Families Systems & Health最新文献

Background: For physicians, the added responsibility of being an informal caregiver (IC, providing regular care for seriously ill loved ones) can create challenges such as increased rates of burnout that have received little attention. In this study, we explored physician mothers' informal caregiving experiences and probed their perspectives on how health systems can better support their needs.

Method: From September 14, 2021, to October 31, 2021, we distributed an online survey to a national sample of physician mothers who self-identified as ICs; survey questions examined their caregiving responsibilities and perspectives on workplace changes needed to support them.

Results: Of 23 respondents, 48% were caregivers for a child, and 74% coresided with their care recipient; 26% spent on average 40 hr per week caregiving and 44% were ICs for 5 years or more. Main caregiving responsibilities included communicating with health care providers (91%) and managing and/or attending medical appointments (70%). Three central themes emerged from open-ended questions: (a) "It's an exhausting and unrecognized burden"; (b) "Our health care system is difficult to navigate, even for physicians"; and (c) "Flexible work schedules, no penalties." Within these themes, respondents described feeling unrecognized and unsupported as ICs in their workplaces.

Conclusion: Physician mothers who are ICs fill critical, demanding roles as health care leaders and caregivers at home. Balancing these dual roles presents significant challenges that can have adverse effects, leaving physician-mother ICs vulnerable to burnout and attrition. Targeted support strategies including flexible staffing models, expanded telehealth, and paid informal caregiving leave may improve experiences for physician ICs more generally. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Integrating pain psychology in primary care has the potential to improve symptom burden; however, identifying those who may benefit is a challenge. The purpose of this study was to gather feedback from a multidisciplinary team to optimize digital screening and referral for psychological treatment of chronic pain distress within primary care.

Method: Team members in a primary care clinic were introduced to the proposed screening process and offered the opportunity to complete a feedback survey. The proposed workflow involved the customer service representative providing patients with digital screeners on an iPad, results transferring to the electronic health record, and a medical assistant (MA) returning the iPad. Positive screens would alert the MA to start the referral process in the electronic health record then signaling the physician to discuss the referral to the psychology team with the patient.

Results: Sixty-eight percent of individuals agreed or strongly agreed that screening for chronic pain and distress is important. Sixty six percent of the respondents selected the customer service representatives as the ideal team member to give the iPad to patients and 84% responded that MAs should be responsible for returning the iPad to the front desk. Some thought a positive screen should directly alert physicians (58%) whereas 40% indicated a preference for signaling the MAs to start the referral process.

Discussion: Team members had favorable opinions about integrating digital chronic pain distress screening. The logistics of the screening and referral process were finalized based on this feedback and will be integrated into the clinic. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Fibromyalgia is a disease that impacts the daily lives of patients and their partners with an impact on quality of life (QoL) and marital adjustment. The purpose of this study was to analyze the relationship among sociodemographic, clinical, and psychological variables on QoL and marital adjustment.

Method: This cross-sectional study included patients (n = 76) and partners (n = 58) assessed on psychological morbidity (anxiety and depression symptoms), fatigue severity, family coping, QoL, and marital adjustment.

Results: Pain control beliefs had an indirect effect in the relationship between psychological morbidity and marital adjustment and between family coping and marital adjustment, and a direct effect in the relationship between psychological morbidity/fatigue severity and QoL and between family coping and marital adjustment, revealing an indirect effect in this latter relationship. Also, the dyadic analysis showed an actor effect between family coping and marital adjustment of both patients and partners and a partner effect between family coping in partners' and patients' marital adjustment.

Discussion: The results of this study underline the need for interventions to address the dyad and be focused on pain beliefs and on the importance of family coping to promote patients and partners' marital adjustment and QoL. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In this narrative, a mother describes the grief she experienced following the death of her infant son. An identical twin son survived. The turning point came with a stark realization. Though many families endure tragedies like hers, they do so with far fewer resources. Opportunities to be present with their children-to hold them, comfort them-become unimaginably precious when you don't know which embrace might be the last. This realization shifted her from mere survival to action. She could no longer be apathetic. Her grief was no longer a private burden but a call to advocacy, to ensure that no child faces fear or suffering alone. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Integrated behavioral health programs bring strong benefits to patients and health organizations including reductions in overall costs. However, obstacles to funding prevent the implementation and maintenance of these programs across the country.

