Families Systems & Health最新文献

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).

Introduction: Youth decision-making involvement (DMI) regarding growth hormone (GH) may be beneficial. Identification of correlates of DMI may inform the development of strategies to encourage youth involvement and enhance self-efficacy. The goal of this study was to examine the associations of DMI regarding GH treatment with youth and parent characteristics.

Method: Youth, aged 8-14 years (34% female), undergoing GH stimulation testing and a parent (94% mothers) completed surveys at the time of testing (Visit 1; 2019-2023); the Decision-Making Involvement Scale was completed 3 months later. Surveys collected demographics; decision-making involvement; youth coping skills, parent social support; parent autonomy support; parental perceived worry, scarcity, and instability regarding the child's current/future environments; and parents' achievement goals for their child. Correlations and multivariable linear regressions were used to identify factors significantly associated with Decision-Making Involvement Scale subscales.

Results: The analysis included 44 parents who indicated that a decision about GH was made and that they discussed the decision with the youth, as well as 30 youth who remembered having such a discussion. On multivariable modeling, youth who had more engaged coping skills and parents who perceived resources in the world as scarce reported higher youth DMI. Parents with older children, less worry about their children being out in the world, and less desire for the child to avoid activities that he/she might not do well in reported higher youth DMI.

Discussion: Parental worry and youth coping may be important targets of intervention when seeking to facilitate youth involvement in GH-related decision making. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Health care organizations have recognized the necessity of addressing diversity, equity, and inclusion (DEI)-related issues to promote anti-racism and improve workplace culture. Little is known about the short- and long-term impacts on staff perceptions of inclusion, psychological safety, and belongingness, or what aspects of DEI initiatives hold meaning and value for team members. In particular, the perspective of clinical staff identifying as racial-ethnic minorities/persons of color (POC), who disproportionately occupy support staff roles with less power on the team, has been unclear and understudied. The purpose of this study was to investigate what makes organizational DEI efforts meaningful and impactful in creating a sense of inclusion for POC clinic team members and identifies perceived barriers to inclusion efforts.

Method: A qualitative study was conducted across 13 community health clinics within a safety-net health care system in Colorado. Semi-structured interviews were conducted with 40 participants (77.5% female; M_age 41; 77.5% POC). Participants' clinic roles included support staff team members (75%), medical providers (15%), and clinic leadership (10%).

Results: Findings illustrated elements of existing DEI initiatives, ranging from the most beneficial to the most detrimental, including some common across all participant groups and some unique to specific races and/or role groups.

Discussion: All participants endorsed common beneficial elements of DEI initiatives. Participants identifying as POC and in roles with less power in the clinic (i.e., support staff members) shared elements with the potential to cause harm. Avoiding detrimental elements and incorporating beneficial elements will allow teams to engage in meaningful DEI initiatives. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Some individuals over their life course will experience significant health-related events, such as a physical or mental illness, that can alter their life pathways or trajectories, known as "turning-point" events. This systematic review aimed to synthesize the evidence from population-based data collections for: (a) parent health-related turning point events and the impact of these events on offspring health and social outcomes; and (b) offspring health-related turning point events and the impact of these events on parent health and social outcomes.

Method: A review of four databases (MEDLINE, CINAHL, PsycINFO, and Scopus) from January 1, 2010 to February 23, 2023 was conducted. Abstracts and full-text articles were screened by four reviewers and critically appraised.

Results: Of 114 articles, 98 (86%) examined the effect of a parental health-related turning point on offspring, 11 (10%) examined the effect of an offspring turning point on parents, and five (4%) investigated bidirectional impacts of a turning point event. For parents and offspring, mental health disorders (50%), physical health (26%), and death (24%) were common turning point events examined. For parents and offspring, common health outcomes included mental disorders (n = 50), physical health (n = 11), substance use (n = 9), and death (n = 7), and common social outcomes included educational performance (n = 14), employment or income level (n = 7), and involvement of child protective services (n = 5).

