Journal of Clinical Psychology in Medical Settings最新文献

The objective of this study is to examine the associations among asthma, depression, and anxiety with sleep outcomes among youth in Puerto Rico and determine whether age moderates the associations. Data came from surveys of 333 youth aged 10-17 living in Puerto Rico. Predicted probabilities derived from logistic regression models were used to assess the associations of asthma, depression, and anxiety with sleep outcomes. Models included interactions between age group (10-13 vs 14-17) and asthma, depression, and anxiety when predicting sleep outcomes. The predicted probability of obtaining a sufficient amount of sleep was 15.9 percentage-points higher among those with asthma compared to those without asthma (p = 0.009), 21.9 percentage-points higher among older youth with asthma compared to older youth without asthma (p = 0.004), and 33.9 percentage-points lower among younger youth with depression compared to younger youth without depression (p = 0.019). There were no significant differences in the predicted probabilities of perceived sleep quality according to asthma, depression, or anxiety status. Findings suggest that age moderates the associations among asthma, depression, and sleep among youth in Puerto Rico. Younger youth with depression may be at increased risk for poor sleep outcomes.

To explore the experiences and preferences of patients and healthcare professionals regarding the development of an app to provide psychological intervention to improve emotion regulation in the context of bariatric surgery (BS). Sixteen people (6 patients who underwent BS and 10 professionals) participated in two separate focus group sessions. We performed a content analysis of transcribed focus group discussions to extract and organize categories, subcategories and areas. Both sets of stakeholders provided information about how to develop and implement an app. According to participants' comment, content should include information (i.e., nutrition, exercise) and emotional regulation skills. Patients and professionals mentioned that the app should include visual information, continuous emotional assessments and peer contact. It was also mentioned that the app should be used before and after BS and its contents should be developed by a multidisciplinary team (i.e., collaboration of endocrinologist, nutritionists and psychologists). Participants in both focus groups considered technology to be useful in the context of BS, especially as part of blended interventions (combining face-to-face and online sessions). Patients and professionals seem to be receptive towards the use of technology in a BS context. Specific recommendations are identified for designing and implementing app solutions for BS. More efforts should be made in the future to develop and implement evidence-based apps according to patients and professionals' needs.

Pediatric Inflammatory Bowel Disease (IBD) is a chronic illness where patients may undergo ostomy surgery. Medical decision-making (MDM) for ostomy surgery is complex for patients/families and multidisciplinary healthcare professionals (HCPs) alike, with current uncertainty about how multidisciplinary HCPs think about ostomy care to inform future interventions to facilitate equitable multidisciplinary care for patients. This study sought to understand pediatric IBD multidisciplinary HCPs' perceptions regarding ostomy-related MDM and education. Multidisciplinary HCPs (e.g., gastroenterology medical providers, social workers, surgeons, and ostomy nurses) participated in semi-structured focus groups. Focus group data underwent qualitative analysis to identify themes. Three multidisciplinary focus groups were conducted, with n = 12 participants across all groups. Qualitative analysis identified three main themes, including (1) HCP perceptions of ostomies, (2) Patient/family-related factors, and (3) Professional roles and collaboration challenges. Ostomy surgery in pediatric IBD requires complex multidisciplinary MDM and education. Perspectives of multidisciplinary HCPs identified patient, HCP, and systems factors that may impact MDM for ostomy surgery. This work highlights nuances in MDM and education in IBD, and the critical role of ongoing research and improved standardized processes to coordinate multidisciplinary ostomy-related MDM and education in this population.

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.

Early diagnosis of autism spectrum disorder (ASD) in children facilitates the provision of services and enhances opportunities for improving functioning via intervention. To date, limited studies have examined whether age of ASD diagnosis is associated with components of care of the patient-centered medical home (PCMH), a model of health care that emphasizes centralized, accessible, and coordinated care. The objective of the current study was to evaluate the associations between components of the PCMH and age of ASD diagnosis while controlling for associated clinical and socio-demographic factors, in a national sample of children 17 years and younger with ASD. The present study was a cross-sectional, observational study. Participants were caregivers of 1,193 children ages with ASD from the 2020 National Survey of Children's Health (NSCH). Hierarchical multiple linear regression analysis was run with age of ASD diagnosis as the criterion variable in two regression models. The binary composite medical home proxy variable was investigated as well as the five individual medical home components (usual source of care, personal doctor or nurse, family-centered care, care coordination, able to obtain referrals when needed). In the first regression analysis, the overall PCMH proxy variable was significantly correlated with the age of ASD diagnosis (standardized beta coefficient = -.08; p < .01). Of the five components of the PCMH assessed in the second regression model, only usual source of sick care was significantly associated with the age of ASD diagnosis (standardized beta coefficient = -.11; p < .01). Having a usual source of sick care may be an important factor in receiving an earlier ASD diagnosis for children and adolescents.

