Psychological Services最新文献

Low sexual desire and arousal are associated with several negative health outcomes, including reduced quality of life, depression, anxiety, and relationship discord. Although women veterans have high rates of risk factors for sexual dysfunctions (e.g., elevated rates of trauma, depression, anxiety), research on their sexual functioning is lacking. Using a retrospective cohort design, we examined the prevalence of documented sexual desire and arousal disorder diagnoses or symptoms, using International Classification of Diseases, 10th Revision codes, among 790,726 women veterans receiving care in the Veterans Health Administration (VHA). In fiscal year 2020, these symptoms and disorders were documented for only 0.19% (n = 1,494) of women veterans receiving care and symptoms of low sexual desire were documented more frequently than formal desire and arousal diagnoses. Most women veterans with desire and arousal problems were married (53.88%), and most (52.28%) were prescribed antidepressants. Mental health (MH) treatment for desire and arousal difficulties was commonly delivered in person (as compared to telephone or telehealth). Psychologists primarily treated desire and arousal concerns, providing an average of 2.81 MH encounters (SD = 7.53) compared to an average of 1.62 (SD = 5.25) MH encounters by social workers and 1.22 (SD = 2.53) by psychiatrists. Problems with low sexual desire and arousal are likely underassessed and undertreated within the VHA. Better assessment of women veterans' low desire and arousal is warranted to improve their well-being and quality of life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

University counseling centers have grappled with clinical supply and demand imbalance for decades. Chronic understaffing, increased scrutiny from the campus community, and concerns about overall student well-being have only exacerbated the challenges. Traditional models of service that rely on advanced scheduling with limited services aside from individual and group psychotherapy continue to flounder each academic semester. This agency revamped its service model by drawing from evidence-based service delivery models of stepped care, flexible care, and consultation and triage systems. This article provides a case example of this agency's urgency, preparation, implementation, and initial outcomes of its navigated care model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dropout or treatment discontinuation from evidence-based psychotherapies (EBPs) has been a concern for clinicians as it is thought that such discontinuation prevents patients from achieving a full course of therapy and obtaining maximum benefit. Recent studies, however, suggest that treatment discontinuation may sometimes be due to symptom improvement. The purpose of the current evaluation was to examine change in self-reported symptoms in participants who completed versus did not complete treatment in a Veterans Affairs outpatient clinic offering EBPs for both depression and posttraumatic stress disorder (PTSD). Data were collected from 128 participants who had at least one treatment session postintake and had been discharged from the clinic. Data were collected on self-reported PTSD and depression symptoms. Of the 128 veterans, 61 completed treatment and 67 did not complete treatment (54.0% noncompletion in PTSD EBPs and 48.7% noncompletion in depression EBPs). Of those who did not complete, 47 were enrolled in a PTSD EBP and 20 in a depression EBP. Of those who did not complete a PTSD EBP, 51.1% had no change in PTSD symptoms prior to treatment discontinuation, whereas 12.8% had a symptom increase, and 27.7% had a symptom decrease. Of those who did not complete a depression EBP, 55% had no change in depression symptoms prior to treatment discontinuation, 15% had a symptom increase, and 30% had a decrease. Overall, results suggest that treatment discontinuation is not as straightforward as it may seem and that prematurely discontinuing an EBP may not necessarily represent treatment failure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Depression is highly prevalent in primary care (PC) settings. While extensive efforts are directed at optimization of depression screening practices, rates remain suboptimal, and barriers continue to be poorly understood. The present study investigated screening-related practices and beliefs. A concurrent mixed-methods approach was utilized to obtain both quantitative and qualitative data. Participants (N = 36) completed a self-report survey and a brief semistructured interview to assess attitudes toward depression screening, knowledge/beliefs about screening, as well as administration practices and screening-related training. Despite low rates of training (52.8%), participants endorsed understanding of the purpose, scope, and specialty populations targeted for screening. 