Psychophysiological Effects of Slow-Paced Breathing on Adolescent Swimmers' Subjective Performance, Recovery States, and Control Perception.

This study examined the effect of a Slow-Paced Breath (i.e., 6 breaths per minute) without Biofeedback (SPB-NoHRVB) protocol on semi-elite adolescent swimmers' psychological and physiological states during a seven-week ecological training period. A linear mixed-effects multilevel regression analysis approach was used with 13 adolescent national-level swimmers. Athletes were randomly assigned to an intervention group (n = 7) and a control group (n = 6). Seven waves of assessments were completed weekly during a seven-week training preparation in ecological conditions. During the protocol, swimmers completed subjective quantitative measures (RESTQ-36-R-Sport; cognitive perceived stress and control states about the training process, training subjective performance, and subjective internal training load) and physiological heart rate (HR) (HR of exercise, absolute and normalized HR recovery during the first 60 s of recovery; HRR60 and nHRR60) and heart rate variability (HRV) (MeanRR, RMSSD, LFnu and HFnu, LF/HF ration) tests (through a submaximal heart rate (5'-5' test) once a week. Results revealed that the SPB-NoHRVB protocol significantly predicts biopsychosocial recovery states, cognitive perception of control, and training subjective performance (i.e., a significant effect of the SPB-NoHRVB protocol with the dependent variables simple time trajectories). However, no significant effects were found for biopsychosocial stress scales, cognitively perceived stress, HR, or HRV markers. Our results suggest that SPB-NoHRVB induces simple evolutions over time for crucial variables in athletes' adaptation to the training process (i.e., cognitive appraisals and biopsychosocial states). In contrast, it highlights that SPB-NoHRVB does not induce better stress states. This specific effect on the resource component is an exciting result that will be discussed in the manuscript.

The structure of the Symptom Checklist-90-Revised: Global distress, Somatization, Hostility, and Phobic Anxiety scales are reliable and robust across community and clinical samples from four European countries.

While the reliability of SCL-90-R subscales is often questioned, five relatively recent European studies have examined the factor structure of SCL-90-R using a bifactor model and concluded that most of these subscales are reliable. However, examination of their results shows that three subscales, Somatization, Hostility, and Phobic Anxiety, consistently had significantly higher reliability than the other six across clinical and community samples recruited in three very different European countries, Greece, Hungary, and the Netherlands. The objective of this study was to examine whether this "top-3″ would be found in a sample from a fourth European country, France. To do this, we had 696 university students (387 women, 56 %) complete the SCL-90-R and we examined the reliability of the scales of this questionnaire by testing a bifactor model using Exploratory Structural Equation Modeling (ESEM). Our results confirmed that, in our sample, the three scales presented a higher reliability than the other six scales. It therefore seems that there exists, at least in the European cultural area, a stable structure of the SCL-90-R comprising a global distress factor and three reliable and robust specific factors: Somatization, Hostility, and Phobic Anxiety.

A reliable instrument for making use of an overly neglected source of information on personality: The French adaptation of the Big Five Inventory-2 (Bfi-2) informant-report form.

OBJECTIVES: The assessment of personality traits is most often based on self-report. However, a growing body of research has shown that informant-report is a valuable and too often overlooked source of unique information. The aim of this study was to validate the French version of the informant-report form of the Big Five Inventory-2 (BFI-2) which assesses 15 facet traits in addition to the five major trait domains. METHODS: We asked 699 psychology and sports science and technology students to describe a person they knew well using the BFI-2 and obtained 661 valid records with demographic information. The data were analyzed using a bi-factor exploratory structural equation model with five bifactors corresponding to the Big Five domains, and three group factors (facets) each. RESULTS: This model had an excellent overall fit. Cronbach's alpha coefficients for the five domains were very satisfactory and the McDonald's omega coefficients were even better. The scales that measured the five major factors were therefore highly reliable, although Extraversion was somewhat less so. The scales measuring facets all had high reliability as measures of the whole formed by the major factor and the group factor. In addition, ten of them were reliable measures of their specific factor, and the remaining five appeared to be pure measures of the five domains. CONCLUSIONS: The informant-report form of the BFI-2 is a reliable instrument which is easy and quick to administer. These qualities should enable clinicians and researchers to exploit the much-neglected source of original information provided by informant-reports.

