The COVID-19 Pandemic's Influence on Family Systems Therapists' Provision of Teletherapy.

The COVID-19 pandemic has altered life globally like no other event in modern history, and psychological service changes to meet the resultant impacts on families have not been assessed in the empirical literature. The purpose of the current study was to examine whether family systems therapists increased their teletherapy use during the pandemic relative to prepandemic usage, and whether projected postpandemic rates would remain at the same level; further, environmental and demographic predictors of these changes were examined. In May 2020, a sample of 626 family systems therapists (58.6% women, 40.6% men; M = 57.4 years old; M years in practice = 25.5) completed a national online study assessing these variables. Results suggested that family systems therapists performed 7.92% of their clinical work using teletherapy before the pandemic and 88.17% during the pandemic. They also projected that they would perform 36.57% of their clinical work using teletherapy after the pandemic. Teletherapy uptake was unrelated to primary practice setting, provider age, gender, race/ethnicity, and practice location (urban/suburban vs. rural) but was higher for family systems therapists who reported increased supportive teletherapy policies and training in their practice setting. Organizational infrastructure and availability of training played an important role in influencing teletherapy uptake during the pandemic. Family systems therapists have a unique opportunity to deploy teletherapy modalities to meet the needs of families during the COVID-19 pandemic, and infrastructure and training to do so may facilitate that work.

La pandemia de la COVID-19 ha alterado la vida a nivel mundial como ningún otro acontecimiento de la historia moderna, y los cambios en el servicio psicológico para atender los efectos resultantes en las familias no se han evaluado en las publicaciones empíricas. El propósito del presente estudio fue analizar si los terapeutas de sistemas familiares aumentaron el uso de la teleterapia durante la pandemia en comparación con el uso previo a la pandemia, y si los índices previstos para después de la pandemia se mantendrían al mismo nivel. Además, se analizaron los predictores ambientales y demográficos de estos cambios. En mayo de 2020, una muestra de 626 terapeutas de sistemas familiares (el 58.6 % mujeres, el 40.6 % hombres, edad promedio=57.4 años; promedio de años en ejercicio de la profesión= 25.5) completó un estudio nacional en línea que evaluaba estas variables. Los resultados sugirieron que los terapeutas de sistemas familiares realizaron el 7.92 % de su trabajo clínico usando teleterapia antes de la pandemia y el 88.17 % durante la pandemia. También pronosticaron que harían un 36.57 % de su trabajo clínico usando teleterapia después de la pandemia. La adopción de la teleterapia no estuvo relacionada con el ámbito de práctica principal, ni con la edad, el género, la raza o la etnia de los profesionales, ni tampoco con el lugar de práctica (urbano o suburbano frente a rural), pero fue mayor entre los terapeutas de sistemas familiares que informaron un aumento de las políticas de apoyo de la teleterapia y de la capacitación en su ámbito de práctica. La infraestructura organizacional y la disponibilidad de capacitación jugaron un papel importante a la hora de influir en la adopción de la teleterapia durante la pandemia. Los terapeutas de sistemas familiares tienen una oportunidad única de implementar modalidades de teleterapia para atender las necesidades de las familias durante la pandemia de la COVID-19, y la infraestructura y la capacitación para hacerlo pueden facilitar ese trabajo.

Resilience, coping, and distress among healthcare service personnel during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has a detrimental effect on the health and well-being of health care workers (HCWs). The extent to which HCWs may differ in their experience of depression and anxiety is unclear, and longitudinal studies are lacking. The present study examined theorized differences in distress between resilient and non-resilient HCWs over time, as reported in a national online survey. We also examined possible differences in distress as a function of sex and doctoral-level status. METHODS: A national sample responded to an online survey data that included the study measures. Of the HCWs who responded, 666 had useable data at the two time points. A longitudinal structural equation model tested an a priori model that specified the relationship of a resilient personality prototype to self-reported resilience, coping, depression and anxiety at both measurement occasions. Additional invariance models examined possible differences by sex and doctoral-level status. RESULTS: The final model explained 46.4% of the variance in psychological distress at Time 1 and 69.1% at Time 2. A non-resilient personality prototype predicted greater depression and anxiety. A resilient personality prototype was predictive of and operated through self-reported resilience and less disengaged coping to effect lower distress. No effects were found for active coping, however. The final model was generally invariant by sex and HCWs status. Additional analyses revealed that non-doctoral level HCWs had significantly higher depression and anxiety than doctoral-level HCWs on both occasions. CONCLUSIONS: HCWs differ in their susceptibility to distress imposed by COVID-19. Those who are particularly vulnerable may have characteristics that contribute to a lower sense of confidence and efficacy in stressful situations, and more likely to rely on ineffective, disengaged coping behaviors that can exacerbate stress levels. Individual interventions and institutional policies may be implemented to support HCWs at risk.