Discussion: The ability to disentangle relationships between turning point events and adverse health and social outcomes is required, as is the development of strategies to disrupt intergenerational disadvantage. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In this narrative, a mother with an unexpected medical setback creates a board game with her children to talk with them about what happened and share their emotions about the experience. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: China's recent policy initiatives and dedication of resources to heighten the public's awareness of cancer risks have led to increased cervical cancer screening and testing for human papillomavirus (HPV) which has resulted in a greater number of people diagnosed with HPV. The psychological stress experienced by women of childbearing age who are infected with HPV is also felt by their spouses, as the close relationship between spouses results in intertwined psychological distress and health statuses. Therefore, this study aimed to explore the dyadic coping experience of HPV-infected patients of childbearing age and their spouses in China and to provide a research basis for marital interventions for the disease.

Method: From July 2022 to January 2023, we used a purposive sampling method to select 11 pairs of HPV-infected patients of childbearing age and their spouses from a tertiary hospital. We conducted in-depth interviews with the patients and their spouses and analyzed the data using Colaizzi's seven-step method.

Results: We identified three main themes and eight subthemes: (a) stress perception (including negative psychological reactions, emotional relationship deterioration, and family social role imbalance), (b) stress communication (including enhancing communication awareness and changing communication methods), and (c) stress adjustment (including supporting each other emotionally, facing the disease together, and seeking social support).

Conclusion: Health care professionals should assess the stress experienced by patients and their spouses. Moreover, they should encourage them to better cope with the disease as a team. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Hazardous drinking by fathers poses a significant risk for negative family interactions and child outcomes. The transition to parenthood may be a time when expectant parents are potentially motivated for health behavior change, suggesting that implementing preventive interventions during this period may be particularly effective. This article provides an overview of the rationale for an innovative prevention strategy incorporating alcohol-use intervention with a family-focused program.

Method: We describe the process of integration and adaptation of two evidence-based interventions beginning in pregnancy: (a) Family Foundations, a universal transition-to-parenthood intervention for couples to enhance coparenting and couple dyadic functioning, and (b) brief intervention to address alcohol use delivered using a couples-focused motivational interviewing style.

Results: Lessons learned from pilot testing (conducted October 2020-March 2021) included the importance of softened framing of the discussions and language used around alcohol use given that parents were not specifically seeking treatment for alcohol use and the program was described as a parenting program that included discussion of health behaviors, including drinking. In addition, we found that evoking discussion and communication within dyads and supporting autonomy in decision making regarding alcohol use also facilitated engagement.

Conclusion: Pilot testing demonstrated the acceptability and feasibility of an adapted, integrated intervention program designed to strengthen coparenting skills and dyadic functioning and promote lower risk levels of alcohol use among couples during the transition to parenthood. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: The prevalence of mental and behavioral health disorders (MBHDs) in children is rising, along with the use of emergency departments (EDs) for care. School-based health centers (SBHCs) are accessible clinics that can provide integrated primary care and behavioral health services and are associated with decreased acute health care utilization. However, little is known about the relationship between SBHC enrollment and ED utilization for MBHD. We sought to describe ED utilization for MBHD among children enrolled in a comprehensive SBHC.

Method: Descriptive, cross-sectional analysis of Medicaid data for SBHC-enrolled students (SBHC users and nonusers) in Grades K-8, September 2015-August 2019, compared to propensity score-matched children not enrolled in the school. We calculated ED visit rates using 10th revision of the International Classification of Diseases codes for MBHD and ranked MBHD codes by percentage of encounters.

Results: A total of 1,173 SBHC-enrolled students (SBHC users: n = 816; SBHC nonusers: n = 357) and 2,594 controls were included. SBHC-enrolled students and controls were well matched (mean age = 10.7 years, SD = 3.5, 51% female, and 82.7% Black, non-Hispanic). ED visit rates with any code for MBHD differed between the subset of SBHC users (49.9 visits/1,000) and the controls (72.5/1,000). Depression was the top reason for primary presentations for MBHD among SBHC users versus attention-deficit/hyperactivity disorder for controls.

Discussion: ED visit rates for MBHD were lower among SBHC users compared to controls. SBHCs may prevent low-acuity ED visits for MBHD by leveraging an integrated approach to behavioral health in the education setting. (PsycInfo Database Record (c) 2025 APA, all rights reserved).