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OBJECTIVE: To examine the unique role of migraine aura in predicting day-to-day levels of headache-related disability. BACKGROUND: Migraine symptoms and psychological variables contribute to headache-related disability. Migraine aura may be associated with more severe symptom profiles and increased risk of psychiatric comorbidities, but the impact of aura on daily functioning is unknown. The present study sought to evaluate the role of migraine aura in predicting same-day and subsequent-day migraine-related disability while accounting for demographic, headache, and psychological variables. METHODS: This was an observational prospective cohort study among 554 adults with migraine. For each participant, data on migraine symptoms and psychological variables were collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days). Analyses assessed whether the presence of aura predicted daily ratings of migraine-related disability independently of other headache and psychological variables. Given the number of predictors examined, statistical significance was set at p < 0.01. RESULTS: The mean (standard deviation, range) patient-level Migraine Disability Assessment questionnaire score across days of the migraine episode was 1.18 (1.03, 0-3). Aura was significantly associated with higher disability ratings on all days of the migraine episode (odds ratio [OR] 1.40, 99% confidence interval [CI] 1.13-1.74; p < 0.001). This relationship remained unchanged after adjusting for patient-level variables (OR 1.40, 99% CI 1.13-1.73; p < 0.001) and day-level psychological variables (OR 1.39, 99% CI 1.12-1.73; p < 0.001) but was fully negated after controlling for day-level headache variables (OR 1.19, 99% CI 0.95-1.49; p = 0.039). Aura on the first day of the episode was associated with increased odds of allodynia (OR 1.87, 99% CI 1.22-2.86; p < 0.001), phonophobia (OR 1.62, 99% CI 1.17-2.25; p < 0.001), photophobia (OR 1.89, 99% CI 1.37-2.59; p < 0.001), and nausea/vomiting (OR 1.54, 99% CI 1.17-2.02; p < 0.001) on all days of the episode, but not episode duration (p = 0.171), peak severity (p = 0.098), or any examined psychological variables (sleep duration [p = 0.733], sleep quality [p = 0.186], stress [p = 0.110], anxiety [p = 0.102], or sadness [p = 0.743]). CONCLUSION: The presence of aura is predictive of increased headache-related disability during migraine episodes, but this effect is attributable to associated non-pain symptoms of migraine.
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Suboptimal disease self-management among adults with type 2 diabetes is associated with greater risk of diabetes related health complications and mortality. Emotional distress has been linked with poor diabetes self-management; however, few studies have examined the role of emotion dysregulation in diabetes management. The purpose of this study was to examine the relations between different facets of emotion dysregulation and diabetes self-management behaviors among a sample of 373 adults with type 2 diabetes. Separate median regression and binary logistic regression models were used to examine the association of emotion dysregulation facets and each diabetes self-care behavior (i.e., medication nonadherence, diet, exercise, self-monitoring of blood glucose (SMBG), foot care, and smoking). Generally, greater difficulties in emotion regulation were associated with poorer self-management behaviors. However, several facets of emotion dysregulation were linked with better self-management behaviors. Addressing emotion dysregulation among adults with type 2 diabetes has the potential to improve diabetes related self-management.
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Diabetes Mellitus Tipo 2 , Regulação Emocional , Autogestão , Humanos , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/complicações , Masculino , Feminino , Pessoa de Meia-Idade , Autogestão/psicologia , Idoso , Adulto , Automonitorização da Glicemia/psicologia , Autocuidado/psicologia , Comportamentos Relacionados com a Saúde , Exercício Físico/psicologia , Adesão à Medicação/psicologiaRESUMO
Approximately one-third of adults with chronic respiratory disease (CRD) have comorbid depressive and anxiety disorders; yet these disorders are often unrecognized in this patient population. Transdiagnostic processes such as anxiety sensitivity (AS) are useful for identifying mechanisms underlying psychological and heath conditions. The Short-Scale AS Index (SSASI) is a brief self-report measure of AS which has potential clinical utility among CRD populations to evaluate psychological distress and inform comprehensive care. The present study investigated the psychometric properties of the SSASI among adults with CRDs. Participants were recruited from a web-based panel of adults with CRDs (n = 768; 49.3% female; 57.8% White) including adults with asthma only (n = 230), COPD only (n = 321), or co-occurring asthma and COPD (n = 217). Participants completed a battery of self-report questionnaires assessing psychological and medical symptoms. Analyses were conducted to examine the factor structure and measurement invariance across CRD groups. Convergent validity and criterion validity of the SSASI were assessed within each group. Results supported partial measurement invariance across CRD groups. The SSASI demonstrated high reliability, convergent validity, and criterion validity with each CRD group. Findings from this study and existing work indicate that the SSASI is an effective and economical assessment tool for identifying patients CRD who may benefit from psychological interventions to reduce AS.
