Psychological Services最新文献

Implementation science (IS) has received increased attention as it provides a means to bridge the know-do gap to implement evidence-based interventions in real-world settings. Against this backdrop, posttraumatic stress disorder (PTSD) is a global mental health concern (Koenen et al., 2017), especially in low- and middle-income countries characterized by limited trained health professionals, infrastructure, and limited access to evidence-based mental health care (Chen et al., 2017). Over the last 3 decades, effective trauma-focused psychotherapies (TFPs) for PTSD have been developed (Hamblen et al., 2019). Prolonged exposure therapy (PE) is a first-line TFP for PTSD (Hamblen et al., 2019), yet the dissemination and implementation of PE have been limited to specialty care settings in developed or industrialized countries (Booysen & Kagee, 2020). Implementation science provides an opportunity for disseminating and implementing TFPs like PE in low- and middle-income countries. This article describes mixed-method data from a pilot implementation study of an abbreviated version of PE, known as prolonged exposure for primary care (S. A. M. Rauch, Kim, et al., 2023), in a semirural city in the Eastern Cape of South Africa. Importantly, prolonged exposure for primary care shows a significant reduction in PTSD when provided by lay counselors and good feasibility and acceptability. In addition, we reflect on the barriers and facilitators related to implementation research within a low-resourced community, namely, (a) training lay counselors, (b) cultural diversity, and (c) mental health literacy. Mental health literacy is proposed as an essential component to consider in implementation science, especially in low-resourced communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reintegration into civilian society following military separation is a challenging process. There is a dearth of research into the impact of these factors on Australian veteran reintegration. The purpose of this phenomenological study was to explore the lived experience of Australian veterans during reintegration, through the lens of acculturative stress and identity. Ten interviews were conducted with ex-serving members of the Australian Defence Force. Post-1990 veterans of all genders, who were at least 18 years of age, from all service branches were eligible for the study. Thematic analysis revealed two overarching themes each with three main themes; acculturative stress (assimilation, societal issues, social isolation), and integrated identity (acceptance, integrated communities, and adapting to the civilian world). Each main theme contained two subthemes illustrating their significance. Difficulty integrating civilian and veteran identities was a key barrier to successful reintegration and negative separation experiences undermined integration of civilian and veteran identities. Acculturative stressors identified were poor understanding by family, community, and clinicians of the incompatibility between military and civilian cultures. Education is needed for clinicians, the community, and families about military culture and difficulties for veterans when reintegrating into civilian society. Support for reintegration should be tailored to the needs of veterans encompassing personally meaningful activities, use of military skills in civilian contexts, ongoing membership of the military community and engagement with other veterans. This will ultimately foster integration of veteran and civilian identities, enabling veterans to retain their veteran identity in a manner that is adaptive for the civilian context. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Academic withdrawal from colleges and universities is a common occurrence, particularly among students with mental health concerns. Receiving a successful course of psychotherapy may reduce students' risk of academic withdrawal, but outcomes in university counseling centers (UCCs) could be hindered by strategies used to meet high service demands with limited resources, such as offering a low number or frequency of sessions. The present study examined associations among psychotherapy dose, clinical outcome, and academic withdrawal among students (N = 16,197) in short-term individual psychotherapy at 85 UCCs in the United States. Structural equation modeling results indicated that after controlling for baseline psychological distress, the number of psychotherapy sessions attended positively predicted, and the average number of days between sessions negatively predicted, clients' self-reported reductions in psychological distress. In turn, after controlling for pretreatment characteristics associated with academic withdrawal (prior psychiatric hospitalization, gender, academic distress) reductions in psychological distress negatively predicted therapists' report of clients voluntarily withdrawing from their academic institution during psychotherapy. This indicates that students who receive higher psychotherapy doses within a short-term context (i.e., 10 or fewer sessions) are less distressed by the end of treatment, which then predicts a lower likelihood of academic withdrawal during psychotherapy. UCC leadership and clinicians might enhance clinical and academic outcomes by providing flexibility in the number and frequency of psychotherapy sessions available to students. However, centers may need additional resources from their academic institutions to provide this flexibility. