The utility of completing adjuvant video lessons based on the unified protocol during psychotherapy: A retrospective study using a telehealth platform in routine clinical care.

Digital supplements to tele-psychotherapy are increasingly needed. The purpose of this retrospective study was to investigate the association between outcomes and the use of supplemental video lessons based on the Unified Protocol (UP), an empirically supported transdiagnostic treatment.Participants included 7,326 adults in psychotherapy for depression and/or anxiety. Partial correlations were calculated between number of UP video lessons completed and change in outcomes after 10 weeks, controlling for number of therapy sessions and baseline scores. Then, participants were divided into those who did not complete any UP video lessons (n = 2355) and those who completed at least 7/10 video lessons (n = 549), and propensity-matched on 14 covariates. Repeated measures analysis of variance compared these groups (n = 401 in each group) on outcomes.Among the entire sample, symptom severity decreased as the number of UP video lessons completed increased, with the exception of lessons on avoidance and exposure. Those watching at least 7 lessons showed significantly greater reduction in both depression and anxiety symptoms than those who did not watch any.Viewing supplemental UP video lessons in addition to tele-psychotherapy had a positive and significant association with symptom improvement and may provide an additional tool for clinicians to implement UP components virtually.

Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression.

BACKGROUND: Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe the use of a proprietary precision prescribing algorithm piloted during routine clinical practice as part of Brightside's telepsychiatry services. The primary aim is to determine the feasibility and acceptability of implementing this intervention. Secondary aims include exploring remission and symptom improvement rates. METHODS: Participants were adult patients enrolled in Brightside who completed at least 12 weeks of treatment for depression and/or anxiety and received a prescription for at least one psychiatric medication. A prescription recommendation was made by Brightside's algorithm at treatment onset and was utilized for clinical decision support. Participants received baseline screening surveys of the PHQ-9 and GAD-7, and at weeks 2,4,6,8,10 and 12. Intent-to-treat (ITT) sensitivity analyses were conducted. Feasibility of the implementation was measured by the platform's ability to enroll and engage participants in timely psychiatric care, as well as offer high touch-point treatment options. Acceptability was measured by patient responses to a 5-star satisfaction rating. RESULTS: Brightside accessed and treated 6248 patients from October 2018 to April 2021, treating a majority of patients within 4-days of enrollment. The average plan cost was $115/month. 89% of participants utilized Brightside's core medication plan at a cost of $95/month. 13.4% of patients in the study rated Brightside's services as highly satisfactory, averaging a 4.6-star rating. Furthermore, 90% of 6248 patients experienced a MCID in PHQ-9 or GAD-7 score. Remission rates were 75% (final PHQ-9 or GAD-7 score < 10) for the study sample and 59% for the ITT sample. 69.3% of Brightside patients were treated with the medication initially prescribed at intake. CONCLUSIONS: Results suggest that the present intervention may be feasible and acceptable within the assessed population. Exploratory analyses suggest that Brightside's course of treatment, guided by precision recommendations, improved patients' symptoms of anxiety and depression.

Exploring Correlates of Social Reactions to Disclosure Among Latina Sexual Assault Survivors.

Social reactions to sexual assault (SA) disclosure are well-documented in the literature, but less is known about disclosure and reactions received by Latina survivors. The current study analyzed correlates of positive and negative social reactions to sexual assault disclosure in a community sample of Latina survivors (n = 239). Compared to White survivors, Latina survivors were more likely to report turning against and acknowledgement without support reactions. Among Latina survivors, contrary to hypotheses, both "stereotypical" (e.g. more violent assaults) and "non-stereotypical" (e.g. pre-assault substance use) assault characteristics were associated with acknowledgement without support negative social reactions. Furthermore, total number of sources Latina survivors disclosed to were associated with turning against social reactions. Implications for future research on disclosure/social reactions and Latina survivors are discussed.