83.3% of the sample assisted patients with screening completion. Rephrasing and reading the screening items were common and (with exception of reading the paper form) were associated with higher reported screening-related barriers (p < .05). Perceived importance of screening scores was significantly, positively associated with screening-related competence scores (r = .50, n = 35, p < .01). Qualitative data analysis revealed that screening may be conducted on a case-by-case basis or deferred based on perception of clinical relevance and time constraints. Finally, participants endorsed multiple screening-related questions and concerns about administration, psychometrics, and overarching screening goals. To improve implementation of universal depression screening, goals of depression screening need to be clearly explained. Screening workflows require optimization balancing employees' feedback and best practice recommendations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Urban Indian Health Programs (UIHPs) are one of the primary sources of government-funded health care for the millions of American Indian and Alaskan Native (AI/AN) people living in urban areas. The goal of this study is to better understand what services are available at UIHPs and how resources are being used to support these services. Semistructured interviews with behavioral health directors at 10 UIHPs were reported, transcribed, and thematically analyzed to address this knowledge gap. Our analysis indicates that UIHP behavioral health services were broad, encompassing numerous commitments that extend far beyond purely psychotherapeutic interactions and interventions to the periphery of behavioral health. An accurate accounting of behavioral health services at UIHPs must consider not only the ways that these services are shaped by distinctive visions to provide Indigenous cultural education and traditional healing, but also by expansive commitments to offering a full range of social services, case management, and community building under the broad umbrella of behavioral health. Implications of these findings include the need for additional funding for UIHPs, greater sponsorship of pathway training programs for AI/ANs in the mental health professions to increase the availability of AI/AN providers, future expansion of traditional healing practices, and direct empirical observation of behavioral health service delivery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Later in life Veterans may report increased thoughts and memories of traumatic military experience in the context of age-related changes, a process called Later-Adulthood Trauma Reengagement (LATR); this process may lead to resilience or distress. We describe the development of a 10-session group intervention with goals of providing psychoeducation about LATR, enhancing stress management and coping skills, and fostering meaning making. We characterize implementation and outcome characteristics for seven group cohorts over 5 years; groups were completed in-person or virtually. Outcomes were measured with the Connor-Davidson Resilience Scale, Meaning in Life Scale, Satisfaction with Life Scale, Positive Appraisals of Military experience (PAMES), Posttraumatic Stress Disorder Checklist-5, and Patient Health Questionnaire-9. Forty-seven Veterans (aged 65-93) began the group, 37 (87%) completed at least six sessions. These 37 Veterans reported an average of eight stressful events in the prior year, mostly major illness, death of a friend, and decline in memory and enjoyable activities, which may have set the stage for LATR. Veterans resonated with the LATR concept on standardized scales and qualitative comments. In pre-post comparisons, participants reported higher levels of PAMES (η² = .225), resilience (η² = .208), and meaning in life (η² = .145), with fewer symptoms of PTSD (η² = .199) and depression (η² = .124). There were no significant differences in outcomes for those who completed the group in-person or virtually. The LATR protocol may provide a framework for working with older adults reporting emergence or exacerbation of thoughts and memories of earlier trauma in later life, fostering positive adaptation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patients with cancer, especially advanced cancer, experience depression at high rates. We aimed to evaluate the quality of depression care received by patients with solid tumor cancer and advanced solid tumor cancer in Veterans Affairs (VA) primary care clinics. This is a retrospective cohort study of patients seen in 82 VA primary care clinics who newly screened positive for depression on the Patient Health Questionnaire (PHQ-2). Outcomes included timely follow-up within 84 or 180 days (3+ mental health specialty, 3+ psychotherapy, or 3+ primary care visits with depression diagnosis codes) and minimum treatment within 1 year (60+ days antidepressants prescribed, 4+ mental health specialty visits, or 3+ psychotherapy visits). 