Understanding How Perfectionism Impacts Intensive Interdisciplinary Pain Treatment Outcomes: A Nonrandomized Trial.

OBJECTIVE: Several factors are known to impact response to the intensive interdisciplinary pain treatment (IIPT) program described in this study, yet no research has explored the role of perfectionism. This secondary data analysis explored direct and indirect relations between perfectionism and functional disability (primary outcome) and pain severity (secondary outcome) after IIPT, with pain catastrophizing and fear of pain as mediators. METHODS: Youth (N = 253) aged 8-21 with chronic pain and associated disability completed pre- and post-IIPT measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), pain catastrophizing, fear of pain, functional disability, and pain characteristics for routine clinical care and this nonrandomized trial. Eight mediated models were run for the two predictors, two mediators, and two outcomes. RESULTS: Pretreatment perfectionism (SOP and SPP) led to greater reductions in pain catastrophizing over the course of IIPT, which resulted in lower pain severity (ß = -.02 [CI = -0.07, -0.01] for SOP and ß = -.02 [CI = -0.06, -0.003] for SPP) and less functional disability (ß = -.06 [CI = -0.13, -0.01] for SOP and ß = -.06 [CI = -0.14, -0.01] for SPP). Independent of pain catastrophizing, pretreatment SPP was directly associated with more posttreatment functional disability (ß = .16 [CI = 0.05, 0.27]). Fear of pain was not a mediator. CONCLUSIONS: Findings suggest perfectionism has the potential to negatively impact IIPT outcomes. However, when perfectionistic youth with chronic pain learn to manage pain-related distress, they benefit. Results highlight the importance of assessing for and treating perfectionism and pain-related distress in youth with chronic pain.

Barriers and Facilitators to Involvement in Children's Diabetes Management Among Minority Parents.

OBJECTIVE: This study aimed to describe parents' perceptions of the factors that facilitate or are barriers to their involvement in children's type 1 diabetes (T1D) management among African American and Latino parents. METHODS: African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability-Opportunity-Motivation-Behavior (COM-B) framework. RESULTS: Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents' desire for their child to have a "normal" life was described as both a Motivation-based facilitator and barrier. CONCLUSIONS: African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families' unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children's diabetes management.

The Protective Role of Connectedness on Depression and Suicidal Ideation Among Bully Victimized Youth.

This longitudinal study examined the relationship between connectedness subtypes (family, school, community) and youth depression and suicidal ideation across a 6-month period within a sample of bully victimized youth. Participants were 142 youth (74.6% female, 47.18% African American, 36.62% Caucasian), 12-15 years of age (M = 13.6, SD = 1.12), recruited from an emergency department, who screened positive for elevated levels of bullying victimization and were reevaluated at a 6-month follow-up assessment. Data on bullying victimization, depression, suicidal ideation, and connectedness (family, school, community) were collected at baseline and 6-month follow-up assessments. Separate Bayesian mixed models were used to examine the effects of connectedness (family, school, community) on depression and suicidal ideation while accounting for dependent observations across time points. Prospectively, family and school connectedness were negatively associated with depression and suicidal ideation. Across time points, community connectedness was negatively associated with suicidal ideation. Results highlight the importance of acknowledging and understanding subtypes of interpersonal connectedness among victimized youth as the three subtypes examined (family, school, community) were associated with depression and suicidal ideation. Findings support the importance of bolstering distinct subtypes of connectedness in efforts to improve functioning and attenuate suicide risk among victimized youth.

Masculinity and Race-Related Factors as Barriers to Health Help-Seeking Among African American Men.

Men's tendency to delay health help-seeking is largely attributed to masculinity, but findings scarcely focus on African American men who face additional race-related, help-seeking barriers. Building principally on reactance theory, we test a hypothesized model situating racial discrimination, masculinity norms salience (MNS), everyday racism (ERD), racial identity, sense of control (SOC), and depressive symptomatology as key barriers to African American men's health help-seeking. A total of 458 African American men were recruited primarily from US barbershops in the Western and Southern regions. The primary outcome was Barriers to Help-Seeking Scale (BHSS) scores. The hypothesized model was investigated with confirmatory factor and path analysis with tests for measurement invariance. Our model fit was excellent [Formula: see text] CFI = 0.99; TLI = 1.00; RMSEA = 0.00, and 90% CI [0.00, 0.07] and operated equivalently across different age, income, and education strata. Frequent ERD and higher MNS contributed to higher BHHS scores. The relationship between ERD exposure and BHHS scores was partially mediated by diminished SOC and greater depressive symptomatology. Interventions aimed at addressing African American men's health help-seeking should not only address masculinity norms but also threats to sense of control, and negative psychological sequelae induced by everyday racism.