Method: The Psychiatric Health, Life Skills and Opportunities for Wellness (PHLOW) Program is based on the collaborative care model and seeks to provide psychiatric care through an integrated model that is financially sustainable for the organization. This pilot observational study included patients who received psychiatric care indirectly via consultations with primary care providers and directly through brief episodes of care.

Results: Patient outcomes were demonstrated by score changes on the nine-item Patient Health Questionnaire and Generalized Anxiety Disorder 7 before and after participation in brief episodes of care. Overall cost of care savings was demonstrated through change over time in risk-adjusted per-member-per-month.

Discussion: Patients participating in the PHLOW program showed potential drops in anxiety and depression ratings, coinciding with a reduction in mental health claims. In addition, participation in the program involved a small number of patient visits and prevented referrals to long-term psychiatry, preserving access for higher acuity presentations. This demonstration of the value of the PHLOW program has led to additional financial support of the program through the primary regional Medicaid payor, enhancing sustainability, and potentially modeling a collaboration that may be feasible for other organizations implementing integrated behavioral health programs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: The reality of transitioning to motherhood is challenging, as a new mother's identity, body, and family dynamics change. Social myths and media portrayals create unrealistic expectations, leaving new mothers unprepared for the reality. Exploring these expectations versus the reality of their experiences is essential to improving mothers' outcomes.

Aim: To explore first-time mothers' early motherhood experiences and how their experiences differed from their expectations.

Method: An exploratory study using three sequential focus groups of 16 first-time mothers in three hospitals in Ireland. Focus groups were audio recorded and analyzed using reflexive thematic analysis.

Findings: Four themes were identified: "I wish I knew," "the myth of normal," "the lottery of support," and "surviving and thriving in the fourth trimester." Participants reported high levels of self-criticism, guilt, and emotional exhaustion, struggling to meet unrealistic parenting standards. Many lacked consistent postpartum support, leaving them unprepared for the emotional and practical challenges of motherhood. Improved antenatal education and extended, structured postpartum care were strongly recommended.

Discussion: This study emphasizes the importance of health care systems and policies which prioritize enhancing the quality and accessibility of professional care during the fourth trimester and beyond. Additionally, antenatal education should provide realistic portrayals of the transition to motherhood to prepare women for this critical period better. This study also recommends new mothers to accept instrumental support from partners and broader support networks.

Conclusion: A gap exists between first-time mothers' expectations of early motherhood and reality. To reduce this gap, mothers require better preparation and improved postpartum care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: To identify distinct and heterogeneous typologies of behavioral health service use and associated factors based on need, predisposing, and enabling determinants, among a predominantly Black and publicly insured youth population in integrated pediatric primary care (IPPC). This study aims to address the unmet behavioral health needs of youth by understanding the characteristics associated with behavioral health engagement in order to tailor interventions accordingly.

Method: Latent class analysis was used to explore distinct subgroups among 416 youth (M_age = 10.81, SD_age = 3.74; 51% female; 74% Black; 74% public insurance) receiving integrated behavioral health services in a large, urban pediatric primary care setting in the Southeastern United States. Caregivers completed the Pediatric Symptom Checklist-17 to assess psychosocial problems in youth.

Results: Latent class analyses revealed two distinct classes of IPPC youth: "high attention and mixed problems," primarily younger boys with nonprivate insurance coverage, and "low attention/externalizing and moderate internalizing problems," primarily older girls with private insurance coverage.

Conclusions: These findings highlight the need for behavioral health services in IPPC for behavioral health specialists, pediatricians, and other interdisciplinary professionals to provide tailored, culturally responsive, and flexible treatment to address the unmet and unique behavioral health needs of this population. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: To better understand appointment scheduling for pediatric behavioral health (BH) referrals, we examined appointment scheduling behavior among patients with and without access to primary care mental health integration (PCMHI).

