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BACKGROUND: For decades, parental self-efficacy (PSE), or parents' belief in their ability to influence their child in a healthy and success-promoting manner, has been understood as a key factor in promoting healthy functioning for parents and their children. In that time, an extensive collection of research examining the specific impact of PSE on parents and their children has developed. However, to the authors' knowledge, no comprehensive and systematic review of the outcomes linked to this factor exists, and the two most closely related non-systematic reviews were published over 10 years ago. METHODS: Therefore, by utilizing an iteratively optimized set of search terms applied across four databases, the current review sought to systematically collect, synthesize, and present the extant literature concerning the role of PSE in parent and child well-being. RESULTS: This search strategy yielded a total of 115 studies, the results of which were organized into three broad thematic categories relating to: the parent and child relationship, parental mental health, or child development. CONCLUSIONS: These results recapitulate the clinical relevance of PSE, and provide an updated and comprehensive understanding of both the role PSE plays in the welfare of parents and children, as well as the gaps in the literature as it currently stands.
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Proteção da Criança/psicologia , Poder Familiar/psicologia , Pais/psicologia , Autoeficácia , Criança , Desenvolvimento Infantil , Filho de Pais com Deficiência/psicologia , Humanos , Saúde Mental , Relações Pais-Filho , PsicometriaRESUMO
Healthy eating is key to successful management of type 2 diabetes (T2D). As discussed in this narrative review, there are strong indications that spousal support is an important element affecting dietary adherence in T2D. To provide a synthesized review of this evidence, Google Scholar and PubMed were searched, 28 relevant studies were selected, and the results were narratively summarized. A framework for information synthesis was developed which categorized results into three major themes: how gender roles and spousal dynamics function in spousal support for dietary adherence, the role of race and ethnicity in the influence of spousal support on dietary adherence, and the extant interventional work specifically targeting spousal support for T2D. The reviewed studies indicate that gender role performance is the principal factor in the relationship between spousal support and dietary adherence in T2D, though race and ethnicity also contribute. Despite this evidence, interventions that specifically target spousal support to improve dietary adherence in T2D have had limited efficacy. A better understanding of the relationship between spousal support and dietary adherence, as well as a subsequent utilization of this information to create targeted and effective interventions, would be of great benefit to the field of diabetes management.
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Diabetes Mellitus Tipo 2/dietoterapia , Dieta com Restrição de Carboidratos , Cooperação do Paciente , Apoio Social , Cônjuges , Identidade de Gênero , Humanos , Fatores SocioeconômicosRESUMO
OBJECTIVE: Despite the clear benefits of physical activity and related behaviors on prognosis, most patients experiencing an acute coronary syndrome (ACS) remain nonadherent to these behaviors. Deficits in positive psychological constructs (e.g., optimism) are linked to reduced participation in health behaviors, supporting the potential utility of a positive psychology (PP)-based intervention in post-ACS patients. Accordingly, we aimed to identify optimal components of a PP-based intervention to promote post-ACS physical activity. METHODS: As part of a multiphase optimization strategy, we completed a randomized factorial trial with eight conditions in 128 post-ACS patients to efficiently identify best-performing intervention components. All participants received a PP-based intervention, with conditions varying in duration (presence/absence of booster sessions), intensity (weekly/daily PP exercises), and content (PP alone or combined with motivational interviewing), allowing three concurrent comparisons within the trial. The study aims included assessments of the overall feasibility, acceptability, and impact of the intervention, along with the primary aim of determining which components were associated with objectively measured physical activity and self-reported health behavior adherence at 16 weeks, assessed using longitudinal models. RESULTS: The intervention was well accepted and associated with substantial improvements in behavioral and psychological outcomes. Booster sessions were associated with greater activity to a nearly significant degree (ß = 8.58, 95% confidence interval = -0.49-17.65, effect size difference = .43, p = .064), motivational interviewing was associated with overall adherence (ß = 0.95, 95% confidence interval = 0.02-1.87, effect size difference = .39, p = .044), and weekly exercise completion was generally superior to daily. CONCLUSIONS: These findings will enable optimization of the PP-based intervention in preparation for a well-powered controlled trial. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT02754895.