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Asma , Doença Pulmonar Obstrutiva Crônica , Adulto , Humanos , Feminino , Masculino , Psicometria , Reprodutibilidade dos Testes , Ansiedade/diagnóstico , Ansiedade/psicologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Asma/complicações , Asma/psicologia , Inquéritos e Questionários , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/psicologiaRESUMO
COPD is one of the leading causes of death in the United States and results in increased healthcare costs and disability. Smoking is the main determinant of COPD development and continued use increases mortality as compared to those who have stopped smoking. Research has indicated that cigarette smoking may play a role in attempts to regulate distressing emotional experiences and thus, may be an important transdiagnostic process underlying continued smoking behavior among adults with COPD. The current study investigated the role of ER difficulties in relation to smoking status and cigarettes smoked per day among adults with COPD. This cross-sectional study included a sample was adults with COPD (N = 320). Participants self-reported current smoking status, daily smoking, and the Difficulties in Emotion Regulation Scale. All analyses were adjusted for age, sex, probable depression, probable anxiety, and dyspnea severity. DERS total scores were associated with greater odds of current smoking. With the exception of impulsivity, all other dimensions of emotion regulation were significantly associated with current smoking. Greater difficulties in emotional awareness were associated with greater cigarettes smoked per day. However, neither the DERS total score nor any other dimensions of emotional regulation were significantly associated with cigarettes smoked per day. The present study provides preliminary data linking ER difficulties to smoking behavior among adults with COPD. If corroborated by future research, these findings suggest that ER might be a potential target for smoking cessation programs among adults with COPD.
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OBJECTIVE: To examine the relative contribution of headache symptoms and psychological factors to headache-related disability. BACKGROUND: Both headache symptoms and comorbid psychological factors (psychiatric symptoms and transdiagnostic constructs) negatively impact functioning among individuals with migraine and tension-type headache, but few studies have explored their relative contribution to headache-related disability. We hypothesized that psychiatric symptoms and transdiagnostic variables would afford incremental contribution to disability beyond headache symptoms, and we investigated the moderating role of headache diagnosis on these relationships. METHODS: This cross-sectional study examined data from a southern U.S. university online sample of 1818 young adults (mean [SD] age 19.0 [5.1] years; 74.6% female) who met the International Classification of Headache Disorders, third edition criteria for primary headache disorders (46.6% episodic migraine, 11.6% chronic migraine, 38.3% episodic tension-type headache, 3.5% chronic tension-type headache) and completed measures assessing psychological factors and headache-related disability. Headache, psychiatric symptoms, and transdiagnostic factors were examined in relation to headache-related disability, after controlling for sex. Moderation analyses examined the conditional effect of diagnosis on disability. RESULTS: As predicted, both psychiatric and transdiagnostic symptoms accounted for unique variance in headache-related disability beyond headache symptoms (R2 changes of 2.7% and 2.3%, respectively). Significant three-way interactions revealed the relationship between psychiatric symptoms and disability (b = -3.16, p = 0.002), and between transdiagnostic variables and disability (b = -2.37, p = 0.034). Tests of simple slopes showed greater psychiatric symptoms and transdiagnostic variables were associated with higher levels of disability. However, the associations of these variables with disability were strongest among individuals with chronic tension-type headache (B = 3.93 for psychiatric symptoms and B = 4.62 for transdiagnostic symptoms, both p < 0.001). CONCLUSION: Psychiatric and transdiagnostic factors contribute uniquely to headache-related functional impairment, which may be important for expanding targeted assessment and behavioral interventions.