Immune Checkpoint Inhibitors Targeting the PD-1/PD-L1 Pathway in Advanced, Recurrent Endometrial Cancer: A Scoping Review with SWOT Analysis.

Results of recent clinical trials using the immune check point inhibitors (ICI) pembrolizumab or dostarlimab with/without lenvatinib has led to their approval for specific molecular subgroups of advanced recurrent endometrial cancer (EC). Herein, we summarise the clinical data leading to this first tissue-agnostic approval. As this novel therapy is not yet available in the United Kingdom standard care setting, we explore the strengths, weaknesses, opportunities, and threats (SWOT) of ICI treatment in EC. Major databases were searched focusing on clinical trials using programmed cell death protein 1 (PD-1) and its ligand (PD-L1) ICI which ultimately contributed to anti-PD-1 approval in EC. We performed a data quality assessment, reviewing survival and safety analysis. We included 15 studies involving 1609 EC patients: 458 with mismatch repair deficiency (MMRd)/microsatellite instability-high (MSI-H) status and 1084 with mismatch repair proficiency/microsatellite stable (MMRp/MSS) status. Pembrolizumab/dostarlimab have been approved for MMRd ECs, with the addition of lenvatinib for MMRp cases in the recurrent setting. Future efforts will focus on the pathological assessment of biomarkers to determine molecular phenotypes that correlate with response or resistance to ICI in order to identify patients most likely to benefit from this treatment.

Asynchronous Heart Rate Variability Biofeedback Protocol Effects on Adolescent Athletes' Cognitive Appraisals and Recovery-Stress States.

This study examined the effect of an asynchronous heart rate variability biofeedback (HRV-BFBasync) protocol on national-level adolescent swimmers' cognitive appraisals and recovery-stress states during a six-week ecological training period. A polynomial mixed-effects multilevel regression analysis approach was used with 27 adolescent national-level swimmers randomly assigned to an intervention group (n = 14) and a control group (n = 13). Six waves of assessments of cognitive appraisals and recovery-stress states were completed during six weeks of training preparation in ecological conditions. The results revealed that the HRV-BFBasync protocol significantly predicts lower levels of biopsychosocial stress states and cognitive stress. However, no significant effects were found for biopsychosocial recovery scales and cognitive perceived control. The results suggested that total stress states, sport-specific stress, and cognitive perceived stress evolutions are a function of polynomial time third-degree interactions with HRV-BFB protocol. Overall, this study suggested that the HRV-BFBasync protocol leads adolescent athletes to experience lower biopsychosocial and cognitive stress levels during training periodization. Our results also suggest that HRV-BFB induces complex evolutions over time for stress and recovery states but does not have a predictive function for the recovery states and perceived control.

Emotional Intelligence in Ultra-Marathon Runners: Implications for Recovery Strategy and Stress Responses during an Ultra-Endurance Race.

The aim of this research was to investigate the role of trait emotional intelligence (EI) in recovery stress states in a mountain ultra-marathon (MUM) race. Recovery stress states of 13 finishers were assessed before, during, and immediately after the end of an extreme MUM, whereas emotional intelligence was assessed 2 days before the MUM race. Temporal evolutions of recovery stress states were examined. Stress states increased after the race whereas recovery states decreased in all participants. In addition, recovery states were influenced by the trait EI level assessed before the competition. Results supported the hypothesis that trait EI tends to have a positive effect by boosting recovery strategies. In this perspective, trait EI could have a protective role against stress and improve pre-competition mental preparation. High scores of trait EI (in comparison to low scores of trait EI) could have helped athletes to increase recovery states in order to improve their psychological adaptation to one of the most difficult races in the world.

