Patient Engagement in Patient Portals in Appalachia v. Surrounding U.S. Census Regions: An Analysis of HINTS (Health Information National Trends Survey) Data, 2017-2020.

Introduction: Those living in the Appalachian Region face a greater number of significant health disparities than residents of other areas of the U.S. Patient portals can decrease disparities, increase health literacy, and improve health outcomes. Purpose: This study explores if those living in the Appalachian Region are offered access to and use their patient portals differently than those in the surrounding U.S. Census regions. Additionally, the study aims to determine if there was a difference in reported reasons for the non-use of patient portals. Methods: A secondary analysis was completed using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) (2017-2020), a nationally representative survey. Descriptive statistics and chi-square tests were used to determine differences in patient portal use between regions. Results: There was no statistically significant difference between the Appalachian and surrounding U.S. Census regions in being offered access to patient portals. However, there was a statistically significant difference (non-weighted) between regions in the use of patient portals. Common reasons for the non-use of patient portals were a preference to speak directly to the provider and the lack of perceived need to use the portal. Implications: Providers in the Appalachian Region should be aware of the non-use of patient portals. Moreover, understanding the reported reasons for non-use may help providers tailor educational materials to increase patient portal use.

Association Between Insurer Connectivity in Appalachian Population Health Networks and Preventable Hospitalizations: Evidence from Kentucky.

Introduction: Addressing complex health and social needs requires cross-sector collaboration to deliver medical, social, and population health services at the community level. Capacity in community health and social services networks may be constrained in regions like Appalachia due to the combined effects of rurality and persistently poor health and social outcomes. One way that cross-sector networks serving low-resource communities can expand their capacity is by engaging partners, like health insurers, who can leverage resources from outside the local area. Purpose: This study examines insurer connectivity in cross-sector networks across Kentucky's geographic regions and the association between connectivity and the probability of an individual experiencing a preventable hospitalization. Methods: A cross-sectional design was used that linked data from the National Longitudinal Survey of Public Health Systems (NALSYS) with 2018 patient-level Kentucky hospital discharge data to examine the association between insurer connectivity in community networks and preventable hospitalizations across urban, rural non-Appalachian, and Appalachian regions. Results: Analysis of the data shows substantial geographic variation in the association between insurer connectivity in community networks and preventable hospitalization. Insurer connectivity in rural Appalachian communities was associated with lower likelihood that an individual was admitted for a preventable hospitalization ( p < 0.01). Implications: Findings suggest insurer connectivity in cross-sector community health and social services networks has the potential to strengthen network capacity to address preventable hospitalizations and improve health outcomes and well-being for the people of Appalachia.

The association of negative mood with automatic and effortful facial expression mimicry.

The natural process of mimicking the facial expressions of others is well established, as are the deficits in this reflexive behavior for individuals with clinical disorders such as depression. This study examines the extent of this deficit in non-clinical individuals with high transient negative mood, and whether it extends to both automatic and effortful emotion expression behavior. One hundred and thirty-six participants were shown happy, sad, and neutral faces, while electromyography (EMG) recorded facial muscle responses. Automatic (reflexive) mimicry was assessed while participants simply viewed facially expressive photographs, while effortful mimicry was monitored when individuals were told to intentionally copy the expressions in the photographs. Results indicated that high levels of negative mood were primarily associated with deficits in effortful mimicry of happy expressions, although some similar evidence was found in automatic mimicry of happy faces. Surprisingly, there were also ties between negative moods and inaccuracies in effortful mimicry of sad expressions (but not automatic mimicry). Inaccurate automatic and effortful mimicry were also tied with lower self-reported social support and greater loneliness. These results indicate that even in healthy individuals, transient and minor changes in negative mood are tied to deficiencies in facial mimicry at both the automatic and effortful level.

Cognitive inhibition and attentional biases in the affective go/no-go performance of depressed, suicidal populations.

BACKGROUND: Although cognitive inhibition deficits and attentional biases have been associated with suicidality, these findings have not been consistently reported across samples. The aim of the current study was to further investigate these variables among participants with differing suicidal risk. METHODS: We compared affective go/no-go performance in 100 depressed individuals with both current suicidal ideation and a prior history of attempted suicide, 100 depressed individuals with current suicidal ideation, but no history of attempted suicide, 100 suicide attempters without current depression or suicidal ideation, and 100 healthy controls. RESULTS: Suicide ideators with a history of attempted suicide committed more commission errors during negative word trials than any other group. Additionally, suicide ideators with no attempt history made more commission errors than did controls and previous attempters. An interaction for group status and emotional word valence revealed that suicide ideators with a history of attempted suicide responded fastest to negative words and slowest to positive words. Suicide ideators without an attempt history displayed a similar, but less pronounced pattern. Whereas, controls and previous attempters responded more quickly to positively valenced words. LIMITATIONS: The use of cross-sectional self-report data and inclusion of only female participants limits generalizability. CONCLUSIONS: Cognitive dysfunctions were apparent in all suicide vulnerable subjects, but significantly greater in suicide ideators with a history of attempted suicide. Suicidal ideation may be associated with a processing bias and inhibitory deficit for negative, mood-congruent information. These findings increase our knowledge of cognitive impairment in suicidality and may potentially help improve intervention strategies.

