IU Indianapolis ScholarWorks :: Browsing by Author "Bonfils, Kelsey A."

Browsing by Author "Bonfils, Kelsey A."

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Affective Empathy in Schizophrenia: A Meta-Analysis
(Elsevier, 2016-08) Bonfils, Kelsey A.; Lysaker, Paul H.; Minor, Kyle S.; Salyers, Michelle P.; Department of Psychiatry, IU School of Medicine
Background Affective empathy, or the emotional response one has to the experiences or emotional states of others, contributes to relationship-maintaining behaviors and is key in fostering social connections, yet no work has synthesized the body of literature for people with schizophrenia. The aim of the present meta-analysis was to determine the extent to which those diagnosed with schizophrenia experience deficits in affective empathy. Methods A literature search was conducted of studies examining empathy. Data were analyzed using a random effects meta-analytic model with Hedges' g standardized mean difference effect size. Results Individuals with schizophrenia exhibited significant, medium deficits in affective empathy (k = 37). Measurement type moderated the affective empathy deficit such that performance-based measures showed larger schizophrenia group deficits than self-report measures. Conclusion Consistent, significant deficits in affective empathy were found comparing people with schizophrenia to healthy controls, especially when using performance-based assessments. The medium effect suggests an important role for empathy in the realm of social cognitive research, and points to the need for further investigation of measurement techniques and associations with functional outcomes.
Benefits of Integrated Care in Mental Illness Management
(Office of the Vice Chancellor for Research, 2014-04-11) Benbow, Kyle L.; Bonfils, Kelsey A.; Salyers, Michelle P.
Many people who suffer from serious mental illness have comorbid physical conditions that can cause further disability. Integrated care combines physical and mental health facilities, focusing on coordination and continuity of treatment in order to better serve patients dealing with multiple health conditions. The present study analyzed qualitative interviews conducted individuals with conditions with severe mental illness and comorbid physical health conditions, speaking about benefits of integrated care. Forty adults receiving services from a community mental health center were asked their opinions about integrated care and what steps could be taken to improve these services. Transcribed interviews were reviewed by two people, searching for common themes within the text. Many positives were highlighted throughout these interviews including the convenience of coordination of care, along with the ability to make one trip for all their medical needs, and the friendless of the on-site staff. Results showed that consumers using integrated care felt a value in its benefits. As the practice of integrate care continues, further research into the connections between mental and physical health can start being conducted. The communication between doctors of different fields presents opportunities to potentially develop new treatment plans and models for therapy. Integrated care is an excellent platform that combines the ability to better serve the community by providing multiple services to those in need while providing another opportunity to research and understand the connections between physical and mental health issues.
Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia- Spectrum Disorders: Relationship to Metacognitive Deficits
(Oxford University Press, 2021-07-20) Mervis, Joshua E.; Bonfils, Kelsey A.; Cooper, Samuel E.; Wiesepape, Courtney; Lysaker, Paul H.; Psychiatry, School of Medicine
People diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.
Compared to high and low cannabis use, moderate use is associated with fewer cognitive deficits in psychosis
(Elsevier, 2016-12) Martin, Ashley M. Schnakenberg; Bonfils, Kelsey A.; Davis, Beshaun J.; Smith, Elizabeth A.; Schuder, Kelly; Lysaker, Paul H.; Department of Psychiatry, IU School of Medicine
Literature on the relationship of cannabis use and cognition in schizophrenia provides the paradoxical view that cannabis use is sometimes linked with less severe impairment in neurocognition. This paper explored the possibility that this is a reflection of a dose related response between lifetime cannabis use and two forms of cognition, neurocognition and metacognition, in schizophrenia. It was hypothesized that three groups of patients could be differentiated, those with (1) little to no cannabis use with poor levels of cognition, (2) moderate cannabis use and relatively better levels of cognition and (3) high cannabis use with relatively poorer levels of cognition. Sixty-six adults with schizophrenia completed assessments of neurocognition, metacognition and months of lifetime cannabis use. A k-means cluster analysis yielded three distinct groups based on these assessments. The clusters included: (1) low cannabis/poor cognition (n = 34); (2) heavy cannabis/moderately impaired cognition (n = 10); and (3) moderate cannabis/higher cognition (n = 22). Consistent with our hypothesis, participants with high and moderate lifetime cannabis use had lesser impairment of neurocognition and metacognition compared to low lifetime cannabis use. Participants with moderate lifetime cannabis use also had lesser impairment of metacognition compared to low and heavy use. These findings suggest that a dose related relationship exists between cannabis use and cognition. Results could be due to an influence of pre-existing cognitive level on likelihood of lifetime cannabis use, or to an interaction between use and cognitive function.
