Psychiatry-Interpersonal and Biological Processes最新文献

Objective: The Emergency Department Longitudinal Integrated Care (ED-LINC) randomized clinical trial (NCT05327166) tests a Collaborative Care-informed intervention for emergency department (ED) patients with opioid use disorder. The ED-LINC intervention was developed before the current fentanyl epidemic; less than 10% of ED-LINC pilot intervention patients reported fentanyl use. To understand fentanyl's impact on the ED-LINC protocol, we utilized a systematic rapid qualitative approach to document clinical observations related to ED-LINC patients' fentanyl use and subsequent protocol modifications.

Method: This study utilized Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) methods to document fentanyl-related clinical observations. As participant observers, the team worked with a mixed methods consultant to analyze observations, informing adaptation to study protocol and intervention.

Results: From 4/12/2022 to 2/10/2023, 86 patients enrolled in the ED-LINC trial. Forty received the ED-LINC intervention and are included in this study. Investigators identified the following themes informing adaptation to the ED-LINC intervention: 1) fentanyl-related suicide risk, 2) fentanyl-catalyzed approach to Medications for Opioid Use Disorder (MOUD), 3) fentanyl-related adaptations to measurement-based care embedded in the Collaborative Care approach, 4) fentanyl-associated survival needs, and 5) engagement challenges with fentanyl. Adaptations included incorporating overdose prevention into suicide risk assessment, nontraditional MOUD induction, and shifting to a component-driven model.

Conclusions: The landscape of clinical practice can change quickly and may require both researchers and healthcare providers to quickly pivot. Rapid assessment procedures integrated into clinical trial investigation allow for modifications and adaptations to study protocols to ensure salient and generalizable results given the rapidly evolving opioid epidemic.

ObjectiveThis article reviews international research on the mental health of children of military service members, with a focus on the United States, United Kingdom, Canada, and Australia. It highlights the unique service-related stressors these children experience and presents Bronfenbrenner's Ecological Systems Theory as a framework for understanding how various risk and protective factors interact to influence mental health outcomes. The article also explores prevention and intervention strategies that support resilience and psychological well-being in this population. Method: A comprehensive review of empirical studies was conducted using peer-reviewed journal articles, governmental reports, and institutional research databases. The review examined key variables including rates of mental health concerns, contributing risk and protective factors linked to military service, and best practice prevention and intervention approaches. Country-specific trends and gaps in research were also analyzed. Results: In addition to extensive research from the United States, a smaller but growing body of work from Canada, Australia, and the United Kingdom was identified. Findings consistently show that children of military service members face increased risks of depression, anxiety, and behavioral challenges. However, protective factors such as strong family cohesion, supportive parental mental health, and access to structured services can buffer these risks. Ecological frameworks help capture how personal, family, and societal systems intersect in shaping outcomes. Conclusions: Continued research is needed to develop and evaluate scalable, evidence-based interventions tailored to military families. A family-centered and ecologically informed approach is essential to fostering resilience and improving long-term psychological outcomes for children of military service members.

ObjectiveCurrently, 47.2 million children worldwide are displaced due to conflict and violence. Most refugees (69%) are relocated to neighboring countries and often live in refugee camps or informal settlements. The transition period during displacement can have significant effects on youth wellbeing and psychosocial development. The paper explores how displacement due to conflict and violence impacts the mental health and wellbeing of children, particularly those living in refugee camps or informal settlements. It aims to guide the development of effective mental health programs and interventions by examining the role of the social environment in shaping the psychosocial development of displaced youth. Method: The Four Core Stressor Framework is introduced and applied to assess the mental health challenges faced by refugee youth, focusing on the effects of conflict and displacement on their psychosocial development. Conclusion: The paper highlights promising psychosocial interventions that address the political, structural, and social challenges faced by displaced youth. These interventions aim to support their mental health, promote resilience, and foster positive growth during displacement.

