Journal of Clinical Psychology in Medical Settings最新文献

Artificial Intelligence (AI) has been developed through interdisciplinary efforts since the 1940s, but generative AI and Large Language Models (LLMs) gained unprecedented attention with the launch of ChatGPT by OpenAI in late 2022. As these AI tools have become globally ubiquitous, significant implications arise for clinicians within and beyond healthcare settings. The simulation or emulation of human intelligence through coded heuristics now permeates clinical domains, creating new opportunities alongside ethical challenges that require careful exploration. For healthcare psychologists, regardless of specialty, it has become a priority to remain at the forefront of these technological advances. This includes developing literacy not only in psychological emulation software but also in the rapidly growing hardware that supports AI. Well-informed clinicians must act as responsible stewards of this advancing technology and its application in healthcare. These responsibilities must be approached through the lens of both existing and evolving ethical standards in human psychology. Although these tasks may seem daunting, the urgency, opportunities, and necessity for healthcare psychologists to engage thoughtfully with AI are clear. This engagement ensures that patient care benefits from innovation while upholding ethical principles. Said opportunities and the urgency for healthcare psychologists are discussed.

This paper examines ethical challenges in clinical health psychology through a diversity-informed lens, drawing on insights gained from a 2025 panel discussion at the biannual meeting of the Association of Psychologists in Academic Health Centers (APAHC), held at Johns Hopkins All Children's Hospital in St. Petersburg, FL. The ethically relevant outcomes from the panel centered on four key domains: (1) ethical practice with diverse patients using organ transplantation as an exemplar, (2) ethical oversight in academic medicine and research, including the roles of Institutional Review Boards (IRBs), (3) the implications of grant terminations based on "gender identity" or diversity, equity, and inclusion (DEI) considerations, and (4) the implications of legal challenges to training a health care workforce that represents the populations they will serve. Across these domains, the panel emphasized the importance of advancing ethical practices that address persistent disparities affecting historically underserved communities.

Integrated behavioral healthcare has addressed common pediatric primary care concerns including anxiety and depression, but is infrequently applied to somatic symptoms (e.g., chronic pain, fatigue, or syncope unattributable to organic causes), which affect one in three youth. Developing an integrated care model for primary care-where most youth with somatic symptoms first present for evaluation and management-may increase access and positively impact child health. This manuscript summarizes the literature surrounding integrated care for pediatric somatic symptoms and proposes an adapted model for primary care. Drawing from the Pediatric Psychosocial Preventative Health model and cognitive-behavioral protocols for somatic symptom management, we propose that youth with mild to moderate symptoms can be effectively co-managed in primary care by a primary care provider delivering psychoeducation and facilitating team coordination, and an embedded behavioral healthcare provider conducting a brief, targeted intervention. This innovative approach leverages shared clinical responsibilities, as well as youth and families' trust in the primary care setting, to accessibly deliver care for mild-moderate symptoms otherwise unaddressed in current management approaches. Implementation likely requires developing clinician support tools and identifying sustainable billing practices, but may result in accessible, holistic, care that curtails symptom persistence and/or progression.

Pregnant people carrying fetuses with congenital anomalies are at increased risk for depressive symptoms. However, the nature of these symptoms is not well-understood. The present study identified profiles of prenatal depressive symptomatology and examined demographic and clinical predictors of profile membership. Pregnant persons (N = 6657) with a confirmed structural fetal anomaly diagnosis at a maternal-fetal care center completed psychosocial measures. K-means clustering analyses identified profiles. ANOVA and chi-square analyses evaluated predictors. Four profiles emerged: Minimal Depressive Type (n = 2259, 33.93%), Emotionally Dysregulated Type (n = 1909, 28.68%), Anxious and Somatic Type (n = 1789, 26.87%), and High Depressive Type (n = 700, 10.52%); indicating a higher likelihood of somatic, anxious, and emotion dysregulation symptoms rather than feelings of guilt/shame and loss of self. Racial identity, number of live births, antidepressant use, relationship with father of baby, and insurance status were associated with profile membership. Findings contribute to the understanding of perinatal depression among those with fetal anomalies, and highlight the need to further examine the clinical utility of depression profiles and responsiveness to psychosocial intervention.