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Síndrome Coronariana Aguda/reabilitação , Terapia Cognitivo-Comportamental/métodos , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Síndrome Coronariana Aguda/psicologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Most mid-life adults have at least one chronic medical condition (CMC) and are at risk for developing additional CMCs. Stressors specific to this life stage may contribute to CMC development by hindering healthy behaviors. The goal of this study was to compare sources and intensity of distress, as they relate to health behaviors, between mid-life and non-mid-life adults with CMCs. We utilized a mixed-methods approach by analyzing quantitative self-report measures of psychiatric symptoms and psychological well-being, with in-depth, semi-structured qualitative interviews to identify sources of stress in three cohorts of patients with CMCs (heart failure, type 2 diabetes, and coronary artery disease). Between-group differences on self-report measures were compared via independent samples t-tests and relevant themes from interview transcripts were compared via chi-square analysis. We found that mid-life participants (n = 30) reported greater psychological distress (depression/anxiety) than non-mid-life (n = 62) participants (Hospital Anxiety and Depression Scale scores 13.8 [SD 7.3] vs. 10.6 [SD 6.6]; t(90)=2.13; p = .035), and qualitative analysis revealed several specific sources of stress significantly more common (p < .001) in mid-life adults. Interventions targeting the needs of this population could reduce distress, improve health behaviors, and have a major impact on public health.
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Ansiedade/psicologia , Doença da Artéria Coronariana/psicologia , Depressão/psicologia , Diabetes Mellitus Tipo 2/psicologia , Comportamentos Relacionados com a Saúde , Insuficiência Cardíaca/psicologia , Estresse Psicológico/psicologia , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , AutorrelatoRESUMO
BACKGROUND: Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers. METHODS: We reviewed prior published work on (1) the appropriate medical workup of the acute presentation of chest pain, (2) the relevant medical and psychiatric differential diagnosis for chest pain determined to be non-cardiac in origin, (3) the management of related conditions in psychosomatic medicine, and (4) management strategies for patients with NCCP. RESULTS: We identified key differential diagnostic and therapeutic considerations for psychosomatic medicine providers in 3 different clinical contexts: acute care in the emergency department, inpatient C-L psychiatry, and outpatient C-L psychiatry. We also identified several gaps in the literature surrounding the short-term and long-term management of NCCP in patients with psychiatric etiologies or co-morbid psychiatric conditions. CONCLUSIONS: Though some approaches to the care of patients with NCCP have been developed, more work is needed to determine the most effective management techniques for this unique and high-morbidity population.
