulletin, 2009
Employment is central to the concept of recovery in severe mental illness. However, common comorb... more Employment is central to the concept of recovery in severe mental illness. However, common comorbid conditions present significant obstacles to consumers seeking employment and benefiting from vocational rehabilitation. We review research on the effects of three common comorbid conditions on work and response to vocational rehabilitation, including cognitive impairment, substance abuse, and medical conditions, followed by research on vocational rehabilitation. We then present the results of a randomized controlled trial evaluating the effects of adding cognitive remediation to a vocational rehabilitation program compared with vocational rehabilitation alone in 34 consumers with severe mental illness. Consumers who received both cognitive remediation and vocational rehabilitation demonstrated significantly greater improvements on a cognitive battery over 3 months than those who received vocational rehabilitation alone and had better work outcomes over the 2-year follow-up period. Substance abuse was associated with worse employment outcomes, but did not interact with treatment group, whereas medical comorbidity was not related to work outcomes. More research is warranted to evaluate the interactions between substance abuse and medical comorbidity with vocational rehabilitation and cognitive remediation.
Psychiatric Services, 2008
Individuals with schizophrenia have consistently been found to exhibit cognitive deficits, which ... more Individuals with schizophrenia have consistently been found to exhibit cognitive deficits, which have been identified as critical mediators of psychosocial functional outcomes. Recent reviews of cognitive remediation (CRT) have concluded that these deficits respond to training. This multi-site community study examined 40 individuals with schizophrenia who underwent cognitive remediation using the Neuropsychological Educational Approach to Remediation 1 (NEAR). Assessments using the same neuropsychological tests and measures of psychosocial outcome were made at four time points: baseline, before start of active intervention, end of active intervention and 4 months after end of active intervention. Dose of antipsychotic medication remained constant throughout the study period. After participating in NEAR, individuals showed significant improvements in verbal and visual memory, sustained attention and executive functioning. This effect persisted 4 months after the treatment ceased. The average effect size was mild to moderate. Social and occupational outcomes also improved from baseline to post-treatment, which persisted 4 months later. Our findings replicate those of previous studies that suggest that NEAR is effective in improving cognition in individuals with schizophrenia in a naturalistic and ecologically valid setting. Further it extends such findings to show a generalisation of effects to social/occupational outcomes and persistence of effects in the short term.
Journal of Traumatic Stress, 2001
The problem of violence against individuals with severe mental illness (SMI) has received relativ... more The problem of violence against individuals with severe mental illness (SMI) has received relatively little notice, despite several studies suggesting an exceptionally high prevalence of victimization in this population. This paper describes the results of an investigation of the prevalence and correlates of past year physical and sexual assault among a large sample of women and men with SMI drawn from inpatient and outpatient settings acmss 4 states. Results confirmed preliminary findings of a high prevalence of victimization in this population (with sexual 615 08~9867/01/1Mx)-o6l5Sl9.5~l 8 2001 Internolionil Society forTmumatic Stttss Studies 616 Goodman et al.
Journal of Science and Medicine in Sport, 2006
Isolating the particular joints/limb segments associated with knee adductor moment variability ma... more Isolating the particular joints/limb segments associated with knee adductor moment variability may provide clinically important data that could help to identify strategies to reduce medial tibiofemoral joint load. The aim of this study was to examine whether or not foot and thigh rotation during human locomotion are significant determinants of knee adductor moment variability. Three-dimensional gait analyses were performed on 32 healthy adult women (mean age 54+/-12 years, mean BMI 25+/-4 kg m(-2)) with radiologically normal knees. The relationships between foot rotation, thigh rotation and the external knee adduction moment were examined during early and late-stance phases of the gait cycle. The degree of foot rotation correlated significantly with the magnitude of the peak knee adduction moment during late stance (r=0.40, p=0.024). No significant associations were apparent between thigh rotation and the peak knee adduction moment. The association between foot rotation and the knee adduction moment in this study suggests that women who walk with external rotation at the foot reduce their knee adduction moment during late stance. This result implies that changes in foot kinematics can modify the medial tibiofemoral load during gait, which may be important in the prevention and management of knee osteoarthritis.
Journal of Neurolinguistics, 2010
Effective social interactions necessary for getting affiliative and instrumental needs met requir... more Effective social interactions necessary for getting affiliative and instrumental needs met require the smooth integration of social skills, including verbal, non-verbal, and paralinguistic behaviors. Schizophrenia is characterized by prominent impairments in social and role functioning, and research on younger individuals with the illness has shown that social skills deficits are both common and distinguish the disease from other psychiatric disorders. However, less research has focused on diagnostic differences and correlates of social skills in older persons with schizophrenia. To address this question, we examined diagnostic and gender differences in social skills in a community-dwelling sample of 183 people older than age 50 with severe mental illness, and the relationships between social skills and neurocognitive functioning, symptoms, and social contact.
Journal of Mental Health, 2001
... KIM T. MUESER, DEBORAH R. BECKER & ROSEMARIE WOLFE ... IPS) model (Becker & D... more ... KIM T. MUESER, DEBORAH R. BECKER & ROSEMARIE WOLFE ... IPS) model (Becker & Drake, 1993), emphasize the importance of attending to client prefer-ences regarding type of job, setting, working hours, and disclosure of psychiatric disabil-ity (Anthony & Blanch, 1987). ...
The Journal of Bone and Joint Surgery, 2004
Classifications of gait patterns in spastic diplegia have been either qualitative, based on clini... more Classifications of gait patterns in spastic diplegia have been either qualitative, based on clinical recognition, or quantitative, based on cluster analysis of kinematic data. Qualitative classifications have been much more widely used but concerns have been raised about the validity of classifications, which are not based on quantitative data.
The Journal of Bone and Joint Surgery (American), 2006
Severe crouch gait in patients with spastic diplegia causes excessive loading of the patellofemor... more Severe crouch gait in patients with spastic diplegia causes excessive loading of the patellofemoral joint and may result in anterior knee pain, gait deterioration, and progressive loss of function. Multilevel orthopaedic surgery has been used to correct severe crouch gait, but no cohort studies or long-term results have been reported, to our knowledge. In order to be eligible for the present retrospective cohort study, a patient had to have a severe crouch gait, as defined by sagittal plane kinematic data, that had been treated with multilevel orthopaedic surgery as well as a complete clinical, radiographic, and instrumented gait analysis assessment. The surgical intervention consisted of lengthening of contracted muscle-tendon units and correction of osseous deformities, followed by the use of ground-reaction ankle-foot orthoses until stable biomechanical realignment of the lower limbs during gait was achieved. Outcome at one and five years after surgery was determined with use of selected sagittal plane kinematic and kinetic parameters and valid and reliable scales of functional mobility. Knee pain was recorded with use of a Likert scale, and all patients had radiographic examination of the knees. Ten subjects with severe crouch gait and a mean age of 12.0 years at the time of surgery were studied. After surgery, the patients walked in a more extended posture, with increased extension at the hip and knee and reduced dorsiflexion at the ankle. Pelvic tilt increased, and normalized walking speed was unaltered. Knee pain was diminished, and patellar fractures and avulsion injuries healed. Improvements in functional mobility were found, and, at the time of the five-year follow-up, fewer patients required the use of wheelchairs or crutches in the community than had been the case prior to intervention. Multilevel orthopaedic surgery for older children and adolescents with severe crouch gait is effective for relieving stress on the knee extensor mechanism, reducing knee pain, and improving function and independence.
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Papers by Rosemarie Wolfe