A Temporal Study on Coach Behavior Profiles: Relationships With Athletes Coping and Affects Within Sport Competition.

The study aimed to identify coach behavior profiles and explore whether athletes from distinct profiles significantly differed on coping and affects experienced within 2 hr before the competition and during the competition (measuring them 2 hr after the competition). A sample of 306 French athletes (Mage = 22.24; SD = 4.91; 194 men and 112 women) participated in the study. The results revealed the emergence of two profiles: (a) a coaching engaged profile that stands out for moderate physical training and planning, technical skills, mental preparation, goal setting, competition strategies, personal rapport, and moderate negative personal rapport; and (b) a less engaged coaching profile with low physical training and planning, technical skills, mental preparation, goal setting, competition strategies, personal rapport, and moderate negative personal rapport. Memberships of coach behavior profiles were not confounded by athletes' practice experience, athlete's gender, and coach experience. Results of latent profile analyses with Bose-Chaudhuri-Hocquenghem method (BCH) method revealed that coping and affective states significantly differed across the coach behavior profiles. As a whole, the less engaged coaching profile engenders the worst outcomes in competition. In conclusion, the detection of less adaptive coaching profiles would be crucial to prevent negative outcomes in athletes during the competition. This might be using intervention programs adapted to the peculiarities of athletes from a particular coach behavior profiles.

Associations Between Heart Rate Variability-Derived Indexes and Training Load: Repeated Measures Correlation Approach Contribution.

ABSTRACT: Davletyarova, K, Vacher, P, Nicolas, M, Kapilevich, LV, and Mourot, L. Associations between heart rate variability-derived indexes and training load: repeated measures correlation approach contribution. J Strength Cond Res 36(7): 2005-2010, 2022-This study aimed to evaluate whether similar associations between indexes derived from heart rate variability (HRV) analyses and training load (TL) could be obtained by using the commonly used Pearson correlation technique and the repeated measures correlation (rmcorr). Fourteen well-trained swimmers (18.5 ± 1.6 years) participated. The training period lasted 4 weeks with a gradual increase in TL. Daily external TL (exTL) and internal TL (inTL) were summed to obtain a weekly TL, and HRV analyses were performed every Saturday morning. During the 4-week period, exTL and inTL increased (p < 0.05) together with a decrease (p < 0.05) in heart rate and an increase (p < 0.05) of cardiac parasympathetic indexes. No significant correlation was found using Pearson correlation while significant associations were found using rmcorr; considering exTL, positive (mean R-R interval [MeanRR], root mean square of differences between successive RR interval [RMSSD], low frequency [LF], high frequency [HF], instantaneous beat-to-beat variability [SD1], continuous beat-to-beat variability [SD2], SD1/SD2; r from 0.59 to 0.46, p value from <0.001 to 0.002) and negative (mean heart rate [meanHR]; r = -0.55, p < 0.001) associations were found. Considering inTL, positive (MeanRR, RMSSD, LF, HF, HFnu, SD1, SD2, SD1/SD2; r from 0.56 to 0.34, p-value from <0.001 to 0.025) and negative (meanHR, LFnu, LF/HF; r from -0.49 to -0.34, p value from 0.001 to 0.025) associations were found. The rmcorr statistical method was able to show associations between parasympathetic indexes and TL contrary to Pearson correlation analysis. Because rmcorr is specifically designed to investigate within-individual association for paired measures assessed on 2 or more occasions for multiple individuals, it should constitute a tool for future training monitoring researches based on a repeated-measures protocol.

Barriers to Immunotherapy in Ovarian Cancer: Metabolic, Genomic, and Immune Perturbations in the Tumour Microenvironment.