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Dor no Peito/diagnóstico , Encaminhamento e Consulta , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Dor no Peito/etiologia , Dor no Peito/psicologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/diagnóstico , Diagnóstico Diferencial , Humanos , Transtorno de Pânico/complicações , Transtorno de Pânico/diagnóstico , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/diagnósticoRESUMO
BACKGROUND: Positive psychological constructs, such as optimism, are associated with greater participation in cardiac health behaviors and improved cardiac outcomes. Positive psychology interventions, which target psychological well-being, may represent a promising approach to improving health behaviors in high-risk cardiac patients. However, no study has assessed whether a positive psychology intervention can promote physical activity following an acute coronary syndrome. OBJECTIVE: In this article we will describe the methods of a novel factorial design study to aid the development of a positive psychology-based intervention for acute coronary syndrome patients and aim to provide preliminary feasibility data on study implementation. METHODS: The Positive Emotions after Acute Coronary Events III study is an optimization study (planned N = 128), subsumed within a larger multiphase optimization strategy iterative treatment development project. The goal of Positive Emotions after Acute Coronary Events III is to identify the ideal components of a positive psychology-based intervention to improve post-acute coronary syndrome physical activity. Using a 2 × 2 × 2 factorial design, Positive Emotions after Acute Coronary Events III aims to: (1) evaluate the relative merits of using positive psychology exercises alone or combined with motivational interviewing, (2) assess whether weekly or daily positive psychology exercise completion is optimal, and (3) determine the utility of booster sessions. The study's primary outcome measure is moderate-to-vigorous physical activity at 16 weeks, measured via accelerometer. Secondary outcome measures include psychological, functional, and adherence-related behavioral outcomes, along with metrics of feasibility and acceptability. For the primary study outcome, we will use a mixed-effects model with a random intercept (to account for repeated measures) to assess the main effects of each component (inclusion of motivational interviewing in the exercises, duration of the intervention, and inclusion of booster sessions) from a full factorial model controlling for baseline activity. Similar analyses will be performed on self-report measures and objectively-measured medication adherence over 16 weeks. We hypothesize that the combined positive psychology and motivational interviewing intervention, weekly exercises, and booster sessions will be associated with superior physical activity. RESULTS: Thus far, 78 participants have enrolled, with 72% of all possible exercises fully completed by participants. CONCLUSION: The Positive Emotions after Acute Coronary Events III study will help to determine the optimal content, intensity, and duration of a positive psychology intervention in post-acute coronary syndrome patients prior to testing in a randomized trial. This study is novel in its use of a factorial design within the multiphase optimization strategy framework to optimize a behavioral intervention and the use of a positive psychology intervention to promote physical activity in high-risk cardiac patients.
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Síndrome Coronariana Aguda/reabilitação , Emoções , Comportamentos Relacionados com a Saúde , Saúde Mental , Entrevista Motivacional , Otimismo , Síndrome Coronariana Aguda/psicologia , Estudos de Viabilidade , Humanos , Avaliação de Resultados em Cuidados de Saúde , Projetos de Pesquisa , TelefoneRESUMO
BACKGROUND: Although socio-environmental factors are known to contribute to the maintenance of smoking behavior, few studies have examined the impact of family functioning on smoking during pregnancy. OBJECTIVE: The current study examined the relationship between perceptions of family functioning and smoking during pregnancy. METHODS: Pregnant women (N = 345, 59% ethnic/racial minority) completed the Family Assessment Device, a gold-standard assessment examining perceptions of family functioning in seven domains. Multinomial logistic regressions analyzed associations between clinically determined suboptimal levels of family functioning by domain and smoking status during pregnancy (smoking, ≥28 continuous days quit, nonsmoking), with stratified analyses exploring ethnic/racial differences (non-Hispanic/White vs. racial/ethnic minority). RESULTS: Participants who reported suboptimal levels of family functioning in domains of Affective Involvement, Affective Responsiveness, Behavioral Control, and Roles were significantly more likely to have been smoking than nonsmoking during pregnancy. Stratified analyses revealed differing effects by ethnic/racial identity, with perceptions of Roles remaining the only significant effect on smoking outcomes for both groups. No significant effects were found regarding the impact of family functioning on whether participants were smoking vs. quit during pregnancy. CONCLUSIONS: Suboptimal family functioning may contribute to smoking during pregnancy, but effects may differ based on domain of family functioning and by ethnic/racial identity.