ObjectiveThis study examined mental, physical, and social variables that may mediate the relationship between mild traumatic brain injury (mTBI) and functional impairment in a nationally representative sample of U.S. military veterans. Method: Data were analyzed from 3,985 U.S. military veterans who participated in the National Health and Resilience in Veterans Study. Results: Study results revealed that 10.0% (95% confidence interval = 8.7-11.4%) of veterans screened positive for mTBI on the Veterans Affairs' Mild TBI Injury Screening and Evaluation tool. Veterans with a positive mTBI screen scored lower on measures of mental, physical, and cognitive functioning, and higher on a measure of psychosocial difficulties compared to those with a negative mTBI screen. Symptoms of major depression, generalized anxiety, and posttraumatic stress disorder, insomnia, somatic symptoms, and loneliness significantly mediated the relationship between mTBI screening status and various functional outcomes. Specifically, these mediators accounted for 87.1% of the association with physical functioning, 84.2% of the association with mental functioning, and 73.0% of the association with cognitive functioning, with mTBI screening status remaining significantly associated with each measure. For psychosocial functioning, these mediators accounted for 89.2% of the association, and mTBI screening status was no longer associated with this outcome. Conclusions: Collectively, these findings underscore the importance of early, targeted, and multi-modal interventions that address psychiatric symptoms, somatic symptoms, insomnia, and loneliness to enhance overall functioning and well-being among veterans with mTBI.

Objective: Older adults represent the fastest growing demographic of cannabis users, and they endorse cannabis use for a variety of reasons including modulation of chronic pain, mental health symptoms, and sleep concerns. However, current evidence leaves questions of efficacy unanswered among these groups. Goals of the present study were to examine the hypothesis that medical cannabis (MC) use will, at the daily level, predict lower pain, depression, anxiety, and improved sleep.

Method: A final sample of 106 MC users were recruited nationwide (ages 55-74, 66.67% female, 82.86% white). A fully within-subject multilevel structural equation model was conducted with use patterns and symptomology broken into four temporal epochs. MC use, operationalized as subjective intoxication (Epoch 1), averaged across the day was used to predict subsequent pain, anxiety, and depression levels (Epoch 2), which were then used to predict sleep that night (Epoch 3), then subsequent pain, anxiety, and depression the following day (Epoch 4) prior to initiation of MC use.Results: Subjective intoxication predicted lower post-use pain, anxiety, and depression. Subjective intoxication is related to lower anxiety and better sleep the following night.

Conclusions: These findings provide evidence of momentary improvements in pain, anxiety, depression, and indirect benefits for sleep quality. In combination with other findings, the results advance our understanding of the efficacy and limitations of MC among older adults. Findings are limited by MC measurement and sample homogeneity (primarily White, non-Hispanic female). Future research should seek to further measurement of use and corresponding effects and examine expectancy effects in aging clinical populations.

Objective: Perceived behavioral control over drinking (PBCD) is an important factor in alcohol use, with lower scores linked to higher consumption. Counterfactual thinking (i.e. "If only … then …"), a cognitive strategy that strengthens causal links between antecedents and consequents, may increase PBCD by increasing engagement in Protective Behavioral Strategies (e.g. alternating water and alcohol to minimize negative drinking outcomes). This study examined a brief counterfactual-based intervention and a personalized normative feedback for protective behavioral strategies intervention (PBS-PNF) to increase PBCD among college students, relative to control, across five follow-up weeks.

Method: Undergraduate students (n = 239; 76.6% female) were randomly assigned to one of four conditions: control (recall negative drinking event), sham (recall and elaborate on negative drinking event), counterfactual (recall negative drinking event and generate counterfactual strategies), or PBS-PNF (estimate peers' use of protective behavioral strategies). PBCD was measured at baseline and at five follow-up sessions.

Results: A Bayesian-approach multi-level model was used to estimate PBCD across follow-up weeks. Those in the counterfactual and PBS-PNF conditions reported greater increases in PBCD across follow-ups compared to those in the sham condition who saw no change. Participants in the control condition saw decreases in PBCD over time. The counterfactual and PBS-PNF conditions did not differ on PBCD across time.

Conclusion: This study highlights the effectiveness of a brief counterfactual-based intervention to increase PBCD among early drinking college students. Specifically, personalized interventions that increase use of protective behavioral strategies may be particularly effective for individuals who have not yet solidified their drinking habits.

ObjectiveIn this article, we review the effects of war on children via their impact on parenting and propose a novel family stress model to inform research and intervention development. Method: Focusing specifically on families living in active war zones, we conducted a review of the empirical literature on parenting and child adjustment, and parenting interventions during wartime. We excluded parental deployment to war if the family at home was not residing in the war zone. Results: A growing body of literature highlights challenges to parenting practices, cognitions and emotions during war, and parental adaptations to living in a war zone but we could find no parenting intervention research reporting outcomes of programs during war. Conclusions: While emerging literature highlights the impact of war on parenting and potential targets for intervention, there is a critical dearth of research on strategies and programs to support parents during wars. We propose a model to guide future research and intervention development for parenting during war and some examples of ways to accomplish this.