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McMahon J, Dowling K, Gallagher E, Donnellan A, Houghton S, Ryan M, O’Connor C, Walsh E. Predictive relationship between COVID-19 anxiety and psychological distress in adolescents during the COVID-19 pandemic. Front Psychol 2024; 14:1095892. [PMID: 39364268 PMCID: PMC11447965 DOI: 10.3389/fpsyg.2023.1095892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/21/2023] [Indexed: 10/05/2024] Open
Abstract
COVID-19 was a novel stressor that gave rise to pandemic related anxiety and increased the risk of mental health issues, particularly in youth. It is important to understand how such events contribute to psychological distress in young people to adequately intervene in the aftermath and to plan for future similar events. Using cross-sectional data from the CoSPACE Ireland study dataset this paper reports on the predictive relationship between COVID-19 anxiety and psychological distress for Irish adolescents (N = 314, M = 14.05, SD = 2.7, 11-18 years), while controlling for other influencing factors across multiple levels of a bioecological systems approach. Covariates were age, gender, ethnicity, social economic status, Peer Support, School Support and Parent-Child Closeness. Findings indicate that COVID-19 anxiety was a significant predictor of adolescents' psychological distress. Specifically, Consequence Anxiety (worries about the indirect consequences of COVID-19) was found to be a predictor of adolescents' psychological distress rather than Disease Anxiety (worries about the COVID-19 virus itself). Individual factors (e.g., age, ethnicity, special educational needs) and microsystem factors (e.g., parent child closeness, peer support) were also found to impact on adolescents' levels of psychological distress. A significant moderation analysis revealed that greater parent-child closeness reduced the strength of the positive association between Consequence Anxiety and psychological distress. These findings suggest that strategies to alleviate adolescents' psychological distress during pandemics should focus on reducing pandemic-related anxiety, specifically Consequence Anxiety. A multisystemic approach is also recommended to reduce the negative mental health impacts of the pandemic on adolescents.
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Affiliation(s)
- Jennifer McMahon
- The School, Child & Youth Mental Health & Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katherine Dowling
- The School, Child & Youth Mental Health & Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Elaine Gallagher
- The School, Child & Youth Mental Health & Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Alanna Donnellan
- The School, Child & Youth Mental Health & Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Sharon Houghton
- The School, Child & Youth Mental Health & Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Megan Ryan
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | | | - Eibhlín Walsh
- The School, Child & Youth Mental Health & Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Reeves JM, Spencer LM, Tsai LL, Baillie AJ, Han Y, Leung RWM, Bishop JA, Troy LK, Corte TJ, Teoh AKY, Peters M, Barton C, Jones L, Alison JA. Effect of a 4-Week Telerehabilitation Program for People With Post-COVID Syndrome on Physical Function and Symptoms: Protocol for a Randomized Controlled Trial. Phys Ther 2024; 104:pzae080. [PMID: 38943360 PMCID: PMC11443032 DOI: 10.1093/ptj/pzae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/29/2024] [Accepted: 06/27/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE COVID-19 has led to significant morbidity and mortality globally. Post-COVID sequelae can persist beyond the acute and subacute phases of infection, often termed post-COVID syndrome (PCS). There is limited evidence on the appropriate rehabilitation for people with PCS. The aim of this study is to evaluate the effect on exercise capacity, symptoms, cognition, anxiety, depression, health-related quality of life, and fatigue of a 4-week, twice-weekly supervised pulmonary telerehabilitation program compared with usual medical care for people with PCS with persistent respiratory symptoms. METHODS The study will be a multi-site randomized controlled trial with assessor blinding. Participants with confirmed previous COVID-19 infection and persistent respiratory symptoms who attend a post-COVID respiratory clinic will be randomized 1:1 to either an intervention group of 4 weeks, twice-weekly pulmonary telerehabilitation or a control group of usual medical care. Participants in the control group will be invited to cross-over into the intervention group after the week 4 assessment. Primary outcome: exercise capacity measured by the 1-minute sit-to-stand test. Secondary outcomes: 5 repetition sit-to-stand test; Montreal Cognitive Assessment; COVID-19 Yorkshire Rehabilitation Scale; Chronic Obstructive Pulmonary Disease Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; and the Kessler Psychological Distress Scale. Outcomes will be collected at baseline, after 4-weeks intervention or control period, after intervention in the cross-over group, and at 12-month follow-up. IMPACT Research into effective rehabilitation programs is crucial given the substantial morbidity associated with PCS and the lack of long-term data for COVID-19 recovery. A short-duration pulmonary telerehabilitation program, if effective compared with usual care, could inform practice guidelines and direct future clinical trials for the benefit of individuals with persistent respiratory symptoms post-COVID.