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PROBLEM: Existing quantitative data is conflicting concerning whether multiparous birthing parents (individuals with an older child(ren)) experience an easier postpartum transition compared to primiparous birthing parents (first time parents). AIM: This convergent mixed methods study leverages the depth of qualitative inquiry to seek a clearer understanding of the way in which acquired parenting experience contributes to observed quantitative differences in outcomes between parity groups. This work can serve as a first step in planning for supportive interventions that effectively address the postpartum needs of both parity groups. METHODS: Thirty birthing parents (43.3% multiparous; 46.7% racial minorities) completed measures of postpartum functioning, perceived stress, anxiety symptoms, and depression symptoms as well as an interview inquiring about factors impacting postpartum functioning. Scores on postpartum functioning and emotional wellbeing were compared between parity groups, and these findings were merged with the qualitative data on firsthand parenting experience to clarify how acquired experience impacts functioning and emotional wellbeing during the postpartum transition. FINDINGS: Primiparous parents reported significantly: worse postpartum functioning, higher perceived stress, higher levels of depression symptoms, and higher levels of anxiety symptoms. Participants' qualitative report of how acquired parenting experience impacts wellbeing suggests that experience grants parents skills, knowledge, and the opportunity to disconfirm maladaptive cognitions about parenting which allows for increased comfort and confidence in the parental role. CONCLUSIONS: The practical and psychological resources gained from acquiring parenting experience during one's first postpartum period appear to be brought forward into subsequent pregnancies and protect against threats to functioning and emotional wellbeing.
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Paridade , Pesquisa Qualitativa , Humanos , Feminino , Adulto , Gravidez , Inquéritos e Questionários , Poder Familiar/psicologia , Período Pós-Parto/psicologia , Pais/psicologiaRESUMO
Objectives: Hundreds of trials have evaluated Mindfulness-Based Stress Reduction (MBSR), but in the United States, it is generally not covered by health insurance. Consequently, the aims were to identify the following: (1) key questions to make decisions about if, how, and when MBSR should be covered by health insurance; (2a) barriers and (2b) facilitators to understand and resolve for MBSR to be covered by health insurance; and (3) highest priority evidence needed to inform health insurance coverage decisions. Methods: Key informants (n = 26) included health insurers, healthcare administrators, policymakers, clinicians, MBSR instructors, and MBSR students. An initial pool of items related to the study aims was generated through qualitative interviews. Through the Delphi process, participants rated, discussed, and re-rated each item's relevance. Items were required to reach a consensus of ≥ 80% agreement to be retained for final inclusion. Results: Of the original 149 items, 42 (28.2%) met the ≥ 80% agreement criterion and were retained for final inclusion. The most highly rated items informing whether MBSR should be covered by health insurance included research demonstrating that MBSR works and that it is not harmful. The most highly rated barriers to coverage were that MBSR is not a medical treatment and patient barriers to attendance. Highly rated facilitators included the potential of MBSR to address common mental health and psychosomatic problems. Finally, understanding what conditions are effectively treated with MBSR and the impact of MBSR on stress were rated as the highest priority evidence needed to inform health insurance coverage decisions. Conclusions: Findings highlight priorities for future research and policy efforts to advance health insurance coverage of MBSR in the United States. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-024-02366-x.
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BACKGROUND: Food insecurity is common in the United States, especially in Rhode Island, where it affects up to 33% of residents. Food insecurity is associated with adverse health outcomes and disproportionally affects people from minoritized backgrounds. Produce prescription programs, in which healthcare providers write "prescriptions" for free or reduced cost vegetables, have been used to address food insecurity and diet-related chronic disease. Although there is growing evidence for the effectiveness of produce prescription programs in improving food security and diet quality, there have been few efforts to use implementation science methods to improve the adoption of these programs. METHODS: This two-phase pilot study will examine determinants and preliminary implementation and effectiveness outcomes for an existing produce prescription program. The existing program is funded by an Accountable Care Organization in Rhode Island and delivered in primary care practices. For the first phase, we conducted a formative evaluation, guided by the Consolidated Framework for Implementation Research 2.0, to assess barriers, facilitators, and existing implementation strategies for the produce prescription program. Responses from the formative evaluation were analyzed using a rapid qualitative analytic approach to yield a summary of existing barriers and facilitators. In the second phase, we presented our formative evaluation findings to a community advisory board consisting of primary care staff, Accountable Care Organization staff, and staff who source and deliver the vegetables. The community advisory board used this information to identify and refine a set of implementation strategies to support the adoption of the program via an implementation blueprint. Guided by the implementation blueprint, we will conduct a single-arm pilot study to assess implementation antecedents (i.e., feasibility, acceptability, appropriateness, implementation climate, implementation readiness), implementation outcomes (i.e., adoption), and preliminary program effectiveness (i.e., food and nutrition security). The first phase is complete, and the second phase is ongoing. DISCUSSION: This study will advance the existing literature on produce prescription programs by formally assessing implementation determinants and developing a tailored set of implementation strategies to address identified barriers. Results from this study will inform a future fully powered hybrid type 3 study that will use the tailored implementation strategies and assess implementation and effectiveness outcomes for a produce prescription program. TRIAL REGISTRATION: Clinical trials: NCT05941403 , Registered June 9, 2023.