Enhancing respiratory sinus arrhythmia increases cardiac output in rats with left ventricular dysfunction.

KEY POINTS: Respiratory sinus arrhythmia is physiological pacing of the heart that disappears in cardiovascular disease and is associated with poor cardiac prognosis. In heart failure, cardiac pacing has little, if any, variation in rate at rest. We proposed that reinstatement of respiratory sinus arrhythmia would improve cardiac function in rats with heart failure. Heart failure rats were paced daily for 2 weeks with either respiratory sinus arrhythmia or paced monotonically at a matched heart rate; cardiac function was measured using non-invasive echocardiography. Cardiac output and stroke volume were increased in rats paced with respiratory sinus arrhythmia compared to monotonic pacing, via improvement in systolic function that persisted beyond the pacing treatment period. We propose that respiratory sinus arrhythmia pacing reverse-remodels the heart in heart failure and is worth considering as a new form of cardiac pacemaking. ABSTRACT: Natural pacing of the heart results in heart rate variability, an indicator of good health and cardiac function. A contributor to heart rate variability is respiratory sinus arrhythmia or RSA - an intrinsic respiratory modulated pacing of heart rate. The loss of RSA is associated with poor cardiac prognosis and sudden cardiac death. We tested if reinstatement of respiratory-modulated heart rate (RMH) would improve cardiac performance in heart failure. Heart failure was induced in Wistar rats by ligation of the left anterior descending coronary artery. Rats were unpaced, monotonically paced and RMH paced; the latter had the same average heart rate as the monotonically paced animals. Cardiac function was assessed non-invasively using echocardiography before and after 2 weeks of daily pacing at a time when pacing was turned off. RMH increased cardiac output by 20 ± 8% compared to monotonic pacing (-3 ± 5%; P < 0.05). This improvement in cardiac output was associated with an increase in stroke volume compared to monotonic pacing (P = 0.03) and improvement in circumferential strain (P = 0.02). Improvements in ejection fraction (P = 0.08) and surrogate measures of left ventricle compliance did not reach significance. Increases in contractility (P < 0.05) and coronary blood flow (P < 0.05) were seen in vitro during variable pacing to mimic RMH. Thus, in rats with left ventricular dysfunction, chronic RMH pacing improved cardiac function through improvements in systolic function. As these improvements were made with pacing switched off, we propose the novel idea that RMH pacing causes reverse-remodelling.

Sexual Assault Survivors Who Exchange Sex: Identity, Stigma, and Informal Responses from Support Providers.

It is well established in the literature that individuals who engage in sex work are more likely to experience sexual trauma/violence, but little research has examined experiences of sexual assault survivors who exchange sex from the survivor's perspective. Sexual assault survivors and their informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about disclosure, social reactions, and help-seeking following assault. Sixteen survivors mentioned experiences exchanging sex, which comprises the sample for the current study, as well as comments from twelve SPs. Qualitative analysis revealed several themes including violence experienced engaging in sex work, navigating stigma and the identity of both sexual assault survivor and sex worker, and how survivors' social supports impact their recovery. Survivors endorsed their sex worker identities at varying levels, and others used their identity as a sexual assault survivor to explain why they engaged in sex work. Social work implications regarding service provision and advocacy work are discussed.

Women's Experiences of Impairment and Incapacitation During Alcohol/Drug-Related Sexual Assaults: Toward a Survivor-Informed Approach to Measurement.

Researchers have categorized level of impact of drinking during alcohol/substance facilitated sexual assaults as unimpaired (perceived no effect of drinking), impaired (conscious, but impacted by substance use), or incapacitated (unconscious due to substance use). However, researchers have not always agreed on what constitutes these categories, and no qualitative research has been done to date to explore those discrepancies. Such work is needed in order to listen to survivors' voices, using their perspectives and experiences to develop trauma-informed practices specific to survivors of alcohol-involved assaults. The current study sought to shed light on impaired/incapacitated sexual assault experiences presenting 141 qualitative written responses of women who were drinking and/or using substances at the time of their assault. Results showed that while some responses aligned with previous researcher-defined quantitative impaired/incapacitated categories, most responses coded could be considered both impaired and incapacitated, or neither of these categories. Implications for further research, particularly qualitative work, are discussed specifically challenging previous research on impaired/incapacitated sexual assault experiences.

