'It's a very grey, very messy area': a qualitative examination of factors influencing undetectable gay men's HIV status disclosure to sexual partners.

HIV disclosure to sexual partners remains a multifaceted yet stigmatised process. The 'undetectable equals untransmittable' (U = U) concept has raised ethical and moral concerns about the obligation and need to disclose, and using Internet applications to seek sex partners has modified disclosure practices. While previous qualitative literature has examined the HIV disclosure process, there is a dearth of information on this topic among gay men in the USA who have an undetectable viral load. Using thematic analysis of data collected during a period of expanded U = U knowledge, this study explores the cognitive, contextual, interpersonal and structural factors impacting undetectable gay men's HIV status disclosure decisions to sexual partners. In-depth interviews were conducted in August 2020 over Zoom with 20 gay men with undetectable viral loads. The main themes included 'sense of obligation,' 'situational disclosure' and 'partners' responsibility in the disclosure process.' Participants balanced the aforementioned factors to inform their disclosure decisions, and disclosure patterns varied across participants dependent upon thoughts regarding ethics and morality of (non-)disclosure. The findings provide new insights to how participants navigate disclosure while considering U = U, HIV criminalisation laws, and finding partners through Internet applications while providing direction for future studies and support for decriminalising HIV and expanding HIV education.

Latent Class Profiles of Police Violence Exposure in 4 US Cities and Their Associations with Anticipation of Police Violence and Mental Health Outcomes.

While studying polyvictimization is well established within the broader violence literature and applied to other types of violence, it has yet to be documented whether polyvictimization also presents in patterns of police violence exposure (i.e., neglectful, psychological, physical, and sexual police violence). Our objective was to analyze latent patterns of co-occurring police contact and their associations with mental health. By applying latent class analysis (LCA) methods to the 2016 and 2017 Surveys of Police-Public Encounters (N = 2615), conducted in 4 Northeastern US cities, we identified classes of direct and vicarious police violence and compared sociodemographic characteristics among classes using multinomial regression. Classes were regressed on mental health outcomes. LCA identified four classes of police contact. Compared to Positive Police Contact (33.0%) class members, members of the (a) Extreme Police Violence (4.0%) class reported higher anticipation of future police victimization, psychological distress, and suicide ideations and attempts; they were more likely to be Black, cisgender men, and Latinx; (b) members of the High Police Violence (23.6%) class reported higher anticipation of future police victimization and psychological distress; they were more likely to be Black, Native American, and multiracial; members of the (c) Low Police Contact (39.5%) class had comparable mental health outcomes; they were more likely to report a household income < $19,999. Notably, no participants were unexposed to police contact. Polyvictimization presents in experiences of police violence and disproportionately impacts structurally marginalized people.

Role of team dynamics in the learning process: a mixed-methods evaluation of a modified team-based learning approach in a behavioral research methods course.

Health sciences education is increasingly focusing on building students' skills to work collaboratively. Therefore, instructors must intentionally incorporate team-based skill building into their courses, using teaching strategies like team-based learning (TBL). An assumption of TBL is that team dynamics facilitate learning; however, limited research has examined this connection. The primary purposes of this mixed-methods evaluation were: (a) to describe the characteristics of team dynamics in a graduate-level research methods course that employs a modified TBL approach, and (b) to examine the association between team dynamics and student grades. Given the importance of preparing health professional students to work collaboratively in their careers, a secondary aim was to examine how team skills developed through a team-based learning approach could be transferred to other courses and to future jobs. We conducted surveys on team dynamics at mid-semester (n = 64) and the end of the semester (n = 66), collected students' grades for the final paper and overall course, and conducted 4 focus groups with Master of Public Health students (n = 25). Paired t tests were used to examine change in team dynamics and correlations were conducted to assess the relationship between team dynamics and grades. Thematic analysis was used to identify themes related to team dynamics from the focus group data. Overall, students reported experiencing positive and beneficial team dynamics. The findings support two main underlying categories of team dynamics, interpersonal team processes and task orientation, and the linkages between the categories that allow teams to function. Team dynamics scores were not associated with student grades. However, students recognized the value of practicing team skills in preparation for future group work and jobs. These findings suggest that active learning approaches, such as TBL, can help to facilitate the acquisition of collaborative skills.

