Using the life course health development model to address pediatric mental health disparities.

TOPIC: Early-life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long-term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods. PURPOSE: The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research. SOURCES: Peer-reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials. CONCLUSIONS: The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children.

A scoping review of the concept of resilience among African American women.

Resilience, thriving in the face of adversity, is a critical component of well-being in African American women. However, traditional definitions and approaches to operationalize resilience may not capture race- and gender-related resilience experiences of African American women. A more complete conceptualization of resilience may help facilitate future investigation of the mechanisms through which resilience influences health in this group. Our team conducted a scoping review of the literature published during twenty years, between 2000 and 2019, on resilience and health in African American women. We included a multidisciplinary set of databases (PubMed, CINAHL, PsycINFO, Scopus, Social Work Abstracts, Sociological Abstracts, Academic Search Premier). Using Covidence software a multi-step review process was conducted; 904 abstracts were initially screened for eligibility, 219 full-text studies were screened in stage two, and 22 remaining studies were reviewed for extraction. The studies reviewed revealed limitations of unidimensional approaches to conceptualizing/operationalizing resilience in African American women. The review highlighted culturally-relevant components of resilience including spirituality/religion, strength, survival, active coping, and social support. Findings highlight the importance of operationalizing resilience as a multidimensional construct so it can be optimally included in research designed to investigate the quality of life, cardiovascular risk, and other health outcomes in African American women.

Cancer patient and provider responses to companion scales assessing experiences with LGBTQI-affirming healthcare.

Background: Sexual and gender minority (SGM) persons are at a higher risk for some cancers and may have poorer health outcomes as a result of ongoing minority stress, social stigma, and cisnormative, heteronormative healthcare environments. This study compared patient and provider experiences of affirming environmental and behavioral cues and also examined provider-reported knowledge, attitudes, behaviors, and clinical preparedness in caring for SGM patients among a convenience sample. Methods: National convenience samples of oncology providers (n = 107) and patients (n = 88) were recruited separately via snowball sampling. No incentives were provided. After reverse coding of appropriate items for unidirectional analysis, lower scores on items indicated greater knowledge, more affirming attitudes or behaviors, and greater confidence in clinical preparedness to care for SGM patients. Pearson chi-square tests compared dichotomous variables and independent samples t-tests compared continuous variables. Other results were reported using descriptive frequencies. Results: Both patient and provider samples were predominantly female sex assigned at birth, cisgender, and heterosexual. Providers were more likely than patients to report affirming cues in clinic, as well as the ability for patients to easily document their name in use and pronouns. Providers were more likely to report asking about patient values and preferences of care versus patients' recollection of being asked. Patients were more likely to report understanding why they were asked about both sex assigned at birth and gender identity compared to providers' perceptions that patients would understand being asked about both. Patients were also more likely to report comfort with providers asking about sex assigned at birth and gender identity compared to providers' perceptions of patient comfort. SGM providers had greater knowledge of SGM patient social determinants of health and cancer risks; felt more prepared to care for gay patients; were more likely to endorse the importance of knowing patient sexual orientation and gender identity; and were more likely to indicate a responsibility to learn about SGM patient needs and champion positive system changes for SGM patients compared to heterosexual/cisgender peers. Overall, providers wished for more SGM-specific training. Conclusion: Differences between patient and provider reports of affirming environments as well as differences between SGM and heterosexual/cisgender provider care support the need for expanded professional training specific to SGM cancer care.

Sudarshan Kriya Meditation Reduces Substance Abuse Cravings and Improves Physical and Emotional Well-Being of Individuals With Opioid Use Disorder: A Pilot Study.

Opioid use disorder (OUD) is widely prevalent in the United States and there are high levels of comorbidity between OUD and mental illnesses, such as depression, anxiety, and posttraumatic stress disorder. Psychotherapy, in addition to medication-assisted therapy, are considered important components of long-term OUD treatment. Sudarshan Kriya Yoga (SKY) is a breathing-based mind-body intervention that has been demonstrated to have multiple physiological and psychological benefits. In the current study, participants (N = 8) recruited from a rural community were offered SKY in addition to treatment-as-usual. Physical and psychological well-being were measured using the Behavior and Symptom Identification Scale-24, Short Form-36, Perceived Stress Scale, and participant logs and journals. Of eight participants, seven (87.5%) successfully completed the SKY intervention. Compared to baseline, there was a significant decrease in substance use cravings (p = 0.04) and depression (p = 0.01). In addition, physical functioning and emotional well-being significantly increased after SKY. SKY demonstrated efficacy in improving physical and social functioning along with enhancing mental and emotional well-being. Larger-scale trials should be performed to validate these findings. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 51-59.].

