Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care.

Purpose: Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers. Methods: This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales. Results: Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health. Conclusion: This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.

Psilocybin-assisted psychotherapy for treatment resistant depression: A randomized clinical trial evaluating repeated doses of psilocybin.

BACKGROUND: Psilocybin-assisted psychotherapy (PAP) has been associated with antidepressant effects. Trials to date have typically excluded participants with complex presentations. Our aim was to determine the feasibility of PAP in a complex population, including high levels of treatment resistance in major depressive and bipolar disorder and patients with baseline suicidality and significant comorbidity. We also evaluated flexible repeated doses over a 6-month period. METHODS: Adults with treatment-resistant depression as part of major depressive or bipolar II disorder without psychosis or a substance use disorder were eligible to participate. Subjects were randomized to immediate treatment or waitlist control, with all eventually receiving PAP. Participants had one, two, or three psilocybin sessions with a fixed dose of 25 mg. Each dose was accompanied by preparation and integration psychotherapy sessions. Acceptability, safety, tolerability, and efficacy were evaluated (this study was registered at ClinicalTrials.gov: NCT05029466). FINDINGS: Participants were randomized to immediate treatment (n = 16) or delayed treatment (n = 14). 29/30 were retained to the week-2 primary endpoint. Adverse events were transient, with no serious adverse events. Greater reductions in depression severity as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) were observed in the immediate treatment arm compared to the waitlist period arm with a large hedge's g effect size of 1.07 (p < 0.01). Repeated doses were associated with further reductions in MADRS scores compared to baseline. CONCLUSIONS: PAP was feasible in complex patients with preliminary antidepressant efficacy and adequate safety and tolerability. Repeated doses were associated with greater reductions in depression severity. FUNDING: This work was funded by Brain and Cognition Discovery Foundation (BCDF), Usona, and Braxia Scientific.

'A human face and voice': transgender patient-educator and medical student perspectives on gender-diversity teaching.

BACKGROUND: Transgender and gender diverse (TGD) people face many obstacles in accessing health care, including discrimination, institutional bias, and clinician knowledge deficits. We developed a clinical skills and education module on gender-affirming care for pre-clinical medical students, in collaboration with a TGD-led civil society organisation. The module consisted of an educational session followed by preceptor-facilitated small group tutorials, led by TGD patient-educators (n = 22) who used their lived experience to explore medical history-taking and broader issues related to TGD healthcare with students (n = 199). This study aimed to explore the views of students and TGD patient-educators on the structure, delivery and impact of the module. METHODS: Analysis of responses of TGD patient-educators and students to the module (2020 and 2021), in post-intervention surveys using open-ended questions for TGD patient-educators (18 responses from 22 educators) and free text comments as part of a quantitative survey for medical students (89 responses). RESULTS: Responses from students and patient-educators to the session were highly positive. Students and patient-educators emphasised that the teaching session succeeded through elevating the centrality of shared experience and creating a safe space for learning and teaching. Safety was experienced by patient-educators through the recognition of their own expertise in a medical environment, while students reported a non-judgemental teaching space which allowed them to explore and redress recognised limitations in knowledge and skill. Patient-educators described their motivation to teach as being driven by a sense of responsibility to their community. Preceptor attitudes may function as a barrier to the effectiveness of this teaching, and further attention should be paid to supporting the education of clinical facilitators in TGD health. CONCLUSION: The experiences of TGD patient-educators and medical students in this study suggest that this model of teaching could serve as a transferable template for TGD health and the inclusion of other historically marginalised groups in medical education.

Synthesizing contemporary integrative interpersonal theory and the narrative identity approach to examine personality dynamics and regulatory processes.

OBJECTIVE: The goal of this paper is to promote the integration of two approaches to personality and assessment: Contemporary Integrative Interpersonal Theory (CIIT) and the Narrative Identity Approach (NI). METHODS: We review CIIT and NI, describe their similarities and differences, and articulate opportunities to integrate the approaches to more fully account for personality dynamics and self-regulation. RESULTS: We identify several areas within which concepts from CIIT and NI could be synthesized and offer four concrete suggestions for integrating the assessment methods within each approach: (1) using narratives to explicate interpersonal perception, (2) using stories to clarify interpersonal context, (3), using the Interpersonal Situation as a framework for unpacking narrative elements, and (4) coding interpersonal sequences in narrative data. CONCLUSIONS: CIIT and NI have potential to augment one another both theoretically and methodologically in ways that would be fruitful for conceptualizing and studying personality dynamics and self-regulation.