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During the postpartum period, a birth parent's level of functioning (ability to perform the activities and roles required to maintain wellbeing) is critical in determining the health of parents and their infants. However, existing approaches to support postpartum parents are insufficient, especially in the United States, and these individuals face barriers to care. The utilization of internet-based intervention may be an effective solution allowing access to resources for this population. In this study, we developed a patient-centered online tool to bolster postpartum functioning, and collected data on the feasibility, acceptability, and initial impact of this tool on functioning and emotional wellbeing. Data collection took place between February and June 2021 from a sample of 124 individuals who were within the first ten months postpartum and living in the US. Results suggest that the tool is acceptable, though there are barriers to feasibility of use. Additionally, pilot-efficacy data suggest that this tool may be effective in improving postpartum emotional wellbeing, though further controlled testing is warranted. A future iteration of the tool that incorporates participant feedback to improve feasibility of use could prove an effective means of delivering support to an at-risk population.
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ABSTRACT.Objective: Noncardiac chest pain is common and can cause distress, impair quality of life, and lead to recurrent evaluation. It is often multifactorial in etiology and influenced by psychological factors. The objective of this study was to describe the development, implementation, and preliminary feasibility of an 8-week multicomponent care management intervention.Methods: Participants with noncardiac chest pain were recruited from primary care clinics, ambulatory cardiac stress testing, and the emergency department (ED) at an urban academic hospital from March 2019 to November 2019. The care management team consisted of a nurse, cardiologist, and psychiatrist. Following a 1-time consultation visit with the cardiologist and nurse, evaluation and treatment recommendations were conveyed to the participant's primary care physician. The nurse completed 8 weekly phone calls with the participant to provide support, introduce therapeutic principles, and assist with care coordination under the supervision of a psychiatrist. Intervention feasibility was assessed on 7 domains. To examine preliminary efficacy, the number of ED visits was recorded, and participants completed pre-post measures of psychological health and health-related quality of life and Likert scales of chest pain symptom severity, frequency, and impact.Results: The intervention was developed and implemented in 3 patients who completed 100% of the consultation visits and a mean of 95.8% of study phone calls. There were no adverse events or ED visits. Mean scores for chest pain severity, chest pain frequency, chest pain impact, depression, anxiety, and somatization all improved. No other trends were observed.Conclusions: The findings suggest that a care management intervention may be feasible with potential to improve chest pain symptoms and psychological outcomes. A larger, randomized trial is needed to explore the efficacy of this intervention.Trial Registration: ClinicalTrials.gov identifier: NCT04904198.
