Voices of Fathers During Pregnancy: The MGH Prenatal Care Obstetrics Fatherhood Study Methods and Results.

INTRODUCTION: Despite the growing recognition of father's importance for early family health and well-being, there has been very limited attention to men's own experiences and developmental needs antenatally, and specifically during their partner's prenatal care (PNC) visits. This study explores the feasibility of capturing men's own voices; documents their antenatal experiences and needs; assesses their treatment by Obstetric staff; and enquires about additional paternal information and skills desired and how best to provide them. METHODS: All fathers accompanying their partners to PNC services during two weeks at Massachusetts General Hospital were invited to fill out an anonymous, 15-min, two-part, iPad survey. RESULTS: 430 fathers participated (85% of men approached). Fathers expressed high levels of joy and involvement with approaching fatherhood; but 55% also expressed substantial levels of stress, 26% acknowledged depressive symptoms, and 42% reported limited social support for becoming fathers. Substantial men's health needs were noted: 75% were overweight (including 24% obese); 36% lacked an annual physical; and 22% had unplanned pregnancies. Most men (85%) desired additional fathering skills. Fathers perceived being very positively treated by the Obstetric staff, though 33% were never asked any direct questions. Most fathers (68%) expressed a desire or openness for additional parenting information, across a wide range of reproductive health topics, and were very enthusiastic about antenatal fatherhood initiatives. CONCLUSION: PNC sites provide a valuable locus for ascertaining men's/fathers' voices and could be enhanced to address their extensive antenatal needs and foster earlier paternal involvement to improve infant, family, and men's own health.

Neural predictors of successful brief psychodynamic psychotherapy for persistent depression.

BACKGROUND: Psychodynamic psychotherapy has been used to treat depression for more than a century. However, not all patients respond equally well, and there are few reliable predictors of treatment outcome. METHODS: We used resting (18)F-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) scans immediately before and after a structured, open trial of brief psychodynamic psychotherapy (n = 16) in conjunction with therapy process ratings and clinical outcome measures to identify neural correlates of treatment response. RESULTS: Pretreatment glucose metabolism within the right posterior insula correlated with depression severity. Reductions in depression scores correlated with a pre- to posttreatment reduction in right insular metabolism, which in turn correlated with higher objective measures of patient insight obtained from videotaped therapy sessions. Pretreatment metabolism in the right precuneus was significantly higher in patients who completed treatment and correlated with psychological mindedness. CONCLUSIONS: Resting brain metabolism predicted both clinical course and relevant psychotherapeutic process during short-term psychodynamic psychotherapy for depression.

Obsessive and compulsive symptoms in a national sample of older people: prevalence, comorbidity, and associations with cognitive function.

OBJECTIVES: To describe the prevalence of obsessive and compulsive symptoms in a national community sample of older adults, their comorbidity with mental disorders, and associations with cognitive impairment. DESIGN: A secondary analysis of data from a national survey. SETTING: The 2000 British National Psychiatric Morbidity Survey. PARTICIPANTS: Primary analyses focused on 2,007 60- to 74-year-old community residents; secondary analyses compared these with 6,573 younger survey participants age 16-59 years. MEASUREMENTS: Obsessive and compulsive symptoms and mental disorders, including International Classification of Diseases, Tenth Revision (ICD-10) obsessive-compulsive disorder, were ascertained from the revised Clinical Interview Schedule and cognitive function from the modified Telephone Interview for Cognitive Status (global function, immediate and delayed word recall), verbal fluency (animal naming), and National Adult Reading Test (estimated verbal IQ). Health-related quality of life (SF12) was measured in addition to subjective impact. RESULTS: One-month prevalences of obsessive and compulsive symptoms and obsessive-compulsive disorder were 4.7%, 2.2%, and 0.4%, respectively (compared with 5.9%, 3.2%, and 0.8% in younger participants). High levels of comorbidity were found. Obsessive and compulsive symptoms were described as distressing by 67.8% and 70.2%, respectively, and both were associated with worse mental health-related quality of life. Obsessive symptoms were associated with lower verbal IQ and also with lower verbal fluency, which was not accounted for by education or estimated verbal IQ. CONCLUSIONS: Obsessions and compulsions had significant prevalence in this national older population. Consistent with previous reports, relative impairment in executive function (verbal fluency) was found in people reporting these symptoms.

Simulated-Scenario and Peer-Mentorship Curriculum to Train Prehospital Providers in the Practice of Mass Gathering Medicine.

OBJECTIVE: A mass gathering medicine training program was established for a 7,200-seat arena. The objectives of this study were to describe the program schema and determine its impact in preparing novice emergency medical technicians (EMTs) to manage the difficulties of large-venue emergency medical services (EMS). METHODS: Optional, anonymous surveys were administered to EMTs. Novice EMTs were assessed pre-/post-program implementation, and both novice and experienced EMTs completed self-reported Likert scales. Data were analyzed with nonparametric methods. RESULTS: A total of 43/56 responses (response rate = 76.8%) were received. Only 37.2% of providers felt prepared to work mass gatherings before the training, and 60.5% stated that their previous education did not prepare them for large-venue challenges. After the training program, novice EMTs were significantly associated with increased knowledge of large-venue EMS procedures (P = 0.0170), higher proficiency using extrication equipment (P = 0.0248), increased patient care skills (P = 0.0438), and both increased confidence working events (P = 0.0002) and better teamwork during patient encounters (P = 0.0001). The majority of EMTs reported the program as beneficial. CONCLUSION: Upon hire, EMS providers felt unprepared to work large-venue EMS. The analyses demonstrated that this training program improved select large-venue emergency skills for prehospital providers and may fill a gap in the education system regarding mass gathering medicine.

COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future.

The COVID-19 pandemic has dramatically transformed the U.S. healthcare landscape. Within psychiatry, a sudden relaxing of insurance and regulatory barriers during the month of March 2020 enabled clinicians practicing in a wide range of settings to quickly adopt virtual care in order to provide critical ongoing mental health supports to both existing and new patients struggling with the pandemic's impact. In this article, we briefly review the extensive literature supporting the effectiveness of telepsychiatry relative to in-person mental health care, and describe how payment and regulatory challenges were the primary barriers preventing more widespread adoption of this treatment modality prior to COVID-19. We then review key changes that were implemented at the federal, state, professional, and insurance levels over a one-month period that helped usher in an unprecedented transformation in psychiatric care delivery, from mostly in-person to mostly virtual. Early quality improvement data regarding virtual visit volumes and clinical insights from our outpatient psychiatry department located within a large, urban, tertiary care academic medical center reflect both the opportunities and challenges of virtual care for patients and providers. Notable benefits have included robust clinical volumes despite social distancing mandates, reduced logistical barrieres to care for many patients, and decreased no-show rates. Finally, we provide clinical suggestions for optimizing telepsychiatry based on our experience, make a call for advocacy to continue the reduced insurance and regulatory restrictions affecting telepsychiatry even once this public health crisis has passed, and pose research questions that can help guide optimal utilization of telepsychiatry as mainstay or adjunct of outpatient psychiatric treatment now and in the future.

Engaging Fathers in Early Obesity Prevention During the First 1,000 Days: Policy, Systems, and Environmental Change Strategies.

OBJECTIVE: Fathers are critical stakeholders in childhood obesity prevention but are difficult to engage. This review presents a new approach to engaging fathers in obesity prevention during the first 1,000 days. METHODS: The review focuses on five existing health and social service programs, including prenatal care, pediatric care, the Special Supplemental Nutrition Program for Women, Infants, and Children, home visiting, and Early Head Start. For each program, the obesity prevention services provided, evidence of father engagement, and barriers thereto are outlined. Subsequently, policy, systems, and environmental strategies are outlined to address the noted barriers and promote father engagement. RESULTS: Although the programs hold great promise in bringing obesity prevention services to fathers, barriers to their engagement are present in the inner (e.g., limited hours of operation, lack of father-specific materials and programming) and outer (e.g., lack of model programs, best practice models, and consistent funding) settings of programs. Policy, systems, and environmental strategies to increase father engagement focus on earmarked funding, changes to national practice guidelines and practitioner training requirements, and the establishment of father-engagement performance metrics. CONCLUSIONS: Increasing father involvement in the specified programs will likely increase their engagement in early obesity prevention in an efficient and sustainable manner.

Beyond brand names of psychotherapy: Identifying empirically supported change processes.

There is considerable debate about which empirical research methods best advance clinical outcomes in psychotherapy. The prevailing tendency has been to test treatment packages using randomized, controlled clinical trials. Recently, focus has shifted to considering how studying the process of change in naturalistic treatments can be a useful complement to controlled trials. Clinicians self-identifying as psychodynamic treated 17 panic disorder patients in naturalistic psychotherapy for an average of 21 sessions. Patients achieved statistically significant reductions in symptoms across all domains. Rates of remission and clinically significant change as well as effect sizes were commensurate with those of empirically supported therapies for panic disorder. Treatment gains were maintained at 6-month follow-up. Intensive analysis of the process of the treatments revealed that integrative elements characterized the treatments: Adherence to cognitive-behavioral process was most characteristic, adherence to interpersonal and psychodynamic process, however, was most predictive of positive outcome. Specific process predictors of outcome were identified using the Psychotherapy Process Q-Set. These findings demonstrate how process research can be used to empirically validate change processes in naturalistic treatments as opposed to treatment packages in controlled trials. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The role of the couch in psychoanalysis: proposed research designs and some preliminary data.

Ever since Freud, the couch has been viewed as an important--some would argue essential--component of psychoanalysis. Although many theoretical papers and case reports have addressed the use of the couch in psychoanalysis, no empirical study has investigated its effect on psychoanalytic process or outcome. After a review of the literature, a number of research designs are proposed that might be used in such an investigation. Finally, preliminary empirical data are presented from archived audiotapes of two psychoanalyses: one in which the patient switched from lying down to sitting up, and one in which the opposite occurred. The aim is to stimulate research-oriented psychoanalysts to undertake empirical investigations of the theoretical concepts underlying use of the couch and, more generally, to present a specific example of research as a paradigm for a broader research agenda for empirical investigation of the key theoretical ideas underlying psychoanalysis.