Journal of Clinical Psychology in Medical Settings最新文献

Pediatric patients who have been discharged from psychiatric hospitalizations are at high risk of negative outcomes, especially if they do not connect to outpatient mental health services. This paper describes the development and implementation of the Transitional Care Coordination Program (TCCP), a novel adaptation of the Child Psychiatry Access Program (CPAP) model, to provide mental health consultation and care coordination services after psychiatric hospitalization. The program offered discharging patients' pediatric primary care providers telephonic child psychiatry consultations and three months of care coordination for patient families over multiple timepoints. Between March 2020 and November 2021, 163 unique patients were enrolled in the TCCP from 170 admissions. Patient families from 89 admissions (52% of total) were reached and participated in the TCCP, with 22 of those (25%) requesting new behavioral health provider resources and 39 (44%) requesting other behavioral health supports. The TCCP reached out to 110 (65% of total) primary care providers, none of whom requested a psychiatric consultation. Findings support the initial feasibility of a novel adaptation of the CPAP model for preemptive support at psychiatric hospitalization discharge. This is the first program of its kind, showing promise as a way for existing CPAPs to leverage their infrastructure to help families connect to needed mental health care after discharge and potentially prevent readmissions or other adverse outcomes. More research is needed to understand its efficacy and applicability to other settings.

Authors sought to elucidate physician perspectives of a health psychology inpatient consultation service to refine practices in addressing physicians' and patients' needs. Invitations to participate in an anonymous online survey were sent to credentialed physicians at an academic medical center in the Midwest. Twelve survey items assessed topics such: perceptions of medical inpatients' behavioral health needs; factors affecting referrals for consultation; types of services needed; preferences for communication; confidence in making referrals to health psychology; and contributions of psychologists beyond patient care. Forty-nine physicians from 12 medical and surgical services completed the survey. Nearly half believed that hospitalized patients could benefit from psychological consultation. Physicians had varied understanding of differences between the roles and services of psychology and other disciplines that address mental and behavioral health. Barriers to referral for consultation included insufficient integration with medical teams and longer wait times to complete consultations. Physicians appreciated direct conversation with health psychology consultants to discuss recommendations for patient care versus exclusive reliance on communication in the electronic medical record. Health psychology consultation is recognized by physicians as a valuable clinical service enhancing inpatient care and as providing additional institutional (e.g., educational) benefits.

Individuals with chronic pain frequently experience emotional distress, negative beliefs, functional limitations, and poor sense of control. Grit, the ability to persist toward goals through passion and perseverance, has been linked to enhanced coping in chronic medical conditions but has received limited attention in the context of chronic pain. This cross-sectional study evaluated the relationship of grit to adjustment in participants with chronic pain (N = 58). Controlling for pain severity, conscientiousness, and neuroticism, greater grit was associated with lower pain catastrophizing (p = .000) and pain interference (p = .02) and greater life control (p = .02); grit was not significantly related to pain distress (p = .07). Prospective, longitudinal research on the relationship between grit and pain outcomes is warranted.

Chronic pain acceptance has been identified as a crucial determinant of functioning among individuals living with chronic pain. However, research examining the relationship between chronic pain acceptance and pain-related disability has revealed variability across studies. The aims of this meta-analysis were to synthesize associations between chronic pain acceptance and pain-related disability, and test the moderating influence of pain characteristics, demographic factors, and methodological variables. Searches of PubMed and PsycINFO electronic databases located 24 studies (N = 6072) reporting correlations between chronic pain acceptance and pain-related disability. Meta-analytic calculations were performed using random effects models. Results indicated a negative association between chronic pain acceptance and pain-related disability that can be characterized as moderate in magnitude (r = -.45) and was stable across pain characteristics and demographic factors. Moderator analyses suggested the association between chronic pain acceptance and pain-related disability may be sensitive to the measures used to assess these constructs. These findings underscore the role of chronic pain acceptance in pain-related disability and reinforce the clinical significance of acceptance-based approaches in enhancing functional outcomes among chronic pain patients.

The health disparities experienced by gender-diverse youth have not yet been adequately examined within specific pediatric populations, such as chronic pain. Furthermore, such disparities need to be examined within the context of the COVID-19 global pandemic, a time when clinicians observed an increase in gender-diverse patients seeking care for pediatric chronic pain. The goal of this study is to better understand the clinical pain-related and psychosocial presentation of gender-diverse youth who sought treatment for chronic pain prior to and following the start of the COVID-19 pandemic. Deidentified intake data were identified using the data repository of an outpatient multidisciplinary pain clinic at a tertiary hospital between December 2017 and November 2023. Descriptive data and the comparison of the gender-diverse patients presenting before and following the start of the COVID-19 pandemic are presented. Gender-diverse participants with pediatric chronic pain generally reported psychological functioning within the "moderate" range and pain-related measures in the "elevated" range. No significant differences were found between youth presenting for care prior to and following the start of the COVID-19 pandemic. 92% of the sample was seen following the start of the pandemic. Far more gender-diverse participants sought treatment for chronic pain following the start of the pandemic. More research, including qualitative data about patient experiences, is needed to ensure pain providers are offering affirming care.