Correction: Neural Processing of Emotional Musical and Nonmusical Stimuli in Depression.

[This corrects the article DOI: 10.1371/journal.pone.0156859.].

Neural Processing of Emotional Musical and Nonmusical Stimuli in Depression.

BACKGROUND: Anterior cingulate cortex (ACC) and striatum are part of the emotional neural circuitry implicated in major depressive disorder (MDD). Music is often used for emotion regulation, and pleasurable music listening activates the dopaminergic system in the brain, including the ACC. The present study uses functional MRI (fMRI) and an emotional nonmusical and musical stimuli paradigm to examine how neural processing of emotionally provocative auditory stimuli is altered within the ACC and striatum in depression. METHOD: Nineteen MDD and 20 never-depressed (ND) control participants listened to standardized positive and negative emotional musical and nonmusical stimuli during fMRI scanning and gave subjective ratings of valence and arousal following scanning. RESULTS: ND participants exhibited greater activation to positive versus negative stimuli in ventral ACC. When compared with ND participants, MDD participants showed a different pattern of activation in ACC. In the rostral part of the ACC, ND participants showed greater activation for positive information, while MDD participants showed greater activation to negative information. In dorsal ACC, the pattern of activation distinguished between the types of stimuli, with ND participants showing greater activation to music compared to nonmusical stimuli, while MDD participants showed greater activation to nonmusical stimuli, with the greatest response to negative nonmusical stimuli. No group differences were found in striatum. CONCLUSIONS: These results suggest that people with depression may process emotional auditory stimuli differently based on both the type of stimulation and the emotional content of that stimulation. This raises the possibility that music may be useful in retraining ACC function, potentially leading to more effective and targeted treatments.

A meta-analytic review of mood-congruent implicit memory in depressed mood.

In studies of explicit memory, researchers have reliably demonstrated that mood-congruent, depressive information is especially likely to be recalled by individuals exhibiting depressed mood. Results from studies of implicit mood-congruent memory in depressed mood, however, have been largely discrepant. The current research reviews 20 studies of implicit mood-congruent memory for emotionally valenced words in the context of dysphoria and clinical depression. Meta-analytic techniques were used to summarize this research. Results indicated that depressive groups exhibited preferential implicit recall of negative information and nondepressed groups exhibited preferential implicit recall of positive information. Also, depressive implicit mood-congruent memory for negative information was associated with recall and encoding tasks that matched with regard to the perceptual versus conceptual processes required. Furthermore, self-relevance emerged as an important moderator for implicit recall in analyses that compared clinically depressed groups to nondepressed groups. These results provide partial support both for the transfer appropriate processing framework of memory and cognitive theories of depression that emphasize self-relevant information. Finally, certain participant characteristics, particularly age and severity of depressive symptoms, emerged as important moderators of the effect of group status on depressive implicit recall biases.

Biased processing of sad faces: an ERP marker candidate for depression susceptibility.

Depression has been associated with task-relevant increased attention toward negative information, reduced attention toward positive information, or reduced inhibition of task-irrelevant negative information. This study employed behavioural and psychophysiological measures (event-related potentials; ERP) to examine whether groups with risk factors for depression (past depression, current dysphoria) would show attentional biases or inhibitory deficits related to viewing facial expressions. In oddball task blocks, young adult participants responded to an infrequently presented target emotion (e.g., sad) and inhibited responses to an infrequently presented distracter emotion (e.g., happy) in the context of frequently presented neutral stimuli. Previous depression was uniquely associated with greater P3 ERP amplitude following sad targets, reflecting a selective attention bias. Also, dysphoric individuals less effectively inhibited responses to sad distracters than non-dysphoric individuals according to behavioural data, but not psychophysiological data. Results suggest that depression risk may be most reliably characterised by increased attention toward others' depressive facial emotion.

Facial affect processing and depression susceptibility: cognitive biases and cognitive neuroscience.

Facial affect processing is essential to social development and functioning and is particularly relevant to models of depression. Although cognitive and interpersonal theories have long described different pathways to depression, cognitive-interpersonal and evolutionary social risk models of depression focus on the interrelation of interpersonal experience, cognition, and social behavior. We therefore review the burgeoning depressive facial affect processing literature and examine its potential for integrating disciplines, theories, and research. In particular, we evaluate studies in which information processing or cognitive neuroscience paradigms were used to assess facial affect processing in depressed and depression-susceptible populations. Most studies have assessed and supported cognitive models. This research suggests that depressed and depression-vulnerable groups show abnormal facial affect interpretation, attention, and memory, although findings vary based on depression severity, comorbid anxiety, or length of time faces are viewed. Facial affect processing biases appear to correspond with distinct neural activity patterns and increased depressive emotion and thought. Biases typically emerge in depressed moods but are occasionally found in the absence of such moods. Indirect evidence suggests that childhood neglect might cultivate abnormal facial affect processing, which can impede social functioning in ways consistent with cognitive-interpersonal and interpersonal models. However, reviewed studies provide mixed support for the social risk model prediction that depressive states prompt cognitive hypervigilance to social threat information. We recommend prospective interdisciplinary research examining whether facial affect processing abnormalities promote-or are promoted by-depressogenic attachment experiences, negative thinking, and social dysfunction.