Telemental health training and delivery in primary care: A case report of interdisciplinary treatment.

Telehealth can overcome access and availability barriers that often impede receiving needed mental health services. This case report describes an interdisciplinary approach to treatment for an individual with chronic physical health conditions and comorbid mental health concerns, which resulted in high utilization (and associated costs) of preventable emergency services. The report describes clinical case progression on anxiety symptoms and emergency service utilization while concurrently highlighting telehealth-specific practice implications, especially as they pertain to training settings.

Impact of a new distal attachment on colonoscopy performance in an academic screening center.

BACKGROUND AND AIMS: Distal attachments placed on the colonoscope tip may positively affect performance by assisting insertion and polyp detection. The original Endocuff (ARC Medical Design, Leeds, United Kingdom) appears to improve adenoma detection rate (ADR), but no data assess the performance of the second-generation Endocuff Vision. METHODS: A pilot service evaluation study (April 2013 to September 2014) was conducted on patients with positive fecal occult blood tests within the National Bowel Cancer Programme during 3 consecutive periods: precuff/no device used, during-cuff/device used, and postcuff/no device used. During the middle period the use of the Endocuff Vision by the 4 screening-accredited colonoscopists was discretional (nonrandomized design). Data were analyzed using pairwise comparisons during the 3 designated periods to examine key performance indicators: adenoma detection, procedural time, sedation requirements, and patient comfort. RESULTS: Four hundred ten complete colonoscopies were performed (137 precuff, 136 cuff, and 137 postcuff period). Overall, there was a notable increase in the mean ADR of 16% (P < .03) and in the mean number adenoma per procedure (MAP) of 83% (P = .007) from precuff to cuff period. The mean cecal intubation time was statistically lower during the cuff period (7 minutes) in relation to the precuff period (8 minutes; reduction of 12.5%, P = .002) and the postcuff period (9 minutes; increase of 28.6%, P = .002). The mean negative colonoscopy withdrawal time was also significantly lower during the cuff period (8 minutes, 30 seconds) when compared with the precuff (12 minutes) or postcuff period (9 minutes, 45 seconds; P ≤ .001). Multivariate regression analysis showed that the use of the Endocuff Vision was not associated with sedation requirements or patient discomfort scores. No adverse events were reported from the use of the Endocuff Vision, although it was electively removed in 6 patients where severe sigmoid colon diverticulosis was encountered and 2 patients because of discomfort during anal insertion. CONCLUSIONS: In this pilot service evaluation study, the use of the Endocuff Vision appears to be associated with an improvement in overall colonoscopy operator performance. We found increased ADR and MAP as well as decreased time for colonoscope insertion and withdrawal time with no increase in sedation requirements or patient discomfort.

Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps.