The Modifying Role of Resilience on Allostatic Load and Cardiovascular Disease Risk in the Jackson Heart Study.

We examined whether resilience modified associations between allostatic load (AL), a physiological indicator of coping with repeated stressors, and cardiovascular disease (CVD) among 2758 African Americans in the Jackson Heart Study. Baseline AL was quantified using biological measures of metabolic, cardiovascular, and immune markers. We constructed a multidimensional resilience measure using validated questionnaires for social support, social networks, religious experiences, and optimism. Participants were followed until 2016 for stroke, coronary heart disease (CHD), and heart failure (HF). We used multivariable-adjusted, sex-stratified Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between dichotomous AL and CVD. High AL was associated with CHD among women (HR = 1.73, 95% CI = 1.00, 2.99) and HF among women (HR = 1.52, 95% CI = 0.98, 2.37) and men (HR = 2.17, 95% CI = 1.28, 3.68). Among women, resilience did not modify the AL-CVD relationship. Among men, we observed higher stroke risk among men with low resilience (HR = 2.21, 95% CI = 0.94, 5.22) and no association among those with high resilience. Counterintuitively, high AL was associated with greater HF (HR = 5.80, 95% CI = 2.32, 14.47) in the subgroup of men with high resilience. Future studies addressing different facets of resilience are needed to elucidate underlying mechanisms for CVD prevention among African Americans.

Developing catalyst films of health experiences: an analysis of a robust multi-stakeholder involvement journey.

BACKGROUND: Those whose lives are most directly impacted by health care-patients, caregivers, and frontline staff-are ideally situated to improve patient health care services and care quality. Despite a proliferation of literature on both Patient and Public Involvement (PPI) and clinical quality improvement (QI), concrete strategies regarding how to involve patients remain elusive. AIM: Research suggests catalyst films, comprised of rigorously-analyzed interview data from diverse patients about their experiences with health and health care ("catalyst films") are a promising way to bring actionable patient feedback to QI. To date, such films have been crafted primarily by researchers. This project aimed to inform the science of engagement through analyzing how deliberate PPI informed the process of creating catalyst films. METHODS: PPI methods included: research team norming activities through a project charter and role delineation process; key informant interviews; participant-ambassador videotaped interviews; clinician and research focus groups; and inclusion of advisors on the research team. Content studied for the analysis presented here included team meeting notes, interview and focus group transcripts, and documentation from a facilitated discussion about team processes. These data were analyzed to determine the impact of our PPI process. Member checking verified themes and lessons learned. RESULTS: PPI shaped team deliberations and final products in substantial ways, including: what material to include in catalyst films and the tone they should convey; multiple issues regarding representation; and our collective understanding of how catalyst films could be used in the United States. Specific discussions addressed: how to include the optimal mix of interview segments that describe experiences with those that more directly point towards care improvement strategies; and how to balance positive and negative feedback from patients about experiences with care. Team process issues included ensuring equity in involvement despite team members having differing and sometimes multiple roles that complicated power dynamics and processes. CONCLUSIONS: Multiple forms and degrees of PPI resulted in significant influence on catalyst films and companion materials. Our project thus provides proof of concept for PPI in creation of video products for QI which have traditionally been crafted by researchers. The model we developed, and document in this paper, can be adapted by others creating research-derived video products. Our findings can also inform future research on how co-designing catalyst films enhances their value for QI and the application of co-designed catalyst film use in QI. Lastly, it can guide those engaged in QI and medical education in their selection of film products focused on patient experiences.

Involving patients in care improvement efforts is valuable for improving the quality and safety of health care services because patients offer unique insights and are directly impacted by the system. Involving patients in these efforts can also inform better patient and family experiences. Studies have shown that using video interviews highlighting good and bad patient experiences in healthcare is one of the promising way to include a wider range of patient narratives and feedback in care improvement. Videos used in these situations are now called catalyst films, formerly known as trigger films. This paper describes how catalyst films are similar to and distinct from other film products used in research and improvement projects. It examines a process for equitably engaging a team of many different stakeholders­patients, providers, and researchers­to select video excerpts from existing research-based patient experience interviews to create catalyst films. It describes methods used to ensure robust input from all team members, so that all perspectives influence the catalyst films. The study concluded that patient and public involvement had significant impact on both the research process and the final products created. Our findings can equip those making or selecting films for use in improving health and social care to ensure films are patient informed. The paper concludes by offering limitations and recommendations for future research to advance the fields of patient and public involvement and quality improvement.