Mental and Addictive Disorders and Medical Comorbidities.

PURPOSE OF REVIEW: Mental and addictive disorders commonly co-occur with medical comorbidities, resulting in poor health and functioning, and premature mortality. This review provides an overview of the intertwined causal pathways and shared risk factors that lead to comorbidity. Additionally, this review examines the strategies to prevent the onset of and to effectively manage chronic medical conditions among people with mental and addictive disorders. RECENT FINDINGS: Recent research provides further evidence for the shared genetic and biological, behavioral, and environmental risk factors for comorbidity. Additionally, there is evidence of effective approaches for screening, self-management, and treatment of medical conditions among people with mental disorders. There are promising health system models of integrated care, but additional research is needed to fully establish their effectiveness. A combination of public health and clinical approaches are needed to better understand and address comorbidity between mental and addictive disorders and chronic medical conditions.

Cumulative burden of comorbid mental disorders, substance use disorders, chronic medical conditions, and poverty on health among adults in the U.S.A.

The health of individuals in the U.S.A. is increasingly being defined by complexity and multimorbidity. We examined the patterns of co-occurrence of mental illness, substance abuse/dependence, and chronic medical conditions and the cumulative burden of these conditions and living in poverty on self-rated health. We conducted a secondary data analysis using publically-available data from the National Survey on Drug Use and Health (NSDUH), which is an annual nationally-representative survey. Pooled data from the 2010-2012 NSDUH surveys included 115,921 adults 18 years of age or older. The majority of adults (52.2%) had at least one type of condition (mental illness, substance abuse/dependence, or chronic medical conditions), with substantial overlap across the conditions. 1.2%, or 2.2 million people, reported all three conditions. Generally, as the number of conditions increased, the odds of reporting worse health also increased. The likelihood of reporting fair/poor health was greatest for people who reported AMI, chronic medical conditions, and poverty (AOR = 9.41; 95% CI: 7.53-11.76), followed by all three conditions and poverty (AOR = 9.32; 95% CI: 6.67-13.02). For each combination of conditions, the addition of poverty increased the likelihood of reporting fair/poor health. Traditional conceptualizations of multimorbidity should be expanded to take into account the complexities of co-occurrence between mental illnesses, chronic medical conditions, and socioeconomic factors.

A dyadic model of living with epilepsy based on the perspectives of adults with epilepsy and their support persons.

Epilepsy is a chronic condition that significantly affects the lives of individuals with epilepsy and their support persons, though few studies have examined the experiences of both. To examine these experiences and explore the interpersonal relationships between dyad members, we conducted in-depth interviews with 22 persons with epilepsy and 16 support persons. Data analysis was guided by a grounded theory perspective. We developed a model that shows how epilepsy impacts the lives of both persons with epilepsy and their support persons and how the experiences of persons with epilepsy and supporters influence one another. The core model elements were seizure and treatment factors, relationship characteristics, self-management, seizure control, support provided, illness intrusiveness, and quality of life. Persons with epilepsy moved through the model in five trajectories depending on seizure control, relationship type, and gender. Support providers followed four trajectories based on seizure control, perception of burden, and support for themselves. Persons with epilepsy and their primary support providers have varied experiences in how epilepsy affects their lives. This model could serve as a basis for future research and intervention efforts focused on ways to reduce illness intrusiveness and improve quality of life for persons with epilepsy and their supporters.

Rate and Predictors of Persistent Major Depressive Disorder in a Nationally Representative Sample.

This study examined predictors of persistent major depressive disorder over 10 years, focusing on the effects of clinical variables, physical health, and social support. Data from the National Survey of Midlife Development in the United States in 1995-1996 and 2004-2006 were analyzed. Logistic regression was used to predict non-recovery from major depression among individuals who met clinical-based criteria for major depressive disorder at baseline. Fifteen percent of the total sample was classified as having major depression in 1995-1996; of these individuals, 37 % had major depression in 2004-2006. Baseline variables that were significantly associated with persistent major depression at follow-up were being female, having never married, having two or more chronic medical conditions, experiencing activity limitation, and less contact with family. Therefore, treatment strategies focused on physical health, social support, and mental health needs are necessary to comprehensively address the factors that contribute to persistent major depressive disorder.

