Families Systems & Health最新文献

Background: Strength of evidence is key to advancing children's mental health care but may be inadequate for driving practice change. The Designing for Accelerated Translation (DART) framework proposes a multifaceted approach: pace of implementation as a function of evidence of effectiveness, demand for the intervention, sum of risks, and costs. To inform empirical applications of DART, we solicited caregiver preferences on key elements.

Method: In March-April 2022, we fielded a population-representative online survey in Illinois households (caregivers N = 1,326) with ≥1 child <8 years old. Six hypothetical scenarios based on the DART framework were used to elucidate caregivers' preferences on a 0-10 scale (0 = never; 10 = as soon as possible) for pace of implementation of a family-based program to address mental health concerns.

Results: Caregivers' pace preference scores varied significantly for each scenario. The highest mean score (7.28, 95% confidence interval [95% CI: 7.06, 7.50]) was for a scenario in which the child's provider thinks the program would be helpful (effectiveness) and the caregiver believes the program is needed (demand). In contrast, the lowest mean score (5.13, 95% CI [4.91, 5.36]) was for a scenario in which online information implies the program would be helpful (effectiveness) and the parent is concerned about the program's financial costs (cost). Caregivers' pace preference scores did not vary consistently by sociodemographic factors.

Conclusion: In this empirical exploration of the DART framework, factors such as demand, cost, and risk, in combination with evidence of effectiveness, may influence caregivers' preferred pace of implementation for children's mental health interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: This study tested for differences based on relationship status at the time of surgery in baseline body mass index (BMI), weight loss outcomes (change in BMI [ΔBMI], percent total weight loss [%TWL], percent excess weight loss [%EWL]), and rates of successful weight loss (defined as ≥ 50%EWL) up to 4-year postbariatric surgery.

Method: Data came from a secondary analysis of patients (N = 492) who were up to 4-year postsurgery and completed a presurgical psychological evaluation and postsurgical survey.

Results: Sixty-nine percent of participants were patients in committed relationships and 31% were single/divorced/widowed patients. Single patients had higher presurgical BMIs than those who were partnered (t = 2.28, p = .02). There were no differences between those who were partnered and singles regarding ΔBMI and %TWL, although singles had smaller %EWL (t = -2.08, p = .04), which became nonsignificant after controlling for covariates. Most participants had successful weight loss (76.8%); however, this was not related to romantic relationship status.

Discussion: The results suggest those who were partnered undergo surgery at better-starting weights than singles and maintain this advantage in the long term. Providers working with patients considering bariatric surgery could inquire about how their romantic and social relationships play a part in their decision-making process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Primary care is at the forefront of addressing the pediatric mental health (MH) crisis due to its broad reach to young children and prevention and health promotion orientation. However, the promise of the delivery system for population impact remains unrealized due to several barriers, including pragmatic screening, decisional uncertainty, and limited access to evidence-based services.

Method: This article lays the conceptual foundations for the articles in this Special Section on Mental Health, Earlier in Pediatric Primary Care, which all apply a translational mindset to proposed strategies and solutions to overcome the barriers that have limited the potential of pediatric primary care for improving the MH and wellbeing of all children.

Results: Valid, pragmatic, transdiagnostic, developmentally-based screening measures to identify children at heightened risk are needed. Risk screening for MH problems should assess and empirically weight socioecological risk and protective factors, as well as the child's own assets for resilience to determine probabilistic risk. Pediatric clinicians require clear clinical cutoffs and guidelines for action when risk for MH problems is identified.

Discussion: These strategies-a developmentally-based screener with associated risk calculator that offers clear guidance to pediatric clinicians-address decisional uncertainty regarding when to worry and when to act. The communication of probabilistic risk requires additional client-centered communication skills to overcome different types of biases (e.g., implicit, benevolent, and cognitive) that contribute to MH inequities and decisional uncertainty in acting on identified risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The author describes how she has earnestly struggled to find her fit in providing mental health services to Hispanic/Latino clients and the Latino communities that she belongs to. She wonders, if no one belongs, then who stands up for historically marginalized Latino communities? Personal and systemic biases and arbitrary criteria for being enough to serve Latino patients hurt providers and clients alike. Her work reminds her of the need to charge against stereotyping and racism to meet patients' needs regardless of skin color or linguistic abilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Depression and anxiety among youth with Type 1 diabetes (T1D) are associated with poor diabetes management. Further guidance regarding psychosocial screening measures would benefit pediatric integrated care clinics. The purpose of this exploratory study was to examine whether screening for anxiety, assessing caregiver reports, and screening children 12 years old and younger could identify a larger percentage of youth who may benefit from behavioral health support compared to the standard approach of only screening youth 13 and older for depression.

Method: Sixty-five youth 8-17 years old with T1D (N = 65; M = 13.2 years; 55.4% females) and their caregivers (75% mothers) completed validated self-report and proxy-report depression and anxiety screeners during routine clinic visits between 2019 and 2021. Twenty-seven youth aged 13-17 also completed a measure of diabetes-related distress.

Results: The standard approach of screening youth aged 13-17 for depression via self-report identified 25.6% of participants, whereas screening youth ages 8-17 for depression and anxiety via self- and proxy-reports identified 47.7%. Screening for depression/anxiety identified unique portions of youth independent of diabetes distress.

