Health insurance, perceived threat, and posttraumatic stress after suspected acute coronary syndrome

OBJECTIVE

Threat perceptions during evaluation for acute coronary syndrome (ACS) in the emergency department (ED) predict posttraumatic stress symptoms (PSS). It is unknown how health insurance status affects threat perceptions. We tested whether lacking health insurance is associated with higher threat perceptions and PSS in patients with suspected ACS in the ED and whether threat perceptions mediate associations between lack of health insurance and subsequent PSS.

METHOD

Patients in the Columbia University Irving Medical Center ED with suspected ACS enrolled in an observational cohort study of psychological and cardiovascular outcomes. A multivariable linear regression model tested health insurance status as the predictor of ED threat perceptions and PSS 1-month posthospitalization, adjusting for age, gender, education, Charlson Comorbidity Index, and Global Registry of Acute Coronary Events risk score. A bootstrapped mediation model tested health insurance status as the predictor, PSS 1-month posthospitalization as the outcome, and ED threat perceptions as the mediator, with the same covariates.

RESULTS

Of 1,741 patients with suspected ACS in the ED (Mage = 61.01 years, SD = 13.27; 47.1% women), a plurality identified as "Other" race (36.1%), Black (23.9%), and White (22.4%), and 10.3% of patients were uninsured. Lack of health insurance was associated with greater threat perceptions, b = -0.16, 95% CI [-0.26, -0.06], p = .002. Threat perceptions mediated the association between lack of health insurance and higher 1-month PSS, indirect effect = -1.04, 95% CI [-1.98, -0.17].

CONCLUSIONS

Lacking health insurance may heighten threat perceptions during ACS evaluation, which may put patients at risk of developing PSS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The contribution of small life events to the psychological distress of married and widowed older women

The contribution of small life events to the prediction of general psychological distress was examined for 50 married and 21 recently widowed older women. These two groups were contrasted as having or not having experienced an uncontrollable major life stressor (i.e., the recent death of a spouse). Negative small life events (i.e., daily hassles) contributed above and beyond general demographic factors; conjugal bereavement status; social support; other, non-conjugal bereavement, major life events; and the interaction of these life events and social support in the prediction of general psychological distress. Results support assessing negative small life events as well as major life events for both married and recently widowed older women.

Locus of control perceptions among conjugally bereaved older adults: a pilot study

While Locus of Control is typically operationalized as a single dispositional trait that generalizes across settings, it has also been conceptualized as two weakly related factors; Domain-Specific State Locus of Control and a generalized Trait Locus of Control. Malleability of these two factors was tested for recently widowed older adults in self-help support groups (n = 17) and a waiting-list control condition (n = 6). Domain-Specific State Locus of Control-Desire for Control subscale increased over the course of the three-week six-session intervention for support group participants. These group participants also showed decreased psychological distress from pre to post intervention. The change in Domain-Specific State Locus of Control-Desire for Control did not relate to this reduction in distress. As expected, Trait Locus of Control remained stable with greater Trait Internality related to less psychological symptomatology.

The psychopathy checklist--screening version: an examination of criteria and subcriteria in three forensic samples

The development and refinement of psychopathy represent a critical issue in clinical and forensic practice. During the last decade, important advances in the operationalization of psychopathy were achieved, primarily through the development of the Psychopathy Checklist (PCL) and its subsequent versions (PCL-R and PCL:SV). PCL ratings are based primarily on item descriptions or subcriteria. The current study serves to break new ground as the first systematic investigation of PCL:SV subcriteria by addressing their psychometric properties and exploring their construct and criterion-related validation. Previously unanalyzed data from three samples were integrated: female offenders, male forensic patients, and male adolescent offenders. Results largely support the use of subcriteria as homogeneous components of criteria and provide strong initial evidence of their construct validity. Results are less conclusive regarding criterion-related validity. For female offenders, they suggested the potential value of specific PCL:SV subcriteria for predicting verbal aggression. Confirmatory factor analysis provided encouraging results on the applicability of the standard two-factor model of psychopathy. However, a first-order principal axis factoring suggested further refinements in our understanding of psychopathy.