Journal of Behavioral Medicine最新文献

Pharmacological treatment is essential for achieving blood pressure control in patients with hypertension; however, medication adherence remains suboptimal. Understanding its determinants is essential, but the role of psychological factors in medication adherence among hypertensive patients is still unclear. This study aimed to identify and synthesize evidence on modifiable psychological determinants associated with medication adherence in hypertensive patients. A comprehensive search was conducted across multiple databases, including Web of Science, PubMed, EMBASE, CINAHL, and PsycARTICLES, up to September 1, 2025. A random-effects model was used to estimate pooled effect sizes with 95% confidence intervals. A total of 5,455 records were initially retrieved, of which 112 studies met the inclusion criteria. Fifty-one studies were eligible for meta-analysis. The findings identified depressive symptoms (OR = 0.86, 95%CI 0.77 to 0.95, I² = 60.6%) and self-efficacy (OR = 1.60, 95% CI 1.15 to 2.23, I²=93.9%) as the most strongly associated modifiable determinants of medication adherence, with findings supported by sensitivity analyses. Illness perception (β = 0.23, 95% CI 0.13 to 0.32, I²=68.8%), and self-regulation (β = 0.34, 95% CI: 0.23 to 0.44, I²=92.9%) were also associated with adherence; however, these associations should be interpreted cautiously due to substantial heterogeneity and limited robustness across analyses. This study identified several modifiable psychological factors related to medication adherence in patients with hypertension, while highlighting considerable variability across studies. Future research should aim to elucidate the mechanisms by which these psychological determinants impact medication adherence and develop targeted interventions to improve treatment uptake and blood pressure control.

Black/African American (hereafter Black) adults in the United States (US) who smoke cigarettes experience tobacco disparities. Although there are established associations between smoking and anxiety in the general population, past work has not explored these associations among Black adults who smoke. The present investigation examined Black adults who smoke combustible cigarettes who did and did not screen positive for an anxiety disorder (defined as a score of > 8 on the Overall Anxiety Severity and Impairment Norman et al., (J Psychiatric Res 45:262-268, 2011) in terms of perceived barriers for smoking cessation, severity of symptoms when trying to quit, and smoking abstinence expectancies. Exploratory tests were also conducted on secondhand smoke exposure. The current sample included 517 Black individuals who reported daily cigarette smoking (five or more cigarettes per day; mean age of 45 years, 51.5% identified as female). In the primary tests, results indicated a positive screen for an anxiety disorder (versus not) was associated with higher levels of perceived barriers for smoking cessation, severity of symptoms when quitting, and negative abstinence expectancies for smoking (negative mood, somatic symptoms, and harmful consequences). No group differences were evident for positive abstinence expectancies. Exploratory tests also indicated that a positive screen for an anxiety disorder (versus not) was related to higher degrees of secondhand smoke exposure. Overall, the present investigation found that screening positive for an anxiety disorder may be associated with a variety of cigarette smoking processes and beliefs among US Black adults who smoke.

Few studies have examined trajectories of perinatal depressive symptoms among women with overweight and obesity. We aimed to identify the longitudinal trajectories of perinatal depressive symptoms among women with overweight and obesity and the predictors of these trajectories. Data were obtained from the Health in Pregnancy and Postpartum study (n = 217). Depressive symptoms were measured twice during pregnancy (baseline, 32 weeks gestation) and twice after delivery (6 and 12 months postpartum) by the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory model was used to identify depressive symptoms trajectories. Multinomial logistic regression model was used to identify baseline predictors. Three trajectories of depressive symptoms were identified: mild-stable (67%), moderate-stable (27%), and high-stable (6%). The participants in the mild-stable group experienced a low level of perinatal depressive symptoms. The EPDS score of the participants in the moderate-stable group approached but remained below the cut-off point for 'probable depression' (EPDS <13) throughout the perinatal period. Whereas the EPDS score of the high-stable group's participants consistently remained close to, but above, the probable depression cut-off point. Elevated perceived stress at early pregnancy was positively associated with membership in both the moderate- and high-stable groups. Our findings of the persistent, moderate and high level of depressive symptoms underscore the need for early detection and treatment of perinatal depression. Furthermore, prevention strategies and treatment modalities tailored to women with subclinical symptomatology are required to prevent their progression to clinical depression.

