Motivation for COVID-19 Vaccination: Applying a Self-Determination Theory Perspective to a Global Health Crisis.

Examining the spectrum of vaccine attitudes within the general public, spanning from hesitancy to confidence, is pivotal in addressing the challenges posed by the COVID-19 pandemic. Despite widespread campaigns advocating for vaccine uptake, a proportion of the population harbour reservations about the safety and efficacy of vaccines. This study seeks to explore the determinants of vaccine attitudes in Canada, leveraging key concepts from the well-established Self-Determination Theory (SDT), including basic psychological needs and the quality of an individual's motivation. During a crucial juncture in the COVID-19 pandemic (December 2021), 292 participants were recruited and completed an online survey assessing levels of satisfaction/frustration of basic psychological needs (sense of autonomy, relatedness, and competence), vaccine attitudes (confidence and hesitancy), and motivation towards vaccination (controlled and autonomous). Two mediation models were employed to examine whether autonomous-controlled motivation mediated the relationship between need satisfaction-frustration and vaccine attitudes. Model 1 revealed a full mediating effect, indicating that need satisfaction influenced vaccine confidence only through autonomous motivation (ab1 = 0.09, SE = 0.04, z = 2.19, 95 % CI [0.01, 0.18]). Meanwhile, Model 2 demonstrated that need frustration was associated with vaccine hesitancy partially through controlled motivation (ab2 = 0.05, SE = 0.02, z = 2.54, 95 % CI [0.02, 0.10]). These findings underscore the applicability of SDT in investigating the motivational mechanisms that shape vaccine attitudes. Recognizing psychosocial factors, including the balance of basic needs and quality of motivations, may be integral to informing effective public health strategies.

Predictors of treatment attrition of cognitive health interventions in first episode psychosis.

AIM: Dropping out of psychological interventions is estimated to occur in up to a third of individuals with psychosis. Given the high degree of attrition in this population, identifying predictors of attrition is important to develop strategies to retain individuals in treatment. We observed a particularly high degree of attrition (48%) in a recent randomized controlled study assessing cognitive health interventions for first-episode psychosis participants with comorbid social anxiety. Due to the importance of developing interventions for social anxiety in first episode psychosis, the aim of the present study was to identify putative predictors of attrition through a secondary analysis of data. METHODS: Participants (n = 96) with first episode psychosis and comorbid social anxiety were randomized to receive cognitive behavioural therapy for social anxiety or cognitive remediation. Differences between completers and non-completers (<50% intervention completed) were compared using t-tests or chi-square analyses; statistically significant variables were entered into a multivariate logistic regression model. RESULTS: Non-completers tended to be younger, had fewer years of education and had lower levels of social anxiety compared to completers. Lower baseline social anxiety and younger age were statistically significant predictors of non-completion in the logistic regression model. CONCLUSIONS: Age and social anxiety were predictors of attrition in cognitive health interventions in first episode psychosis populations with comorbid social anxiety. In the ongoing development of social anxiety interventions for this population, future studies should investigate specific engagement strategies, intervention formats and outcome monitoring to improve participant retention in treatment.

The depth of stories: How Black young adults' disclosure of high arousal negative affect in narratives about the COVID-19 pandemic and the BLM protests improved adjustment over the year 2020.

The present study investigates whether the way Black young adults constructed their narratives regarding the stressful events of the COVID-19 pandemic and the black lives matter (BLM) protests related to adjustment over time. A two-wave mixed prospective and retrospective longitudinal study was conducted in July and December 2020 and included a total of 90 Black young adults. Narrative reports were collected at baseline to determine the psychological interpretations of the two events and were coded based on affect disclosure. Both time points examined adjustment to the COVID-19 pandemic and the BLM protests as well as the extent to which the basic psychological needs for autonomy, relatedness, and competence were affected. Our results showed that disclosure of high arousal negative affect in narratives at baseline was associated with better adjustment over time. Additionally, results of process analyses showed that satisfaction of the basic psychological need for autonomy (e.g., feelings of personal agency, choice, and volition) mediated the association between narratives and adjustment. These results suggest that engaging in disclosure of high arousal negative affect may be associated with heightening adjustment because it enhances individuals' autonomy, perhaps resulting in a beneficial integration of the events into their broader life narratives. These findings highlight the potential of well-constructed narratives to impact adjustment over time and have implications for clinical practice to support Racialized communities during unprecedented events.

Coping in adolescents: A mediator between stress and disordered eating.

BACKGROUND: Adolescence is a developmental period that can place individuals at heightened risk of engaging in disordered eating patterns. Stress and coping have been included as etiological factors of eating pathology, yet the mechanism of this relationship in adolescent males and females remains understudied. AIMS: This study investigated the role of coping as a mediator in the stress-disordered eating relationship in a sample of adolescents. DEMOGRAPHICS/SETTINGS: Participants included 2262 grade 7-12 students from a larger cross-sectional study entitled, Research on Eating and Adolescent Lifestyles (REAL). METHODOLOGY/ANALYSES: Participants completed measures of perceived stress, life stressors, coping style, and disordered eating. Multiple mediator models of coping were analyzed to examine the extent to which coping mediated the stress-disordered eating relationship, for males and females separately. FINDINGS: Emotion-oriented coping was a significant partial mediator in the relationship between stress (perceived stress, life stressors) and disordered eating in male and female adolescents. Findings suggest adolescents experiencing high stress tend to engage in emotion-oriented coping, which may lead to greater levels of disordered eating. IMPLICATIONS: Interventions targeting effective coping strategies for dealing with different stress types may prevent youth from disordered eating, thus reducing their risk of eating disorders during a vulnerable period in development.