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Crisis Stabilization Units (CSUs) are short-term residential facilities that provide care to people experiencing mental health crises, seeking to reduce reliance on local emergency departments and avoid unnecessary jail detention. Despite these intentions, there is little foundational literature to support research on CSU efficacy and a dearth of research on the sociodemographic characteristics and specific needs of CSU patients. Here, we recruited and surveyed 208 participants admitted to one of two focal Arkansas CSUs on their sociodemographic characteristics, justice-involvement, mental health, substance use, and health care utilization. Results revealed that participants were mostly unemployed (68.16%), low-income (72.34%), and experiencing insecure housing (33.33%). They reported extensive justice-involvement (85.57%), high rates of clinically significant mental illness symptom severity (77.00% for anxious symptoms; 78.33% for depressive symptoms; 79.40% for traumatic stress symptoms), and recent substance use (73.34%). Recent engagement with other medical services was common, though more participants reported visiting an emergency department (42.23%) than did receiving outpatient medical care (26.73%). While research on CSU patient outcomes is needed, our results indicate that CSUs have the potential to be an essential part of the health care continuum by serving a population with multiple, intersecting needs and addressing a deficit in community-based crisis care. Continued investigation of community-based crisis intervention services is critical to bridging the gap between vital behavioral health resources and the populations in need of them. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Black veterans experience disparities in mental health (MH) care access and are disproportionately affected by COVID-19. Video telehealth to home (VTH) may reduce disparities by addressing barriers, particularly with pandemic-related shifts to remotely delivered care. Considering potential needs for tailored implementation across racial/ethnic groups, we examined differences in VTH use by non-Hispanic Black veterans versus all other races/ethnicities and among Black (Hispanic and non-Hispanic) veterans by age, rurality, and gender during the pandemic. We extracted a cohort of Veterans Health Administration-enrolled veterans receiving at least one MH encounter between October 2019 and September 2020 (n = 1,627,791) from electronic health records. Multilevel linear growth curve models examined the percentage of VTH use for non-Hispanic Black versus other races/ethnicities before and after pandemic onset. Black veteran-only subgroup analyses examined differences by ethnicity in percentage of VTH MH encounters since pandemic onset by age, rurality, and gender, using regression and analysis of covariance models. Despite significant increases in VTH during the pandemic, on average, VTH use was consistently lower for non-Hispanic Black veterans across both periods. During the pandemic, differences in VTH use between non-Hispanic Black and non-Black veterans accelerated over time. VTH use was greater during the pandemic for Black veterans who were Hispanic, younger, urban, and female. Adoption of VTH for MH was low for non-Hispanic Black veterans before COVID-19 and during COVID-19 compared to non-Black groups. Future VTH research and implementation efforts should question why adoption remains low, work to meet cultural needs, and promote equitable adoption for Black veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

With the rise of anti-Asian racism and discrimination that followed the onset of the COVID-19 pandemic, the need to improve Asian Americans' (AA) connection to and experiences with clinical care is critical. AA at risk for or experiencing psychosis represent a particularly vulnerable subset of a population that already exhibits low service utilization and a multitude of barriers to mental health care treatment. Considering that victimization and discrimination were well-documented factors that exacerbate psychotic symptoms prepandemic, preparing clinicians to adequately support this already hard-to-reach population warrants special attention. In this article, we argue for the importance of addressing the unique needs of this population in an acute time of need. We outline three main considerations for working with AA across the psychosis spectrum, including actionable steps clinicians can implement related to (a) the variability in AA identities, (b) the relationship between victimization and psychosis, and (c) improving access to culturally sensitive mental health care treatment. By considering the diverse needs of AA at risk for or living with psychosis, clinicians across professional levels and contexts can better serve this vulnerable population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