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Dor no Peito , Qualidade de Vida , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/terapia , Serviço Hospitalar de Emergência , Estudos de Viabilidade , Humanos , TelefoneRESUMO
During the first twelve months postpartum, infants require intensive care and mothers are susceptible to physical and mental health concerns as they undergo a period of tremendous psychological and physiological adjustment. The mother's level of postpartum functioning not only impacts her experience as a mother but also the infant and family unit. However, efforts to bolster functioning are lacking, and previous literature has identified a gap between what experts recommend and what mothers desire during the postpartum period. To address this, we conducted structured interviews with a diverse sample of 30 postpartum mothers to identify factors that mothers report are most influential to their postpartum functioning. In total, we identified 23 clinically actionable factors, all of which are backed by existing literature. In addition to an in-depth presentation of the qualitative findings, we also present a heat map to visualize the relevance of these factors to each of seven established domains of maternal functioning. Lastly, based on our findings, we offer a taxonomy of interventional strategies that could bolster maternal functioning during this critical period.
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Saúde Mental , Mães , Período Pós-Parto , Criança , Feminino , Humanos , Lactente , Masculino , Período Pós-Parto/psicologia , Gravidez , Estados UnidosRESUMO
LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:⢠Identify the relationships between depression, anxiety, and heart failure (HF).⢠Assess methods for accurately diagnosing depression and anxiety disorders in patients with HF.⢠Evaluate current evidence for treatment of anxiety and depression in patients with HF. BACKGROUND: In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes such as reduced adherence to treatment, poor function, increased hospitalizations, and elevated mortality. Despite the adverse impact of these disorders, anxiety and depression remain underdiagnosed and undertreated in HF patients. METHODS: We performed a targeted literature review to (1) identify associations between depression, anxiety, and HF, (2) examine mechanisms mediating relationships between these conditions and medical outcomes, (3) identify methods for accurately diagnosing depression and anxiety disorders in HF, and (4) review current evidence for treatments of these conditions in this population. RESULTS: Both depression and anxiety disorders are associated with the development and progression of HF, including increased rates of mortality, likely mediated through both physiologic and behavioral mechanisms. Given the overlap between cardiac and psychiatric symptoms, accurately diagnosing depression or anxiety disorders in HF patients can be challenging. Adherence to formal diagnostic criteria and utilization of a clinical interview are the best courses of action in the evaluation process. There is limited evidence for the efficacy of pharmacologic and psychotherapy in patients with HF. However, cognitive-behavioral therapy has been shown to improve mental health outcomes in patients with HF, and selective serotonin reuptake inhibitors appear safe in this cohort. CONCLUSIONS: Depression and anxiety disorders in HF patients are common, underrecognized, and linked to adverse outcomes. Further research to improve detection and develop effective treatments for these disorders in HF patients is badly needed.
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Transtornos de Ansiedade , Comorbidade , Transtorno Depressivo , Insuficiência Cardíaca , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/psicologia , HumanosRESUMO
OBJECTIVE: Dropout from health behavior interventions in patients with heart disease is a major clinical issue that can impact recovery and prognosis. Positive psychology (PP)-based treatments have the potential to promote health behaviors, but predictors of PP intervention completion have not been examined in persons with heart disease. METHODS: Among 128 patients receiving a phone-based PP intervention to promote physical activity among acute coronary syndrome (ACS) patients, numerous baseline sociodemographic, medical, and psychological variables, along with self-reported pre/post improvements in happiness and optimism (on 0-10 Likert scales) associated with an initial PP exercise, were examined as potential predictors of intervention completion. Logistic and linear regression analyses were used to assess relationships between these predictors and (a) intervention completion (at least 4 of 8 sessions completed) and (b) number of total sessions completed. RESULTS: No patient characteristic was associated with greater likelihood of completing the PP intervention. However, immediate pre-post change in optimism following the initial exercise was associated with intervention completion (odds ratioâ¯=â¯1.98; 95% confidence interval: 1.28-3.05; pâ¯=â¯.002; mean post-exercise increase in optimism 0.79 [SD 1.52] in completers vs. mean optimism decrease of 0.59 [SD 1.42] in non-completers). CONCLUSIONS: Pre-post change in optimism with a single PP activity predicted completion of an 8-week PP-based health behavior intervention in post-ACS patients. This information could be used clinically by having potential enrollees complete a single PP activity to assess intervention fit.