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Affiliation(s)
- Jack M Reeves
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Lissa M Spencer
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Ling-Ling Tsai
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Andrew J Baillie
- Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
- Allied Health Professorial Unit, Sydney Local Health District, Sydney, NSW, Australia
| | - Yuna Han
- Physiotherapy Department, Canterbury Hospital, Sydney, NSW, Australia
| | - Regina W M Leung
- Physiotherapy Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Respiratory Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Joshua A Bishop
- Physiotherapy Department, Balmain Hospital, Sydney, NSW, Australia
| | - Lauren K Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Alan K Y Teoh
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Matthew Peters
- Respiratory Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Carly Barton
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lynette Jones
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jennifer A Alison
- Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
- Allied Health Professorial Unit, Sydney Local Health District, Sydney, NSW, Australia
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Reed H, Thapar A, Riglin L, Collishaw S, Eaton CB. The unequal impacts of the COVID-19 pandemic on young adults' mental health. Predictors of vulnerability and resilience using longitudinal birth cohort data in the UK. J Adolesc 2024. [PMID: 39205604 DOI: 10.1002/jad.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/28/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Previous studies have demonstrated deteriorations in young adult mental health during the COVID-19 pandemic, but evidence suggests heterogeneity in the mental health impacts of the pandemic. We sought to identify factors which may predict changes in psychological distress and wellbeing during the COVID-19 pandemic in UK young adults. METHODS A total of 2607 young adults from the Millennium Cohort Study were included. Psychological distress and mental wellbeing were measured using the Kessler-6 and Short Warwick-Edinburgh Mental Wellbeing Scale, respectively. Assessment occurred at three timepoints between the ages of 17-19: 2018/19 (pre-COVID Baseline), May 2020 (COVID Wave 1) and September/October 2020 (COVID Wave 2). Latent change score models were used to study change in distress and wellbeing across the study period, as well as the impact of sex, relative family poverty, parental education, preexisting mental health difficulties and perceived social support on these changes. RESULTS The latent change score models suggested both distress and wellbeing tended to increase across the study period. Being female and in relative poverty predicted greater increases in distress and/or poorer wellbeing. Higher levels of parental education and greater perceived social support were protective against increased distress and associated with improved wellbeing. CONCLUSIONS The impact of the COVID-19 pandemic on UK young adult mental health is complex. We provide further evidence for a distinction between symptoms of poor mental health and wellbeing. Research is urgently needed to assess the long-term impacts of the COVID-19 pandemic on the mental health and wellbeing of young people, particularly in more vulnerable groups.
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Affiliation(s)
- Harriet Reed
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Ajay Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Stephan Collishaw
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Christopher B Eaton
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
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Jou J, Hicks A, Johnson PJ. Mental health and employment outcomes in working-age US adults, 2010-2019. Occup Med (Lond) 2024:kqae054. [PMID: 39058930 DOI: 10.1093/occmed/kqae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Individuals with severe mental illness experience greater unemployment and barriers to workforce re-entry. However, less is known about additional indicators of employment stability for individuals across mental illness severity. AIMS This study aims to examine associations between mental illness severity, use and adequacy of mental health treatment, and indicators of employment stability. METHODS In this repeated cross-sectional study, 2010-2019 data from the U.S. National Survey of Drug Use and Health were used to construct multivariate logistic regression models predicting the odds of part-time employment, past-year work interruption, number of past-year employers, and past-month health-related work absence by mental illness severity and adequacy of mental health treatment. RESULTS Compared to individuals with no mental illness, those with any and severe mental illness had significantly higher odds of part-time employment (adjusted odds ratios [AORs] = 1.51 and 2.16, 95% confidence intervals [CIs] 1.4-1.6 and 2.0-2.3), multiple past-year employers (AORs = 1.78 and 2.34, CIs 1.7-1.9 and 2.1-2.6), past-year work interruption (AORs = 1.69 and 2.20, CIs 1.6-1.8 and 2.1-2.4), and >7 days of past-month work absence (AORs = 2.51 and 3.82, CIs 2.3-2.8 and 3.3-4.5). Among respondents with mental illness, perceived inadequacy of mental treatment predicted higher odds of all adverse employment outcomes. CONCLUSIONS Compared to those with no mental illness, individuals with mental illness of any severity have higher odds of employment instability. Policy and programmatic support aimed at addressing the needs of individuals with mental illness, including access to adequate mental health treatment, are needed to facilitate continued, competitive employment.