Caregiving can provide purpose and life satisfaction but is often linked to increased burden and reduced quality of life. Understanding mechanisms influencing caregivers' experiences is crucial for effective support. One key factor is illness integration-the extent to which caregivers incorporate the patient's illness into their identity. Caregivers may feel engulfed, reject, accept, or find enrichment in the illness, shaping their psychological outcomes. This study examines the relationships between illness integration, care burden, well-being, and attachment orientation to illuminate identity processes in caregiving and guide interventions to reduce strain and foster resilience. The results from our cross-sectional online survey of 162 informal caregivers indicated that caregivers predominantly accepted their loved ones' illness into their identity, and this acceptance was in turn associated with both their well-being and care-burden. Caregivers high on attachment anxiety reported greater feelings of engulfment by the illness, leading to increased burden and diminished well-being. On the other hand, caregivers high on avoidant attachment struggled to accept the illness, and also experienced heightened burden. This study underscores the significance of illness integration in shaping caregivers' experiences. The findings highlight the need to promote adaptive integration processes and address attachment-related challenges, reducing caregiver strain and enhancing resilience.

Severe fatigue in adolescents with immune dysregulation disorders (IDD) is prevalent and affects daily functioning. This study tested Internet-based cognitive behavior therapy (I-CBT) for the treatment of persistent fatigue in adolescents with IDD. This study used a multiple single-case experimental design (SCED) with a randomized waiting list period of 7-26 weeks, followed by 26 weeks of I-CBT and a 16-week follow-up. Nine adolescents participated, focusing on fatigue severity as the primary outcome. Secondary outcomes included physical functioning, school absence, and, if applicable, pain severity. Pre-post-differences were examined across subjects and individually for weekly measures. At the group level, pre-post-differences in primary and secondary outcomes were examined using mixed models. The across-subject analyses demonstrated the expected effect for fatigue severity. Furthermore, there was a significant reduction in fatigue severity and school absence, and improvement in physical functioning. Single-case analyses demonstrated significant reductions in fatigue in 5/9 patients post-I-CBT, with improvements in physical functioning noted in 6/9 patients. Effect sizes ranged from medium to large. Pain severity significantly improved in 1/5 patients with a small effect size. In a sample of nine adolescents, results indicated that I-CBT could be an effective and feasible treatment of persistent severe fatigue in IDD.

Introduction: Parents of children newly diagnosed with autism report higher parenting stress levels than parents of typically developing children. Parent-mediated interventions include parents as interventionists in their child's intervention but often require increased parent effort and time to engage in the intervention. We investigated the influence of a parent-mediated early intervention for autistic children, the Bridge Skill Development Program, on parenting stress and child outcomes.

Methods: Thirty-eight families of autistic children completed the Parenting Stress Index-4th Edition-Short Form (PSI-4-SF) at pre- and post-intervention. We used paired-samples t tests and linear regressions to examine the effects on intervention outcomes and parenting stress on program outcomes.

Results: Controlling for mastered pre-intervention skills, children demonstrated significant improvements in core skills from pre- to post-intervention (t(37) = 6.81, p < .001). Parents reported significant pre- to post-intervention reduction in parental distress (t(37) = - 2.53, p = .008), parent-child dysfunction (t(37) = - 4.03, p < .001), parents' perception of their child's difficult behavior (t(37) = - 1.94, p = .03), and overall parenting stress (t(37) = - 3.34, p < .001).

Discussion: Results suggest that families benefitted from this parent-mediated intervention, regardless of pre-intervention parenting stress levels, and intervention participation increased child skill development without increasing parenting stress.