BACKGROUND: Delayed bleeding is the most common significant complication after piecemeal endoscopic mucosal resection (p-EMR) of large nonpedunculated colorectal polyps (NPCPs). Risk factors for delayed bleeding are incompletely defined. We aimed to determine risk factors for delayed bleeding following p-EMR. METHODS: Data were analyzed from a prospective tertiary center audit of patients with NPCPs ≥ 20 mm who underwent p-EMR between 2010 and 2012. Patient, polyp, and procedure-related data were collected. Four post p-EMR defect factors were evaluated for interobserver agreement and included in analysis. Delayed bleeding severity was reported in accordance with guidelines. Predictors of bleeding were identified. RESULTS: Delayed bleeding requiring hospitalization occurred after 22 of 330 procedures (6.7 %). A total of 11 patients required blood transfusion; of these, 4 underwent urgent colonoscopy, 1 underwent radiological embolization, and 1 required surgery. Interobserver agreement for identification of the four post p-EMR defect factors was moderate (kappa range 0.52 - 0.57). Factors associated with delayed bleeding were visible muscle fibers (P = 0.03) and the presence of a "cherry red spot" (P = 0.05) in the post p-EMR defect. Factors not associated with delayed bleeding were American Association of Anesthesiologists class, aspirin use, polyp size, site, and use of argon plasma coagulation. CONCLUSIONS: Visible muscle fibers and the presence of a "cherry red spot" in the resection defect were associated with delayed bleeding after p-EMR. These findings suggest evaluation and photodocumentation of the post p-EMR defect is important and, when considered alongside other patient and procedural factors, may help to reduce the incidence and severity of delayed bleeding.

Resilience and Traumatic Brain Injury Among Iraq/Afghanistan War Veterans: Differential Patterns of Adjustment and Quality of Life.

OBJECTIVE: We examined the degree to which a resilient personality prototype predicted adjustment among war Veterans with and without a traumatic brain injury (TBI) while covarying the level of combat exposure. METHOD: A total of 127 war Veterans (107 men, 20 women; average age = 37 years) participated. Personality prototypes were derived from the Multidimensional Personality Questionnaire (Patrick, Curtain, & Tellegen, 2002). Measures were administered at baseline, and a subset was administered at 4- and 8-month follow-ups. RESULTS: Veterans with resilient personalities reported less sleep disturbance, more health-promoting behaviors, psychological flexibility, and emotional distress tolerance than Veterans with undercontrolled or overcontrolled prototypes. Path models revealed that resilience significantly predicted posttraumatic stress disorder (PTSD), depression, quality of life, and social support over time. TBI had unique and consistent effects only on PTSD. CONCLUSION: Personality characteristics influence distress and quality of life among war Veterans with and without TBI. Implications for assessment, interventions, and research are discussed.

Compartment-specific immunity in the human gut: properties and functions of dendritic cells in the colon versus the ileum.

OBJECTIVE: Dendritic cells (DC) mediate intestinal immune tolerance. Despite striking differences between the colon and the ileum both in function and bacterial load, few studies distinguish between properties of immune cells in these compartments. Furthermore, information of gut DC in humans is scarce. We aimed to characterise human colonic versus ileal DC. DESIGN: Human DC from paired colonic and ileal samples were characterised by flow cytometry, electron microscopy or used to stimulate T cell responses in a mixed leucocyte reaction. RESULTS: A lower proportion of colonic DC produced pro-inflammatory cytokines (tumour necrosis factor-α and interleukin (IL)-1ß) compared with their ileal counterparts and exhibited an enhanced ability to generate CD4(+)FoxP3(+)IL-10(+) (regulatory) T cells. There were enhanced proportions of CD103(+)Sirpα(-) DC in the colon, with increased proportions of CD103(+)Sirpα(+) DC in the ileum. A greater proportion of colonic DC subsets analysed expressed the lymph-node-homing marker CCR7, alongside enhanced endocytic capacity, which was most striking in CD103(+)Sirpα(+) DC. Expression of the inhibitory receptor ILT3 was enhanced on colonic DC. Interestingly, endocytic capacity was associated with CD103(+) DC, in particular CD103(+)Sirpα(+) DC. However, expression of ILT3 was associated with CD103(-) DC. Colonic and ileal DC differentially expressed skin-homing marker CCR4 and small-bowel-homing marker CCR9, respectively, and this corresponded to their ability to imprint these homing markers on T cells. CONCLUSIONS: The regulatory properties of colonic DC may represent an evolutionary adaptation to the greater bacterial load in the colon. The colon and the ileum should be regarded as separate entities, each comprising DC with distinct roles in mucosal immunity and imprinting.

Resilience, Pain Interference, and Upper Limb Loss: Testing the Mediating Effects of Positive Emotion and Activity Restriction on Distress.