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Affiliation(s)
- J Jou
- Department of Health Science, California State University-Long Beach, Long Beach, CA 90840, USA
| | - A Hicks
- Department of Public Health, North Dakota State University, Fargo, ND 58105, USA
| | - P J Johnson
- Department of Public Health, North Dakota State University, Fargo, ND 58105, USA
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Leonelli BR, Bean CAL, Hughes JW. Psychometric Properties and Factor Structure of the Multidimensional Behavioral Health Screen (MBHS) With a University Sample. Assessment 2024; 31:1148-1164. [PMID: 37887355 DOI: 10.1177/10731911231205547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The Multidimensional Behavioral Health Screen (MBHS) is a brief screening measure of behavioral health symptoms. Although the measure was first developed for primary care, it is likely to have clinical utility in other settings. This study examined the MBHS's factor structure and psychometric properties with a university undergraduate and graduate student sample (n = 602, 58.6% female, 75.9% White, primarily aged 20-24) during the COVID-19 pandemic. MBHS subscale scores demonstrated internal consistency reliability and both convergent and discriminant relations with external, criterion variables. Confirmatory factor analyses supported a 7-subscale factor structure of the MBHS and did not find evidence of higher order factors. Clinical and theoretical implications, as well as future research directions, are discussed.
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Toyoshima H, Yamamoto N, Komiya S. Letter to the editor: Gut feelings: associations of emotions and emotion regulation with the gut microbiome in women. Psychol Med 2024:1-2. [PMID: 38619307 DOI: 10.1017/s0033291724000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Hisao Toyoshima
- Pharmacy Management Institute, Graduate School of Business, Japan University of Economics, 25-17, Sakuragaoka-chou, Shibuya-ku, Tokyo 150-0031, Japan
| | - Norio Yamamoto
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Shinnosuke Komiya
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Obstetrics and Gynecology, Kansai Medical University Graduate School of Medicine, Shinmachi 2-5-1, Hirakata-shi, Osaka 573-1010, Japan
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Deitz AHH. Self-compassion, childhood emotional neglect, and posttraumatic growth: Parental well-being during COVID-19. J Affect Disord 2024; 350:504-512. [PMID: 38244798 DOI: 10.1016/j.jad.2024.01.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/28/2023] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND The CoronaVirus Disease 2019 (COVID-19) pandemic can be conceptualized as a trauma that created additional unique stressors for parents. Self-compassion might promote posttraumatic growth (PTG); however, parents with histories of childhood emotional neglect may struggle to practice self-compassion when their own affectional needs were unmet earlier in life, carrying implications for both parental and child well-being. The objective is to examine the relationship between childhood emotional neglect and pandemic-related PTG, and the moderating role of self-compassion. METHODS An online cross-sectional survey collected information from 436 parents (M = 37.62 years, SD = 9.31) across the U.S. on pandemic- and parenting-related stresses, childhood emotional neglect, self-compassionate behavior, psychological distress, and pandemic-related PTG. Multiple regression analyses were conducted to analyze relationships among childhood emotional neglect, self-compassionate behavior, and pandemic-related PTG. RESULTS Parents who reported greater frequency of self-compassionate behavior tended to report higher pandemic-related PTG. Childhood emotional neglect alone did not predict pandemic-related PTG; however, for parents who reported less frequent self-compassionate behavior, greater childhood emotional neglect predicted lower pandemic-related PTG. LIMITATIONS The cross-sectional design and sample homogeneity limit both causal inference and generalizability. Limitations in operationalization of PTG and self-compassion constructs are discussed. CONCLUSIONS Findings emphasize the utility of self-compassionate behavior in promoting pandemic-related PTG, especially for adults with histories of childhood emotional neglect. Self-compassion is a freely accessible practice that individuals can implement successfully with minimal instruction. In terms of clinical relevance, therapists may be able to identify points of intervention wherein self-compassion may stimulate pandemic-related PTG.