A mixed methods analysis of support for self-management behaviors: perspectives of people with epilepsy and their support providers.

Social support is associated with improved self-management for people with chronic conditions, such as epilepsy; however, little is known about the perceived ease or difficulty of receiving and providing support for epilepsy self-management. We examined patterns of epilepsy self-management support from the perspectives of both people with epilepsy and their support persons. Fifty-three people with epilepsy and 48 support persons completed a survey on epilepsy self-management support. Of these individuals, 22 people with epilepsy and 16 support persons completed an in-depth interview. Rasch measurement models were used to evaluate the degree of difficulty of receiving or providing support often for nine self-management tasks. We analyzed model-data fit, person and item location along the support latent variable and differential person and item functioning. Qualitative methods were used to provide context and insight into the quantitative results. The results demonstrated good model-data fit. Help with seizures was the easiest type of support to receive or provide more often, followed by rides to a doctor's appointments and help avoiding seizure triggers. The most difficult types of support to receive or provide more often were reminders, particularly for taking and refilling medications. While most participants' responses fit the model, responses of several individuals misfit the model. Person misfit generally occurred because the scale items did not adequately capture some individuals' behaviors. These results could be useful in designing interventions that use support as a means of improving self-management. Additionally, the results provide information to improve or expand current measures of support for epilepsy self-management to better assess the experiences of people with epilepsy and their support persons.

Perspectives of adults with epilepsy and their support persons on self-management support.

Social support is an important mechanism for improving self-management, although little is known about its role in epilepsy self-management. We examined the type of support provided to people with epilepsy and its influence on self-management. We conducted in-depth interviews with 22 people with epilepsy and 16 support persons, representing 14 pairs and 10 unpaired individuals. We analyzed the data using principles of grounded theory. Supporters, who were mainly parents and spouses, aided people with epilepsy in every dimension of self-management. Support for self-management occurred along a continuum from person with epilepsy-led management to support person-led management. Where the pairs fell on the continuum depended on developmental stage, relationship type, and relationship dynamics. Seizure control shaped individuals' experiences with self-management and support within each group. The self-management continuum provides a new aspect that can be integrated into existing models of self- and family management.

Supporting Implementation Through Online Learning Communities: Lessons Learned From a National Training and Technical Assistance Network.

Recent implementation science frameworks highlight the role of training and technical assistance (TTA) in building workforce capacity to implement evidence-based practices (EBPs). However, evaluation of TTA is limited. We describe three case examples that highlight TTA by three regional centers in the national Mental Health Technology Transfer Center (MHTTC) network. Each MHTTC formed Learning Communities (LCs) to facilitate connections among behavioral health professionals with the goals of sharing implementation strategies, discussing best-practices, and developing problem solving techniques. Data on outcomes were collected through a combination of self-report surveys and qualitative interviews. LC participants reported strong connectedness, gains in knowledge and skills, improvements in implementation capacity, and intentions to advocate for organizational and systems-level change. Furthermore, across the case examples, we identified LC characteristics that are associated with participant perceptions of outcomes, including tailoring LC content to workforce needs, providing culturally relevant information, engaging leaders, forming connections among participants and trainers, and challenging participants' current workplace practices. These findings are interpreted through the lens of the Interactive Systems Framework, which focuses on how TTA, such as LCs, can facilitate connections between the theoretical and empirical foundations of interventions and the practices of implementing interventions in real-world settings to advance workforce capacity.

Therapists' perspectives on access to telemental health among Medicaid-enrolled youth.