Is non-occupational HIV Post Exposure Prophylaxis (nPEP) still used? An exploration of nPEP use since widespread availability of HIV PrEP.

BACKGROUND: Non-occupational Post-Exposure Prophylaxis (nPEP) is an effective HIV prevention strategy in gay and bisexual men (GBM) taken after possible exposure. HIV Pre-Exposure Prophylaxis (PrEP) is also a highly effective HIV prevention strategy. METHODS: A retrospective audit of medical records of GBM presenting to a sexual health centre and provided with nPEP compared two periods to determine if nPEP usage changed following availability of PrEP. In the first period (P1) PrEP was available through extended trials. In the second period (P2) PrEP became more accessible through the Australian Pharmaceutical Benefits Scheme (PBS). Period comparisons were performed using a two-population test of proportions with one-tailed testing and significance set at P < .05 using SPSS Statistics Version 25. RESULTS: There were 232 GBM provided with nPEP in P1, and 202 in P2. A two-population test of proportions demonstrated that GBM presentations for nPEP decreased significantly from 302/4779 (6.3%) of GBM visits in P1 to 221/7205 (3.1%) in P2 when PrEP was more accessible (Z=8.53, P < .001). PrEP uptake after presenting for nPEP increased from 30 (12.9%) of total GBM visits in P1 to 69 (34.2%) in P2 (Z=5.26, p < .001). CONCLUSIONS: GBM accessing nPEP decreased with statistical significance post introduction of PBS PrEP.

Why, How, and When to Integrate Narrative Identity Within Dimensional Approaches to Personality Disorders.

Researchers and clinicians are beginning to adopt dimensional approaches in the study and treatment of personality disorders (PD). Although dimensional approaches in the DSM-5 and ICD-11 hold considerable benefit, they need to better incorporate an appreciation of individuals' life stories, or narrative identities. Doing so will be necessary to flesh out the emphasis that both frameworks place on the role of identity in personality pathology. In this article, the authors review why, how, and when narrative identity theory and research can be integrated within dimensional approaches to PD. The authors describe established ways to assess narrative identity, review extant research on this construct in relation to PD, and signal areas crucial for future research. Stories lie at the heart of what it means to be human. The authors conclude that a greater consideration of the ways in which the self is storied can help further understanding and treatment of PD.

Characteristics and outcomes of Aboriginal and Torres Strait Islander patients with dialysis-dependent kidney disease in Australian intensive care units.

BACKGROUND: In Australia, 531 people per million population have dialysis-dependent chronic kidney disease (CKD5D). The incidence is four times higher for Aboriginal and Torres Strait Islander (indigenous) people compared with non-Indigenous Australians. CKD5D increases the risk of hospitalisation, admission to the intensive care unit (ICU) and mortality compared with patients without CKD5D. There is limited literature describing short-term outcomes of patients with CKD5D who are admitted to the ICU, comparing indigenous and non-indigenous patients. AIMS: This registry-based retrospective cohort analysis compared demographic and clinical data between indigenous and non-indigenous patients with CKD5D and tested whether indigenous status predicted short-term outcomes independently of other contributing factors. Adjusted hospital mortality was the primary outcome measure. METHODS: Data were from the Australian and New Zealand Intensive Care Society's Centre for Outcome and Resource Evaluation Adult Patient Database. Australian ICU admissions between 2010 and 2017 were included. Data from 173 ICU (2136 beds) include 1 051 697 ICU admissions, of which 23 793 had a pre-existing diagnosis of CKD5D. RESULTS: Indigenous patients comprised 11.9% of CKD5D patients in ICU. CKD5D was prevalent among 4.9% of indigenous and 2.9% of non-indigenous ICU admissions. Indigenous patients were 13.5 years younger, had fewer comorbidities and lower crude mortality despite equivalent calculated mortality risk. After adjusting for age, remoteness and severity of illness, indigenous status did not predict mortality. CONCLUSIONS: Socioeconomic disadvantage contributes to earlier development of CKD5D and the overrepresentation in ICU of indigenous people. Mortality is equivalent once correcting for confounders, but addressing inequality requires strengthening preventative care.

The cycle of life and story: Redemptive autobiographical narratives and prosocial behaviors.

Adults often understand their lives by constructing personal stories and then living into them. Time and time again, a positive relation has been found between the tendency to build redemptive personal stories wherein negative and challenging experiences ultimately give way to positive endings and prosocial behavior. Here, I review the relevant literature in the interest of advancing the notion that redemptive stories and prosociality exist in a virtuous cycle. Engaging in prosocial acts can stimulate the redemptive framing of one's past. By the same measure, once formed, individuals work to bring the story to life, and the ethos of redemption holds the potential to stimulate and sustain prosocial behavior.