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Transtornos Mentais , Transtornos de Enxaqueca , Cefaleia do Tipo Tensional , Adulto Jovem , Humanos , Feminino , Adulto , Masculino , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/epidemiologia , Cefaleia do Tipo Tensional/complicações , Estudos Transversais , Cefaleia/psicologia , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Transtornos Mentais/complicaçõesRESUMO
Adults with diabetes frequently experience diabetes related distress, which is associated with negative health outcomes. Family members are commonly involved in patients' diabetes self-management. However, family involvement can have helpful and/or harmful effects on patients' diabetes outcomes. Use of interpersonal strategies to regulate negative emotions may play a role in patients' interactions with family members and experience of diabetes distress. This study examined the influences of interpersonal emotion regulation and family and friend involvement on diabetes distress among 373 adults with type 2 diabetes. Two separate three-step sequential linear regression models were used to test the main and interactive effects of harmful and helpful family involvement and interpersonal emotion regulation on diabetes distress. Greater use of interpersonal strategies to regulate negative emotions (p = .006) and greater harmful family involvement (p < .001) were significantly associated with greater diabetes distress. Interpersonal emotion regulation moderated the relationship of helpful (p = .007), but not harmful (p = .171) family involvement on diabetes distress. Specifically, greater helpful family involvement was associated with lower diabetes distress among adults with low (p = .017) but not high (p = .419) use of interpersonal strategies to regulate negative emotions. Helpful family involvement appears to be associated with lower diabetes distress, but only among patients with low levels of interpersonal emotion regulation.
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Diabetes Mellitus Tipo 2 , Regulação Emocional , Adulto , Humanos , Diabetes Mellitus Tipo 2/complicações , Família , Comportamentos Relacionados com a Saúde , AmigosRESUMO
Obesity is a major public health concern, and sugar consumption is a key risk factor for obesity. Thus, there is a need to identify factors that may increase motivation to consume sugar. One such factor may be negative affect, as research has shown that negative affect increases motivation for and engagement in appetitive behaviors, including sugar consumption. The goal of the present study was to extend past research on the role of negative affect in sugar consumption by examining: (a) the effect of a socially-oriented negative affect induction (i.e., social rejection) on the consumption of flavored beverages with varying levels of sugar, and (b) the negative and positive affect regulating properties of varying levels of sugar consumption. Undergraduate students (N = 116) were randomized to receive either a neutral or socially-oriented negative affect induction. Participants were then presented with three flavored beverages with varying levels of sugar (low, medium, high). Negative and positive affect were assessed prior to and following the affect induction procedure, as well as following consumption of the beverage. Participants exposed to the negative affect induction consumed a larger volume of the high sugar beverage (as well as a larger volume of all sugary beverages) relative to participants in the neutral induction condition. Moreover, these findings could not be attributed to a greater preference for the high sugar beverage among participants in the negative affect condition. Additionally, lower levels of positive affect post-induction across all participants (regardless of condition) were associated with greater consumption of the high sugar beverage, and high sugar beverage consumption was significantly positively associated with post-consumption positive affect. Results provide evidence for an affect-regulating function of sugar consumption following social rejection.
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Bebidas , Açúcares , Açúcares da Dieta , Aromatizantes , Humanos , Obesidade/etiologia , EstudantesRESUMO
BACKGROUND: Patients with diabetes (PWD) often experience diabetes distress which is associated with worse self-management and glycemic control. In contrast, PWD who receive support from family and friends (supporters) have better diabetes outcomes. PURPOSE: To examine the associations of PWD diabetes distress and supporters' distress about PWDs' diabetes with supporters' roles and PWD cardiometabolic outcomes. METHODS: We used baseline data from 239 adults with Type 2 diabetes and their supporters participating in a longitudinal trial. PWD and supporter diabetes distress (high vs. low) were determined using the Problem Areas in Diabetes Scale-5. Outcomes included PWD-reported help from supporters with self-care activities, supporter-reported strain, PWD metabolic outcomes (glycemic control [HbA1c], systolic blood pressure [SBP], and non-HDL cholesterol) and 5 and 10 year risk of cardiac event (calculated using the United Kingdom Prospective Diabetes Study algorithm). RESULTS: PWDs with high diabetes distress were more likely to report that their supporters helped with taking medications, coordinating medical care, and home glucose testing (p's < .05), but not more likely to report help with diet or exercise. High supporter distress was associated with greater supporter strain (p < .001). High supporter diabetes distress was associated with higher PWD HbA1c (p = .045), non-HDL cholesterol (p = .011), and 5 (p = .002) and 10 year (p = .001) cardiac risk. CONCLUSIONS: Adults with high diabetes distress report more supporter help with medically focused self-management but not with diet and exercise. Supporter distress about PWD diabetes was consistently associated with worse outcomes. PWD diabetes distress had mixed associations with their diabetes outcomes.