A lack of explicit early clinical signs and effective screening measures mean that ovarian cancer (OC) often presents as advanced, incurable disease. While conventional treatment combines maximal cytoreductive surgery and platinum-based chemotherapy, patients frequently develop chemoresistance and disease recurrence. The clinical application of immune checkpoint blockade (ICB) aims to restore anti-cancer T-cell function in the tumour microenvironment (TME). Disappointingly, even though tumour infiltrating lymphocytes are associated with superior survival in OC, ICB has offered limited therapeutic benefits. Herein, we discuss specific TME features that prevent ICB from reaching its full potential, focussing in particular on the challenges created by immune, genomic and metabolic alterations. We explore both recent and current therapeutic strategies aiming to overcome these hurdles, including the synergistic effect of combination treatments with immune-based strategies and review the status quo of current clinical trials aiming to maximise the success of immunotherapy in OC.

The Uncertain Benefit of Adjuvant Chemotherapy in Advanced Low-Grade Serous Ovarian Cancer and the Pivotal Role of Surgical Cytoreduction.

In our center, adjuvant chemotherapy is routinely offered in high-grade serous ovarian cancer (HGSOC) patients but less commonly as a standard treatment in low-grade serous ovarian cancer (LGSOC) patients. This study evaluates the efficacy of this paradigm by analysing survival outcomes and by comparing the influence of different clinical and surgical characteristics between women with advanced LGSOC (n = 37) and advanced HGSOC (n = 300). Multivariate analysis was used to identify independent prognostic features for survival in LGSOC and HGSOC. Adjuvant chemotherapy was given in 99.7% of HGSOC patients versus in 27% of LGSOC (p < 0.0001). The LGSOC patients had greater surgical complexity scores (p < 0.0001), more frequent postoperative ICU/HDU admissions (p = 0.0002), and higher peri-/post-operative morbidity (p < 0.0001) compared to the HGSOC patients. The 5-year OS and progression-free survival (PFS) was 30% and 13% for HGSOC versus 57% and 21.6% for LGSOC, p = 0.016 and p = 0.044, respectively. Surgical complexity (HR 5.3, 95%CI 1.2-22.8, p = 0.024) and complete cytoreduction (HR 62.4, 95% CI 6.8-567.9, p < 0.001) were independent prognostic features for OS in LGSOC. This study demonstrates no clear significant survival advantage of chemotherapy in LGSOC. It highlights the substantial survival benefit of dynamic multi-visceral surgery to achieve complete cytoreduction as the primary treatment for LGSOC patients.

Relationships between perceived coach leadership and athletes' affective states experienced during competition.

We examined whether coach leadership behaviours predicted the intensity and direction of positive and negative affects experiencing during competition controlling for affects experienced within two hours before competition. A total of 296 athletes (33% female and 67% male; Mage = 21.61; SD = 6.32) voluntarily participated in the study. A partial least square path modelling (PLS-PM) approach was used to examine the relationships between the study variables. The results showed that coach social support significantly positively predicted the direction of negative affects during competition controlling for pre-competitive negative affect direction. Besides, results revealed that coach democratic behaviour marginally and negatively predicted Negative Affects direction during competition whereas coach autocratic behaviour marginally and negatively predicted Positive Affects intensity. Thus, coach social support emerged as an adaptive coaching behaviour. The usefulness of a longitudinal approach might reveal the multivariate experience of affects states and the manner to handle them from a coach leadership perspective.

Coping with Antarctic demands: Psychological implications of isolation and confinement.

Working in extreme environments requires a wide range of cognitive, psychological and social competences. Antarctica represents one of the most challenging habitats to work in due to its aridity, extremely cold weather, and isolated conditions. This study aimed to assess mood variations and coping strategies, as well as their possible modulation by group dynamics in a crew at the Belgrano II Argentine Antarctic Station throughout 1 year of confinement. Thirteen members of the Argentine Army completed emotional, coping and social dynamics questionnaires bimonthly in March, May, July, September and November. Results showed a significant decline in social dynamics scales, evidenced by decreases in perceived peer and hierarchical support. Additionally, coping strategies displayed a drop in mature defence throughout the expedition. A positive correlation was found between social support and recovery from stress. Our results highlight the importance of interpersonal relationships in psychological adjustment to isolation and extreme environments.