VMAT2 Inhibitors for the Treatment of Tardive Dyskinesia.

Psychiatric nurses are at the forefront of optimizing psychiatric care, including educating patients and caregivers on the risks of antipsychotic-induced movement disorders such as tardive dyskinesia (TD). Nurses should be aware that all patients taking antipsychotics should be regularly monitored for the development of TD. Given the current pandemic and increase in telehealth, assessing for TD is challenging; however, evaluation can be successfully completed by implementing the best practices described in this paper. Once TD is diagnosed, nurses can reassure patients that safe and effective FDA-approved treatments for TD (e.g., valbenazine) are now available.

Burnout and Well-Being: Evaluating Perceptions in Bone Marrow Transplantation Nurses Using a Mindfulness Application.

BACKGROUND: Oncology nurses are at increased risk for developing burnout. Although various interventions have been researched, mindfulness has been proven to be beneficial in mitigating burnout while improving well-being. OBJECTIVES: The aim was to evaluate whether the use of a mindfulness mobile application (app), Headspace®, increases perceptions of well-being and decreases perceptions of burnout among inpatient bone marrow transplantation (BMT) staff nurses and nurse practitioners (NPs). METHODS: This evidence-based practice quality improvement initiative introduced the Headspace app to BMT nurses and evaluated its impact on burnout and well-being at baseline and every 30 days for 90 days. FINDINGS: There were significant improvements in burnout and well-being in staff nurses and NPs from baseline to each time point. Sleep hygiene meditations were the most widely used programs within the Headspace app for both nursing groups.

Cognitive-Behavioral Skills Building to Alleviate the Mental Health Effects of Bullying Victimization in Youth.

Bullying is a long-standing problem with relatively few intervention options for individual youth who have experienced it and have adverse mental health concerns. Depression, anxiety, and suicidal ideation are major consequences of bullying victimization. Although few evidence-based interventions have been put forth to address bullying victimization at the individual level, cognitive-behavioral therapy (CBT) and cognitive-behavioral skills building (CBSB) have been well researched for mental health concerns in youth. The purpose of the current article is to examine the theoretical framework of cognitive theory for individuals who have experienced bullying. Previous work that has addressed CBT for bullying interventions is described. Specific examples of how CBSB components could be applied to a bullying intervention program for youth are discussed. Ultimately, providing a theoretical framework to address this public health concern sets the stage for future intervention research. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 15-20.].

Implementation of Universal Adolescent Depression Screening: Quality Improvement Outcomes.

INTRODUCTION: Despite the increasing incidence of adolescent depression, suicide and evidence-based recommendations for adolescent depression screening, 70% of teens report not discussing depression with their provider. The aim of this quality improvement project was to improve the identification and management of adolescent depression by implementing a practice-based, universal depression screening. METHOD: The Patient Health Questionnaire-9 modified for Adolescents was implemented during annual wellness visits for adolescents aged 12-18 years over 3 months. Retrospective chart reviews were conducted to determine a change in the rates of depression screening, depression diagnoses, referrals to mental health, and pharmaceutical treatment of depression. RESULTS: Pre/postimplementation data were compared. Documented adolescent depression screening increased from 0% to 74.5%. Increased rates of diagnosed depression (12.1%), mental health referrals (8%), and pharmaceutical treatment of depression (4.9%) were clinically and statistically significant. DISCUSSION: Adopting evidence-based recommendations for universal depression screening in pediatric primary care can improve the early diagnosis and management of adolescent depression.

The Synergistic Influence of Life Experiences and Cultural Nuances on Development of Depression: A Cognitive Behavioral Perspective.

The synergistic influences of everyday life experiences, societal expectations, and cultural nuances affect a person's ability to successfully manage their life and remain mentally healthy. Persons from culturally and ethnically diverse populations may incur depression when societal expectations and cultural influences are in conflict with each other. Chronic stress, often-referred to as toxic stress, contributes to the development of depression as it is unrelenting, beginning in childhood and continuing into adulthood. This article discusses connections between societal expectations, persons' cultural perspectives as well as the role that these connections may contribute to in the development of toxic stress and depression. Beck's Cognitive Behavioral Theory provides a basis to describe the role that synergistic influences play in development of depression for culturally and ethnically diverse persons.