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Diabetes Mellitus Tipo 2 , Adulto , Glicemia , Diabetes Mellitus Tipo 2/complicações , Humanos , Estudos Prospectivos , Autocuidado , Apoio SocialRESUMO
This study examined the role of autonomy support from adults' informal health supporters (family or friends) in diabetes-specific health behaviors and health outcomes. Using baseline data from 239 Veterans with type 2 diabetes at risk of complications enrolled in behavioral trial, we examined associations between autonomy support from a support person and that support person's co-residence with the participant's diabetes self-care activities, patient activation, cardiometabolic measures, and predicted risk of a cardiac event. Autonomy support from supporters was associated with significantly increased adherence to healthy lifestyle behaviors (diet, p < .001 and exercise, p = .003); higher patient activation (p < .001); greater patient efficacy in interacting with healthcare providers, and lower 5-year (p = .044) and 10-year (p = .027) predicted cardiac risk. Autonomy support was not significantly associated with diabetes-specific behaviors (checking blood glucose, foot care, or medication taking); or hemoglobin A1c, systolic blood pressure, or non-HDL cholesterol. There was a significant interaction of autonomy support and supporter residence in one model such that lack of autonomy support was associated with lower patient activation only among individuals with in-home supporters. No other interactions were significant. Findings suggest that autonomy support from family and friends may play a role in patient self-management, patient activation, and lower cardiac risk.
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Diabetes Mellitus Tipo 2 , Veteranos , Adulto , Glicemia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas/análise , Humanos , Autocuidado , Apoio SocialRESUMO
Adults with type 2 diabetes mellitus (T2DM) often receive self-management support from adult children, siblings or close friends residing outside of their home. However, the role of out-of-home support in patients' self-management and well-being is unclear. Patients (N = 313) with HbA1c > 7.5% were recruited from community primary care clinics for a mobile health intervention trial and identified an out-of-home informal support person, herein called a CarePartner; 38% also had an in-home supporter. We tested cross-sectional adjusted associations between CarePartner relationship characteristics and patients' self-management, diabetes distress, and HbA1c and whether having an in-home supporter modified these associations. Greater CarePartner closeness was associated with a greater odds of perfect medication adherence (AOR = 1.19, p = .029), more fruit/vegetable intake (ß = 0.14, p = .018), and lower diabetes distress (ß = - 0.14, p = .012). More frequent CarePartner contact was associated with better HbA1c among patients with an in-home supporter but with worse HbA1c among patients without an in-home supporter (interaction ß = - 0.45, p = .005). Emotional closeness with a CarePartner may be important for supporting T2DM self-management and reducing diabetes distress. CarePartners may appropriately engage more frequently when patients with no in-home supporter have poorly controlled diabetes.
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Diabetes Mellitus Tipo 2 , Hemoglobinas Glicadas , Controle Interno-Externo , Adesão à Medicação , Autocuidado , Telemedicina , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/psicologia , Relações Familiares , Adesão à Medicação/psicologia , Autocuidado/psicologia , Autogestão , Apoio Social , Telemedicina/métodos , Filhos AdultosRESUMO
Posttraumatic stress is associated with increased body mass index (BMI) and rates of obesity. Black adults are at greater risk for obesity, trauma exposure, development of posttraumatic stress disorder, and comorbid sleep problems compared to White adults. Accordingly, Black adults with a history of trauma exposure may be at greater risk for elevated BMI associated with posttraumatic stress and insomnia. Multiple linear regression was used to examine race as a moderator of the relationship between posttraumatic symptoms and insomnia with BMI in a sample of Black and White trauma-exposed Veterans (N = 171), controlling for age and sex. There was a significant interaction of race with PTSD (p = 0.042) and insomnia symptoms (p = 0.045) on BMI. Simple slopes showed a significant positive association of posttraumatic stress and BMI among Black (p = 0.003), but not White Veterans (p = 0.590). Similarly, insomnia was significantly associated with greater BMI for Black (p = 0.023), but not White Veterans (p = 0.496). Posttraumatic stress and insomnia may play a particularly important role in the development of weight related health problems among Black Veterans. Early identification and treatment of these symptoms may reduce the risk of obesity among this vulnerable population.