Poor sleep is increasingly recognized as a behavioral risk factor for cardiovascular disease. Few studies have examined how multidimensional sleep health and negative affect jointly relate to blood pressure (BP) in young adults. This study examined sleep health in relation to resting BP and tested whether negative affect accounted for or moderated the association. Participants were 129 young adults (mean age = 19.2 years, 70.5% female) without diagnosed sleep disorders. Sleep health was assessed using a composite index derived from actigraphy (regularity, timing, efficiency, duration) and self-report (satisfaction, alertness) metrics. Resting BP was measured in the laboratory. Hierarchical linear regression models were adjusted for demographics, body mass index, and attitudes toward sleep. Indicators of negative affect (depressive symptoms, anxiety, and hostility) were also included as covariates and tested as moderators. Better sleep health was associated with lower systolic BP only after adjusting for indicators of negative affect (B = - 1.40, SE = 0.63, p = .03). Hostility moderated associations between sleep health and systolic BP, such that effects were only significant among participants lower in hostility. These findings identify sleep health as a potential modifiable risk factor for hypertension and highlight the importance of considering both psychosocial context and multiple sleep dimensions when evaluating cardiovascular risk in early adulthood.

Fibromyalgia involves symptoms of pain, sleep disruption, and fatigue, which can have a deleterious impact on mental and physical health, and role functioning. Health self-efficacy, the perceived ability to manage and cope with health problems, may mitigate risk for functional disability and improve health perceptions. As a contributor to goal-oriented motivation, self-efficacy may facilitate hope and reduce hopelessness, thereby promoting willingness and motivation to engage in functional activities, with consequent benefit to perceived health. Our sample of 416 persons with self-reported fibromyalgia completed assessments of health self-efficacy, hope, hopelessness, role functioning, and general health. We conducted serial mediation linear regression analyses, covarying age, sex, and race/ethnicity. Supporting hypotheses, greater health self-efficacy was related to more hope and less hopelessness and, in turn, to fewer role limitations due to physical/emotional difficulties and, consequently, to better health perceptions (p < .001). Self-efficacy may facilitate health promotion engagement and use of adaptive coping (e.g., goal-setting; problem-solving), resulting in greater hope and less hopelessness, with downstream benefits for role functioning and health perceptions, perhaps as a result of strengthened motivation and determination to manage health, reduced negative emotionality, and enhanced perceptions of role capabilities. Healthcare providers should consider promoting self-efficacy and hope, and reducing hopelessness, perhaps via Cognitive Behavioral Therapy or self-management strategies, and by fostering interpersonal wellbeing, to facilitate role functionality and improve health perceptions in individuals with symptoms of fibromyalgia.

Cancer survivors often experience multiple cooccurring symptoms such as insomnia, pain, fatigue, and anxiety; yet conventional analyses in symptom science typically analyze symptoms one at a time and thus overlook putative clusters of shared symptom experiences. We applied a novel machine learning approach to supporting tailored symptom management to cooccurring symptoms. Bayesian nonparametric (BNP) clustering was applied to discover unique subgroups of symptom profiles in cancer survivors diagnosed with insomnia (N = 160) and with cooccurring pain, fatigue, and anxiety, using secondary symptom data from a clinical trial (clinicaltrials.gov: NCT02356575) comparing cognitive-behavioral therapy for insomnia (CBT-I) and acupuncture. BNP identified survivor subgroups by recognizing shared features in symptoms that contributed to heterogeneous treatment responses at 8 weeks. Simulations evaluated sensitivity to model assumptions. BNP identified three patient subgroups: (1) "insomnia-predominant" (N = 84) with high severity insomnia alone; (2) "insomnia & pain" (n = 21) with high severity of both insomnia and pain; and (3) "high symptom burden" (n = 54) with high severity across all symptoms. CBT-I produced greater insomnia reduction among "insomnia-predominant" patients (posterior mean=-2.45, 95% Bayesian Highest Density Interval: - 4.38, - 0.35) and among "insomnia & pain" patients (- 2.66, 80% HDI: - 4.50, - 0.50). However, acupuncture produced greater pain reduction among "insomnia & pain" patients (- 1.47, 95% HDI: - 2.79, - 0.18). CBT-I and acupuncture were equally effective for all symptoms among the "high symptom burden" patients. Simulations showed that our main BNP settings accurately identified these subgroups. Unsupervised BNP learning supports interventions tailored to patients' symptom burden and their main concerns. If further validated, BNP learning provides a roadmap for precision symptom management for cancer survivors, and broadly applicable in behavioral medicine data analysis.

