Psychology, Department of


Date of this Version



A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Professor William D. Spaulding. Lincoln, Nebraska: July, 2011

Copyright 2011 Ashley R. Wynne


The purpose of the present study was to further examine the relationship between adolescent psychiatric pathology and SMI by assessing the relationship between prior mental health services before the age of 18 and time of assessment on people’s insight into their illnesses. A secondary relationship between adolescent psychiatric pathology and functioning in a variety of domains before, during, and after treatment was assessed. Overall, there was an inconsistent pattern of results and partial support of hypotheses. The current study was a retrospective longitudinal study in which assessments were given to 308 participants in an inpatient psychiatric rehabilitation unit every 6 months. Results indicated that those with service use during adolescence were younger at admission to CTP, have slightly lower levels of education, had an earlier age of onset, and significantly more previous hospitalizations. A relationship between Axis I and II diagnoses and service use was also identified. Improvements in neurocognitive, sociocognitive, insight, and behavioral functioning measures are evident over the course of treatment, however are not consistent for all groups and all measures used within this study. Contrary to the hypothesis, those adults with service usage in adolescence did not endorse differing overall insight or ability to relabel symptoms scores over the course of treatment. However, as hypothesized, there were no differences between those with and without service usage in adolescence on any measure of insight after one year of psychiatric rehabilitation. In general, the CTP participants endorsed lower insight into need for treatment scores across treatment. Also, analyses revealed no significant relationship between whether or not someone used services in adolescence or APP severity level and rate of rehospitalization or discharge location restrictiveness.

In summary, this study was exploratory in nature and inconsistent results and mixed support of hypotheses was found. This field of research has numerous implications for increasing insight and bettering outcomes for persons with SMI.

Adviser: William D. Spaulding