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Affiliation(s)
- Allison H H Deitz
- University of Maryland, Baltimore, School of Social Work, 525 W. Redwood Street, Baltimore, MD 21201, United States of America.
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Pontes HM, Rumpf HJ, Selak Š, Montag C. Investigating the interplay between gaming disorder and functional impairments in professional esports gaming. Sci Rep 2024; 14:6557. [PMID: 38503756 PMCID: PMC10951285 DOI: 10.1038/s41598-024-56358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
The relationship between Gaming Disorder (GD) and the experience of functional impairments has received considerable theoretical attention in the recent past and current diagnostic approaches underscore the centrality of functional impairments as a requirement for GD diagnosis. However, there is limited empirical evidence illuminating the interplay between GD and functional impairments, particularly among specific vulnerable groups. The present study seeks to bridge this gap by investigating an English-speaking sample (N = 5198) comprising an age- and gender-matched group of Professional Gamers (PG, n = 2599) and Non-Professional Gamers (NPG, n = 2599) sub-sampled from a larger sample of 192,260 individuals. The results revealed that PG were at a greater risk for GD compared to NPG as the prevalence rate of GD among PG (3.31%) was significantly higher and almost doubled that of NPG (1.73%), with PG further exhibiting higher overall GD symptom-load and weekly time spent gaming compared to NPG. Furthermore, PG reported experiencing significantly higher frequency of gaming-related functional impairments compared to NPG, with the in particular affected areas for both PG and NPG being 'school and/or work', 'physical health', and 'family', with other key differences emerging in relation to other outcomes. Overall, the present findings show that not only GD symptom-load but also some functional impairment is higher in PG compared to NPG which highlights the need to develop and support prevention and intervention strategies for this at-risk population.
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Affiliation(s)
- Halley M Pontes
- School of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Špela Selak
- National Institute of Public Health, Ljubljana, Slovenia
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstr. 8/1, 89081, Ulm, Germany.
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Viña SM. Diminished psychedelic returns on distress: Marital status and household size. PLoS One 2024; 19:e0293675. [PMID: 38451885 PMCID: PMC10919602 DOI: 10.1371/journal.pone.0293675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/18/2023] [Indexed: 03/09/2024] Open
Abstract
Although the use of psychedelics to impact health has seen growth, little research has tested the effects of culture conditions on the relationship. More specifically, how does marital status and family size affect the relationship between psychedelics and health? This study tests the relationship between Lifetime Classic Psychedelic Use (LCPU), marital status, and household size (number of people living in a household) on levels of psychological distress in the past 30 days. This project uses pooled data from the National Survey of Drug Use and Health (NSDUH) (2010 to 2018) (N = 674,521). The Final sample size is determined by the dependent variable, psychological distress in the past month (n = 158,633). The analysis includes a series of nested logistic regression models conducted in Stata 17. Results indicate that LCPU is independently associated with better health, but the association between LCPU and health varies across levels of household size. Larger households are associated with higher levels of distress, which are then exacerbated among psychedelics users. Furthermore, three-way interactions reveal that the negative association between household size and distress gets larger among psychedelic users who are married, divorced, and widowed. Overall, results suggest that household size negatively impacts the association between LCPU and health, with those who are married, divorced, and widowed experiencing the worst outcomes.