OBJECTIVE: To test mediating effects of positive emotion and activity restriction on the associations of resilience and pain interference with distress reported by individuals with traumatic upper limb loss evaluated for prosthetics. DESIGN: Cross-sectional correlational study of several demographic and self-report measures of resilience, pain interference, activity restriction, positive emotions, and symptoms of depression and posttraumatic stress. SETTING: Six regional centers throughout the United States. PARTICIPANTS: A total of 263 prospective participants consented to be evaluated for eligibility and need for upper extremity prosthetics; participants (N=202; 57 women [28.2%] and 145 men [71.8%]; mean age, 41.81±14.83y; range, 18.01-72.95y) who sustained traumatic injuries were retained in this study. Most of them were identified as white (70.8%; n=143), followed by black (10.4%; n=21), Hispanic (9.9%; n=20), Asian (3.0%; n=6), other (1.5%; n=3), and missing (4.5%; n=9). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Primary Care Posttraumatic Stress Disorder Screen and depression screen. RESULTS: Resilience and pain interference were significantly correlated in predicted directions with positive emotions, activity restriction, and the 2 distress variables. A path model revealed that the associations of resilience and pain interference with both distress variables were completely mediated by positive emotions and activity restriction. There were no significant direct effects of resilience or pain interference on either distress variable. CONCLUSIONS: Resilience may facilitate adjustment via beneficial and predicted associations with positive emotions and active engagement with the environment. These relations are independent of the significant and inverse associations of pain interference with these same variables. Longitudinal research is needed to understand interactions between positive emotions and activity over time in promoting adjustment after traumatic limb loss. Individuals reporting depression and/or posttraumatic stress disorder symptoms may require interventions that reduce avoidance and promote activities that may increase the likelihood of experiencing positive emotions.

Trajectories of Life Satisfaction Over the First 10 Years After Traumatic Brain Injury: Race, Gender, and Functional Ability.

OBJECTIVE: This study investigated the influence of race, gender, functional ability, and an array of preinjury, injury-related, and sociodemographic variables on life satisfaction trajectories over 10 years following moderate to severe traumatic brain injury (TBI). SETTING/PARTICIPANTS: A sample of 3157 individuals with TBI from the TBI Model Systems database was included in this study. DESIGN: Hierarchical linear modeling (HLM) analyses were conducted to examine the trajectories of life satisfaction. MAIN MEASURES: The Functional Independence Measure, Glasgow Coma Scale, and the Satisfaction With Life Scale were utilized. RESULTS: Initial models suggested that life satisfaction trajectories increased over the 10-year period and Asian/Pacific Islander participants experienced an increase in life satisfaction over time. In a comprehensive model, time was no longer a significant predictor of increased life satisfaction. Black race, however, was associated with lower life satisfaction, and significant interactions revealed that black participants' life satisfaction trajectory decreased over time while white participants' trajectory increased over the same time period. Life satisfaction trajectories did not significantly differ by gender, and greater motor and cognitive functioning were associated with increasingly positive life satisfaction trajectories over the 10 years. CONCLUSION: Individuals with more functional impairments are at risk for decreases in life satisfaction over time. Further research is needed to identify the mechanisms and factors that contribute to the lower levels of life satisfaction observed among black individuals post-TBI. This work is needed to determine strategic ways to promote optimal adjustment for these individuals.

Lamina propria macrophage phenotypes in relation to Escherichia coli in Crohn's disease.

BACKGROUND: Abnormal handling of E. coli by lamina propria (LP) macrophages may contribute to Crohn's disease (CD) pathogenesis. We aimed to determine LP macrophage phenotypes in CD, ulcerative colitis (UC) and healthy controls (HC), and in CD, to compare macrophage phenotypes according to E. coli carriage. METHODS: Mucosal biopsies were taken from 35 patients with CD, 9 with UC and 18 HCs. Laser capture microdissection was used to isolate E. coli-laden and unladen LP macrophages from ileal or colonic biopsies. From these macrophages, mRNA was extracted and cytokine and activation marker expression measured using RT-qPCR. RESULTS: E. coli-laden LP macrophages were identified commonly in mucosal biopsies from CD patients (25/35, 71 %), rarely in UC (1/9, 11 %) and not at all in healthy controls (0/18). LP macrophage cytokine mRNA expression was greater in CD and UC than healthy controls. In CD, E. coli-laden macrophages expressed high IL-10 & CD163 and lower TNFα, IL-23 & iNOS irrespective of macroscopic inflammation. In inflamed tissue, E. coli-unladen macrophages expressed high TNFα, IL-23 & iNOS and lower IL-10 & CD163. In uninflamed tissue, unladen macrophages had low cytokine mRNA expression, closer to that of healthy controls. CONCLUSION: In CD, intra-macrophage E. coli are commonly found and LP macrophages express characteristic cytokine mRNA profiles according to E. coli carriage. Persistence of E. coli within LP macrophages may provide a stimulus for chronic inflammation.