608,042 individuals were seen in VA primary care clinics during this period; 49,839 patients (8.2%) had solid tumor cancer and 9,278 (1.5%) had advanced or poor-prognosis solid tumor cancer. For 686 observations of patients with cancer and new depression, rates of appropriate follow-up were 22.3% within 84 days and 38.2% within 180 days. For 73 observations of patients with advanced or poor-prognosis cancer and new depression, rates of appropriate follow-up were 21.9% within 84 days and 34.3% within 180 days. Rates of minimum treatment within 1 year were 68.4% and 64.4% for patients with cancer and patients with advanced or poor-prognosis cancer, respectively. Quality of timely depression management is low in patients with solid tumor cancers. Even in health systems with well-integrated mental health services, care gaps remain for patients with cancer and depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Due to the recognition of the high prevalence and widespread effects of trauma, trauma-informed care (TIC) framework has emerged to address its impact and prevent retraumatization in the systems of care. Since organizational support has been identified as crucial in TIC implementation and sustainability, this systematic review assessed the status quo of TIC interventions which explicitly incorporate an organizational component. Our search yielded 880 articles, and 15 met the inclusion criteria. All the studies were carried out in the United States, more than half in mental health and Child Welfare Services, through longitudinal designs with no randomization or control group. All the studies utilized one to six organizational components, the most frequent related to presence of a defined leadership, procedures against retraumatization and provision of strength-based services. A wide variety of measures were used to assess the effectiveness of TIC interventions, with staff perceptions and safety management indicators being the most frequently used. In summary, the review indicates a positive trend in relation to the effectiveness of the interventions included in the study, with an improved functioning of beneficiaries, enhanced accessibility, and quality of services. However, the low quality and high heterogeneity of the studies make it difficult to draw conclusions with certainty. Therefore, the primary endeavor in TIC research is to provide more solid evidence. Partnerships between academic and community stakeholders will be of high value in this process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family member (FM) involvement in treatment for posttraumatic stress disorder (PTSD) has the potential to enhance veterans' sense of support and connection and reduce treatment dropout. Little is known, however, about women veterans' preferences, concerns, and goals regarding FM involvement in PTSD treatment. The study employed a mixed-methods approach consisting of surveys (n = 143) and interviews (n = 10) with women veterans seeking treatment for PTSD in a Veterans Affairs medical center. Married and partnered women veterans, and women veterans who identified as gay/lesbian, were more likely to be open to FM involvement. Results revealed a range of preferences and goals regarding FM involvement. Women veterans expressed a preference for joint sessions at the midpoint or near the end of treatment. Veterans' goals for FM involvement included enhancing the relationship with their FM and providing the FM with a basic understanding of PTSD. Conclusions, limitations, and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Starting in 2008, the U.S. Veterans Health Administration required the integration of mental health providers (MH providers) in Home-Based Primary Care (HBPC) programs to promote access to and quality of mental health services for veterans enrolled in HBPC. Surveys were administered in both 2010 and 2019 to HBPC program directors and MH providers to evaluate the status of mental health practice in HBPC programs and inform the continued development of program resources. Findings reported here summarize responses to the 2019 survey and highlight changes compared to 2010 in key areas (e.g., mental health staffing and workload, services provided, training needs, and integration with and impact on the HBPC team). In 2019, approximately half of invited HBPC program directors (n = 66) and MH providers (n = 136) completed the voluntary, anonymous, and confidential surveys. Descriptive and bivariate analyses of quantitative data, and thematic analyses of open-text responses, were conducted. Comparisons of survey responses were made between the 2019 surveys and those collected in 2010 from MH providers (n = 132) and program directors (n = 112), and indicated similar patterns of variability in program staffing and practices across sites, with ongoing behavioral/mental health education and training needs reported for both MH providers and teams. The perceived degree and value of mental health integration in HBPC also remained high. Survey responses suggest integration of mental health services into HBPC continues to be feasible and improves access to key services. Findings may inform the expansion of home-based mental health services for meeting the needs of an aging population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).