We use a novel method (cross-lagged hidden Markov models) to identify which combinations of job demands and resources occur among workers, how often, and how these affect mental health and vice versa. Hidden Markov models (HMM) are a longitudinal extension of latent class analysis (LCA), which can be used to measure concepts that are not directly observable. As in LCA, indicator variables are used to measure such concepts. We use twelve indicators of JDR, and five indicators of mental health. HMMs group individuals with similar response patterns on the indicators in categories of the latent variable and analyse how individuals move between these categories. Additionally, predictors can be added to the model to investigate which factors influence transitions between the identified states. We used this model to study the cross-lagged relations between JDR and mental health: how JDR in time point [Formula: see text] affects mental health in time point t and mental health in time point [Formula: see text] affects JDR in time point t. We used yearly data from the Dutch Longitudinal Internet Social Survey (LISS) from 2016 to 2023. Our sample includes respondents who were employees in 2016 and for whom we had data on their JDR and mental health for at least four years. We identified six JDR states, ranging from 'Tough job' (high demands and few resources) to 'Dream job' (moderate demands and very high resources). We also identified three mental health states: poor, moderate, and good. Among those in moderate health, transitions to good health were more common for respondents in the 'Dream job' state and less common for respondents in the 'Tough job' state. Our results suggest a healthy worker effect: transitions from states with a disadvantageous combination of JDR to better states were more common among employees in moderate or good mental health. Our study shows how HMMs can improve our knowledge on the empirical predictions of widely studied theories such as the JDR model and its interplay with mental health. This is relevant for scholars and practitioners alike.

Behavioral science and health psychology researchers often strive to investigate treatment effects using traditional statistical approaches, such as repeated measures ANOVA. However, these methods often fall short in addressing complexities like measurement error, intraindividual variability, and change processes over time. This study introduces the Two-Wave Latent Change Score Model (2W-LCSM; Henk & Castro-Schilo, 2016) as a robust alternative for modeling treatment-induced change and its long-term behavioral consequences. We demonstrate an illustrative example using data from individuals convicted of sexual crimes, incarcerated, and completing psychotherapy programs based on cognitive behavioral therapy. Our findings highlight the utility of 2W-LCSM in capturing both within-person change and its predictive relationship with recidivism. Results indicate a significant reduction in cognitive distortions post-treatment, with latent change scores emerging as a significant predictor of reduced sexual crime recidivism. These findings underscore the value of 2W-LCSM in behavioral medicine research, offering insights for tailoring interventions and advancing statistical methodologies in the field.

The purpose of this study was to examine the relations between barriers, self-efficacy, and daily moderate-to-vigorous physical activity (MVPA) among adults within underresourced communities using 7-day accelerometry wear. A total of 84 adult staff from 24 underresourced afterschool programs (ASPs) completed the Self-Efficacy for PA Scale (perceived barriers) and Self-Efficacy for Exercise Questionnaire (self-efficacy). The results indicated no differences in the predominant types of PA barriers by race for adults, but European American adults reported slightly more PA barriers than African American adults within these underrecourced communities. Perceived barriers were negatively related to daily MVPA. Self-efficacy (the mediator variable) was significantly and positively related with daily MVPA. Contrary to what was expected, perceived barriers were positively related with self-efficacy. In the full mediation model, self-efficacy served as a significant mediator between barriers of PA on staff MVPA. This study highlights the negative impact of barriers on ASP staff MVPA that can be attenuated by self-efficacy and suggests that addressing barriers of culture and environmental factors, promoting self-efficacy, and exploring effective model characteristics continues to be an important research direction for future ASP staff health initiatives.Trial registration Connect Through PLAY: A Staff-based Physical Activity Intervention for Middle School Youth (Connect). https://clinicaltrials.gov/ct2/show/NCT03732144 . Registered 11/06/2018. Registration number: NCT03732144.