Development of a new measure of encounters with health care barriers: The Commonly Experienced Health Care Barriers Index.

Common barriers to health care, such as lack of insurance or transportation, hold a key theoretical role in many models attempting to explain problems with health care utilization (not seeking needed health care). However, the assessment of barriers is often post hoc, with no existing scales appropriate for a general population. This study developed and tested a new measure of commonly experienced health care barriers across three studies (Study 1, N = 194; Study 2, N = 206; Study 3, N = 741). Items were developed in line with recommendations for causal indicator models, emphasizing content validity. The measure showed preliminary test-retest reliability, sensitivity to health care inequities between Black and White individuals (beyond socioeconomic status and including association with health care discrimination), expected associations with health care utilization problems and other health experiences and life stressors, and unique associations with health care utilization problems accounting for health experiences and life stressors. The new measure has the potential to identify modifiable factors related to health care inequities and common problems with health care utilization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attachment-based family therapy versus nondirective supportive therapy for lesbian, gay, bisexual and questioning adolescents with depression, and suicidal ideation: An exploratory study.

INTRODUCTION: Lesbian, gay, bisexual, and questioning (LGBQ) adolescents are particularly at risk for suicidal ideation; however, little clinical research is focused on treating this population. Attachment-based family therapy (ABFT) is among the few empirically supported youth suicide treatments adapted for LGBQ adolescents. The purpose of this exploratory study is to determine the differential treatment effects and rates of change for LGBQ and heterosexual adolescents with depression and suicidal ideation receiving either ABFT or family enhanced nondirective supportive therapy (FE-NST). METHOD: The sample included 129 adolescents (31% LGBQ), ages 12-18 randomized to the two treatment groups. Multilevel modeling was used to examine individual changes in depression and suicidal ideation over the 16-week treatment. RESULTS: Results revealed that LGBQ adolescents in the ABFT condition showed a greater rate of reduction in depressive symptoms over treatment, slope = -0.94, p < 0.001, than did LGBQ adolescents in the NST condition, slope = -0.41, p = 0.12. Heterosexual adolescents showed symptom reduction in both treatment conditions (ABFT slope = -0.47, p < 0.001; NST slope = -0.79, t (113) = -7.48, p < 0.001). Changes in suicidal ideation were found across time, but not across conditions. CONCLUSION: LGBQ adolescents in the ABFT condition had a sharper decrease in depressive symptoms and better outcomes at week 16.

Differentiating Between Youth with a History of Suicidal Thoughts, Plans, and Attempts.

Limited research has examined factors distinguishing between patterns of adolescent suicidal thoughts and behaviors. The current study examined demographic, school, family, and mental health differences across patterns identified by Romanelli and colleagues (2022): history of thoughts only, plans with thoughts, attempt with thoughts and/or plans, and attempt without thoughts. The current study includes 4,233 students (M age = 14.65 years, SD = 2.06) with a history of suicide risk referred to school Student Assistance Program teams. The sample was approximately 60.7% female, 59.8% White (16.0% Black, 15.4% multiracial, 8.8% other), and 14.4% Hispanic. Results indicated that the "attempt without thoughts" group was small with no differentiating characteristics. However, membership in the other three groups was predicted by demographic, school, family, and mental health factors. These results support the importance of examining suicidal thoughts, plans, and attempts as distinct indicators and assessing key biopsychosocial factors. Further research could improve how behavioral health systems identify at risk youth.

Parent experiences during and after adolescent suicide crisis: A qualitative study.

Parents of adolescents who have suicide crises (i.e. suicide attempt and/or significant ideation) are often highly involved in the care management, treatment and preventing future suicides of their children. How they experience these suicide crises, and the period afterward, has not been well studied. The purpose of this study was to understand parents' (defined in this study as any legal guardian of an adolescent taking on a parental role) experience of adolescent suicide crises and its impact on themselves and the family system. Semi-structured interviews were conducted with parents (N = 18) of adolescents who had a suicide crisis in the past 3 years. Thematic analysis was used with a combined inductive-deductive coding approach, drawing from Diamond's conceptualization of family treatment engagement for suicidal youth and iterative close readings of transcripts. Five themes emerged related to parent experience: Trauma of the Experience (subtheme: Feelings of Failure); Living in Fear; Alone and Seeking Connection; Lasting Impact; and A New Normal (subtheme: Turn the Pain to Purpose). Parents experienced these events as traumatic, damaging their sense of self. They experienced long periods of time where fear and loneliness dominated their lives. Recovery was both an individual and a family process, occurring in tandem with, but distinct from, adolescent experiences. Descriptions and illustrative quotes illustrate parent experiences and their understanding of the impact on the family system. Results highlighted that parents require support both for themselves and as caregivers for adolescents around an adolescent's suicide crisis and that family-focused services are vital.