The data on psychological adaptation during polar winter-overs in Sub-Antarctic and Antarctic stations.

The data presented in this article relate to the research article entitled "assessing psychological adaptation during polar winter-overs: The isolated and confined environments questionnaire (ICE-Q)" [1]. These data were acquired in order to develop a standardized instrument - the ICE-Q - designed to assess psychological adaptation within isolated, confined, and extreme environments. A total of 140 winterers from several sub-Antarctic (Amsterdam, Crozet, Kerguelen) and Antarctic (Concordia, Terre Adélie) stations voluntarily participated. Data were collected by multiple self-report questionnaires including a wide variety of well-known and validated questionnaires to record the winterers' responses to polar stations. Data were gathered across two or three winter seasons within each of the 5 polar stations to ensure sufficiently large sample. From four to seven measurement time along a one-year period were proposed to the participants, resulting in 479 momentary assessments. Results of exploratory factor analyses, confirmatory factor analyses, exploratory structural equation modelling, reliability analyses, and test-retest provided strong evidence for the construct validity of the ICE-Q (19-item 4-factor questionnaire). The four factors were social, emotional, occupational and physical. Future studies would examine the dynamic of psychological adaptation in isolated, confined and/or extreme environments during polar missions.

Longitudinal emotional process among adolescent soccer player in intensive training centre.

Grounded in Lazarus's (1999) cognitive motivational relational theory of emotions, this study aimed to explore longitudinal relationships between appraisals, everyday emotions related to the competitive environment and emotional regulation strategies during a competitive season. Forty adolescent soccer players (Mage = 15.8) involved in an intensive training centre from a professional club voluntarily participated to the study. A series of hierarchical linear modelling analyses were conducted upon the 9 measurement times to: (a) examine the relationships between appraisals (threat, challenge, loss), pleasant (happiness, excitement) and unpleasant (anxiety, dejection, anger) emotions, and emotional regulation strategies (adaptive and less adaptive); and (b) ascertain whether the relationships between appraisals and emotions were mediated by emotion regulation strategies. The results of the random coefficient regression models showed: (a) positive relationships between challenge appraisal, adaptive emotion regulation, and pleasant emotions as well as between threat and loss appraisals, less adaptive emotion regulation and unpleasant emotions; and (b) mediating effects of emotional regulation strategies in the appraisals - emotions relationships. As a whole, this study furthered knowledge base about the competitive environment in showing that appraisals, emotion regulation and emotions are intertwined psychological constructs in a dynamic relationship allowing athletes to continuously adjust to their constantly changing everyday demands.

Emotional Intelligence (EI) Training Adapted to the International Preparation Constraints in Rugby: Influence of EI Trainer Status on EI Training Effectiveness.

Given the positive influence of emotional intelligence (EI) on sports performance, particular attention should be paid on how to improve it. Following promising results, previous research concluding that it was possible to improve EI via specific training programs also raised considerable debates. Indeed, previous EI training programs were very time-consuming for participants. This lessens consequently their suitability with the schedule constraints of elite sport. While, in the absence of sport psychologists, numerous coaches or physiologists try to work with players to improve their emotional competences, the aim of this study was to investigate the effectiveness of EI training programs fitting the schedule constraints of elite team sports, provided by three different EI trainers: the team's coach, the team's physiotherapist, and an expert in sport psychology. Young elite rugby union players (N = 96) participated in this study. Based on schedule constraints imposed by the head coach of the French u18 rugby union national team, the program consisted in three 1 h group-based EI training sessions occurring the last 3 days before a game (1 per day). Linear mixed-effects models showed that despite the constraining organizational challenge imposed by the coach, the intervention helped the players to increase some emotional competences at the trait level. Furthermore, a pairwise analysis showed that the type of emotional competencies developed depended on the status of the EI trainers. These findings highlight the suitability of a group-based approach in the training-week structure. They also point the way to EI improvement in a short period of time. Moreover, the specific influences of the EI trainer's status on players' EI development invite coaches and researchers to jointly combine their efforts in order to increase the EI training opportunities and to maximize the effects of their interventions. Together, these preliminary results provide first evidence facilitating the integration of such work in the preparation periods during international seasons.