Protective Role of Religious Involvement Against Depression and Suicidal Ideation Among Youth with Interpersonal Problems.

This study examined religious involvement-private religious practices (PRP), organizational religiousness (OR), and religious support (RS)-in relation to depressive symptoms and suicidal ideation (SI) and its protective role, considering youths' school and parent-family connectedness. Youth, ages 12-15 (n = 161), were screened for peer victimization, bullying perpetration, and low social connectedness, and assessed for depressive symptoms, SI, school connectedness, parent-family connectedness, and religious involvement. Results indicated PRP and RS were associated with lower levels of depressive symptoms; PRP and OR were associated with less SI. Controlling for connectedness, PRP remained associated with less SI only. Results suggest the importance of considering religious involvement as a target of youth depression and suicide prevention interventions.

Associations of racial discrimination and parental discrimination coping messages with African American adolescent racial identity.

Research links racial identity to important developmental outcomes among African American adolescents, but less is known about the contextual experiences that shape youths' racial identity. In a sample of 491 African American adolescents (48% female), associations of youth-reported experiences of racial discrimination and parental messages about preparation for racial bias with adolescents' later racial identity were examined. Cluster analysis resulted in four profiles of adolescents varying in reported frequency of racial discrimination from teachers and peers at school and frequency of parental racial discrimination coping messages during adolescents' 8th grade year. Boys were disproportionately over-represented in the cluster of youth experiencing more frequent discrimination but receiving fewer parental discrimination coping messages, relative to the overall sample. Also examined were clusters of adolescents' 11th grade racial identity attitudes about the importance of race (centrality), personal group affect (private regard), and perceptions of societal beliefs about African Americans (public regard). Girls and boys did not differ in their representation in racial identity clusters, but 8th grade discrimination/parent messages clusters were associated with 11th grade racial identity cluster membership, and these associations varied across gender groups. Boys experiencing more frequent discrimination but fewer parental coping messages were over-represented in the racial identity cluster characterized by low centrality, low private regard, and average public regard. The findings suggest that adolescents who experience racial discrimination but receive fewer parental supports for negotiating and coping with discrimination may be at heightened risk for internalizing stigmatizing experiences. Also, the findings suggest the need to consider the context of gender in adolescents' racial discrimination and parental racial socialization.

Racial Discrimination and Depressive Symptoms Among African-American Men: The Mediating and Moderating Roles of Masculine Self-Reliance and John Henryism.

Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this association among African-American men are poorly understood. Guided by the Transactional Model of Stress and Coping, we frame masculine self-reliance and John Henryism as appraisal mechanisms that influence the relationship between racial discrimination, a source of significant psychosocial stress, and depressive symptoms among African-American men. We also investigate whether the proposed relationships vary by reported discrimination-specific coping responses. Participants were 478 African-American men recruited primarily from barbershops in the West and South regions of the United States. Multiple linear regression and Sobel-Goodman mediation analyses were used to examine direct and mediated associations between our study variables. Racial discrimination and masculine self-reliance were positively associated with depressive symptoms, though the latter only among active responders. John Henryism was negatively associated with depressive symptoms, mediated the masculine self-reliance-depressive symptom relationship, and among active responders moderated the racial discrimination-depressive symptoms relationship. Though structural interventions are essential, clinical interventions designed to mitigate the mental health consequences of racial discrimination among African-American men should leverage masculine self-reliance and active coping mechanisms.

The Telehealth Tradeoff: A Multimethod Study of the Benefits and Challenges Associated With Maintaining Treatment Outcomes Using a Hybrid Model of Pediatric Intensive Interdisciplinary Pain Treatment.