Primary care for individuals with serious mental illness (PriSMI): protocol for a convergent mixed methods study.

INTRODUCTION: People with serious mental illness (SMI) have poor health outcomes, in part because of inequitable access to quality health services. Primary care is well suited to coordinate and manage care for this population; however, providers may feel ill-equipped to do so and patients may not have the support and resources required to coordinate their care. We lack a strong understanding of prevention and management of chronic disease in primary care among people with SMI as well as the context-specific barriers that exist at the patient, provider and system levels. This mixed methods study will answer three research questions: (1) How do primary care services received by people living with SMI differ from those received by the general population? (2) What are the experiences of people with SMI in accessing and receiving chronic disease prevention and management in primary care? (3) What are the experiences of primary care providers in caring for individuals with SMI? METHODS AND ANALYSIS: We will conduct a concurrent mixed methods study in Ontario and British Columbia, Canada, including quantitative analyses of linked administrative data and in-depth qualitative interviews with people living with SMI and primary care providers. By comparing across two provinces, each with varying degrees of mental health service investment and different primary care models, results will shed light on individual and system-level factors that facilitate or impede quality preventive and chronic disease care for people with SMI in the primary care setting. ETHICS AND DISSEMINATION: This study was approved by the University of Ottawa Research Ethics Board and partner institutions. An integrated knowledge translation approach brings together researchers, providers, policymakers, decision-makers, patient and caregiver partners and knowledge users. Working with this team, we will develop policy-relevant recommendations for improvements to primary care systems that will better support providers and reduce health inequities.

WHODAS 2.0: Associations of functional disability with sex, age, and length of care in outpatients with schizophrenia-spectrum disorders.

Schizophrenia is a disabling mental disorder that is associated with impairments in both social and occupational functioning. Few studies, however, have explored functional domains of disability and its associations with age, sex, and length of care. As part of a hospital quality improvement initiative, data were collected on outpatients' age, sex, length of care, and levels of disability (using the WHODAS 2.0; N=180; M=45.72; 68% male). Mean disability summary and domain scores were compared with population norms from international samples and two published studies in schizophrenia. A series of three-way ANOVAs and post-hoc tests evaluated differences in levels of disability based on age, sex, and length of care categories. Sample mean summary scores were comparable to published studies in schizophrenia (M=24.81; SD=17.37; 85th percentile). Statistically significant main effects of sex and age on summary and domain-specific scores were found, whereas length of care was not significant. A statistically significant three-way interaction of sex x length of care x age was found for summary and mobility scores. Findings provide support for the reliability and validity of the WHODAS 2.0 in outpatients with schizophrenia. Although causal inferences cannot be made, findings show that age and sex are important factors to consider in addressing disability.

Examining Shared Pathways for Eating Disorders and Obesity in a Community Sample of Adolescents: The REAL Study.

Several psychosocial models have been proposed to explain the etiology of eating disorders (EDs) and obesity separately despite research suggesting they should be conceptualized within a shared theoretical framework. The objective of the current study was to test an integrated comprehensive model consisting of a host of common risk and protective factors (socio-environmental, psychological, and behavioral) expected to explain both eating and weight disorders simultaneously in a large school-based sample of adolescents. Data were collected from 3,043 youth (60% female, 14.00 ± 1.61) from 41 schools in the Ottawa region, Canada. Working with interested school staff, validated self-report scales in the form of a questionnaire booklet were administered to participating students to assess several understood risk and protective factors common to both eating disorders and obesity. Anthropometric measurements of weight and height were taken at the end of the questionnaire administration period by trained research staff. Structural equation modeling with cross-validation was used to test the hypothesized model. Findings demonstrated that dysregulated eating was associated with both eating disorder and weight status with diet culture and emotion dysregulation directly associated with some of these disordered eating patterns. It equally pointed to how lifestyle made up of high sedentary behaviors, low vigorous exercise and varied eating patterns contributed to both emotion dysregulation and poor body image which subsequently affected eating issues and weight status simultaneously, signaling the complex interplay of psychosocial factors that underlie these concerns. This study provides evidence for an integrated psychosocial model consisting of socio-environmental, psychological, and behavioral factors may best explain the complex interplay of risk and protective factors influencing eating disorders and obesity. It equally highlights understanding the direct and indirect effects of some of the most salient risk factors involved in eating and weight-related concerns, including the strong effects of diet culture and stressors such as weight-based teasing, providing interventionalists evidence of important risk factors to consider targeting in eating disorder and weight-based prevention efforts.

"We're Working in a Trauma Avoidant Culture": A Qualitative Study Exploring Assertive Community Treatment Providers' Perspectives on Working with Trauma and PTSD in People with Severe Mental Illness.

Assertive Community Treatment (ACT) is the most widely used evidence-based community mental health intervention for people with severe mental illness (SMI). Despite research showing that the vast majority of those with SMI have traumatic histories, the ACT service model does not have consistent guidelines on how to address trauma in their client population. This study employed thematic-analysis through interviewing ACT providers to better understand their perspectives on working with trauma in clients. Five overarching themes with 21 sub-themes emerged: the role and scope of ACT teams and model regarding trauma, discussions of trauma with clients, current treatment of trauma, barriers to working with trauma, and recommendations for enabling trauma discussions and treatment. Some examples for recommendations were: a need for more training regarding trauma, increasing resources like including a psychologist and trauma specialized professionals on the team, more support from leadership, and a cultural change from medicalization. Implications of the barriers and suggestions are discussed.