The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?

Mature overall survival (OS) data are often unavailable at the time of regulatory and reimbursement decisions for a new cancer treatment. For patients with early-stage cancers treated with potentially curative treatments, demonstrating an OS benefit may take years and may be confounded by subsequent lines of therapy or crossover to the investigational treatment. For patients with advanced-stage cancers, mature OS data may be available but difficult to interpret for similar reasons. There are strong opinions about approval and reimbursement in the absence of mature OS data, with concerns over delay in patient access set against concerns about uncertainty in long-term benefit. This position paper reflects our individual views as patient advocate, clinician or health economist on one aspect of this debate. We look at payer decisions in the absence of mature OS data, considering when and how non-OS trial outcomes could inform decision-making and how uncertainty can be addressed beyond the trial, supporting these views with evidence from the literature. We consider when it is reasonable for payers to expect or not expect mature OS data at the initial reimbursement decision (based on criteria such as cancer stage and treatment efficacy) acknowledging that there are settings in which mature OS data are expected. We propose flexible strategies for generating and appraising patient-relevant evidence, including context-relevant endpoints and quality of life measures, when survival rates are good and mature OS data are not expected. We note that fair reimbursement is important; this means valuing patient benefit as shown through prespecified endpoints and reappraising if there is ongoing uncertainty or failure to show a sustained benefit. We suggest that reimbursement systems continue to evolve to align with scientific advances, because innovation is only meaningful if readily accessible to patients. The proposed strategies have the potential to promote thorough assessment of potential benefit to patients and lead to timely access to effective medicines.

Incorporating narrative repair in the treatment of avoidant personality disorders: A case in point.

Avoidant personality disorder (AvPD) is characterized by multiple struggles, including shyness, feelings of inadequacy, and hypersensitivity to interpersonal judgments. Research indicates that people with AvPD also show disturbances in narrative identity, which is an internal and evolving story created about the personal past, present, and presumed future. Here, the novel Guide for Narrative Repair (GNaR) recently developed by (Thomsen et al., 2020) is introduced as a potentially useful tool to help people with AvPD in crafting more adaptive narrative identities. The guide is brought to life via a case study analysis of Adam, a male outpatient suffering from AvPD. Consistent with the GNaR, disturbances in Adam's storied self are brought to light and ways to facilitate his narrative repair are proposed. We conclude with implications related to the case as well as the potential narrative turn in AvPD treatment.

Psychological mediators of exercise adherence among older adults in a group-based randomized trial.

OBJECTIVE: To examine the psychological mediators of exercise adherence among older adults in a group-based physical activity randomized controlled trial. METHOD: Older adults (≥65 years) were randomized to one of three conditions as part of the "GrOup-based physical Activity for oLder adults" (GOAL) randomized controlled trial. These included similar age same gender (SASG) and similar age mixed gender (SAMG) exercise programs that were informed by the tenets of self-categorization theory, and a "standard" mixed age mixed gender (MAMG) exercise program. Participants represented a subgroup (n = 483, Mage = 71.41 years) from the larger trial (n = 627) who completed measures of the trial's putative psychological mediators (i.e., group cohesion and affective attitudes) over the course of the 24-week exercise programs. RESULTS: Piecewise latent growth modeling revealed different trajectories between participants in the two intervention conditions (SASG, SAMG) when compared with the comparison MAMG condition with regard to perceptions of group cohesion and affective attitudes. Results of subsequent cross-lagged panel modeling revealed that better program adherence in the two intervention conditions, when compared with the referent MAMG condition, was mediated by perceptions of group cohesion. CONCLUSIONS: The findings provide insight into how the two intervention programs differentially strengthened perceptions of group cohesion and affective attitudes over time. Consistent with self-categorization theory, the results also shed light on the role of group cohesion, in particular, as a psychological mechanism of action to promote older adults' exercise adherence behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The redemption and contamination research form: exploring relations with narrative identity, personality traits, response styles, and life satisfaction.