Parallel processing modeling in longitudinal designs: An example predicting trajectories of distress and life satisfaction.

PURPOSE: Parallel process modeling (PPM) can be used to analyze co-occurring relationships between health and psychological variables over time. A demonstration is provided using data obtained from the British Household Panel Survey (years 2005, 2006, 2007, and 2008), examining predictors of ongoing changes in their distress and life satisfaction of a subsample from the survey. RESEARCH METHOD: In the 2005 survey, data were available from 7,970 participants based on the following demographic variables: gender, age, ever registered as disabled, and ever experienced any strokes (before or at 2005). Time-varying variables included distress and life satisfaction collected yearly from 2005 to 2008. Time-invariant variables included age (65 or older), gender, disability condition, and stroke survivor status. RESULTS: Steps of fitting the PPM are presented. Four distinct distress trajectory groups-chronic, recovery, delayed, and resilient-were identified from the PPM estimates. Resilient and recovery groups showed a positive trend in life satisfaction. The delayed distress and chronic groups had a slight decrease in satisfaction. The time-invariant covariates only significantly predicted baseline levels of distress and satisfaction (i.e., their intercepts). CONCLUSIONS: PPM is a relatively simple and powerful tool for simultaneously studying relations between multiple processes. A step-by-step approach on decomposing the significant predictive relation from the change of distress to the change of satisfaction is presented. Properly decomposing any significant growth factor regressed on another growth factor is necessary to fully comprehend the intricate relationships within the results. Practical implications and additional methodological information about fitting PPM are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Fatigue and Altered Cognition Scale among SARS-CoV-2 Survivors: Psychometric Properties and Item Correlations with Depression and Anxiety Symptoms.

Background/Objectives: This study examined the psychometric properties of the Fatigue and Altered Cognition Scale (FACs) among adult COVID-19 survivors and its unique ability to assess symptomology not accounted for by measures of depression and anxiety. Methods: COVID-19 survivors completed an online survey that included the FACs, a measure of brain fog and central fatigue with 20 items rated on a digital-analog scale. Useable data from 559 participants were analyzed to test the two-factor structure of the FACs, test for measurement invariance by sex and device was used to complete the survey (hand-held, computer), and item correlations with symptoms of depression and anxiety were examined. Results: The two-factor structure of the FACs replicated, supporting the separate assessments of brain fog and fatigue, χ2(164) = 1028.363, p < 0.001, CFI = 0.934, TLI = 0.923, RMSEA = 0.097, SRMR = 0.053. The FACs exhibited invariance at the scalar level, indicating item and factor integrity regardless of sex and device type. Using a correlation > 0.70 as a criterion (i.e., indicating more than 50% shared variance between two items), items on the FACs (assessing fatigue and lack of energy) were highly correlated with feeling tired or having little energy on the depression measure. No other items correlated with any anxiety symptom larger than 0.70. Conclusions: The FACs appears to be a psychometrically sound and efficient measure for use with COVID-19 survivors, assessing symptoms of brain fog and central fatigue that are not attributable to symptoms assessed by established measures of depression and anxiety.

Prevalence of fatigue and cognitive impairment after traumatic brain injury.