OBJECTIVES: The COVID-19 pandemic required intensive interdisciplinary pain treatment (IIPT) programs to shift to virtual models of care. This study used a multimethod approach to examine outcomes of a pediatric hybrid IIPT program (50% in-person treatment and 50% synchronous video-based telehealth) and assessed staff experiences while treating within this model. MATERIALS AND METHODS: Patients (M=14.73, SD=2.04; 79% female) reported pain intensity, functional disability, and psychological factors (anxiety, depressive symptoms, fear of pain, pain catastrophizing, social functioning) at admission, discharge, and short-term follow-up. Differences in treatment outcomes at discharge and short-term follow-up between patients who participated in the hybrid IIPT model (n=42) during the pandemic and those who participated in the traditional in-person model before the pandemic (n=42) were examined. Quantitative assessments of staff burnout and perceived effort and qualitative assessments exploring staff perspectives about the challenges and advantages of the hybrid IIPT model were gathered. RESULTS: Youth in both groups made significant improvements across the majority of treatment outcomes; however, the hybrid group reported higher levels of pain at discharge and anxiety at follow-up. The majority of IIPT staff reported moderate to high levels of overall burnout, and almost half reported high levels of emotional exhaustion. Staff highlighted various challenges and benefits associated with treating within the hybrid model. DISCUSSION: When considering telehealth as a treatment tool for youth with complex chronic pain, it is crucial to leverage its benefits while addressing its challenges for patients and providers.

Religious Social Support, Discrimination, and Psychiatric Disorders among Black Adolescents.

Discrimination is a common experience for Black youth that can jeopardize their mental health. However, research suggests that various dimensions of religion have positive effects on youths' mental health and well-being. Additionally, exposure to discrimination may vary by youths' socio-demographic factors, such as gender and ethnicity. Numerous studies identify the protective effects of emotional and tangible religious social support on the mental health of Black adults reporting discrimination. Conversely, fewer studies address the influence of emotional and tangible religious social support on mental health for Black adolescents experiencing discrimination, while also accounting for socio-demographic heterogeneity among Black adolescents. Historically, religion has played an instrumental role in the diverse narratives of the Black Diaspora in the United States. It is important to account for its potential protective effects for Black youth. Examining these factors using a compensatory risk and resilience model, our study finds that Black adolescents who experience discrimination are also more likely to meet criteria for a psychiatric disorder. Additionally, those who report experiencing religious social support are less likely to meet criteria for a psychiatric disorder. These findings were not moderated by the sociodemographic factors of race or ethnicity. To date, this investigation is one of the first to examine the effect of different types of religious social support in the presence of discrimination on psychiatric illness among African American and Caribbean Black adolescents.

What Would I Know About Mercy? Faith and Optimistic Expectancies Among African Americans.

A small body of research has begun to explore the association between faith and optimism among African Americans. However, missing from the extant work is an examination of the extent to which traditional indices of religious commitment work together with beliefs about God to shape optimism. The present study examines the utility of indices of social location, religious commitment (i.e., early and current religious service attendance, subjective religiosity), belief about the quality of one's relationship with God (i.e., a belief that one is connected to a loving God), and beliefs about being the recipient of divine forgiveness for predicting dispositional optimism among a sample of community residing African American adults (N = 241). Age, subjective religiosity, and organizational religiosity were positively related to optimism in bivariate analyses. Hierarchical regression analyses demonstrated a significant association between age, subjective religiosity, and optimism; however, those associations were eliminated once relationship with God and belief in one's forgiveness by God were entered into the model. Only belief in God's love predicted optimism in multivariate analyses. Serial mediation analyses revealed that beliefs about the quality of one's relationship with God and belief in divine forgiveness fully mediated the relationship between subjective religiosity and optimism, but that the relationship is driven largely by relationship with God. Implications of these findings are discussed.

Coping with suicidal urges among youth seen in a psychiatric emergency department.

This study of youth seeking psychiatric emergency department (ED) services examined (1) youth self-efficacy to use suicide-specific coping strategies, (2) whether these self-efficacy beliefs varied by demographic and clinical characteristics, (3) and associations of these beliefs with suicide attempts and ED visits 3-5 months later. Participants were 286 psychiatric ED patients (59% Female), ages 13-25. Ratings of self-efficacy to engage in 10 suicide-specific coping behaviors were assessed at index visit. A total of 226 participants (79%) were assessed 3-5 months later. Youth endorsed low-to-moderate self-efficacy for different suicide-specific coping behaviors, with lowest ratings endorsed for limiting access to lethal means and accessing professional resources. More severe baseline psychopathology was associated with lower self-efficacy. Males endorsed higher self-efficacy for coping behaviors not requiring external support. Lower coping self-efficacy for some of the key strategies, and lower confidence that these strategies will be helpful, differentiated those with and without follow-up suicide attempts and ED visits. The generally low-to-moderate confidence in youths' ability to engage in coping behaviors to manage suicidal crises, and its association with follow-up suicidal crises, is concerning because many of these strategies are commonly included as part of discharge recommendations or safety planning. Implications of findings are discussed.