Cardiorespiratory interactions in humans and animals: rhythms for life.

The cardiorespiratory system exhibits oscillations from a range of sources. One of the most studied oscillations is heart rate variability, which is thought to be beneficial and can serve as an index of a healthy cardiovascular system. Heart rate variability is dampened in many diseases including depression, autoimmune diseases, hypertension, and heart failure. Thus, understanding the interactions that lead to heart rate variability, and its physiological role, could help with prevention, diagnosis, and treatment of cardiovascular diseases. In this review, we consider three types of cardiorespiratory interactions: respiratory sinus arrhythmia (variability in heart rate at the frequency of breathing), cardioventilatory coupling (synchronization between the heart beat and the onset of inspiration), and respiratory stroke volume synchronization (the constant phase difference between the right and the left stroke volumes over one respiratory cycle). While the exact physiological role of these oscillations continues to be debated, the redundancies in the mechanisms responsible for its generation and its strong evolutionary conservation point to the importance of cardiorespiratory interactions. The putative mechanisms driving cardiorespiratory oscillations as well as the physiological significance of these oscillations will be reviewed. We suggest that cardiorespiratory interactions have the capacity to both dampen the variability in systemic blood flow as well as improve the efficiency of work done by the heart while maintaining physiological levels of arterial CO2. Given that reduction in variability is a prognostic indicator of disease, we argue that restoration of this variability via pharmaceutical or device-based approaches may be beneficial in prolonging life.

Respiratory modulated sympathetic activity: a putative mechanism for developing vascular resistance?

KEY POINTS: Sympathetic activity exhibits respiratory modulation that is amplified in hypertensive rats. Respiratory modulated sympathetic activity produces greater changes in vascular resistance than tonic stimulation of the same stimulus magnitude in normotensive but not hypertensive rats. Mathematical modelling demonstrates that respiratory modulated sympathetic activity may fail to produce greater vascular resistance changes in hypertensive rats because the system is saturated as a consequence of a dysfunctional noradrenaline reuptake mechanism. Respiratory modulated sympathetic activity is an efficient mechanism to raise vascular resistance promptly, corroborating its involvement in the ontogenesis of hypertension. ABSTRACT: Sympathetic nerve activity (SNA) exhibits respiratory modulation. This component of SNA is important - being recruited under cardiorespiratory reflex conditions and elevated in the spontaneously hypertensive (SH) rat - and yet the exact influence of this modulation on vascular tone is not understood, even in normotensive conditions. We constructed a mathematical model of the sympathetic innervation of an arteriole, and used it to test the hypothesis that respiratory modulation of SNA preferentially increases vasoconstriction compared to a frequency-matched tonic pattern. Simulations supported the hypothesis, where respiratory modulated increases in vasoconstriction were mediated by a noradrenergic mechanism. These predictions were tested in vivo in adult Wistar rats. Stimulation of the sympathetic chain (L3) with respiratory modulated bursting patterns, revealed that bursting increases vascular resistance (VR) more than tonic stimulation (57.8 ± 3.3% vs. 44.8 ± 4.2%; P < 0.001; n = 8). The onset of the VR response was also quicker for bursting stimulation (rise time constant = 1.98 ± 0.09 s vs. 2.35 ± 0.20 s; P < 0.01). In adult SH rats (n = 8), the VR response to bursting (44.6 ± 3.9%) was not different to tonic (37.4 ± 3.5%; P = 0.57). Using both mathematical modelling and in vivo techniques, we have shown that VR depends critically on respiratory modulation and revealed that this pattern dependency in Wistar rats is due to a noradrenergic mechanism. This respiratory component may therefore contribute to the ontogenesis of hypertension in the pre-hypertensive SH rat - raising VR and driving vascular remodelling. Why adult SH rats do not exhibit a pattern-dependent response is not known, but further modelling revealed that this may be due to dysfunctional noradrenaline reuptake.