OBJECTIVE: The COVID-19 pandemic exacerbated risk for poor mental health (MH) outcomes among youth from low-income families and propelled a shift to telemental health. Yet, little is known about barriers to and facilitators of MH care access when services are delivered via synchronous telehealth to Medicaid-enrolled youth. STUDY DESIGN: Between December 2020 and March 2021, we conducted in-depth interviews with 19 therapists from a large safety-net organization who served Medicaid-enrolled youth (< 18 years of age) to elucidate their perspectives on barriers to and facilitators of access to telemental health services among this population. METHODS: We conducted a thematic content analysis, guided by the 5 dimensions of health care access identified by Fortney and colleagues: geographical, temporal, digital, cultural (including acceptability of services), and financial access. RESULTS: Therapists noted that when components of digital access are met (ie, access to hardware and software, connectivity, and technological literacy), then telehealth could facilitate temporal access and eliminate geographic barriers; elimination of these barriers was particularly beneficial for youth in rural and hard-to-reach communities. Notably, many families depended on smartphones for telemental health access, and many youth depended on their caregiver's smartphone. When considering acceptability of services, some youth preferred in-person services, whereas other youth (especially some teenagers with high technological literacy) had a preference for telemental health. CONCLUSIONS: Our results highlight the need for flexibility in reimbursement policies that allows providers to optimize MH care access by offering telehealth delivered via telephone and video as well as in-person services, depending on the needs and preferences of youth and families.

Hearing Their Voices: Engaging Certified Peer Specialists in Dialogues About Racism and Recovery.

Certified peer specialists (CPSs) may be uniquely situated to help address inequities within the behavioral health system. However, CPSs and other mental health care providers often do not have opportunities to discuss their experiences with racism in the workplace. The Southeast Mental Health Technology Transfer Center and Georgia Mental Health Consumer Network offered the six-part Racism and Recovery event series as a space for such discussions (N=356 participants). Participant responses on the Government Performance and Results Act survey (N=239) and supplemental Qualtrics survey (N=213) identified potential actions at the individual and organizational levels for disrupting racism. The responses indicated that the series was a feasible and well-received model for engaging diverse participants.

Qualitative Study of Certified Peer Specialists' Experiences Delivering Peer Support Services During the COVID-19 Pandemic.

OBJECTIVE: The purpose of this qualitative study was to examine the experiences of certified peer specialists (CPSs) in delivering telehealth services during the COVID-19 pandemic. METHODS: Fourteen semistructured interviews with CPSs were conducted from August to November 2020. Data were analyzed by using thematic analysis. RESULTS: Helpful support from employers during the transition to telehealth included clear communication and access to training on telehealth technologies. Main barriers and facilitators were related to interpersonal relationships and logistical factors. CPSs reported that telehealth allowed them to continue to support the peers they serve but that the quality of interactions was not as good as with in-person services. Logistical challenges included inadequate equipment and Internet access. CONCLUSIONS: To support CPSs in delivering telehealth, employers can engage them in open and transparent communication about guidelines for service delivery, provide training and equipment, and allow them the flexibility to tailor service delivery modalities to the peers they serve.

The Language of Compassion: Hospital Chaplains' Compassion Capacity Reduces Patient Depression via Other-Oriented, Inclusive Language.

Objectives: Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or "active ingredients" of chaplain spiritual consults. Here, we examined how chaplains' compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes. Methods: Hospital chaplains (n = 16) completed self-report measures that together were operationalized as self-reported "compassion capacity." Next, chaplains conducted consultations with inpatients (n = 101) in five hospitals. Consultations were audio-recorded, transcribed, and analyzed using Linguistic Inquiry Word Count (LIWC). We used exploratory structural equation modeling to identify associations between chaplain-reported compassion capacity, chaplain linguistic behavior, and patient depression after the consultation. Results: We found that compassion capacity was significantly associated with chaplains' LIWC clout scores, a variable that reflects a confident leadership, inclusive, and other-oriented linguistic style. Clout scores, in turn, were negatively associated with patient depression levels controlling for pre-consult distress, indicating that patients seen by chaplains displaying high levels of clout had lower levels of depression after the consultation. Compassion capacity exerted a statistically significant indirect effect on patient depression via increased clout language. Conclusions: These findings inform our understanding of the linguistic patterns underlying compassionate and effective chaplain-patient consultations and contribute to a deeper understanding of the skillful means by which compassion may be manifest to reduce suffering and enhance well-being in individuals at their most vulnerable.

Social support for self-management behaviors among people with epilepsy: a content analysis of the WebEase program.