Public health systems and services research: dataset development, dissemination, and use.

Public health systems and services research (PHSSR) is defined as "a field of study that examines the organization, financing, and delivery of public health services within communities and the impact of those services." PHSSR is a relatively young field and suffers from a paucity of research resources. In this article, we describe the development and utility of a data resource, housed on the Health Services and Sciences Research Resources website maintained by the National Library of Medicine, which provides easy access to instruments, indices, and datasets that are relevant to PHSSR researchers. We also investigate efforts to promote the use and dissemination of these data resources, including the awarding of research grants and the organization of a PHSSR conference.

Introduction to the special section on cognitive processes and psychotherapy.

Theoretical models featuring cognitive processes have played a fundamental role in advancing knowledge of psychopathology and its treatment and have emphasized the importance of cognition in psychotherapy. Recognition of the importance of cognition in psychotherapy has led to a number of questions that are addressed by the articles in this special section of the Journal of Consulting and Clinical Psychology. Cognitive therapy is well represented in the articles in this special section, but therapeutic procedures that do not represent typical cognitive therapy are also examined. The articles in this special section focus on homework in the modification of cognition, cognition in the treatment of anxiety in adults and in children, change in depressive cognitions in children, cognition and rapid change in the treatment of depression, and the role of cognition in the treatment and prevention of depression that is recurrent. Examination of these types of questions holds the possibility of advances in existing treatments and the possibility of innovations in new treatments.

Comparative data on child and adolescent cognitive measures associated with depression.

As a way to better understand the effects of treatment for depression, comparative data on measures of cognition have been compiled previously for adults. Such data should be able to aid the evaluation of cognition and cognitive change, and may provide valuable information for clinicians and researchers alike. In this article, analogous comparative data on cognitive measures associated with depression in children and adolescents are presented. The reviewed instruments assess cognitive errors, attributional style, dysfunctional attitudes, hopelessness, negative self-statements, and Beck's negative cognitive triad. As with adults, these data may have implications for enhancing understanding of empirically supported treatments for children and adolescents, may be useful in vulnerability research, and may be useful to clinicians seeking to develop treatment strategies and to gauge treatment effectiveness.

Clinical training for the next millennium.

Several issues regarding the matrix model (C.R. Snyder & T.R. Elliott, this issue, pp. 1033-1054) are addressed. First is the role that positive psychology can play in therapy and prevention training. Next, assumptions of the medical model are discussed concerning training students to be competent therapists in an era of managed care. Finally, questions are raised about the response of training programs to the integration of psychology with biobehavioral approaches to human behavior.

Cognitive reactivity and vulnerability: empirical evaluation of construct activation and cognitive diatheses in unipolar depression.

Cognitive vulnerability is a central concept in cognitive theories of unipolar depression. This idea suggests that negative cognitive factors emerge during stressful situations, and that this cognitive reactivity is critical for the onset, relapse, and recurrence of depression. The number of empirical investigations that model the diathesis-stress nature of cognitive reactivity has substantially increased within the last decade. This review examines this literature, with a focus on priming and longitudinal designs. Extant research supports the concept of cognitive vulnerability to depression among adults, and support is accruing for the validity of this concept among children. Research that examines direct links between cognitive vulnerability and depression onset, relapse, and recurrence and the attachment origins of cognitive vulnerability is also accruing, although at a slower pace.

The Parent Threat Inventory: development, reliability, and validity.

OBJECTIVE: The goal was to develop a retrospective inventory of parental threatening behavior to facilitate a better understanding of such behavior's role in the etiology of psychological distress. METHOD: Inventory items were developed based on theory and 135 students' responses to a question eliciting examples of threatening parental behavior. Following item development, two additional student samples (n = 200 and n = 603) completed batteries of self-report measures. Responses were used to eliminate unstable or redundant items from the inventory and to examine the inventory's psychometric properties. RESULTS: Factor analysis of the inventory revealed three factors, accounting for 66.2% of variance; this factor structure is compatible with theory, and consistent across maternal behavior scores, paternal behavior scores, and combined maternal and paternal scores. Cronbach's coefficient alphas indicated acceptable internal consistency; Pearson correlation coefficients indicated acceptable 4-week test-retest reliability. Moderate intercorrelations with two retrospective measures of childhood experiences suggested construct validity. Regression analyses demonstrated the ability of the inventory to predict both anxious and depressive symptomatology and lifetime symptoms of anxiety and depressive disorder. Normative data on combined parent scores, maternal scores, and paternal scores are also presented. CONCLUSIONS: Initial psychometric testing of the Parent Threat Inventory (PTI) suggests it is a reliable and valid tool for investigating the developmental antecedents of adult psychological distress. Further research should focus on addressing two limitations: (1) lack of normative and psychometric data on men and women suffering from clinical disorders, and (2) lack of validation by parental reporting.