Silicon central pattern generators for cardiac diseases.

Cardiac rhythm management devices provide therapies for both arrhythmias and resynchronisation but not heart failure, which affects millions of patients worldwide. This paper reviews recent advances in biophysics and mathematical engineering that provide a novel technological platform for addressing heart disease and enabling beat-to-beat adaptation of cardiac pacing in response to physiological feedback. The technology consists of silicon hardware central pattern generators (hCPGs) that may be trained to emulate accurately the dynamical response of biological central pattern generators (bCPGs). We discuss the limitations of present CPGs and appraise the advantages of analog over digital circuits for application in bioelectronic medicine. To test the system, we have focused on the cardio-respiratory oscillators in the medulla oblongata that modulate heart rate in phase with respiration to induce respiratory sinus arrhythmia (RSA). We describe here a novel, scalable hCPG comprising physiologically realistic (Hodgkin-Huxley type) neurones and synapses. Our hCPG comprises two neurones that antagonise each other to provide rhythmic motor drive to the vagus nerve to slow the heart. We show how recent advances in modelling allow the motor output to adapt to physiological feedback such as respiration. In rats, we report on the restoration of RSA using an hCPG that receives diaphragmatic electromyography input and use it to stimulate the vagus nerve at specific time points of the respiratory cycle to slow the heart rate. We have validated the adaptation of stimulation to alterations in respiratory rate. We demonstrate that the hCPG is tuneable in terms of the depth and timing of the RSA relative to respiratory phase. These pioneering studies will now permit an analysis of the physiological role of RSA as well as its any potential therapeutic use in cardiac disease.

Deep brain stimulation for the treatment of resistant hypertension.

Hypertension is a leading risk factor for the development of several cardiovascular diseases. As the global prevalence of hypertension increases, so too has the recognition of resistant hypertension. Whilst figures vary, the proportion of hypertensive patients that are resistant to multiple drug therapies have been reported to be as high as 16.4 %. Resistant hypertension is typically associated with elevated sympathetic activity and abnormal homeostatic reflex control and is termed neurogenic hypertension because of its presumed central autonomic nervous system origin. This resistance to conventional pharmacological treatment has stimulated a plethora of medical devices to be investigated for use in hypertension, with varying degrees of success. In this review, we discuss a new therapy for drug-resistant hypertension, deep brain stimulation. The utility of deep brain stimulation in resistant hypertension was first discovered in patients with concurrent neuropathic pain, where it lowered blood pressure and improved baroreflex sensitivity. The most promising central target for stimulation is the ventrolateral periaqueductal gray, which has been well characterised in animal studies as a control centre for autonomic outflow. In this review, we will discuss the promise and potential mechanisms of deep brain stimulation in the treatment of severe, resistant hypertension.

Are All Substance-Involved Sexual Assaults Alike? A Comparison of Victim Alcohol Use, Drug Use, and Combined Substance Use in Sexual Assaults.

Sexual assaults involving victim substance use at the time of the assault are common, but little is known about how different types of substances used at the time of the assault impact post-assault outcomes. The current study sought to compare victim alcohol use, drug use, and combined substance use in sexual assaults among a community sample of 693 victims. It was hypothesized that victims in the combined substance use assault type would report overall worse post-assault outcomes, more contextual and interpersonal traumas, and higher assault severity. Our results partially confirmed these hypotheses, but victims in the drug-involved assault type group overall reported higher assault severity and worse post-assault outcomes. These findings are probably partially attributed to the demographic characteristics of victims in the drug-only group (e.g. Black victims) who are more likely to experience a higher severity of violence. Implications for future research and policy regarding drug decriminalization are discussed.