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Negro ou Afro-Americano/estatística & dados numéricos , Índice de Massa Corporal , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , População Branca/estatística & dados numéricos , Comorbidade , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia , Veteranos/psicologiaRESUMO
OBJECTIVES: To enhance our understanding of the factors that may account for increased aggression in socially anxious individuals, this study examined associations among emotion-driven impulse control difficulties, social anxiety, and dimensions of aggression (i.e., hostility, anger, physical aggression, verbal aggression). METHOD: Individuals (N = 107; 73.8% male; Mage = 40.8 years) receiving residential substance abuse treatment participated in this cross-sectional study. RESULTS: Social anxiety symptoms were significantly positively correlated with emotion-driven impulse control difficulties, anger, and hostility, but not verbal or physical aggression. Separate models for each aggression facet were examined to test the direct and indirect paths. Bootstrapped mediation analyses indicated a significant indirect path from social anxiety symptoms to each facet of aggression through emotion-driven impulse control difficulties (ps < .05). CONCLUSION: Results highlight the potential utility of targeting emotion-driven impulse control difficulties to decrease aggression among socially anxious individuals.
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Agressão/psicologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/psicologia , Emoções , Fobia Social/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Comportamento Impulsivo , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
This study examined the association between psychiatric symptoms and diabetes knowledge (DK) among 90 adults with serious mental illness (SMI) and type 2 diabetes. The relationship between DK and glucose control (i.e., A1C) was also examined. In a hierarchical linear regression, greater negative symptom severity and lower cognitive functioning both predicted lower DK, though cognitive functioning superseded negative symptom severity when analyzed simultaneously. A Pearson correlation showed no significant relationship between DK and A1C. Although symptom severity and cognitive functioning are both related to DK among this population, cognitive functioning maybe particularly important.
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Comorbidade , Diabetes Mellitus Tipo 2/psicologia , Transtornos do Humor/epidemiologia , Educação de Pacientes como Assunto/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Self-efficacy is a core element of diabetes self-care and a primary target of diabetes interventions. Adults with serious mental illness (SMI) are twice as likely as adults among the general population to have Type 2 diabetes. This population faces substantial barriers (i.e., cognitive impairment, psychiatric symptoms) to optimal diabetes self-care, but the relationship of these barriers to both self-efficacy and glycemic control (hemoglobin A1C [A1C]) is not clearly understood. METHODS: Data collected from adult participants with SMI (i.e., schizophrenia, schizoaffective disorder, bipolar disorder) and Type 2 diabetes (n = 92) were used to examine the moderating effects of cognitive functioning and psychiatric symptoms (i.e., positive and negative symptoms) on the association between self-efficacy and A1C. RESULTS: The relationship between self-efficacy and A1C was moderated by cognitive functioning (B = -4.03, standard error = 1.54, p = .011). Greater self-efficacy was associated with better glycemic control when cognitive functioning was high, but worse control when functioning was low. The relationship between self-efficacy and A1C was moderated by negative symptom severity (B = 6.88, standard error = 3.34, p = .043). Higher self-efficacy was associated with poorer glycemic control only when negative symptom severity was high. Positive symptoms did not interact with self-efficacy to predict A1C. CONCLUSIONS: These results suggest that adults with SMI and low cognitive function or high negative symptom severity may misperceive their ability to manage their diabetes. They may benefit from efforts, including care management and monitoring, cognitive remediation, and skill training, to identify and correct inaccurate diabetes self-efficacy.