Consumer and Relationship Factors Associated with Shared Decision-Making in Mental Health Consultations
(2014-12) Matthias, Marianne S.; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A.; Firmin, Ruth; Oles, Sylwia; Adams, Erin L.; Collins, Linda A.; Salyers, Michelle P.; Department of Psychology, IU School of Science
Objective: This study explored the association between shared decision making and consumers’ illness management skills and consumer-provider relationships. Methods: Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Results: Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Conclusions: Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.
Consumer Outcomes After Implementing CommonGround as an Approach to Shared Decision Making
(APA, 2017-03) Salyers, Michelle P.; Fukui, Sadaaki; Bonfils, Kelsey A.; Firmin, Ruth L.; Luther, Lauren; Goscha, Rick; Rapp, Charles A.; Holter, Mark C.; Psychology, School of Science
Objective: The authors examined consumer outcomes before and after implementing CommonGround, a computer-based shared decision-making program. Methods: Consumers with severe mental illness (N=167) were interviewed prior to implementation and 12 and 18 months later to assess changes in active treatment involvement, symptoms, and recovery-related attitudes. Providers also rated consumers on level of treatment involvement. Results: Most consumers used CommonGround at least once (67%), but few used the program regularly. Mixed-effects regression analyses showed improvement in self-reported symptoms and recovery attitudes. Self-reported treatment involvement did not change; however, for a subset of consumers with the same providers over time (N=83), the providers rated consumers as more active in treatment. Conclusions: This study adds to the growing literature on tools to support shared decision making, showing the potential benefits of CommonGround for improving recovery outcomes. More work is needed to better engage consumers in CommonGround and to test the approach with more rigorous methods.
Correlates of attendance in mental health services for individuals with psychotic disorders: A critical review
(Taylor & Francis, 2016) Bonfils, Kelsey A.; Bouchard, Lauren; Kukla, Marina; Miller, Alex P.; McGuire, Alan B.; Department of Psychology, School of Science
Low attendance to mental health care results in loss of time, money, and treatment gains. No prior review in this area has taken into account the quality of studies or varying definitions of attendance. The current review provides a critical evaluation of variables associated with attendance in consumers with psychotic symptoms participating in outpatient mental health services, with a focus on study quality and operationalization of attendance. EMBASE, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library were searched for empirical articles relevant to attendance to mental health services by individuals diagnosed with a psychotic disorder. Eligible articles were rated for quality by two coauthors; high-quality articles were reviewed in-depth. Twenty-eight articles were eligible; 11 articles qualified for in-depth review. Four attendance outcome types were identified, including the prediction of dropout, time engaged, categorical attendance, and continuous attendance. Ongoing substance use during treatment was consistently associated with lower attendance in high-quality articles. More high-quality research using systematically defined outcome types is needed to identify reliable associations with attendance. Commonly tested variables such as demographics show little utility in predicting attendance. Future research in this area should expand upon current findings focusing on clinically and theoretically relevant variables.
