Journal of Clinical Psychology in Medical Settings最新文献

There is growing recognition of the profound mental health challenges faced by the 53 million U.S. family caregivers, and the need for increased access to psychosocial care for this vulnerable population. Family caregivers are increasingly seeking support from hospital-based counseling centers. This trend-combined with a public policy landscape that promotes the delivery of caregiver-specific supports and services-highlights challenges faced by mental health professionals to provide and bill for psychosocial care to family caregivers. In this paper, we discuss three interrelated challenges that mental health professionals face in providing care to family caregivers and which our field needs to confront as healthcare transfers more responsibilities onto the shoulders of family caregivers: (1) caregiver burden is not recognized as a formal diagnosis; (2) current documentation for caregivers is typically linked to patient encounters; and (3) support for family caregivers occurs within larger systematic barriers to mental health integration. By accurately describing and documenting caregiver burden and advocating for increased parity in mental health coverage, we hope that the field can bridge the gap between emerging research, momentum in policy, and available psychosocial services for this vulnerable population.

Loneliness and low social support are associated with negative health outcomes among adults with asthma or COPD. Although social support is correlated with loneliness, low social support is neither necessary nor sufficient for the experience of loneliness. This study compares the relative association of loneliness and social support on symptom exacerbation (i.e., acute deteriorations in respiratory health) and acute health service utilization (i.e., hospitalizations, emergency department visits) among 206 adults with asthma and 308 adults with COPD. Separate logistic regression models were used to simultaneously examine the association of loneliness and social support with each outcome. Among adults with asthma, loneliness was associated with greater odds of hospitalization (AOR = 2.81, 95%CI [1.13, 7.02]), while low social support was not (AOR = 1.44, 95%CI [0.78, 2.65]). However, neither loneliness nor social support were associated with any other acute health service use or symptom exacerbation among adults with asthma. Among adults with COPD, loneliness, and greater social support were associated with increased odds of symptom exacerbation (AOR = 1.67, 95%CI [1.03, 2.69]; AOR = 1.36, 95%CI 1.02, 1.83]) and hospitalization (AOR = 3.46, 95%CI [1.65, 7.24]; AOR = 1.92, 95%CI [1.15, 3.22]), but only social support was significantly associated with ED visits (AOR = 1.72, 95%CI 1.12, 2.66]). These findings support prior research demonstrating that loneliness and social support are related but separate determinants of patients' physical symptoms and service utilization.

Childhood experiences, both positive and negative, play a crucial role in shaping individual development. Extensive research has demonstrated that adverse childhood experiences (ACEs) have long-lasting negative effects on physical, mental, and social health. Over the last two decades, many studies have found a strong link between ACEs and poor health outcomes in adults. However, there is less understanding of how positive childhood experiences (BCEs) might lead to better health in adulthood, particularly in overcoming adversity. This study aims to explore how BCEs impact adult physical and mental health and how they might mitigate the harmful effects of ACEs. Resilience theory served as the theoretical framework for this research. A total of 177 participants aged 19 to 41 years completed an online survey evaluating their physical, social, cognitive, and mental health, including their ACEs and BCEs. Regression analyses were used to investigate the connections between BCEs, ACEs, and adult health. The results show that BCEs act as protective factors that enhance overall well-being and significantly reduce depressive symptoms and physical discomfort. Additionally, when ACE levels are moderate, positive childhood experiences can largely counteract the negative health effects of ACEs.

Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants' explanation of why they perceived lower adherence for dyads with obesity-obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers' less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.

Little is known about the impact of the COVID-19 pandemic on medical students. We examined medical students' burnout, career regret, and medical school experiences from before to during the pandemic, and differences between students from marginalized and nonmarginalized groups. We analyzed data from 2019 to 2022 Association of American Medical Colleges Year Two Questionnaires (N = 52,152) and Graduation Questionnaires (N = 66,795). Given large samples, we focused on effect sizes versus statistical significance. All effects of study year were less than small (η² < .01) indicating minimal differences in medical students' burnout, career regret, and school experiences from before (2019) to during (2020-2022) the pandemic. Interactions between study year and demographic characteristics (gender, race-ethnicity, sexual orientation) were less than small; thus, students from marginalized groups were not affected more by the pandemic than others. Across study years, women reported more exhaustion and discrimination than men. Black students reported more discrimination than students from other racial-ethnic groups; bisexual students reported more discrimination than heterosexual students (all ds > 0.20). Differences between students from marginalized and nonmarginalized groups were bigger than the effects of the pandemic, suggesting a need for system-level interventions to foster inclusion in medical education.