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Transtorno Bipolar/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Diabetes Mellitus Tipo 2/sangue , Hemoglobinas Glicadas , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia , Autocuidado/psicologia , Autoeficácia , Transtorno Bipolar/epidemiologia , Disfunção Cognitiva/epidemiologia , Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologiaRESUMO
BACKGROUND: Anxiety symptoms commonly occur in dermatological patients and can affect the severity of dermatological symptoms. Anxiety sensitivity (AS), defined as the fear of anxiety symptoms, is a well-supported cognitive vulnerability factor that may be particularly significant in these patients. OBJECTIVE: This study compared the severity of AS between patients with psychodermatological (e.g., psoriasis) and nonpsychodermatological disorders (e.g., skin cancer). It was predicted that individuals with psychodermatological disorders would evidence significantly greater AS compared to individuals with nonpsychodermatological disorders. METHOD: Adults presenting to outpatient dermatology clinics with psychodermatological (n = 63) and nonpsychodermatological (n = 52) conditions completed self-report questionnaires assessing sociodemographic characteristics, general anxiety, and AS. RESULTS: Individuals with psychodermatological conditions reported significantly greater AS compared to individuals with nonpsychodermatological conditions (p < 0.05). Social concerns of AS emerged as the only significant factor that differentiated these categories of dermatological diseases, odds ratio = 1.13, 95% CI: 1.02-1.24, after adjusting for general anxiety. CONCLUSIONS: These findings contribute to an advancing area of research linking AS and physical health problems. The results suggest that adjunctive cognitive-behavioral treatments targeting AS reductions could help patients with psychodermatological conditions.
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Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/psicologia , Dermatopatias/diagnóstico , Dermatopatias/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Ansiedade/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Transtornos Psicofisiológicos/epidemiologia , Fatores de Risco , Dermatopatias/epidemiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/psicologia , Inquéritos e Questionários , Adulto JovemRESUMO
This study used qualitative methods to investigate barriers to and facilitators of oral health care among 25 adult community mental health outpatients with serious mental illness (SMI). Participants completed 30- to 60-min, semi-structured interviews that were recorded and transcribed. Qualitative analysis was used to characterize common themes. Results showed that lack of awareness of dental problems, poverty, and dental care access were key barriers to oral health care. When oral health care was accessed, fear of stigma was associated with missed opportunities to educate about the intersection of mental and oral health. Community mental health providers were viewed as trusted and important sources of advocacy and support for obtaining oral health care when needed. Oral health may be improved for persons with SMI by implementing education in points of frequent service contact, such as community mental health.
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Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/psicologia , Saúde Bucal , Adulto , Serviços Comunitários de Saúde Mental , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Avaliação das Necessidades , Noroeste dos Estados Unidos , PobrezaRESUMO
BACKGROUND: People with schizophrenia are at increased risk for type 2 diabetes, its complications, depression, and disability. However, little is known about the interrelationships of these 3 factors in adults with schizophrenia and type 2 diabetes. OBJECTIVE: We sought to assess the number of diabetic complications and depressive symptom severity as predictors of disability and evaluate depressive symptom severity as a mediator of the relationship between diabetic complications and disability in a sample of 62 adults with schizophrenia and type 2 diabetes. METHODS: Two- and 3-step sequential regression models were used to evaluate the relationship of depression and number of diabetic complications with disability. Path analysis with bootstrapping was used to evaluate depressive symptom severity as a mediator of the relationship between complications and disability. RESULTS: Diabetic complications significantly predicted disability scores when controlling for age, gender, socioeconomic status, hemoglobin A1C, positive symptom severity, and negative symptom severity. The addition of depression severity scores resulted in a significant increase in explained variance in disability scores. In the final model, only depression severity scores were significantly associated with disability scores. The full model accounted for 56.2% of the variance in disability scores. Path analysis revealed a significant indirect association of diabetic complications to disability through depression severity scores while controlling for all covariates. The association between complications and disability was nonsignificant when depressive symptom severity was included in the model. CONCLUSIONS: Depressive symptoms may present an important and tractable target for interventions aimed at reducing disability in people with schizophrenia and type 2 diabetes.