Consumer Expectations and Attitudes About Psychotherapy: Survey Study.

BACKGROUND: Although mental illness is common among adults in the United States, access to, and public perception of, mental health care continue to present as key barriers to care. OBJECTIVE: Given the importance of attitudes toward, and perceptions of, mental health treatment in the successful access to mental health care and treatment of mental health issues, the primary goal of this survey study was to further investigate consumer perspectives of psychotherapy among adults in the United States; specifically, adding to the literature by investigating perceptions of both the general public and patients receiving telehealth. More specifically, the aims were to better understand openness to, and satisfaction with, therapy; perceptions, preferences, and expectations around therapy; and perceptions of psychotropic medication. METHODS: An electronic survey was administered to current and former patients (those receiving psychotherapy) of Brightside, a nationwide telehealth company, as well as to the general public; both were convenience samples. Using the same survey questions, Brightside surveyed its own members (using Qualtrics; Qualtrics International Inc) and the general population (using SurveyMonkey's Audience tool; Momentive). This survey included questions about basic participant demographics, as well as questions about current mental health treatment, perceptions about therapy, and therapists' qualities. RESULTS: A total of 714 people completed the survey. The data were fairly evenly split between those collected from Brightside patients (368/714, 51.5%) and those collected from the general public (346/714, 48.5%). Combining both samples, overall participation was 67.1% (479/714) women; 73.1% (522/714) White, 7.3% (52/714) Asian, 6.7% (48/714) African American, and 7.4% (53/714) Hispanic or Latinx; largely aged 25 to 34 years (255/714, 35.7%) or 35 to 44 years (187/714, 26.2%); from either the Mid-Atlantic (131/714, 18.3%) or South Atlantic (129/714, 18.1%) regions of the country; and most (402/714, 56.3%) earning annual salaries of US $30,000 to US $100,000. There were generally favorable perceptions of both psychotherapy and psychiatric medication. Selecting a therapist as well as cost and insurance are the common factors in therapy that are important to patients. The most commonly held perception of psychotherapy duration was indefinite (250/714, 35%). Very few (58/714, 8.1%) thought that therapy typically lasts 1 to 3 months. Most of the participants (414/714, 58%) thought that evidence-based practice was important. CONCLUSIONS: Public education is needed to increase awareness of the typical duration and cost of psychotherapy. There seem to be generally favorable perceptions of both psychotherapy and psychotropic medication. Selecting a therapist as well as cost and insurance are the common factors in therapy that are important to patients. Practitioners and those marketing their services might consider using their marketing campaigns to counter some of the more common falsely held beliefs.

Addressing the educational challenges of urban poverty: a case for solution-based research.

Introduction: Math achievement for economically disadvantaged students remains low, despite positive developments in research, pedagogy, and funding. In the current paper, we focused on the research-to-practice divide as possible culprit. Our argument is that urban-poverty schools lack the stability that is necessary to deploy the trusted methodology of hypothesis-testing. Thus, a type of efficacy methodology is needed that could accommodate instability. Method: We explore the details of such a methodology, building on already existing emancipatory methodologies. Central to the proposed solution-based research (SBR) is a commitment to the learning of participating students. This commitment is supplemented with a strength-and-weaknesses analysis to curtail researcher bias. And it is supplemented with an analysis of idiosyncratic factors to determine generalizability. As proof of concept, we tried out SBR to test the efficacy of an afterschool math program. Results: We found the SBR produced insights about learning opportunities and barrier that would not be known otherwise. At the same time, we found that hypothesis-testing remains superior in establishing generalizability. Discussion: Our findings call for further work on how to establish generalizability in inherently unstable settings.

Novel Telehealth Adaptations for Evidence-Based Outpatient Suicide Treatment: Feasibility and Effectiveness of the Crisis Care Program.