Poor sleep and chronic pain are commonly related in adolescents. Only 5% of adolescents meet recommendations for physical activity and screen time, both of which impact the experience of sleep and pain disturbances. Research is needed to better understand the sleep-pain relationship in adolescents and to identify potential protective factors, such as activity-related health behaviors. This study examined sleep, behaviors that influence activity (i.e., physical activity, screen time), and their interaction as predictors of pain in a sleep-disordered sample of 105 adolescents aged 12-18 presenting for polysomnography. A hierarchical multiple linear regression was conducted to examine these relationships. Consistent with hypotheses, worse insomnia predicted worse pain. However, other activity-related health behaviors did not influence this relationship, ps > .05. Findings suggest that sleep should be the focus of treatment for adolescents with primary sleep disorders to prevent the onset or exacerbation of pain.

Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and fractures, short stature, dental abnormalities, hearing loss, scoliosis, and chronic pain. Despite a growing literature on the functional outcomes of OI, limited research has explicitly examined the psychosocial outcomes of pain within OI. Adults with OI (N = 15) were interviewed to understand pain-related experiences through a thematic analysis of semi-structured interview data. Research team members, genetic research experts, and OI clinicians developed an interview guide focused on topics related to pain and mental health challenges. Participants' transcripts were coded by two independent coders; codes were then merged across coders and quotation outputs were subsequently abstracted (paraphrased then thematically classified) to identify common themes. Themes related to pain management variability regarding pain type, pain risk management and accessibility, pain outcomes (e.g., behavior, cognitive, affective), and pain exacerbating factors (e.g., individual, contextual) were identified. Participants reported chronic and acute pain, and despite the inaccessibility and stigmatization of pain medications (e.g., opioids), pharmacological treatments were the most common pain management approach. Participants reported negative pain outcomes, such as limited daily functioning and activity participation, fear, anger, anxiety, depression, and difficulty concentrating. Lastly, participants suggested that lack of physician and community knowledge on chronic pain in OI indirectly exacerbates both subjective pain intensity and outcomes. Although limited by a small, nondiverse sample, the current study provides valuable exploration of the unique pain experiences of adults with OI that may have implications for proactive management, treatment development, and clinician training.

Vital Exhaustion (VE) refers to a physical and mental state of excessive fatigue, feelings of demoralization, hopelessness, and increased irritability. The short form of the Maastricht Vital Exhaustion Questionnaire (MVEQ) is a widely used measure to assess VE. Despite its utility is broadly recognized, the validity and reliability of the scale have yet to be examined in the Italian context. The present study aimed to evaluate the psychometric properties of the shortened MVEQ in a community sample of Italian older adults. A total of 722 older adults (M_age = 72.97, SD = 7.71; 60.4% females) completed the MVEQ, as well as other self-report questionnaires assessing anxiety, depression and stress in order to evaluate the criterion-related validity of the scale. A confirmatory factor analysis (CFA) was conducted to examine the original MVEQ latent structure. Internal consistency was assessed through model-based omega coefficient. Test-retest reliability was examined by re-administering the MVEQ after three months to a subsample of 568 participants. Factorial invariance tests across gender were conducted by means of multi-group CFAs. The one-factor model showed an acceptable fit to the data. The MVEQ yielded a reliable total score (ω = 0.822) and showed moderate-to-large correlations with measures of anxiety, depression, and stress (r range 0.30 to 0.75, ps < 0.001). Test-retest reliability was supported by an Intraclass Correlation Coefficient (ICC) of 0.661. Lastly, the scale was factorially invariant across gender. Overall, the MVEQ provided evidence of reliability and criterion-related validity in a sample of Italian older adults and may be useful for both clinical and research practices.

Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.

Transgender and gender diverse (TGD) youth with chronic pain may be at unique risk for psychological distress and associated functional impairment, yet research on the intersection of chronic pain and gender identity is lacking. In a retrospective chart review of 491 participants admitted to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States over an approximately 4-year period, 6.11% were TGD. TGD participants who completed the IIPT program reported significant and large improvements in anxiety, depression, pain catastrophizing, and functional ability. At baseline, TGD participants presented as more emotionally distressed and functionally impaired compared to age-matched, cisgender peers. When accounting for baseline scores, TGD participants who completed the IIPT program reported similar scores to cisgender peers at discharge, yet TGD youth were significantly less likely than cisgender peers to complete the IIPT program. Future directions and implications for clinical practice are discussed.