Multi-System Adaptation to Confinement During the 180-Day Controlled Ecological Life Support System (CELSS) Experiment.

Confinement experiments are essential to prepare long-term space exploration. The 180-day Chinese CELSS (Controlled Ecological Life Support System) study is unique in its design, including a closed-loop system and mid-mission simulation of Mars-like day-night cycle of 24 h 40 min for 36 days (days 72-108). Our aim was to study physiological and psychological consequences of this confinement in four healthy volunteers (one female). CELSS platform consisted of six interconnected modules including four greenhouses. Life support systems were controlled automatically. Body composition, fluid compartments, metabolic state, heart, large vessels, endothelial function, and muscle tone were studied using biological, functional, and/or morphological measurements. Behavioral activities were studied by ethological monitoring; psychological state was assessed by questionnaires. Body weight decreased by ∼2 kg mostly due to lean mass loss. Plasma volume and volume-regulating hormones were mostly stable. Carotid intima-media thickness (IMT) increased by 10-15%. Endothelium-dependent vasodilation decreased. Masseter tone increased by 6-14% suggesting stress, whereas paravertebral muscle tone diminished by 10 ± 6%. Behavioral flow reflecting global activity decreased 1.5- to 2-fold after the first month. Psychological questionnaires revealed decrease in hostility and negative emotions but increase in emotional adaptation suggesting boredom and monotony. One subject was clearly different with lower fitness, higher levels of stress and anxiety, and somatic signs as back pain, peak in masseter tone, increased blood cortisol and C-reactive protein. Comparison of CELSS experiment with Mars500 confinement program suggests the need for countermeasures to prevent increased IMT and endothelial deconditioning. Daily activity in greenhouse could act as countermeasure against psycho-physiological deconditioning.

Time courses of emotions experienced after a mountain ultra-marathon: Does emotional intelligence matter?

This research examined the time courses of emotions in sport settings (anxiety, dejection, anger, happiness, excitement) experienced by mountain ultra-marathon (MUM) runners within the month following a demanding MUM race and the role of emotional intelligence (EI) in these time courses. A six-wave one-month longitudinal design was used with one measurement point within two days before the race to measure EI and five time points within the month following the race to assess emotions experienced among a sample of 29 runners. Results of multilevel growth curve analyses showed significant linear decreases of dejection and anxiety and a significant linear increase of anger. EI was related to the intercept (level at the end of the MUM race) of happiness, excitement and dejection. Moreover the interaction of EI with time was associated with happiness, excitement and anger. This means that high and low emotional intelligent runners exhibited distinct trajectories of emotional intelligence within the month following the MUM race. Indeed, trait-EI appeared to have a protective role against stress process leading to emotional adjustment within the recovery period following an ultra-endurance event. As such, consultants and coaches could conduct specific program over the sport season designed to enhance trait-EI of MUM runners.

Monitoring stress and recovery states: Structural and external stages of the short version of the RESTQ sport in elite swimmers before championships.

BACKGROUND: Psychological stress and recovery monitoring is a key issue for increasing athletes' health, well-being, and performance. This multi-study report examined changes and the dose-response relationships between recovery-stress psychological states, training load (TL), heart rate (HR), heart rate recovery (HRR), and heart rate variability (HRV) while providing evidence for the factorial validity of a short French version of the Recovery-Stress Questionnaire for Athletes (RESTQ-36-R-Sport). METHODS: Four hundred and seventy-three university athletes (Study 1), 72 full expert swimmers (Study 2), and 11 national to international swimmers (Study 3) participated in the study. Data were analyzed through confirmatory factor analyses (Study 1), repeated ANOVAs and correlational analyses (Study 2), t tests and correlational analyses (Study 3). RESULTS: Multiple-group confirmatory factor analyses showed that the RESTQ-36-R-Sport scores were partially invariant across gender, type of sport, and practice level (Study 1). A dose-response relationship was performed between TL and RESTQ-36-R-Sport scores during an ecological training program (Study 2). Finally, relationships were found between physiological (HRR) and psychological (RESTQ-36-R-Sport) states during an ecological tapering period leading to a national championship (Study 3). CONCLUSION: As a whole, these findings provided evidence for the usefulness of the short version of the RESTQ-36-R-Sport for regular monitoring to prevent potential maladaptation due to intensive competitive sport practice.