Discussion: Utilizing anxiety and proxy-report measures may identify youth likely to benefit from behavioral health support who are not identified when only a self-report depression measure is used in screening. Research should evaluate whether utilizing multiple measures and screening children under 13 years old improve detection and connection to care for youth experiencing difficulty managing diabetes. Early identification and intervention could subsequently mitigate the negative impacts of social-emotional difficulties on diabetes management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Social-emotional risk for subsequent behavioral health problems can be identified at toddler age, a period where prevention has a heightened impact. This study aimed to meaningfully engage pediatric clinicians, given the emphasis on health promotion and broad reach of primary care, to prepare an Implementation Research Logic Model to guide the implementation of a screening and referral process for toddlers with elevated social-emotional risk.

Method: Using an adaptation of a previously published community partner engagement method, six pediatricians from community health centers (CHCs) comprised a Clinical Partner Work Group. The group was engaged in identifying determinants (barriers/facilitators), selecting and specifying strategies, strategy-determinant matching, a modified Delphi approach for strategy prioritization, and user-centered design methods. The data gathered from individual interviews, two group sessions, and a follow-up survey resulted in a completed Implementation Research Logic Model.

Results: The Clinical Partner Work Group identified 16 determinants, including barriers (e.g., patient access to electronic devices) and facilitators (e.g., clinician buy-in). They then selected and specified 14 strategies, which were prioritized based on ratings of feasibility, effectiveness, and priority. The highest-rated strategies (e.g., integration of the screener into the electronic health record) provided coverage of all identified barriers and comprised the primary implementation strategy "package" to be used and tested.

Conclusions: Clinical partners provided important context and insights for implementation strategy selection and specification to support the implementation of social-emotional risk screening and referral in pediatric primary care. The methodology described herein can improve partner engagement in implementation efforts and increase the likelihood of success. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Despite the well-documented youth mental health crisis, there has been a lag in the development of a specialized workforce to meet needs of young people experiencing these challenges. Little is known about the comfort of primary care pediatricians when faced with children and adolescents with mental health care concerns.

Method: A brief online survey was conducted to assess patterns of behavioral and mental health concerns in pediatric practices affiliated with a pediatric health system in Alabama. The survey asked about frequency of conditions that providers encountered, comfort treating these conditions, and frequency of external referrals.

Results: Pediatric providers reported high volumes of children with mental health concerns and varying levels of comfort treating independently. Providers frequently refer externally.

Conclusions: High rates of referrals could further stress an already overloaded system of specialty care. Interventions must be implemented to ensure a workforce prepared to meet the growing needs of youth requiring support for mental and behavioral health conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Appalachia is characterized by many contextual stressors, including geographic, economic, and cultural barriers to healthcare. Guided by the biobehavioral family model (BBFM), an understanding of the influence of interpersonal relationships (i.e., marital and nonmarital relationships) on health outcomes could be critical to mitigating the region's contextual stressors.

Method: Data were collected from 2018 to 2019 among 243 participants across seven pop-up medical clinics in central and southern Appalachia 59% from rural Appalachian counties (rural M_age = 41, 66% women, 90% White; urban M_age = 36, 74% women, 82% White). A series of multivariate regression models were conducted for outcome measures (i.e., depression, pain, physical symptoms, number of conditions, and perceived health).

Results: The results suggest that family quality was significantly related to all outcome measures except for perceived health, whereas marital satisfaction was only significantly linked to physical symptoms. Rurality was not significantly associated with any outcome measures and only moderated the association between family quality and a number of conditions.

Discussion: These findings demonstrate the importance of nonmarital family relationships on health outcomes for people in Appalachia. Given the limited direct impact rurality in this sample, close relationships may be important for the health and well-being of all economically marginalized Appalachians regarding where they live. Given the cultural tendency for Appalachians to rely on family and kinship networks for healthcare support and the findings in this study, medical professionals should develop innovative programs to incorporate family into healthcare visits, and disease management interventions for people living in Appalachia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: Although family relationship quality has been linked to later chronic pain incidence for aging adults, it is unclear whether the quality of these relationships is linked to the impact of pain. We estimated longitudinal associations between family relationship quality (i.e., family support and family strain) and pain interference for adults who develop novel chronic pain across 10 years of midlife.

Method: We conducted a secondary analysis of data from the Midlife in the United States (MIDUS) study. Using path analysis, we tested whether family support and strain reported by participants (54% female, age M = 54.8 years) who denied having chronic pain at the study's second wave (MIDUS 2, 2004-2006) but reported chronic pain 10 years later (MIDUS 3, 2014-2016; N = 406) was associated with the interference of that pain with daily activities after accounting for key covariates, including sociodemographics, depression symptoms, global physical health, and MIDUS 3 reports of family support and strain.

Results: The hypothesized model demonstrated good fit to the data based on multiple model fit indices. Greater family strain at baseline, but not family support, was significantly associated with greater pain interference 10 years later.

Discussion: Findings build on prior studies to suggest that not only are stressful family relationships likely associated with the odds of developing chronic pain, but they are also linked to the interference of that chronic pain when it develops. We recommend biopsychosocial screening in primary care that captures family relationship quality and can inform best practices for nonpharmacological, family-based pain management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This narrative recounts a medical resident's experience with a patient's desire to not receive life sustaining treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).