Narrative identity is typically assessed by collecting participants' autobiographical scenes and then coding these stories for themes including redemption (negative beginning, positive ending) and contamination (positive beginning, negative ending). Complimenting this approach, we introduce a self-report measure capturing the degree to which individuals explicitly view their lives and social worlds in redemptive and contaminated ways - the Redemption and Contamination Research Form (RCRF). In Studies 1 and 2, participants completed the RCRF and a measure of life satisfaction. In Study 2, participants also provided three autobiographical scenes, later coded for redemption and contamination. Across studies, our novel self-rated redemptive mindset variable corresponded positively with life satisfaction and, in Study 2, the redemption present in scenes. Relations remained significant after considering several covariates (e.g., traits, response styles). These results, which illustrate the utility of self-rated redemptive mindsets, carry implications for the multi-method assessment of constructs indigenous to narrative identity.

Narrating the nadir: examining personal and vicarious stories of cancer-related low points among survivors and romantic partners.

Objective: To investigate low point autobiographical narratives among cancer survivors and romantic partners.Design: Cancer survivors (Study 1) and romantic partners (Study 2) narrated the low points of their cancer experiences. Partners also narrated stories of cancer survivors' low points. Narratives were coded for their manifest content, as well as redemption (negative-to-positive arc), contamination (positive-to-negative arc), and tone (positive or negative valence).Main Outcome Measures: Self-reported measures of health and well-being (life satisfaction, cancer-related worry, impact of cancer).Results: The diagnosis moment was the most frequently recognised low point among survivors and partners. Survivors who narrated contaminated low points reported marginally less somatisation, salience of cancer recurrence, and that cancer had a marginally less positive impact, relative to survivors whose narratives did not contain contamination. Tone in partners' low points predicted marginally less worry and more somatisation. The tone of their vicarious low points negatively correlated with anxiety.Conclusion: This research contributes to the growing body of work examining, and giving voice to, the experiences of cancer survivors and those close to them. As such, it informs applied health researchers of potentially challenging cancer-related experiences, and the way(s) in which the storying of these experiences align with psychological flourishing.

Effects of Group-Based Exercise on Flourishing and Stigma Consciousness among Older Adults: Findings from a Randomised Controlled Trial.

BACKGROUND: To examine the extent to which group-based exercise programs, informed by self-categorisation theory, result in improvements in psychological flourishing and reductions in age- and gender-related stigma consciousness among older adults. METHODS: In the study, older adults (N = 485, ≥ 65 years) were randomised to similar age same gender (SASG), similar age mixed gender (SAMG), or "standard" mixed age mixed gender (MAMG) group-based exercise programs. Flourishing and stigma consciousness were assessed on six occasions during the 24-week intervention and represented secondary trial outcomes. Multilevel growth models examined the effects of the interventions on flourishing and stigma consciousness over time. RESULTS: Participants in the SASG and SAMG conditions demonstrated, on average, higher levels of flourishing, relative to the MAMG condition, over the course of the 24 weeks (p < .05). Additionally, participants demonstrated lower levels of age- and gender-related stigma consciousness in both the SASG and SAMG conditions relative to the MAMG condition (p < .05). No time by group interaction effects were observed for either flourishing or stigma consciousness. CONCLUSIONS: The results provide some support for the utility of group exercise programs, informed by self-categorisation theory, to enhance psychological flourishing and reduce stigma consciousness among older adults.

The empirical structure of narrative identity: The initial Big Three.

A robust empirical literature suggests that individual differences in the thematic and structural aspects of life narratives are associated with and predictive of psychological well-being. However, 1 limitation of the current field is the multitude of ways of capturing these narrative features, with little attention to overarching dimensions or latent factors of narrative that are responsible for these associations with well-being. In the present study we uncovered a reliable structure that accommodates commonly studied features of life narratives in a large-scale, multi-university collaborative effort. Across 3 large samples of emerging and midlife adults responding to various narrative prompts (N = 855 participants, N = 2,565 narratives), we found support for 3 factors of life narratives: motivational and affective themes, autobiographical reasoning, and structural aspects. We also identified a "functional" model of these 3 factors that reveals a reduced set of narrative features that adequately captures each factor. Additionally, motivational and affective themes was the factor most reliably related to well-being. Finally, associations with personality traits were variable by narrative prompt. Overall, the present findings provide a comprehensive and robust model for understanding the empirical structure of narrative identity as it relates to well-being, which offers meaningful theoretical contributions to the literature, and facilitates practical decision making for researchers endeavoring to capture and quantify life narratives. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Australian private emergency departments can assist ambulance services by taking public emergency patients during surge and disasters.