Social-Emotional Screening Protocol Implementation: A Trauma-Informed Response for Young Children in Child Welfare.

Adverse childhood experiences in young children result in negative outcomes as trauma affects brain development. In child welfare services, early recognition of delayed social-emotional skills and treatment referral is essential in reducing the effects of trauma. This quality improvement pilot project implemented an evidence-based social-emotional screening protocol using the Ages and Stages Questionnaire: Social Emotional-2 screening tool for very young children placed in out-of-home care through the county's child welfare system. Findings showed significant improvement in identification of children younger than 3 years with social-emotional concerns (p < .0001) and significant improvement in referral of those children positively identified (p = .0130). Ongoing use of the protocol was recommended, because it showed improved identification and referral for young children in the child welfare system with social-emotional concerns that were potentially trauma related. Further collaboration between child protective services, pediatric medical systems, and pediatric mental health systems is needed to facilitate trauma-informed care for children in the child welfare system.

Attention, Externalizing, and Internalizing Problems of Youth Exposed to Parental Incarceration.

Few studies have examined the effects of parental incarceration (PI) on outcomes above and beyond other risk and adverse childhood experiences (ACEs). The objectives of this study were to (1) the associations between PI and mental health problems (attention, externalizing, internalizing, and total behavioral problems) and (2) the mediating role of current socioeconomic status and cumulative ACEs. An observational and cross-sectional design was employed. Analyses included hierarchical multivariable linear regression modeling. The analytic sample included 613 adolescents (11-17 years). On average, youth exposed to PI experienced three times as many ACEs compared with youth unexposed. Youth exposed to PI were more likely to have behavioral problems than their unexposed peers. The main effect for all models was attenuated by current economic hardship as well as exposure to increasing numbers of ACEs. Exposure to PI can be viewed as a marker of accumulative risk for intervention since youth impacted by PI are more likely to experience behavioral difficulties and associated adverse childhood experiences. Due to the associated adversity that impact youth exposed to PI, mental health providers need to be able to identify and screen for symptoms associated with trauma.

Stress, Resilience, and Cardiovascular Disease Risk Among Black Women.

BACKGROUND: Empirical data on the link between stress and cardiovascular disease (CVD) risk among black women is limited. We examined associations of stressful life events and social strain with incident CVD among black women and tested for effect modification by resilience. METHODS AND RESULTS: Our analysis included 10 785 black women enrolled in the Women's Health Initiative Observational Study and Clinical Trials cohort. Participants were followed for CVD for up to 23 years (mean, 12.5). Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for associations between stress-related exposures and incident CVD. We included interactions between follow-up time (age) and stressful life events because of evidence of nonproportional hazards. Effect modification by resilience was examined in the sub-cohort of 2765 women with resilience and stressful life events measures. Higher stressful life events were associated with incident CVD at ages 55 (hazard ratio for highest versus lowest quartile=1.80; 95% CI, 1.27-2.54) and 65 (hazard ratio for highest versus lowest quartile=1.40; 95% CI, 1.16-1.68), but not at older ages. Adjustment for CVD risk factors attenuated these associations. Similar associations were observed for social strain. In the sub-cohort of women with updated stressful life events and resilience measures, higher stressful life events were associated with incident CVD in multivariable-adjusted models (hazard ratio=1.61; 95% CI, 1.04-2.51). Resilience did not modify this association nor was resilience independently associated with incident CVD. CONCLUSIONS: In this cohort of older black women, recent reports of stressful life events were related to incident CVD. Resilience was unrelated to incident CVD. CLINICAL TRIALS REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00000611.

Eliminating perinatal HIV in the United States: mission possible?

: In 2015, only 53 infants born in the United States acquired HIV - the lowest recorded number of perinatal HIV infections. Recognizing this significant achievement, we must acknowledge that the United States has not yet reached the goal of eliminating perinatal HIV transmission. This analysis describes different approaches to perinatal HIV preventive services among five states and the District of Columbia as case studies. Continuous focus on improving identification, surveillance and prevention of HIV infection in pregnant women and their infants is necessary to reach the goal of eliminating perinatal HIV transmission in the United States.

High-Effort Coping and Cardiovascular Disease among Women: A Systematic Review of the John Henryism Hypothesis.