Validation of a parent report on externalizing symptoms scale: A downward extension of the behavioral health screen.

Externalizing problems are common in children ages 6-14, can have lifelong consequences, and may pose a particular risk when combined with other risk factors and symptoms (like depression and anxiety). Schools are uniquely positioned to assess and address these types of behavioral health concerns, but many school-based assessments do not focus on mental health distress (partially because they often lack the infrastructure for identification, screening, and referral). To address this gap, the Behavioral Health Works program student mental health software system has integrated teacher training, psychometrically strong assessments, feedback, and referral tools. However, this self-report tool for adolescents needed to be adapted for younger children. Thus, a parent-report version was added as well as new scales for better assessing this age group. The present study examines the psychometric properties of the new parent-report attention-deficit hyperactivity disorder (ADHD) and oppositional defiant/conduct scales within a sample of 440 children referred for school-based assessments. Overall, the new scales demonstrated good structural validity, measurement invariance across most demographic groups, discrimination in item response theory analyses, and evidence of convergent validity and good classification accuracy in relation to a validation battery. These externalizing scales are distinct and precise and show promise for improving the effectiveness of school-based programs for identifying at-risk children. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identifying Youth at Risk for Suicidal Thoughts and Behaviors Using the "p" factor in Primary Care: An Exploratory Study.

Suicide is a major, preventable public health problem. The general factor of psychopathology ("p" factor) might help improve detection and prediction of individuals at risk for suicide. This cross-sectional proof-of-concept study tests whether the p-factor score is associated with suicidal thoughts and behaviors (STB) better than a depression scale alone. Youth (N = 841; mean age 18.02, SD = 3.36) in primary care were universally screened using the Behavioral Health Screen (BHS). Factor analysis and ROC results showed the BHS assesses the p-factor, and the p-factor score demonstrates higher classification accuracy of several types of STB than a depression scale. The p-factor could help clinicians in the identification of youths with STB.

Maternal and paternal attachment in high-risk adolescents: Unique and interactive associations with anxiety and depressive symptoms.

Anxiety and depressive symptoms are common, comorbid, and consequential for adolescents. Attachment theory suggests that styles of relationships with parents, developed from patterns of interactions over time, contribute to risk for these internalizing symptoms. This may be especially relevant for high-risk, clinically severe adolescents. However, most research focuses primarily on attachment relationships to mothers. Some theoretical perspectives also suggest that attachment to other caregivers (such as fathers) may not only be uniquely important for understanding internalizing symptoms but may also interact with maternal attachment. Therefore, it is important to examine these attachment relationships in tandem. The present study examines associations between attachment and internalizing symptoms in a sample of 1,141 youth (12-20 years old; 54.0% female, 96.5% White) from a multisite residential treatment facility. Youth reported on attachment anxiety and avoidance with both parents, as well as anxiety and depressive symptoms. Response surface analyses were used to examine curvilinear, interactive, and fit effects using a model comparison approach. Overall, for patterns of anxious attachment, the best-fitting models reflected simple additive and linear effects. For avoidant attachment, best-fitting models included interactions and fit patterns, suggesting the meaning of maternal attachment was dependent on paternal and vice versa. After accounting for covariates, however, maternal attachment was the sole predictor in most models except attachment avoidance predicting depressive symptoms. These results have implications for attachment theory and research, and further work untangling these complex effects may inform clinical practice for high-risk adolescents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social relationships, stress, and treatment adherence perceptions in type 2 diabetes and hypertension: between-person, within-person, and compositional associations.