Social support is an important component in managing epilepsy; however little is known about support provided to people with epilepsy. This study examined whom people with epilepsy identify as supportive, and how those individuals support people with epilepsy's self-management efforts. Data come from the WebEase project, an effective online epilepsy self-management program. People with epilepsy who participated in the pilot (n=35) and efficacy trials (n=118) were included. A content analysis was conducted on responses to open-ended questions related to support. The majority of participants provided information about their supporters. The number of support providers ranged from 0 to 6, with about 12% indicating no support. Parents and significant others were most commonly listed as supporters. Support providers mainly offer emotional and instrumental support, reminders and aid for taking medication, and support for self-management strategies. These results could be useful for interventions aimed at bolstering support in order to improve self-management.

Qualitative Study of Mentorship for Women and Minorities in Surgery.

BACKGROUND: Despite the growth of mentorship opportunities for women in surgery, women remain largely underrepresented in the surgical field. Mentorship is an effective strategy to increase female entry and retention within surgical careers. There is limited literature evaluating mentorship for women in surgery across different career levels and racial backgrounds. STUDY DESIGN: In-depth interviews were conducted with female fourth-year medical students applying for a surgical residency, female surgical residents, and female surgical faculty from a single academic institution. RESULTS: A total of 35 women in surgery, including 14 faculty, 11 residents, and 10 fourth-year medical students were interviewed. Twenty (57%) self-identified as White, 7 (20%) as Asian, 6 (17.1%) as Black, and 2 (5.7%) as Other. Key themes included: (1) access to mentorship, (2) characteristics valued in a mentor, (3) role of gender identity when choosing a mentor, (4) role of racial identity when choosing a mentor, and (5) importance of early mentorship for women and underrepresented minorities in medicine (URiM). Mentorship was important for early career development. Mentors who were approachable, invested in their mentees, and were available and honest were most valued. Shared gender and racial identity were appreciated most by younger and URiM mentees, respectively. Respondents from each career level acknowledged the importance of early mentorship for women and URiM in surgery to facilitate increased diversity in the surgical field. CONCLUSION: Mentorship plays a pivotal role in early career development for women in the surgical field. Access to mentors with shared gender and racial compositions can provide a unique level of support for female and URiM mentees. Expanded and earlier mentorship access for women and minority students can increase diversity in the surgical field.

Suturing the gender gap through sponsorship: The role of sponsorship in female entry and advancement through their surgical careers.

BACKGROUND: Sponsorship promotes female entry and advancement through the surgical field, and can mitigate gender inequities that persist in the surgical field. METHODS: 35 women in surgery, including 14 surgeons, 11 residents, and 10 fourth-year medical students, were interviewed from July 30, 2021 to August 18, 2021 at a single institution. RESULTS: All participants had provided or received sponsorship. Main themes included: (1) Evolving needs of sponsorship, (2) Decreased Access to Sponsorship as Career Level Advances, (3) Evolving importance of sponsorship, (4) Perceived limitations of receiving sponsorship, and (5) Perceived limitations of providing sponsorship. Faculty members most frequently reported barriers to both receiving and providing sponsorship. CONCLUSIONS: The lack of sponsorship for female faculty limits their ability to rise to organizational leadership, and consequently, their ability to sponsor others. Increasing access to sponsorship for female surgeons can help to bridge the gender gap in the surgical field.

Results of a research study evaluating WebEase, an online epilepsy self-management program.

WebEase (Epilepsy Awareness, Support, and Education) is an online epilepsy self-management program to assist people with taking medication, managing stress, and improving sleep quality. The primary study aims were to determine if those who participated in WebEase demonstrated improvements in medication adherence, perceived stress, and sleep quality. Participants were randomized to a treatment (T) or waitlist control (WCL) group (n=148). At follow-up, participants in the T group reported higher levels of medication adherence than those in the WLC group. Analyses were also conducted comparing those who had completed WebEase modules with those who had not. Those who had completed at least some modules within the WebEase program reported higher levels of self-efficacy and a trend toward significance was observed for the group×time interactions for medication adherence, perceived stress, self-management, and knowledge. The results highlight the usefulness of online tools to support self-management among people with epilepsy.