We describe a novel ambulance diversion programme, piloted in Victoria. This article discusses creating increased emergency capacity during surge or disasters by utilising private EDs, tested during a recent thunderstorm asthma disaster and an influenza epidemic. Public hospitals and EDs often run at or over capacity during normal operations. This leaves limited ability to manage surges in demand, resulting in suboptimal outcomes for patients, public ED staff and ambulance services. It is feasible to create surge capacity in private EDs for public ambulance patients. Other states could consider this option to help manage health disasters.

Medical perspectives regarding goals-of-care consultations in Emergency Departments.

Goals-of-care discussions aim to establish patient values for shared medical decision-making. These discussions are relevant towards end-of-life as patients may receive non-beneficial treatments if they have never discussed preferences for care. End-of-life care is provided in Emergency Departments (EDs) but little is known regarding ED-led goals-of-care discussions. We aimed to explore practitioner perspectives on goals-of-care discussions for adult ED patients nearing end-of-life. We report the qualitative component of a mixed methods study regarding a 'Goals-of-Care' form in an Australian ED. Eighteen out of 34 doctors who completed the form were interviewed. We characterised ED-led goals-of-care consultations for the first time. Emergency doctors perceive goals-of-care discussions to be relevant to their practice and occurring frequently. They aim to ensure appropriate care is provided prior to review by the admitting team, focusing on limitations of treatment and clarity in the care process. ED doctors felt they could recognise end-of-life and that ED visits often prompt consideration of end-of-life care planning. They wanted long-term practitioners to initiate discussions prior to patient deterioration. There were numerous interpretations of palliative care concepts. Standardisation of language, education, collaboration and further research is required to ensure Emergency practitioners are equipped to facilitate these challenging conversations.

Impact of scribes on emergency medicine doctors' productivity and patient throughput: multicentre randomised trial.

OBJECTIVES: To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. DESIGN: Randomised, multicentre clinical trial. SETTING: Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit. PARTICIPANTS: 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site. INTERVENTIONS: Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. MAIN OUTCOME MEASURES: Physicians' productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians' productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done. RESULTS: Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians' productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes. CONCLUSIONS: Scribes improved emergency physicians' productivity, particularly during primary consultations, and decreased patients' length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia's. TRIAL REGISTRATION: ACTRN12615000607572 (pilot site); ACTRN12616000618459.

Structure and Measurement Invariance of Adult Romantic Attachment.

Romantic attachment is a popular theory for explaining affect, cognition, and behavior in romantic contexts. This popularity has led to a surge of self-report measures assessing dimensions of attachment. In this study, we considered the ability of 2 common attachment measures, the Adult Attachment Questionnaire (AAQ) and the Experience in Close Relationships-Revised (ECR-R), to replicate the avoidant and anxious attachment factors. We also determined the degree of measurement invariance across, and mean differences between, genders and single and nonsingle individuals. Both the AAQ (N = 650) and the ECR-R (N = 1,271) successfully distinguished avoidant and attachment factors. The AAQ showed evidence for partial strong measurement invariance, whereas the ECR-R showed strict factorial invariance for both gender and relationship status. Gender differences were detected on both measures in a direction consistent with previous research, with males exhibiting higher levels of avoidant attachment (relative to females) and females exhibiting higher levels of anxious attachment (relative to males). Furthermore, when compared to individuals who were currently single, those in romantic relationships exhibited lower levels of avoidant tendencies. This research aligns with the notion that the AAQ and ECR-R reliably assess similar constructs, across genders and single and nonsingle individuals.

Contextualizing personality: Personality within and across social roles and conceptual levels.

OBJECTIVE: Personality psychologists have begun to consider the predictive ability of comparable personality characteristics at the levels of traits, goals, and narrative identity. Here, we build upon and extend this work by adopting a contextualized personality approach. Doing so entailed exploring the implications of personality characteristics within three social roles and at each level of personality in relation to role-specific and generalized measures of psychological adjustment. METHODS: Undergraduates (N = 155) rated traits and specified goals and narratives pertaining to their roles as friends, students, and sons/daughters. Measures of trait-based, goal-based, and narrative-based approach orientation were subsequently derived. RESULTS: Within personality levels, mean-levels of approach orientation differed significantly across social roles. Goal-based and narrative-based approach orientation showed inconsistent associations with role-specific psychological adjustment. When approach orientation was aggregated across roles, however, it demonstrated positive relations with adjustment at each personality level. CONCLUSIONS: There exists contextual variability among and between personality characteristics and adjustment. In addition, in certain cases, aggregating across contextualized personality measures (within conceptual levels) may provide a more reliable indicator of the underlying psychological construct. These results contribute to an evolving understanding of personality coherence and the relation between personality characteristics and context.