Stroke is a major cause of disability, and patients who suffer strokes have limited mobility and functional tasks, necessitating daily reliance on caregivers. However, caregivers of stroke patients often experience depression and anxiety, negatively impacting their mental health and reducing their quality of life. Psychoeducational interventions may be a solution to support the well-being of stroke caregivers. This study is performed to assess the overall effectiveness of individual psychoeducational interventions for caregivers of stroke patients. A thorough search of Scopus, PubMed, Web of Science, and Cochrane databases was performed for published studies in English up to June 2023. Clinical trials assessing the efficacy of psychoeducational interventions on quality of life, depression, or care burden among stroke caregivers compared to usual care were included. A total of 18 clinical trials, 16 randomized clinical trials (RCTs), and two non-RCTs, with a total of 2007 patients, were included. The study's pooled results revealed a significant increase in the quality of life in the group receiving psychoeducational interventions compared to the comparison group (SMD = 0.34, 95% CI 0.13-0.55, p value = 0.002), while no significant difference was found in terms of depression (SMD =  - 0.05, 95% CI  - 0.23 to 0.14, p value = 0.62) or caregiver burden (SMD =  - 0.61, 95% CI  - 1.65 to 0.44, p value = 0.25). Psychoeducation programs should be considered as a supportive intervention to improve quality of life in caregivers; however, their impact on depression and caregiver burden remains inconclusive. However, further studies with a larger sample size are needed to confirm the results.

Providing care to pediatric oncology patients involves delivering sensitive information to families, addressing diverse psychosocial needs, and navigating patient and family emotions. Psychosocial providers embedded within pediatric oncology clinics are uniquely qualified to address communication gaps between patients and providers, provide support to patients, and facilitate collaborative discussions between patients and the medical team. This quality improvement project aimed to describe the impact of including psychosocial providers in critical conversations between medical teams and families. Through conversation tracking, members of the psychosocial team recorded their involvement in thirty-six critical conversations. The psychosocial team offered various interventions including therapeutic processing, emotional assessment, medical translation, psychosocial support, child-focused support, and facilitation of discussions between families and medical providers. While challenges were identified including time and availability, physicians noted several benefits of psychosocial involvement, particularly in addressing emotional needs and enhancing communication with families. Psychosocial providers also noted benefits including demonstrating alignment with the medical team and enhancing the support that they are able to provide the family following the conversation. By integrating psychosocial support into critical conversations, medical providers can foster a patient-centered approach to care and optimize care delivery to effectively support families facing childhood cancer diagnoses.

Integrated Care (IC) models have increased, but the current mechanisms to analyze the efficacy and fidelity of behavioral interventions within IC models are limited. A mixed methods concurrent process evaluation was used within the context of a randomized clinical trial to assess intervention fidelity for a Solution-focused brief therapy (SFBT) intervention implemented within an IC model. A qualitative content analysis was conducted to develop a participant survey and charting template for the SFBT intervention. Quantitative data were collected through (1) participant surveys, (2) interventionist self-report surveys, and (3) data from participant charts. Descriptive statistics and repeated measures ANOVA were used to analyze quantitative data. Data triangulation was used to present findings. The average SFBT intervention was 24.6 min and 33/34 (97%) of participants in the intervention group completed all 3 SFBT sessions. Most visits were weekly follow-ups (53.9%), followed by biweekly (28.2%) and then 3-week follow-ups (5.1%). The interventionist used session templates and a self-report checklist to monitor intervention integrity. Those in the intervention group had increased growth regarding Solution-focused core constructs (a scale created by the authors) when compared to the treatment-as-usual group (F [1, 64] = 22.7, p < 0.001): mean difference, 15.1 [95% CI 11.2 to 18.9]. Our study examined fidelity comprehensively and provides a foundation for studies interested in fidelity monitoring of SFBT interventions as well as behavioral interventions within IC models. Trial Registration: The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 01/05/2023.