African-American women living in the United States experience higher cardiovascular disease risk (CVD) mortality compared to White women. Unique mechanisms, including prolonged high-effort coping in the face of discriminatory stressors might contribute to these racial disparities. The John Henryism hypothesis is a conceptual framework used to explain poor health outcomes observed among individuals with low resources who repeatedly utilize active coping to overcome barriers. The aims of our study were to summarize the literature related to John Henryism and CVD-related factors with a particular focus on women and to identify gaps for areas of future inquiry. We searched MEDLINE, EMBASE, Scopus, and CINAHL to identify literature that used the John Henryism Active Coping scale. Reviewers independently reviewed eligible full-text study articles and conducted data extraction. We qualitatively summarized the literature related to John Henryism and cardiovascular disease (CVD)-related health behaviors (e.g., smoking or physical activity) and risk factors (e.g., hypertension) with a focus on study populations inclusive of women. Our review included 21 studies that used the John Henryism Active Coping scale, of which 10 explicitly reported on the interaction between John Henryism and socioeconomic status (SES) and CVD-related factors. With respect to the original hypothesis, three studies reported results in line with the hypothesis, four were null, and three reported findings in opposition to the hypothesis. The remaining studies included in the review examined the main effects of John Henryism, with similarly mixed results. The literature related to the interaction between John Henryism and SES on CVD-related factors among women is mixed. Additional studies of John Henryism that incorporate biological measures, varied indicators of resources, and larger study populations may illuminate the relationship between coping and deleterious health outcomes among women.

A Multicomponent Approach to Evaluating a Pre-exposure Prophylaxis (PrEP) Implementation Program in Five Agencies in New York.

Research has shown that pre-exposure prophylaxis (PrEP) is effective for preventing HIV infection. We developed the Targeted PrEP Implementation Program (TPIP), an 18-month project that involved five statewide agencies, to assess the extent to which PrEP could be implemented in "real world" clinical settings. The target population was men who have sex with men at high risk for HIV infection. Data were collected from a variety of sources. Implementing PrEP statewide required facilitating provider capacity, developing resources, and identifying/addressing potential barriers. TPIP focused on three key questions: (a) Can providers identify and retain appropriate candidates for PrEP? (b) Can PrEP participants adhere to daily medication? (c) Can PrEP be delivered as part of a comprehensive/integrated plan? There were 171 participating clients, most of whom successfully incorporated PrEP into their daily routines. After addressing initial barriers, we found that PrEP could be routinely delivered as part of a comprehensive prevention plan.

Implementing Substance Abuse Intervention Services in New York City Sexually Transmitted Disease Clinics: Factors Promoting Interagency Collaboration.

This report presents results of Project LINK, a Substance Abuse and Mental Health Services Administration (SAMHSA)-funded, 5-year collaboration (2007-2012) between New York City (NYC) health and NY State substance abuse disorder (SUD) agencies, an LGBT organization contractor, and multiple SUD, social service, and mental health referral agencies. LINK allowed the first ever SUD screening, brief intervention, and referrals to treatment (SBIRT) intervention services onsite in NYC Bureau of Sexually Transmitted Disease Control (BSTDC) clinics. Factors favoring collaboration were (a) joint recognition of substance abuse as an STD risk factor; (b) prior collaborations; (c) agreement on priority of BSTDC's mission and policies; (d) extensive SBIRT training, cross training on STDs; (e) a memorandum of agreement; and (f) mutual transparency of collaborative efforts, among others. LINK screened over 151,000 STD clinic patients and delivered brief interventions to 60% of positively screened patients and met a mandated follow-up target. Factors found to facilitate collaboration here may help screen prospective new health collaborations.

Multi-century record of anthropogenic impacts on an urbanized mesotidal estuary: Salem Sound, MA.

Salem, MA, located north of Boston, has a rich, well-documented history dating back to settlement in 1626 CE, but the associated anthropogenic impacts on Salem Sound are poorly constrained. This project utilized dated sediment cores from the sound to assess the proxy record of anthropogenic alterations to the system and compared the proxy records to the known history. Proxies included bulk stable isotopes of organic matter, magnetic susceptibility, and trace metal concentrations. Our data reveal clear changes in organic matter composition and concentration associated with land use changes and twentieth century sewage disposal practices. Further, metals data correspond with local industrial activity, particularly the historic tanning industry in Peabody, MA. Although conservation practices of past decades have improved the state of Salem Sound, the stratigraphic record demonstrates that the environment is still affected by anthropogenic influences, and has not attained conditions consistent with pre-anthropogenic baseline. The approach and results of this study are applicable to coastal embayments that are being assessed for remediation, especially those with scant historic or monitoring data.