Method: A prospective cohort study compared PCMHI and non-PCMHI pediatric patients with BH referrals from January 17, 2022, to June 10, 2022. Six pediatric primary care clinics affiliated with a southern California Children's Hospital were studied: two PCMHI and four non-PCMHI clinics with similar patient demographic characteristics. BH referrals at PCMHI clinics are directly referred to the embedded integrated health therapists. Non-PCMHI clinics referred patients to community BH services. Data were collected from electronic health record abstraction and telephone interviews.

Results: PCMHI (n = 471) and non-PCMHI (n = 97) groups did not differ significantly in patient characteristics. About 87.3% (n = 172) of PCMHI patients eligible for an integrated health therapist initial BH appointment scheduled their appointment within 14 days compared to 9.2% (n = 7) of the non-PCMHI patients (χ² = 148.2, p < .001). There was no difference in median days to initial BH appointment between the cohorts, PCMHI: 21 (interquartile range = 15, 27.5) and non-PCMHI: 23 (interquartile range = 13, 35), p = .71. Primary reasons for not scheduling initial BH appointments were similar for both groups and included confusion about the referral and patient/parent busy schedules.

Conclusion: Patients in the PCMHI cohort were more likely to schedule their initial BH appointment compared to the non-PCMHI cohort. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Family factors and stressful life events are reasons for not proceeding immediately with metabolic and bariatric surgery, yet there is no formal screening for these factors during routine preoperative psychological evaluation. This pilot study determined the feasibility of implementing a preoperative relational screener and referral to a behavioral health consultation, and associations between relational factors with 12-month weight loss.

Method: Preoperative patients (N = 137) were asked to participate. Feasibility was noted by interest, completion of screener, screening as impaired on the relational measures, and completion of consultation. For patients proceeding to surgery, five models were conducted to determine changes in percent total weight loss (%TWL) over 12 months, based on the interaction with visits and screening as impaired, family functioning, stressful life events, death of a close friend or relative, and major financial crisis.

Results: Sixty-seven patients were interested; 57 completed the screener (85.1%, 79% female, 72% White); 43 screened (75.4%) as impaired on ≥ 1 assessment and were eligible for the consultation, 21 patients (48.8%) completed the consultation. Patients who screened as impaired had poorer %TWL (p = .013) compared to patients who did not. Patients with ≥ 1 stressful life event had poorer %TWL compared to those who did not experience any (p = .008), including the top two endorsed events-death of a close friend (p ≤ .001) or a major financial crisis (p = .009).

Conclusion: The relational screener provides additional information about patients' psychosocial needs and challenges before surgery. This is critical considering the majority of participants screened as impaired on at least one assessment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Insomnia and nightmares have both been associated with suicide risk and are both known to be commonly reported in a primary care setting. However, we are unaware of any studies examining the sleep-suicide relationship in the primary care setting. Clarifying these relationships could reveal important clues for improving suicide prevention efforts in primary care and other medical settings.

Method: Participants included 2,744 primary care patients recruited from six clinics located at five U.S. military installations. Participants completed measures of suicidal ideation, insomnia, and nightmares at baseline and suicidal ideation and suicide attempts were tracked at 6- and 12-month follow-up interviews.

Results: Of the 1,792 patients with follow-up data, 57 (3.2%) attempted suicide during the 12-month follow-up. Patients who attempted suicide during follow-up were more likely than patients who did not attempt suicide to have clinical insomnia and nightmares at least weekly. When adjusting for baseline suicidal ideation, clinical insomnia and nightmares at least weekly remained significant predictors of follow-up suicide attempts.

Conclusions: Our findings suggest that insomnia and nightmares are accurate predictors of subsequent suicidal behavior among a primary care population and may offer positive predictive value for suicidal behavior over and above what can be provided by assessing suicidal ideation alone. (PsycInfo Database Record (c) 2025 APA, all rights reserved).