Testing the added value of self-reported health and well-being in understanding healthcare utilization and costs.

PURPOSE: We investigated the relationship between measures of self-reported health and well-being and concurrent and prospective healthcare utilization and costs to assess the added value of these self-reported measures in understanding utilization and cost. METHODS: Kaiser Permanente members (N = 6752) completed a 9-item survey measuring life evaluation, financial situation, social support, meaning and purpose, physical health, and mental health. Responses were linked to medical record information during the period 12 months before and after the survey. RESULTS: Correlations between health and well-being measures and healthcare utilization and cost variables were generally weak, with stronger correlations for future life evaluation and selected health measures (ρ = .20-.33, ps < .001). Better overall life evaluation had a significant but weak association with lower total cost and hospital days in the following year after controlling for age, sex, and race/ethnicity (p < .001). Full multivariate models, adjusting for age, sex, race/ethnicity, prior utilization, and relative risk models, showed weak associations between health and well-being measures and following year total healthcare cost and utilization, though the associations were relatively stronger for the health variables than the well-being variables. CONCLUSION: Overall, the health and well-being variables added little to no predictive utility for future utilization and cost beyond prior utilization and cost and the inclusion of predictive models based on clinical information. Perceptions of well-being may be associated with factors beyond healthcare utilization. When information about prior use is unavailable, self-reported health items have some predictive utility.

From writing tasks to a public service announcement: Experimentally assessing savoring as a means of increasing help-seeking for depression.

RATIONALE: Prior studies that used positive emotion infusions (PEIs) to increase help-seeking for depression found initial support for the approach (Siegel & Thomson, 2016; Straszewski & Siegel, 2018, 2020). However, as people with depression experience negative biases that may be maximized when self-relevance is high (Clark et al., 1999), a potential way to maximize the effect of the PEI approach may be to reduce self-focus. OBJECTIVE: We used two preregistered studies (US; 2/19/19 to 9/25/19) to identify the strongest version of a savoring writing task for the current context (Study 1) and test it in the form of a savoring-public service announcement (Study 2; S-PSA). METHODS: Study 1 (N = 1308) compared five savoring writing tasks that varied in self-focus to a control writing task: vicarious, self-distanced, relational, combination, and personal savoring. Study 2 (N = 1238) compared a relational S-PSA to a comparison PSA and a basic control video on help-seeking attitudes, intentions, and behavior. RESULTS: In Study 1, relational savoring was associated with greater help-seeking intentions than the combination savoring condition among all participants and greater help-seeking intentions than the control among participants who self-reported paying full attention during the study. In Study 2, the S-PSA did not perform better than the comparison PSA or basic control video on the outcome measures. CONCLUSIONS: The present research highlights three important takeaways. 1) Researchers should continue to explore relational savoring as an approach to increase help-seeking for depression. 2) Similar to findings of prior depression help-seeking studies, crowdsourcing platforms may be useful for testing informational videos but less appropriate for testing videos that require deep levels of thinking for people experiencing heightened depressive symptomatology. 3) From a theoretical and methodological standpoint, these studies underscore the value of conceptual replications using multiple methods.

Differential Effects of High- and Low-Arousal Positive Emotions on Help-Seeking for Depression.

BACKGROUND: The current set of pre-registered studies tested the effect of savoring a high-arousal (exciting) or low-arousal (calm) positive experience on help-seeking intentions among people with heightened depressive symptomatology. METHODS: Across all three studies, participants with heightened depressive symptomatology who had not yet sought help were randomly assigned to complete a 6-minute writing task where they reflected on an exciting memory, a calm memory, or what they did today and yesterday. RESULTS: Savoring an exciting memory was associated with significantly greater arousal than savoring a calm memory and the control condition (Study 1; N = 218). Both savoring conditions were associated with greater positive emotion than the control condition (Study 2; N = 193). In Study 3 (N = 1,238), savoring an exciting memory, when compared to the control condition, increased help-seeking intentions, whereas savoring a calm memory did not. CONCLUSIONS: The current studies support the use of high-arousal, rather than low-arousal, positive emotions to increase help-seeking intentions among people with depression.

Using the County Health Rankings Framework to Create National Percentile Scores for Health Outcomes and Health Factors.

INTRODUCTION: As a means of conceptualizing population health, the County Health Rankings & Roadmaps program developed a methodology to rank counties within each state on Health Outcomes and Health Factors. We built on this framework by introducing an additional application that utilized national percentile scores and population size weighting to compare counties on a national, rather than a state, level. METHODS: We created national percentile scores for 3078 US counties and used population size weighting in our calculations so that values for counties with larger populations would be weighted more heavily than values for counties with smaller populations. RESULTS: We demonstrated how this application can be used to 1) compare counties nationally, 2) examine clustering and variability among counties, and 3) compare the health of states and regions. To underscore its utility, we included an example application by Kaiser Permanente. As a form of method validation, the results of this application are in line with other ranking systems (eg, US News and World Report and United Health Foundation; ρ = 0.39 to 0.91, p < 0.001). DISCUSSION: This application can be used by communities and organizations that may be interested in comparing the health of counties, service areas, and regions in which they operate. We included additional considerations and highlighted some limitations for those interested in utilizing this application. CONCLUSION: By comparing counties nationally and utilizing population size weighting, community partners can focus on areas that may be of greatest need in moving toward a national Culture of Health.

Positive Emotion Infusions: Can Savoring Increase Help-Seeking Intentions among People with Depression?

BACKGROUND: The current research effort used two experimental studies to assess whether a savoring-based, positive emotion infusion (PEI) could increase help-seeking intentions among individuals with elevated depressive symptomatology and whether this relationship would be mediated by positive emotion, arousal, and perceptions of personal control. METHODS: In Study 1, participants with elevated depressive symptomatology, recruited from Amazon's Mechanical Turk (N = 135), were randomly assigned to complete a 6-minute savoring or control writing task followed by a help-seeking intentions scale. Study 2 participants (N = 136) were randomly assigned to the same tasks, but a scale assessing positive emotion, arousal, and personal control was added. RESULTS: Study 1 indicated a direct effect; those who savored reported greater help-seeking intentions compared to control participants. Study 2 revealed an indirect effect of savoring on help-seeking intentions through greater positive emotion but not through greater arousal or perceptions of personal control. CONCLUSION: Together, these results offer additional support for continued research on PEIs, and specifically, savoring-based PEIs. Although the experimental manipulations may be limited in regard to their ecological validity, for those seeking to create interventions, these studies offer a novel and efficacious approach for motivating individuals with elevated depressive symptomatology to seek help.