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Affiliation(s)
- Sean M. Viña
- Department of Sociology, The University of the Incarnate Word, San Antonio, Texas, United States of America
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Sherman ADF, Higgins MK, Balthazar MS, Hill M, Klepper M, Schneider JS, Adams D, Radix A, Mayer KH, Cooney EE, Poteat TC, Wirtz AL, Reisner SL. Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis. J Nurs Scholarsh 2024; 56:42-59. [PMID: 38228564 PMCID: PMC10792251 DOI: 10.1111/jnu.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring. DESIGN/METHODS Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress). RESULTS The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW. CONCLUSION Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts. CLINICAL RELEVANCE This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.
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Affiliation(s)
| | - Melinda K. Higgins
- Nell Hodson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Monique S. Balthazar
- Nell Hodson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Georgia State University Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, Georgia, USA
| | - Miranda Hill
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Jason S. Schneider
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dee Adams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Asa Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, New York, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Erin E. Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tonia C. Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrea L. Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Anderson AR, Holliday D. Mapping the associations of daily pain, sleep, and psychological distress in a U.S. sample. J Behav Med 2023; 46:973-985. [PMID: 37382795 DOI: 10.1007/s10865-023-00432-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
Chronic pain, sleep problems, and psychological distress (PD) can be disabling conditions and previous research has shown that they are associated. The nuances of the comorbid nature of these conditions may be important to understand for those who treat these conditions. This study examined the bidirectional associations of these health factors concurrently and over time in a sample of U.S. adults (N = 1,008, Mage = 57.68) from the Midlife in the United States (MIDUS) study. Participants reported on their daily pain, sleep quantity, and psychological distress over eight days. A modified Random Intercept Cross-lagged Panel Model was used to analyze the relations, starting with the whole sample and then a comparison of those with and without chronic pain. Results indicated that nightly variation in sleep quantity predicted next day psychological distress for both groups. Sleep quantity also predicted next-day pain, but only for individuals with chronic pain. Associations between pain and psychological distress were found both at the daily level and individual (between-person) level. This between-person association was stronger for those with chronic pain. The lagged associations between sleep, and both pain and psychological distress for the chronic pain group indicate that, increased quantity of sleep predicts decreased next-day pain and psychological distress. Providers could consider this unidirectional lagged relationship when prioritizing treatment for patients with these comorbid conditions. Future research may examine whether responsive, just-in-time treatments might intervene after participants wake from a poor night's sleep to counteract the negative effects of reduced sleep on PD and pain.
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Affiliation(s)
- Austen R Anderson
- School of Psychology, University of Southern Mississippi, 118 College Dr. #5025, Hattiesburg, MS, 39406, USA.
| | - Danielle Holliday
- School of Psychology, University of Southern Mississippi, 118 College Dr. #5025, Hattiesburg, MS, 39406, USA
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Gray J, Santos-Lozada AR, Hard G, Apsley H, O’Sullivan D, Jones AA. Serious Psychological Distress, Substance Use Disorders, and Social Issues Among Men and Women in the United States During the COVID-19 Pandemic. Am J Health Promot 2023; 37:933-939. [PMID: 37401052 PMCID: PMC10333561 DOI: 10.1177/08901171231188187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
PURPOSE This study assesses the association between SUD, economic hardship, gender, and related risk and protective factors on serious psychological distress (SPD) during the COVID-19 pandemic. DESIGN Quantitative cross-sectional design. SETTING National Survey on Drug Use and Health (NSDUH). SAMPLE Data were from the NSDUH (2020) N = 25,746, representing 238,677,123 US adults, who identified as 18 or older and either male or female. MEASURES SPD measured as scoring a 13 or more on the Kessler (K6) distress scale. SUDs were determined using DSM5 criteria. Sociodemographic and socioeconomic variables included in analyses. ANALYSIS Logistic regressions evaluated the association between gender, protective, and risk factors on SPD. RESULTS After controlling for sociodemographic and related factors of SPD, having a SUD was the strongest correlate of SPD. Other significant correlates of SPD included female gender and an income level at or below the federal poverty threshold. Gender stratified regressions illustrated that religiosity, self-identifying as Black, and high levels of education were protective against SPD for women but not men. Poverty level was more associated with SPD for women than men. CONCLUSION In the United States, individuals with SUDs were nearly four times more likely to report SPD than those without SUDs, controlling for economic hardship and markers of social support during 2020. Effective social interventions to reduce SPD among individuals with SUDs are needed.