Cognitive impairments, including memory and concentration difficulties, are common in individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID. These conditions frequently co-occur, but it remains unclear how cognitive difficulties differ between individuals with ME/CFS, long COVID, both, or neither. The purpose of this study was to examine cognitive impairment presence and type for individuals with and without these conditions. Data from the 2022 and 2023 National Health Interview Survey were analyzed. Participants included 27,512 and 29,404 U.S. adults in 2022 and 2023, respectively. Survey weights and variance estimation variables were utilized and multivariate logistic regression models assessed the likelihood of cognitive difficulty, accounting for sociodemographics and shared variance. Participants from both cohorts were primarily female, white, and non-Hispanic/Latine, with an average age of 48.1 years in both cohorts. ME/CFS (aOR 6.18; 95% CI 4.82-7.93; aOR 5.33; 95% CI 4.04-7.05) and long COVID (aOR 2.01; 95% CI 1.67-2.44; aOR 2.16; 95% CI 1.82-2.56) were significantly associated with reported cognitive difficulties, after controlling for the other condition and sociodemographic factors. Individuals with ME/CFS, particularly those with comorbid long COVID, are especially prone to memory and concentration difficulties.

Allogeneic hematopoietic cell transplantation (HCT) can be a lifesaving treatment for patients with hematologic disease. However, adherence to the post-HCT clinical regimen has many challenges that patients and their family caregivers must manage after hospital discharge. To address their needs, we developed a Dyadic Problem-Solving Therapy (DPST) intervention, then examined its feasibility and acceptability to patients and their family caregivers. Twelve patient-family caregiver dyads participated. Four dyads received DPST in person, four received it via online video conferencing. Another four received an enhanced usual care (EUC) intervention of the same length. Feasibility was assessed using completion rates, while acceptability was assessed using satisfaction ratings on the Client Satisfaction Questionnaire. DPST and EUC were both feasible (100% of dyads who started the intervention completed it) and acceptable with satisfaction ratings ranging from 3.6 to 4 for patients and 3.6-3.9 for family caregivers on a 1-4 scale for both DPST groups and ranging from 3.3 to 3.8 for EUC patients and 3.5-4 for EUC family caregivers. There were no evident differences by mode of intervention delivery. DPST, both in person and via video, appears feasible and acceptable for training patient-family caregiver dyads to manage challenges to adherence to the post-HCT regimen.

Optimism, defined as the tendency to expect positive outcomes and view challenges as manageable, plays a vital role in the lives of individuals with chronic illnesses, including multiple sclerosis. Given its potential benefits, measuring optimism through validated tools like the Life Orientation Test-Revised (LOT-R) is essential for both research and clinical practice. This study aims to validate the Spanish version of the LOT-R within a sample of MS patients, assessing its psychometric properties and exploring its potential utility in clinical settings. This study included 179 patients with Relapsing-Remitting Multiple Sclerosis (PwMS). Confirmatory factor analysis (CFA) was performed to assess the factor structure of the LOT-R. Model fits were evaluated by the χ2/df value, comparative fit index (CFI), and root mean square error of approximation (RMSEA). The LOT-R showed good psychometric characteristics in our sample of PwMS. The CFA's for both models (the two correlated factors model and the second-order factor model) yielded a good model fit. Cronbach's alpha and McDonald's omega were acceptable. Optimism was significantly correlated with quality-of-life scores, resilience, and fear of relapse scale. In general terms, the LOT-10 has satisfactory psychometric properties and is suitable for measuring dispositional optimism in Spanish-speaking patients with multiple sclerosis.

Few studies have examined effects of intrinsic motivation (IM) on adaptive behaviors among adolescents with type 1 diabetes (T1D), although greater IM has been associated with less diabetes-related family conflict (FC) and increased regimen adherence. Greater FC has also been associated with disordered eating behaviors (DEBs). We examined the moderating role of IM between FC and DEBs in a culturally diverse sample of youth with T1D. 226 adolescents (Mage = 15.03, 59.3% female, 65.8% Hispanic, 19.0% Black, MA1c = 8.19%, 74.30% eligible for subsidized health insurance) completed pre-visit screening measures assessing IM, FC, and DEBs. Gender, race, ethnicity, A1c, BMI, and insurance status were obtained from medical records and treated as covariates. Black youth had higher rates of DEBs (p < .01) and A1c levels (p < .001) than White youth. Significant correlations were observed across study variables. Accounting for covariates, IM moderated the relationship between FC and DEBs, whereby the effect of FC on DEBs emerged strongest at low IM (p < .001). As IM levels increased, the effect of FC on DEBs decreased, making the relationship between FC and DEBs non-significant. Greater IM for diabetes management attenuates the association between FC and DEBs. Promoting IM may decrease FC and DEBs in youth with T1D.

Psychologists in inpatient settings may be called upon to evaluate patients mental health when patients request to terminate interventions or refuse to engage in life- sustaining treatments. Although rates of distress are high in patients experiencing acute and chronic illness, especially as symptoms impact quality of life, less has been written on the nuances of assessing how affective symptoms may influence treatment decisions. This article describes some of the challenges health care providers may face in situations in which patients appear to be actively or passively withdrawing from care. We offer suggestions for assessment and considerations for referrals and resources to guide providers in conceptualization and intervention within these situations. This paper can ideally serve as a guide to aid psychologists to assist the medical team, the patient, and their family with appropriate decision-making regarding terminating medical care and to ensure these decisions were not unduly influenced by a potentially treatable and modifiable mood concern.