Correlates of Attendance in Psychiatric Services: A Critical Review
(Office of the Vice Chancellor for Research, 2013-04-05) Bonfils, Kelsey A.; McGuire, Alan B.; Bouchard, Lauren M.; Kukla, Marina
Attendance and dropout are concerning problems in the mental health field. With dropout rates averaging around 50%, mental health agencies lose money and resources invested in missed appointments and under-attended groups, providers lose valuable time, and consumers do not receive recommended levels of services. While there is research on consumer, provider, and agency factors that affect attendance, it has not been integrated and reviewed in the context of community services for those with psychotic disorders. The authors conducted a critical review of literature examining correlates of attendance in community services provided to samples with psychotic disorders as the most prominent diagnostic category. Twenty-two studies were identified that met inclusion criteria. Over 100 unique correlates of attendance were tested; the authors categorized these into eight content areas: demographics, current functioning, history (psychiatric/functional), neurocognitive functioning, services/treatment, social functioning, self-stigma/insight, and symptoms/psychopathology. Correlates were also sorted according to how often they were examined and how many times they were found to be significantly related to consumer attendance. The category containing the most unique correlates was symptoms/psychopathology. Demographic correlates were researched the most, with three unique correlates examined in over ten studies (age, sex, and living situation). Of these demographic correlates, all but two were found significant 25% of the time or less, and none exceeded 40%. Alternatively, some correlates have been investigated few times, but with promising results and theoretical connections to attendance, such as baseline illness severity, which has been found significant in 75% of analyses. There is evidence that researchers are examining correlates for which there is little empirical evidence of a connection to attendance. This may lead to missed opportunities to maximize attendance, use of services, and resources. Implications for future research in the area are discussed.
Correlates of observer-rated active involvement in psychiatric treatment visits
(Elsevier, 2017-10) Bonfils, Kelsey A.; Luther, Lauren; Fukui, Sadaaki; Adams, Erin L.; Dreison, Kimberly C.; Firmin, Ruth L.; Salyers, Michelle P.; Department of Psychology, School of Science
Among people with serious mental illness, increased patient activation has been linked to a range of key recovery outcomes. To date, patient activation has been measured largely through self-report. The present study investigated correlates of a new tool that assesses active involvement through rating audio-recordings of treatment visits. The key domains of patient activation assessed in visits included: patients asking questions, discussing with providers instances of being active in managing illness outside the session, talking about goals, bringing up concerns, making evaluative statements about treatment, setting the agenda for the visit, and making requests about the course of treatment. The new coding scheme proved to be a feasible and reliable method for identifying multi-faceted behavioral indicators of patient activation. Contrary to our hypotheses, in a sample of 166 people diagnosed with severe mental illnesses, self-reported activation and observer-rated indices of activation were often not correlated or correlated in unexpected directions with the new behavioral measure of patient activation. This suggests the nature of patient activation may be complex and work is needed to understand how observer-rated and self-rated activation may predict differential recovery outcomes.
Development and preliminary validation of the romantic relationship functioning scale
(2014) Bonfils, Kelsey A.; Salyers, Michelle P.; Minor, Kyle S.; McGrew, John H., 1953-; Grahame, Nicholas J.
Background: Research has repeatedly shown that individuals with severe mental illness desire interpersonal and romantic relationships and that social support (including spousal relationships) is beneficial. In addition, social deficits in mental disorders can often get in the way of developing fulfilling relationships. However, there is little currently available to help clinicians and researchers assess romantic relationship functioning in those with mental illness. The aim of this pilot study was to examine reliability and validity of a new measure of functioning in romantic relationships, the Romantic Relationship Functioning Scale (RRFS). Method: The RRFS was constructed based on theory proposed by Redmond, Larkin, and Harrop (2010). In an analog study, we tested the measure in a sample of college students (N=387), examining reliability, stability over time, factor structure, and relationships with measures of psychopathology and related measures of social functioning to assess convergent validity. Results: The RRFS exhibited a hierarchical four-factor structure, supporting the use of a total score. Although subscales were supported in the factor analysis, other psychometric evidence was weaker, and the use of a total score is advocated. Internal consistency and test-retest reliability were acceptable for the total scale (>.8). The RRFS had moderate to large correlations in the expected direction with all psychopathology measures. In predictive models, overall mental health, social functioning, and fewer interpersonal difficulties predicted higher romantic relationship functioning. Conclusions: The RRFS total score shows preliminary evidence of reliability and validity. The RRFS has potential to be of use in treatment centers for undergraduates and for individuals with diagnosed mental disorders. Future research should further investigate the RRFS subscales and the measure’s performance in clinical samples.

Browsing by Author "Bonfils, Kelsey A."

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