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Affiliation(s)
- Joy Gray
- Department of Educational Psychology, Counseling, and Special Education College of Education, The Pennsylvania State University, University Park, PA, USA
| | - Alexis R. Santos-Lozada
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Greg Hard
- Simches Division of Child and Adolescent Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Hannah Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Deirdre O’Sullivan
- Department of Educational Psychology, Counseling, and Special Education College of Education, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA, USA
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA, USA
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Alshehri K, Wen M, Michaud T, Chen B, Li H, Qu J, Chen L, Li J, Zhang D, Li Y, Chen Z, Han X, Shi L, Su D. Experience of Racial Discrimination was Associated with Psychological Distress and Worsening Sex Life Among Adult Americans During COVID-19. JOURNAL OF SEX RESEARCH 2023:1-9. [PMID: 37307401 DOI: 10.1080/00224499.2023.2221673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The recent escalation of racism in the U.S. during the COVID-19 pandemic points to the importance of examining the association between experienced racism and sexual health. Based on data from a nationally representative survey conducted in the U.S. in October 2020 (n = 1,915), Chi-square tests and multivariable logistic regressions were estimated to examine the association between experience of racism and changes in sex life during the pandemic. We further performed a causal mediation analysis using the bootstrap technique to assess the mediating role of psychological distress in the observed association between the experience of racism and changes in sex life. Among the respondents, the proportions reporting better, worse, or no change in sex life were, respectively, 15%, 21%, and 64%. Experiencing racial discrimination during COVID-19 was significantly associated with worsening sex life (adjusted odd ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.04, 2.25). Respondents with experienced racism were also more likely to report psychological distress (AOR = 1.68; 95% CI = 1.09, 2.59). About one-third (32.66%) of the observed association between experienced racism and worsening sex life was mediated through psychological distress. Addressing racism and its association with psychological distress has the potential to improve sexual health and reduce related racial and ethnic disparities.
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Affiliation(s)
- Khalid Alshehri
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
| | - Ming Wen
- Department of Sociology, University of Utah
| | - Tzeyu Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston
| | - Hongmei Li
- Department of Media, Journalism and Film, Miami University
| | - Joshua Qu
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
| | - Liwei Chen
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society
| | - Lu Shi
- Department of Public Health Sciences, Clemson University
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center
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14
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Kaur N, Esie P, Finsaas MC, Mauro PM, Keyes KM. Trends in Racial-Ethnic Disparities in Adult Mental Health Treatment Use From 2005 to 2019. Psychiatr Serv 2023; 74:455-462. [PMID: 36321320 PMCID: PMC10151427 DOI: 10.1176/appi.ps.202100700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although U.S. mental health treatment rates increased in the 2000s, gaps in treatment among racial-ethnic groups grew. Little is known, however, about national trends after 2012, when treatment access increased overall. This study assessed trends in racial-ethnic disparities in past-year treatment rates among people with a major depressive episode, serious psychological distress, or serious mental illness. METHODS National Survey on Drug Use and Health (2005-2019) data of adults with a past-year major depressive episode (N=49,791) or serious psychological distress (N=89,233) and of adults with past-year serious mental illness (N=24,944; 2008-2019) were analyzed. Linear risk regressions were used to model trends in past-year use of mental health treatment and included an interaction term between survey year and race-ethnicity. RESULTS Treatment use prevalence (2005-2019) among marginalized individuals with a major depressive episode remained lower than that among White people. The magnitude of the disparity in treatment use between White and Hispanic people with major depressive episode decreased slightly (percentage-point difference=-25.1% to -14.9%), whereas the disparity in treatment use between White people and American Indian/Alaska Native people with serious mental illness increased significantly (percentage-point difference=23.4% to -12.2%), from 2005 to 2019. The magnitude of the disparities for other marginalized racial-ethnic groups did not meaningfully change. CONCLUSIONS Racial-ethnic disparities in past-year mental health treatment use have persisted. Efforts to reduce disparities should consider structural barriers that hinder treatment use among marginalized groups.