BACKGROUND: Following traumatic brain injury (TBI) some patients develop lingering comorbid symptoms of fatigue and cognitive impairment. The mild cognitive impairment self-reported by patients is often not detected with neurocognitive tests making it difficult to determine how common and severe these symptoms are in individuals with a history of TBI. This study was conducted to determine the relative prevalence of fatigue and cognitive impairment in individuals with a history of TBI. METHODS: The Fatigue and Altered Cognition Scale (FACs) digital questionnaire was used to assess self-reported fatigue and cognitive impairment. Adults aged 18-70 were digitally recruited for the online anonymous study. Eligible participants provided online consent, demographic data, information about lifetime TBI history, and completed the 20 item FACs questionnaire. RESULTS: A total of 519 qualifying participants completed the online digital study which included 204 participants with a history of TBI of varied cause and severity and 315 with no history of TBI. FACs Total Score was significantly higher in the TBI group (57.7 ± 22.2) compared to non-TBI (39.5 ± 23.9; p<0.0001) indicating more fatigue and cognitive impairment. When stratified by TBI severity, FACs score was significantly higher for all severity including mild (53.9 ± 21.9, p<0.0001), moderate (54.8 ± 24.4, p<0.0001), and severe (59.7 ± 20.9, p<0.0001) TBI. Correlation analysis indicated that more severe TBI was associated with greater symptom severity (p<0.0001, r = 0.3165). Ancillary analysis also suggested that FACs scores may be elevated in participants with prior COVID-19 infection but no history of TBI. CONCLUSIONS: Adults with a history of even mild TBI report significantly greater fatigue and cognitive impairment than those with no history of TBI, and symptoms are more profound with greater TBI severity.

Predictors of health-related quality-of-life following traumatic brain injury.

PRIMARY OBJECTIVE: To examine the predictive associations of family satisfaction, functional impairment, pain, and depression on health-related quality-of-life (HRQoL) among persons with traumatic brain injury (TBI) through structural equation modelling (SEM). RESEARCH DESIGN: Participants were part of a larger longitudinal study of adjustment following TBI. Direct and indirect effects of predictor variables on HRQoL were analyzed through SEM. METHODS AND PROCEDURES: The sample included 131 participants with TBI (89 men, 42 women) who had been discharged from an acute care hospital. The Sickness Impact Profile was administered to measure HRQoL at or beyond 24 months post-discharge. Predictor variable measures included the Functional Independence Measure, Family Satisfaction Scale and single items assessing the presence of pain and depression. MAIN OUTCOMES AND RESULTS: SEM revealed direct effects of functional impairment (p < 0.001), family satisfaction (p < 0.01), depression (p < 0.05) and pain (p < 0.01) on HRQoL. Indirect effects from functional impairment (p < 0.05) and pain (p < 0.05) to HRQoL through depression were also present. CONCLUSIONS: The presence of pain and depression, greater functional impairment and lower family satisfaction were predictively associated with lower HRQoL. Depression further mediated the effects of pain and functional impairment on HRQoL. The present study advances understanding of the ways in which pain, depression and functional impairment predict HRQoL.

Assessing depression in rural communities.

OBJECTIVES: Examined the severity of depressive symptoms and the rates of probable depression assessed by different instruments that were included in two separate surveys of residents in a predominately rural region of the United States. METHOD: Surveys of the Brazos Valley region in south central Texas were conducted and responses to the short form of the Center for Epidemiological Studies-Depression scale (in the 2006 survey) and the Patient Health Questionnaire-9 (in the 2010 survey) were analyzed. RESULTS: Regardless of instrument used, results indicate that women and African Americans are at greater risk for depression in this underserved region, but no unique effects were found for rural residency. IMPLICATIONS: Implications for research, assessment, program planning, and policy are discussed.

Resilience and distress among young adults with chronic health conditions: A longitudinal study.