The time courses of runners' recovery-stress responses after a mountain ultra-marathon: Do appraisals matter?

Objectives: The aim of this study was to: (a) examine the time courses of runners' recovery-stress states within the month following a demanding Mountain Ultra-Marathon (MUM) race; and (b) explore the role of primary and secondary appraisals in these trajectories. Design: A seven-wave one-month longitudinal design was used with one measurement point within two days before the race to measure appraisals and six time points within the month following the race to assess recovery-stress states experienced by athletes. Method: A multilevel growth curve analysis approach was used among a sample of 29 MUM runners. Results: Recovery-stress states were characterized by distinct trajectories during the month following MUM race. Results of multilevel growth curve analyses showed significant linear increases of general and total recovery, significant linear decreases of general, sport-specific and total stress and a positive quadratic effect of squared time (U shape over time) on specific recovery. Primary appraisal significantly positively predicted levels of sport-specific recovery, total, general and sport-specific stress and significantly negatively predicted total and general recovery. Secondary appraisal significantly negatively predicted total and general stress. Conclusions: This study provided insights into the role played by appraisals on the recovery-stress states experienced by MUM runners the month following a demanding MUM race. Operational strategies were suggested in order to optimize the recovery-stress balance and in turn psychological adaptation processes in response to an ultra-endurance race.

Optimizing the Use of Electronic Health Records to Identify High-Risk Psychosocial Determinants of Health.

BACKGROUND: Care coordination programs have traditionally focused on medically complex patients, identifying patients that qualify by analyzing formatted clinical data and claims data. However, not all clinically relevant data reside in claims and formatted data. Recently, there has been increasing interest in including patients with complex psychosocial determinants of health in care coordination programs. Psychosocial risk factors, including social determinants of health, mental health disorders, and substance abuse disorders, are less amenable to rapid and systematic data analyses, as these data are often not collected or stored as formatted data, and due to US Health Insurance Portability and Accountability Act (HIPAA) regulations are often not available as claims data. OBJECTIVE: The objective of our study was to develop a systematic approach using word recognition software to identifying psychosocial risk factors within any part of a patient's electronic health record (EHR). METHODS: We used QPID (Queriable Patient Inference Dossier), an ontology-driven word recognition software, to scan adult patients' EHRs to identify terms predicting a high-risk patient suitable to be followed in a care coordination program in Massachusetts, USA. Search terms identified high-risk conditions in patients known to be enrolled in a care coordination program, and were then tested against control patients. We calculated precision, recall, and balanced F-measure for the search terms. RESULTS: We identified 22 EHR-available search terms to define psychosocial high-risk status; the presence of 9 or more of these terms predicted that a patient would meet inclusion criteria for a care coordination program. Precision was .80, recall .98, and balanced F-measure .88 for the identified terms. For adult patients insured by Medicaid and enrolled in the program, a mean of 14 terms (interquartile range [IQR] 11-18) were present as identified by the search tool, ranging from 2 to 22 terms. For patients enrolled in the program but not insured by Medicaid, a mean of 6 terms (IQR 3-8) were present as identified by the search tool, ranging from 1 to 21. CONCLUSIONS: Selected informatics tools such as word recognition software can be leveraged to improve health care delivery, such as an EHR-based protocol that identifies psychosocially complex patients eligible for enrollment in a care coordination program.