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Affiliation(s)
- Navdep Kaur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
| | - Precious Esie
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
| | - Megan C Finsaas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
| | - Pia M Mauro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City
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15
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Carter SR, Collins JC, Hu J, O’Reilly CL, Wheeler AJ, McMillan SS, El-Den S. Confirmatory Factor Analysis of the Kessler-6 Psychological Distress (K6) Scale in a Community Sample of People Living with Severe and Persistent Mental Illness: a Bifactor Model. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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16
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Grau PP, Sripada RK, Pietrzak RH, Ganoczy D, Harpaz-Rotem I. Treatment response trajectories in residential PTSD programs for veterans: A national cohort investigation. J Anxiety Disord 2022; 92:102645. [PMID: 36334317 DOI: 10.1016/j.janxdis.2022.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/05/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
Although improving residential PTSD care is a priority for the Department of Veterans Affairs, previous evaluations have been limited by a lack of systematic data collection across more than two timepoints. This study used recently available data to assess symptom trajectories in a large, national sample of veterans who engaged in residential PTSD treatment. Group-based trajectory analysis PROC TRAJ was used to identify PTSD residential treatment response in a national cohort of veterans (n = 10,832) and the subset of veterans (n = 6515) receiving evidence-based psychotherapy (EBP). PTSD symptoms were assessed at intake, discharge, and 4-month follow-up. Predictors of trajectory membership were estimated using multinomial models. For the full cohort, a three-group trajectory model provided the best fit with the following identified groups: "Severe/Stable" (51.8%), "Moderate/Rebound" (40.1%), and "Mild/Rebound" (8.1%). For the EBP sub-cohort, a three-group trajectory model was selected with the following groups: "Severe/Stable" (58.5%), "Moderate/Rebound" (34.1%), and "Mild/Rebound" (7.4%). Across all trajectories, psychological distress, pain severity, substance use, Iraq/Afghanistan combat era, non-White race, and treatment dropout were associated with poorer treatment response. In the EBP sub-cohort, homelessness and unemployment at the time of admission were also associated with poorer treatment outcomes to varying degrees. This study demonstrates that residential treatment for PTSD is associated with heterogeneous treatment trajectories which highlight the need to continue to explore and improve residential PTSD treatment outcomes. Our results underscore the importance of obtaining follow-up data and identifying ways to maintain therapeutic gains following discharge.
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Affiliation(s)
- Peter P Grau
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road, Bldg 16, Ann Arbor, MI 48109, United States; VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan Medical School, United States.
| | - Rebecca K Sripada
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan Medical School, United States; Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States
| | - Robert H Pietrzak
- Veterans Affairs National Center for PTSD, Veteran Affairs Connecticut Healthcare System, West Haven, CT, United States; Yale University, Department of Psychiatry, New Haven, CT, United States
| | - Dara Ganoczy
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States
| | - Ilan Harpaz-Rotem
- Veterans Affairs National Center for PTSD, Veteran Affairs Connecticut Healthcare System, West Haven, CT, United States; Yale University, Department of Psychiatry, New Haven, CT, United States; Veterans Affairs Northeast Program Evaluation Center, West Haven, CT, United States
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17
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Thimbriel R, Urkmez B, Lee B, Umucu E. COVID-19 stress, resilience, and job loss concerns in people with chronic conditions and disabilities. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: People experience higher levels of psychological distress during times of crisis, such as the current COVID-19 pandemic. Resilience is a psychological resource that helps people to recover from adverse events. OBJECTIVE: The purpose of this study was to determine the effects of resilience on COVID-19-related stress and worry about job loss in people with chronic conditions and disabilities (PwCID). METHODS: The Perceived Stress Questionnaire -8 (PSQ-8) and the Brief Resilience Scale were used to measure COVID-19-related stress and resilience, respectively. Demographics were also assessed. A two-step hierarchical regression and binary regression analyses were conducted. RESULTS: A moderate amount of perceived stress and resilience with mean scores of 2.45 (SD = 0.69; range 1-4) and 3.17 (SD = 0.98; range 1-5), respectively, were found among the 269 participants. Resilience (β=-0.44, p < 0.001) was significantly associated withCOVID-19-related stress after controlling for demographic variables. Results also revealed that those with higher resilience scores had lower probability to worry about job loss. CONCLUSION: PwCID who have higher scores on resilience reported lower levels of COVID-19-related stress. Resilience can be cultivated among PwCID for better psychological outcomes during times of crisis. Vocational rehabilitation counselors can implement strategies to improve resilience in PwCID.