OBJECTIVES: To test the beneficial associations of a resilient personality prototype among emerging adults with chronic health conditions (CHC) over an 8-year period. DESIGN: Longitudinal, prospective observation study. METHODS: Data obtained from emerging adults in the Add Health project with a CHC and completed study measures at two time points (286 men, 459 women) were examined. Cluster analysis was used to identify a resilient personality prototype at the first time point, as defined in the Block model of personality. Differences between those with a resilient and non-resilient prototype were examined. A structural equation model (SEM) tested the association of a resilience prototype with positive affect, perceived control and family relationships in predicting distress over time. RESULTS: A resilient personality profile was identified (n = 256). These individuals reported higher positive affect, greater perceived control and less distress at both measurement occasions than those without this profile (n = 489). Women reported more distress than men. SEM revealed the relationship of a resilient prototype to distress was explained by its beneficial association with positive affect and perceived control at the first assessment, and through its beneficial association with perceived control 8 years later. Gender independently predicted distress. CONCLUSIONS: A resilient personality prototype appears to operate through its beneficial association with perceived control to prospectively predict distress reported by emerging adults with CHC. The self-regulatory properties theoretically associated with a resilient personality prototype may function through perceptions of control which, in turn, prevent prolonged experiences of distress. Clinical implications are considered.

Resilience and well-being among persons with spinal cord injury/disorders.

PURPOSE: We examined positive behavioral resources and characteristics that might distinguish resilient personality prototypes among persons with chronic spinal cord injury/disorder (SCID). Positive psychology variables with clear linkages to existing psychological interventions were examined as potential mediators of the resilience-well-being relationship. Research Method and Design: A cross-sectional, self-report study was conducted. Two hundred and ninety-eight consenting members of the Paralyzed Veterans of America (268 male; 236 self-identified as white) provided useable survey data for analysis (including 161 veterans with tetraplegia, 107 with paraplegia, 30 with cauda equina). Cluster analysis of Big Five personality traits identified resilient and nonresilient personality profiles. Tests of mean differences between resilient and nonresilient participants on behavioral resources and characteristics were performed. Path models predicting well-being and health-related quality of life (HRQL) were conducted. RESULTS: One hundred and sixty-three respondents had resilient personality profiles and 135 had nonresilient profiles. Resilient individuals reported significantly more optimal scores on every positive psychology variable, and greater well-being and HRQL than nonresilient respondents. Path models found the relationship of resilience to well-being was explained through its beneficial associations with psychological flexibility, use of personal strengths, meaning in life (MIL), and gratitude. Psychological flexibility also mediated the resilience-HRQL relationship. Cauda equina was significantly associated with higher pain interference and lower HRQL. CONCLUSIONS: Higher gratitude, MIL, use of personal strengths, and psychological flexibility appear to characterize resilience and well-being among persons with chronic SCID. Further studies are needed to understand the impact of pain interference on HRQL among individuals with cauda equina. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Efficient assessment of brain fog and fatigue: Development of the Fatigue and Altered Cognition Scale (FACs).

Debilitating symptoms of fatigue and accompanying "brain fog" are observed among patients with various chronic health conditions. Unfortunately, an efficient and psychometrically sound instrument to assess these co-occurring symptoms is unavailable. Here, we report the development and initial psychometric properties of the Fatigue and Altered Cognition Scale (the FACs), a measure of self-reported central fatigue and brain fog. Traumatic brain injury (TBI) was chosen to model and develop the FACs due to research team expertise and established links between TBI and the symptom complex. Potential items were generated by researchers and clinicians with experience treating these symptoms, drawing from relevant literature and review of patient responses to measures from past and current TBI studies. The 20 candidate items for the FACs-ten each to assess altered cognition (i.e., brain fog) and central fatigue-were formatted on an electronic visual analogue response scale (eVAS) via an online survey. Demographic information and history of TBI were obtained. A total of 519 participants consented and provided usable data (average age = 40.23 years; 73% female), 204 of whom self-reported a history of TBI (75% reported mild TBI). Internal consistency and reliability values were calculated. Confirmatory factor analysis (CFA) examined the presumed two-factor structure of the FACs and a one-factor solution for comparison. A measurement invariance test of the two latent constructs (altered cognition, fatigue) among participants with and without TBI was conducted. All items demonstrated normal distribution. Cronbach's alpha coefficients indicated good internal consistency for both factors (α's = .95). Omega reliability values were favorable (α's = .95). CFA supported the presumed two-factor model and item loadings which outperformed the one-factor model. Measurement invariance found the two-factor structure was consistent between the two groups. Implications of these findings, study limitations, and potential use of the FACs in clinical research and practice are discussed.