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Depressão/etiologia , Complicações do Diabetes/etiologia , Diabetes Mellitus Tipo 2/complicações , Esquizofrenia/complicações , Diabetes Mellitus Tipo 2/psicologia , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de RiscoRESUMO
UNLABELLED: Genetic essentialism suggests that beliefs in genetic causes of mental illness will inflate a desire for social distance from affected individuals, regardless of specific disorder. However, genetic contingency theory predicts that genetic attributions will lead to an increased desire for social distance only from persons with disorders who are perceived as dangerous. PURPOSE: To assess the interactive effect of diagnosis and attribution on social distance and actual helping decisions across disorders. METHODS: Undergraduate students (n = 149) were randomly assigned to read one of the six vignettes depicting a person affected by one of the three disorders (i.e., schizophrenia, bipolar disorder, or major depression) with either a genetic or environmental causal attribution for disorder. Participants completed measures of perceived dangerousness, social distance, empathic concern, familiarity with mental illness, and actual helping decisions. RESULTS: When provided with genetic attributions, participants' desire for social distance was greater for targets with schizophrenia relative to targets with depression or bipolar disorder. This effect was mediated by perceived dangerousness. The indirect effect of diagnosis on helping decisions, through social distance, was significant within the genetic attribution condition. CONCLUSION: Consistent with genetic contingency theory, genetic attributions for schizophrenia, but not affective disorders, lead to greater desire for social distance via greater perceived dangerousness. Further, results suggest that genetic attributions decrease the likelihood of helping people with schizophrenia, but have no effect on the likelihood of helping people with affective disorders. These effects are partially accounted for by desired social distance from people with schizophrenia.
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Comportamento Perigoso , Transtornos Mentais/diagnóstico , Transtornos Mentais/genética , Distância Psicológica , Percepção Social , Adulto , Análise de Variância , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/genética , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/genética , Transtorno Depressivo Maior/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Comportamento de Ajuda , Humanos , Masculino , Transtornos Mentais/psicologia , Reconhecimento Psicológico , Esquizofrenia/diagnóstico , Esquizofrenia/genética , Psicologia do EsquizofrênicoRESUMO
The investigators used qualitative methods to examine perspectives of community mental health professionals on obesity management in adults with serious mental illness (SMI). Data from 5 focus groups were subjected to constant comparison analysis and grounded theory. Results showed that influences at individual, social, community, and societal levels impact development and maintenance of obesity. Mental health providers desired a collaborative relationship with health promotion program staff. They also believed that frequent, group-based health promotion should include participation incentives for adults with SMI and should occur over durations of at least 6-months to achieve improved health outcomes for this population.
Assuntos
Atitude do Pessoal de Saúde , Serviços Comunitários de Saúde Mental , Pessoal de Saúde , Transtornos Mentais/reabilitação , Obesidade/terapia , Comportamento de Redução do Risco , Colorado , Feminino , Grupos Focais , Comportamentos Relacionados com a Saúde , Promoção da Saúde , Humanos , Masculino , Obesidade/psicologia , Gravidade do Paciente , WyomingRESUMO
BACKGROUND: Youth with attention-deficit hyperactivity disorder (ADHD) are more vulnerable to developing obesity. Stimulant medication use, an evidence-based treatment for ADHD, is associated with lower body mass index (BMI) and higher blood pressure among non-overweight youth. OBJECTIVES: The purpose of this study was to examine the longitudinal influence of ADHD and stimulant medication use on BMI and blood pressure among a sample of 456 youth with overweight and obesity treated in a paediatric weight management clinic. METHODS: Mixed linear modelling examined the main and interactive effects of time by ADHD status and stimulant medication use on BMI and blood pressure. RESULTS: Youth without ADHD experienced a significantly faster decrease in BMI compared to youth with ADHD (p < 0.001). Youth with ADHD who were taking stimulant medication had a significantly faster decrease in BMI compared to youth with ADHD who were not taking stimulant medication (p = 0.009). There was no significant effect of ADHD status or stimulant medication use on diastolic or systolic blood pressure trajectories over time (ps >0.05). CONCLUSIONS: Results from this study suggest that youth with ADHD who are not taking stimulant medication may not benefit from clinical weight management to the same extent as either youth without ADHD or youth with ADHD who are taking a stimulant medication.