OBJECTIVE: Type 2 diabetes and hypertension are "intertwined" conditions with lifestyle treatment plans, but patients often struggle to consistently engage in and follow treatment plans. To identify potential mechanisms for improving patient adherence to lifestyle treatment plans for type 2 diabetes and hypertension, this longitudinal study investigated the extent to which situational changes in patient-practitioner relationships, close relationships, and stress, explain between-person, immediate within-person, and compositional change in patient behavior and attitudes.Methods and measures: Over one year, 167 participants with type 2 diabetes and/or hypertension completed seven questionnaires assessing adherence perceptions (adherence, benefit, and burden), patient-practitioner experiences (alliance and confusion), close interpersonal interactions (positive and negative), and stress. RESULTS: Multilevel structural equation modeling analyses revealed that nearly all hypothesized between-person associations were significant. Moreover, all hypothesized predictors explained within-person change in at least one adherence outcome. Predictors also produced compositional effects where outcomes were predicted by scores sustained over time. Most social and stress variables had unique associations with adherence perceptions after controlling for other predictors. CONCLUSION: Results highlight the complexity of change processes and importance of social relationships and stress for adherence. Greater understanding of these processes may improve outcomes for individuals with type 2 diabetes and/or hypertension.

Positive exchanges buffer negative exchanges: Associations with marital satisfaction among U.S. mixed-sex couples.

Perceived positive and negative exchanges in relationships contribute to marital satisfaction in qualitatively distinct manners. However, the nature of these associations is unclear with some studies demonstrating curvilinear relationships and some literature suggesting interaction effects of positive and negative exchanges on marital satisfaction. Extant work has not compared curvilinear and interactive models to address this discrepancy. The present study clarifies these associations by comparing multiple models. Based on cross-sectional data from 886 mixed-sex married couples from across the U.S., we found that marital satisfaction was associated with greater positive exchanges and lower negative exchanges. In addition, the data support interaction effects of positive and negative exchanges on marital satisfaction, but not curvilinear effects. Specifically, high positive exchanges may buffer the impact of negative exchanges on relational satisfaction. Gender differences in effects were not supported. These findings confirm that positive and negative exchanges are distinct constructs and demonstrate how relationship satisfaction scores suffer from issues of equifinality by failing to distinguish between very different qualitative relational experiences. We suggest that curvilinear, plateauing effects may be an artifact of data loss when analyzing individuals in relationships rather than whole dyads, and suggest that scholars study positive and negative exchanges with both members of a dyad moving forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessing Attitudes Toward COVID-19 Prevention: Defining Two Attitudes Crucial for Understanding Systemic and Social Variables Associated with Disparities.

This study tested a conceptual model identifying two distinct types of attitudes people may have toward following recommendations to prevent COVID-19. These attitudes were expected to be important for understanding types of systemic and social variables associated with health disparities such as racial discrimination, residential environment, lack of healthcare access, and negative healthcare experiences. The conceptual model was drawn from previous work examining adherence to medical recommendations that identified two distinct and consequential attitudes that influence behavior: perceived benefit (believing recommendations are effective and necessary) and perceived burden (experiencing recommendations as unpleasant or difficult). Approximately equal proportions of Black and White individuals living in the USA (N = 194) were recruited to complete an online survey. A psychometric analysis indicated that perceived benefit and burden attitudes were two distinct and meaningful dimensions that could be assessed with high validity, and scales demonstrated measurement invariance across Black and White groups. In correlation analyses, benefit and burden attitudes were robustly associated with neighborhood violence, healthcare access, and healthcare experiences (but not with experiences of discrimination), and all these associations remained significant after accounting for subjective stress and political affiliation. These findings have implications for increasing compliance to public health recommendations and addressing health disparities.

Family and Peer Relationships in a Residential Youth Sample: Exploring Unique, Non-Linear, and Interactive Associations with Depressive Symptoms and Suicide Risk.