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Affiliation(s)
- Roberta Thimbriel
- Interdisciplinary Health Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - Bilal Urkmez
- Department of Counseling and Higher Education, Ohio University, Athens, OH, USA
| | - Beatrice Lee
- Department of Rehabilitation Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, USA
| | - Emre Umucu
- Department of Rehabilitation Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, USA
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18
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De Jesús-Romero R, Wasil A, Lorenzo-Luaces L. Willingness to Use Internet-Based Versus Bibliotherapy Interventions in a Representative US Sample: Cross-sectional Survey Study. JMIR Form Res 2022; 6:e39508. [PMID: 36001373 PMCID: PMC9453577 DOI: 10.2196/39508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Self-help interventions have the potential to increase access to evidence-based mental health care. Self-help can be delivered via different formats, including print media or digital mental health interventions (DMHIs). However, we do not know which delivery format is more likely to result in higher engagement. Objective The aims of this study were to identify if there is a preference for engaging in print media versus DMHIs and whether there are individual differences in relative preferences. Methods Participants were 423 adults between the ages of 18 and 82 years (201/423, 47.5% female) recruited on Prolific as a nationally representative sample of the US population, including non-Hispanic White (293/423, 69.2%), non-Hispanic Black (52/423, 12%), Asian (31/423, 7%), Hispanic (25/423, 6%), and other individuals (22/423, 5%). We provided individuals with psychoeducation in different self-help formats and measured their willingness to use print media versus DMHIs. We also assessed participants’ demographics, personality, and perception of each format’s availability and helpfulness and used these to predict individual differences in the relative preferences. Results Participants reported being more willing to engage with print media than with DMHIs (B=0.41, SE 0.08; t422=4.91; P<.001; d=0.24, 95% CI 0.05-0.43). This preference appeared to be influenced by education level (B=0.22, SE 0.09; t413=2.41; P=.02; d=0.13, 95% CI –0.06 to 0.32), perceived helpfulness (B=0.78, SE 0.06; t411=13.66; P<.001; d=0.46, 95% CI 0.27-0.66), and perceived availability (B=0.20, SE 0.58; t411=3.25; P=.001; d=0.12, 95% CI 0.07-0.30) of the self-help format. Conclusions This study suggests an overall preference for print media over DMHIs. Future work should investigate whether receiving mental health treatment via participants’ preferred delivery format can lead to higher engagement.
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Affiliation(s)
- Robinson De Jesús-Romero
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Akash Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
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Barriers Associated with Access to Prescription Medications in Patients Diagnosed with Type 2 Diabetes Mellitus Treated at Federally Qualified Health Centers. PHARMACY 2022; 10:pharmacy10040079. [PMID: 35893717 PMCID: PMC9326716 DOI: 10.3390/pharmacy10040079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 12/10/2022] Open
Abstract
This study describes access to prescription medications and examines personal, financial, and structural barriers associated with access to prescription medications in patients with type 2 diabetes treated at Federally Qualified Health Centers. We used a cross-sectional design to analyze data retrieved from the 2014 Health Center Patient Survey. Adult participants who self-reported having type 2 diabetes were included in this study. Predictor variables were categorized into personal, financial, and structural barriers. Outcomes include being unable to get and delayed in getting prescription medications. Chi-square and multivariable regression models were conducted to examine associations between predictor and outcome variables. A total of 1097 participants with type 2 diabetes were included in analyses. Approximately 29% of participants were delayed, and 24% were unable to get medications. Multivariable regression results showed that personal barriers, such as federal poverty level, health status, and psychological distress were associated with being unable to get medications. Financial barriers including out-of-pocket medication cost and employment were associated with access to prescription medications. Type of health center funding program as a structural barrier was associated with access to medications. In conclusion, multi-level tailored strategies and policy changes are needed to address these barriers to improve access to prescription medications and health outcomes in underserved patient populations.
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