Jennifer Klein

Purpose The network theory assumes that mental disorders are an emergent property of the dynamic interaction between variables such as symptoms of mental disorder. Most studies of the network theory have focused on these symptom interactions. Here, we examine the association of common mental health syndromes and core psychological processes. Methods An explorative network analysis was performed on the data of 87 patients currently treated with psychotherapy. A cross-sectional partial correlation network with four syndromes (depression, anxiety, somatization, and disordered eating) and six processes (activation, self-functioning, valuing, repression/denial, avoidance, and rumination) was estimated and strength centrality was calculated for all nodes. The six processes were selected out of twelve processes by empirical criteria. Results A network with 24 edges, i.e., adjusted partial correlations between the ten variables was estimated. Particularly strong edges emerged connecting valuing and activation, repression/denial and self-functioning, and rumination and self-functioning. The process of self-functioning was the node with the highest strength centrality, followed by the process of valuing and the depressive syndrome. Conclusions We have found connections within processes and syndromes as well as between them. This suggests that they might interact in the maintenance of psychopathology. Idiographic analysis of longitudinal data is needed to assess if these connections are causal in nature.

Introduction In the treatment of borderline personality disorder (BPD), there is empirical support for both dialectical behavior therapy (DBT) and schema therapy (ST); these treatments have never been compared directly. This study examines whether either of them is more effective than the other in treating patients with BPD. Methods In this randomized, parallel-group, rater-blind clinical trial, outpatients aged between 18 and 65 years with a primary diagnosis of BPD were recruited in a tertiary outpatient treatment center (Lübeck, Germany). Participants were randomized to DBT or ST with one individual and one group session per week over 1.5 years. The primary outcome was the BPD symptom severity assessed with the mean score of the Borderline Personality Disorder Severity Index at 1-year naturalistic follow-up. Results Between November 26, 2014, and December 14, 2018, we enrolled 164 patients (mean age = 33.7 [SD = 10.61] years). Of these, 81 (49.4%) were treated with ST and 83 (50.6%) with DBT, overall, 130 (79.3%) were female. Intention-to-treat analysis with generalized linear mixed models did not show a significant difference at 1-year naturalistic follow-up between DBT and ST for the BPDSI total score (mean difference 3.32 [95% CI: -0.58-7.22], p = 0.094, d = -24 [-0.69; 0.20]) with lower scores for DBT. Pre-to-follow-up effect sizes were large in both groups (DBT: d = 2.45 [1.88-3.02], ST: d = 1.78 [1.26-2.29]). Conclusion Patients in both treatment groups showed substantial improvements indicating that even severely affected patients with BPD and various comorbid disorders can be treated successfully with DBT and ST. An additional non-inferiority trial is needed to show if both treatments are equally effective. The trial was retrospectively registered on the German Clinical Trials Register, DRKS00011534 without protocol changes.

Unionization of home care has depended on the state location of the occupation. Government social policies and funding created home care, shaping the structure of the industry and the conditions of work. The welfare nexus, linking old age, disability, health, and welfare policies, however, also transformed care hidden in the home into a public service. Through case studies of California and Oregon, leaders in deinstitutionalizing care of the elderly and disabled, we explore the social struggles that forced the state to recognize its invisible workforce. The home location of personal attendants and other health aides has entailed not only organizing challenges but policy innovation as well. Using the welfare state location of the labor, workers allied with consumers to develop the public authority as a newstructure of representation. The history of home care shows that social welfare and health policy have long been entangled with labor policy.