Close relationships are consequential for youth depressive symptoms and suicide risk, but nuanced research examining intersecting factors is needed to improve identification and intervention. This study examines a clinical, residential sample of 939 adolescents and young adults ages 10 to 23 years old (M = 15.84, SD = 1.53; 97.7% white, 99.5% non-Hispanic, 55% female). The final model found that family conflict, parental criticism, verbal bullying, and interactions with friends were associated with depressive symptoms in the expected directions, and there were significant interactions with family, peer, and demographic variables. However, most associations with suicide risk were indirect. Associations involving family factors, peer factors, depressive symptoms, and suicide are not always straightforward, and should be understood within a microsystemic context.

Attitudinal and social predictors of adherence to oral endocrine therapy: A psychometrically-informed model.

There is a need for a psychometrically-informed model identifying attitudinal and social factors explaining adherence to oral endocrine therapy (OET) for women with hormone receptor positive breast cancer. This study tested a model with variables selected by stringent psychometric criteria, including attitudes about benefit and burden, patient-practitioner alliance and confusion, and positive and negative interpersonal interactions. Self-report scales were completed by 150 current or past OET users. Fourteen correlations and six mediated pathways implied by the model were tested. All hypothesized associations were significant. This preliminary study suggests the model is a valuable framework for OET adherence research and intervention.

A special kind of stress: Assessing feelings of decisional distress for breast cancer treatment decisions.

OBJECTIVE: Women with breast cancer need to make difficult treatment decisions and may experience decisional distress (worry, anxiety, and thought intrusion) associated with these decisions. This study investigated ways that decisional distress was both associated with and distinct from other variables regarding decisional process and life functioning, and it investigated the validity of a decisional distress scale. METHODS: A total of 263 women previously or currently diagnosed with breast cancer reported on initial treatment decisions regarding surgery, chemotherapy, or radiation, or decisions involving oral endocrine therapy (either currently or retrospectively). Participants completed online measures of decisional distress, alliance and confusion in patient-practitioner relationships, positive and negative interactions in close relationships, financial and general distress, and decision satisfaction. RESULTS: Decisional distress demonstrated a unidimensional factor structure invariant across treatment context groups, a wide range of meaningful variation, significant correlations with all hypothesized variables (especially patient confusion), but also key distinctions from other variables. CONCLUSION: Decisional distress is a meaningful construct that can be assessed with precision, and important for understanding medical decision-making processes and patient quality of life. PRACTICE IMPLICATIONS: Assessing decisional distress is crucial for evaluating treatment decision outcomes. One key to reducing decisional distress may involve reducing patient confusion.

Both trusting and understanding medical advice: Assessing patient alliance and confusion after medical consultations.

OBJECTIVE: The current objective is to validate the Medical Consultation Experience Questionnaire (MCEQ) and to examine distinctions between constructs of patient perceived alliance and experienced confusion in relation to key health outcomes. METHODS: A total of 857 participants were recruited online across two samples (adults with various medical conditions and with diabetes and/or hypertension specifically). RESULTS: A confirmatory factor analysis demonstrated good fit and high item loadings for the theoretical bifactor model. Item response theory analyses showed very high individual item discrimination and good test information across a wide range of values. Confusion was uniquely and significantly more strongly related to psychological distress than was alliance; the same was true for alliance with positive affect. Both alliance and confusion significantly contributed to treatment motivation. Only confusion explained unique variance in control of HbA1C levels and blood pressure after controlling for alliance and other variables. CONCLUSIONS: The MCEQ is a valid instrument for assessing distinct constructs of alliance and confusion. Future research should focus on the unique role of confusion for patient outcomes. PRACTICE IMPLICATIONS: By using the MCEQ to assess patient alliance and confusion, it may be possible to detect and prioritize individual patient needs and improve patient outcomes.

Treatment Adherence Perception Questionnaire: Assessing patient perceptions regarding their adherence to medical treatment plans.