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.

Objectives: For pediatric cancer survivors in the post-treatment, school-reintegration period, integrating multi-informant reports and promoting a mutual clinician-family-school understanding of the child's needs are critical for comprehensive care. This study evaluated patterns of agreement between child, parent, and teacher reports of psychosocial functioning in pediatric brain tumor survivors (PBTS) and non-CNS solid tumor survivors (PSTS).

Participants and methods: PBTS (n = 51) and PSTS (n = 34) age 7-14 who received tumor-directed therapy completed the study. Parents and teachers completed the CBCL/TRF and SSIS, and parents and children completed the PedsQL and PROMIS peer relationships. Intra-class correlation coefficients, % disagreements, t-tests, and correlations quantified inter-rater agreement.

Results: Analysis yielded poor-to-moderate ICC levels across measures. Parent-teacher agreement was higher for reports of externalizing symptoms. Parents had higher ratings of child-internalizing problems, but lower ratings of overall social skills than teacher ratings. Parents had higher ratings of child emotional functioning and social skills compared to self-reports.

Conclusions: Findings underscore the necessity for integrating multi-informant reports of psychosocial functioning in assessment for pediatric cancer survivors. Findings also highlight critical gaps in mutual parent-teacher-child understanding, indicating the need for increased collaboration in the post-treatment period.

Clinical practice guidelines indicate treatments for specific anxiety diagnoses. Misdiagnosing specific anxiety disorders as unspecified anxiety may prevent patients from receiving appropriate care. Provider knowledge and attitudes may influence diagnostic practices. This study evaluated provider knowledge of diagnostic criteria for anxiety disorders and attitudes toward diagnostic processes and the relevance of diagnosis to patients' treatment. This qualitative analysis of interviews included 32 Veterans Health Administration providers in Primary Care Behavioral Health and Specialty Mental Health. Interview guides were created using a framework that outlines barriers regarding provider knowledge, attitudes, and behaviors as they pertain to following clinical practice guidelines. Most providers described themselves as familiar with diagnostic criteria for anxiety disorders and discussed consulting the Diagnostic and Statistical Manual of Mental Disorders if unsure about criteria. Providers were divided on the relevance of diagnostic specificity to a patient's treatment plan and outcomes. In the Veterans Health Administration, providers across different settings, roles, and tendency toward assigning specific diagnosis disagree on the relevance of diagnostic specificity for a patient's treatment and outcomes. Future research should seek to understand this divide and evaluate methods for optimizing a patient's likelihood of receiving a proper, accurate diagnosis.

Mental health disparities between racial/ethnic minority groups and non-Latinx Whites in the United States persist despite significant efforts aimed at decreasing these disparities. Efforts to address mental health disparities have largely focused on individual (e.g., stigma, help-seeking, health behaviors) and structural (e.g., public policy, interventions, addressing poverty) level factors. In contrast, this paper considers how processes at the interactional level (i.e., interactions between patients and providers) are also an important contributor to racial/ethnic disparities in mental health. Specifically, social psychological research has demonstrated how biases, including stereotypes, prejudice, and discrimination, can affect patient-provider interactions and contribute to mental health disparities. This narrative review of empirical studies that examine interactional processes between patients and mental health providers identified eleven studies to be included. Concepts represented in the studies are summarized and additional frameworks that can help explain how disparities are maintained are proposed. Last of all, practical suggestions for mitigating provider bias during patient-provider interactions are provided based on the findings from the narrative review.

Psychologists in academic medicine face pressure to juggle multiple roles, and research is often limited by a lack of available resources and funding. In other academic settings, student-led psychology research teams that utilize a tiered mentorship approach are able to produce advances in meaningful research while supporting the development of future professionals in the field. This article identifies the barriers of implementing a tiered mentorship model into an academic medicine setting and reviews a case study of how the model can be effectively adapted and evaluated to promote a self-sustaining, student-led psychology research team.