To explore health outcomes in caregivers of service members and veterans (SMV) with traumatic brain injury (TBI) enrolled in two programs within the U.S. Department of Veterans Affairs (VA) Caregiver Support Program (CSP) (General and Comprehensive Programs) and those not enrolled. Participants were 290 caregivers classified into three groups: (a) General Program (n = 34); (b) Comprehensive Program (n = 104); and (c) Not Enrolled (n = 152). Main outcome measures assessed caregiver health-related quality of life (HRQOL), SMV functional ability, and caregiver needs. Compared to the Not Enrolled group, the General, and Comprehensive Program groups reported worse scores on five of 25 caregiver HRQOL measures and had a higher proportion of elevated scores on two measures. The Comprehensive Program group reported worse scores on an additional seven HRQOL measures and a higher proportion of elevated scores on three measures compared to the Not Enrolled group. Over 20% of caregivers in each group reported clinically elevated scores on eight HRQOL measures. Few differences between caregiver groups were identified for unmet needs. In the total sample, eight HRQOL measures consistently emerged that were more strongly associated with caregiver needs. Caregivers enrolled in the VA CSP tended to report worse HRQOL and caring for a SMV with worse functional ability compared to those not enrolled. A better understanding of health care utilization for those not enrolled in the CSP and in need of help is required. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The posttraumatic stress disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5 (PCL-5; Weathers et al., 2013) is a well-validated self-report instrument intended to assess provisional diagnostic status and symptom severity of PTSD. With the recent release of the Department of Veterans Affairs measurement-based care initiative, the PCL-5 is now required to be used by VA-based PTSD Specialty Clinics to track and monitor patient progress in treatment. With the rise of telehealth modalities in response to the COVID pandemic, clinicians have turned to remote, asynchronous assessment (i.e., assessments completed without the provider present through remote platforms) as a means to provide best care to virtual patients and reduce time burden on providers. We review the psychometric properties of the PCL-5 along with relevant criticisms of the measure to provide recommendations for its optimal use through remote, asynchronous means. We also explore considerations for using remote, asynchronous assessment to assist with measurement-based care more broadly. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sexual and gender minority (SGM) groups experience exposure to minority stress, including discrimination, prejudice, microaggressions, and internalized stigma. Despite the sizable portion of the United States' population that identifies as SGM, relatively little research has been done to comprehensively understand the mental health consequences of SGM stress-particularly as they relate to serious mental illnesses (SMIs)-and SGM status is rarely reported in published studies. This article provides an overview of SGM research among people with SMIs as well as other relevant disorders. Findings show that sizable gaps remain in our knowledge of whether SGM groups experience higher rates or greater severity of SMIs, including schizophrenia-spectrum and bipolar disorders, though findings related to depressive and trauma-related disorders may be able to inform research and treatment for those with SMIs. To increase our understanding of potential mental health disparities for those with SMIs, researchers are encouraged to include measures to assess SGM identity, report upon this demographic information within their manuscripts, and examine differences in rates and severity of SMIs between these groups. Clinicians are encouraged to incorporate demographic questions into their standard intake batteries and initiate discussion of SGM status and minority stressors early on in treatment to promote more positive outcomes for this group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A large proportion of adults experiencing mental health problems do not receive care due to structural and attitudinal barriers. Mood Lifters (ML) is an evidence-based mental wellness program designed to reduce depression, anxiety, and stress symptoms. This study aims to extend the literature by examining whether ML reduces posttraumatic stress disorder (PTSD) symptoms, and if childhood trauma (CT) affects treatment outcomes. We hypothesized that ML will be effective for all symptoms. However, we predicted that those who endorse higher levels of CT would experience a diminished impact of ML on their symptoms. Graduate students and young professionals (N = 221), a demographic that is known to have greater mental health concerns, were randomly assigned to either the waitlist condition (n = 78) or the intervention condition (n = 143). Before and after ML participation, participants completed a series of questionnaires about their symptoms. ML reduced symptoms of PTSD for participants who received the intervention relative to the waitlist. Further, we also observed that while the overall regression models with CT predict posttreatment scores for all the clinical symptoms, the CT variable itself was predictive of only posttreatment anxiety. Unexpectedly, given that CT is often associated with less improvement, we found that those at all levels of CT experienced similar reductions in depression, anxiety and PTSD symptoms. Taken together, ML is a viable option to help people reduce depression, anxiety, stress, and PTSD regardless of the level of CT exposure. (PsycInfo Database Record (c) 2024 APA, all rights reserved).