The Treatment Adherence Perception Questionnaire (TAPQ) is a new, brief self-report instrument for assessing patient perceptions and attitudes regarding their own adherence to medical treatment plans. It includes 3 distinct scales: Perceived Behavior, Perceived Benefit, and Perceived Burden. In contrast with existing measures, the TAPQ was expected to have a clear factor structure; have good discrimination; and assess distinct types of perception, each of which has different patterns of association with interpersonal, personality, motivational, and emotional variables. Foundational work on the TAPQ (with 891 patients) included 5 quantitative scale development studies and 1 qualitative study. The present report focuses on results from a final validation study using 450 patients recruited via market research panels to complete online questionnaires. This study included a general medical sample and a sample of people with either diabetes or hypertension. A confirmatory factor analysis specifying strict measurement invariance across these groups produced a good fit. Analysis with item-response theory suggested that the scales on the TAPQ provide good discrimination across a wide range of experience levels. The 3 scales on the TAPQ each had distinct patterns of association with criterion variables regarding conscientiousness, health behavior, motivation, affect, type of diagnosis, and interpersonal communication with health-care professionals. These effects could not be explained by another existing measure of adherence or by a measure of response bias. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Medical Consultation Experience Questionnaire: Assessing perceived alliance and experienced confusion during medical consultations.

The Medical Consultation Experience Questionnaire (MCEQ) is a new, brief self-report instrument that can be used with both adult patients and parents of child patients to assess two dimensions of people's experiences interacting with medical practitioners: Alliance and Confusion. In contrast with existing measures, the MCEQ was expected to provide good discrimination across a full range of experience levels and to assess two distinct dimensions of experience with good factor validity. It was developed in a series of 7 preliminary studies (with 758 participants) and tested in 3 subsequent validation studies, which are the focus of the present report. Study 1 was an Internet sample of 199 parents of child patients, Study 2 was a hospital sample of 173 parents of child surgery patients, and Study 3 was an Internet sample of 204 adult patients. A confirmatory factor analysis specifying strict measurement invariance across the 3 groups produced a good fit. An item response theory analysis suggested that scales on the MCEQ provide good discrimination across a wide range of experience levels. The new scales measuring Alliance and Confusion each had a distinct pattern of convergent validity associations with criterion variables regarding alternate measures of consultation experience, treatment context, and patient-reported perception, behavior, and affect. Results support the validity of the MCEQ and suggest that Alliance and Confusion are two distinct and informative dimensions of medical consultation experience. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Negative relationship behavior is more important than positive: Correlates of outcomes during stressful life events.

When people who are married or cohabiting face stressful life situations, their ability to cope may be associated with two separate dimensions of interpersonal behavior: positive and negative. These behaviors can be assessed with the Couple Resilience Inventory (CRI). It was expected that scales on this instrument would correlate with outcome variables regarding life well-being, stress, and relationship satisfaction. It was also expected that effects for negative behavior would be larger than effects for positive and that the effects might be curvilinear. Study 1 included 325 married or cohabiting people currently experiencing nonmedical major life stressors and Study 2 included 154 married or cohabiting people with current, serious medical conditions. All participants completed an online questionnaire including the CRI along with an alternate measure of couple behavior (to confirm scale validity), a measure of general coping style (to serve as a covariate), and measures of outcome variables regarding well-being, quality of life, perceived stress, and relationship satisfaction. The effects for negative behavior were larger than effects for positive in predicting most outcomes, and many effects were curvilinear. Notably, results remained significant after controlling for general coping style, and scales measuring positive and negative behavior demonstrated comparable levels of validity. (PsycINFO Database Record

The Parting Parent Concern Inventory: Parents' appraisals correlate with divorced family functioning.

When married parents go through a divorce, they may have concerns in 6 areas that are associated with postdivorce family adjustment. These include concerns about malice, power, custody, child rejection, esteem, and finances. The Parting Parent Concern Inventory assesses these concerns. It was developed in a series of preliminary studies, and this report focuses on results from 2 subsequent validation studies including 643 divorced parents with at least 1 child from their former marriage under the age of 18. Participants completed Internet assessments of their concerns and 14 different convergent validity criterion variables regarding aspects of child internalizing behavior, coparenting relationships, settlement outcomes, and personal well-being. Across both studies, the new measure of concerns fit an expected 6-dimensional factor structure. A total of 25 convergent validity correlations were tested, and all were significant. The distinctiveness of each concern scale was supported by the fact that all but 1 convergent association remained significant after controlling for variance explained by other concern scales. These results provide preliminary validation support for the new instrument. (PsycINFO Database Record