Background: Suicide rates in the United States have escalated dramatically over the past 20 years and remain a leading cause of death. Access to evidenced-based care is limited, and telehealth is well-positioned to offer novel care solutions. The Crisis Care program is a suicide-specific treatment program delivered within a national outpatient telehealth setting using a digitally adapted version of the Collaborative Assessment and Management of Suicidality (CAMS) as the framework of care. This study investigates the feasibility and preliminary effectiveness of Crisis Care as scalable suicide-specific treatment model. Methods: Patient engagement, symptom reduction, and care outcomes were examined among a cohort of patients (n = 130) over 16 weeks. The feasibility of implementation was assessed through patient engagement. Clinical outcomes were measured with PHQ-9, GAD-7, and the CAMS SSF-4 rating scales. Results: Over 85% of enrolled patients were approved for Crisis Care at intake, and 83% went on to complete at least four sessions (the minimum required to graduate). All patient subgroups experienced declines in depressive symptoms, anxiety symptoms, suicidal ideation frequency, and suicide-specific risk factors. Conclusions: Results support the feasibility and preliminary effectiveness of Crisis Care as a suicide-specific care solution that can be delivered within a stepped-care model in an outpatient telehealth setting.

Pica in children with sickle cell disease: two case reports.

Children with sickle cell disease (SCD) are at greater risk for developing pica compared to other children. This comorbidity can result in harmful medical and nutritional, and neurodevelopmental consequences. This article will describe the medical, nutritional, and psychosocial functioning in two children with SCD and pica in order to illustrate the potential complications and correlates of this co-morbidity. In addition, the clinical implications of pica in children with SCD will be discussed.

Differences in Women's Substance-Related Sexual Assaults: Force, Impairment, and Combined Assault Types.

This study furthers previous research on sexual assaults (SAs) involving substances and/or force by examining effects of perpetrator behaviors of alcohol and/or drug impairment level (none, impaired, incapacitated) and/or force during SA in relationship to various assault and recovery outcomes. A diverse sample of 632 women from a large Midwestern city participated in a study on women's experiences with SA. Of this sample of substance-involved SAs, 37.3% (n = 236) reported a forcible-only unimpaired assault, 50.6% (n = 320) reported a combined impairment/incapacitation and force assault, and 12% (n = 76) reported an impaired/incapacitated-only assault. Multivariate analyses of covariance (MANCOVAs) and chi-square analyses compared assault types as defined by combined alcohol and/or drug impairment level and/or force to determine how these assaults differed in demographics, other assault characteristics, and post-assault experiences. Assault types differed on several demographic, assault, and post-assault factors with most differences showing that the combined assault type was related to worse outcomes than forcible-type assaults, including greater reexperiencing, avoidance, and numbing post-traumatic stress disorder (PTSD) symptoms. Implications for clinical intervention include recognizing that assaults involving substance use and force are traumatic and warrant individualized treatment.

Sexual Harassment in the Academy: Harnessing the Growing Labor Movement in Higher Education to Address Sexual Harassment Against Graduate Workers.

Higher education is not immune to the epidemic of sexual harassment in the United States, particularly sexual harassment of graduate workers. This is due largely to power differentials of status and income, as academia relies on low-wage work. While the literature shows sexual harassment is prevalent across disciplines, current work to address the problem does not account for graduate worker precarity. The graduate labor movement, which addresses precarity, is beginning to tackle sexual harassment. We review how the labor and anti-gender-based violence movements in higher education should come together to prevent sexual harassment, presenting recommendations for structural changes to academia.

A Comparative Evaluation of Measurement-Based Psychiatric Care Delivered via Specialized Telemental Health Platform Versus Treatment As Usual: A Retrospective Analysis.

Background and objective A significant proportion of the adult population in the United States (US) live with some form of mental illness. The more prevalent conditions of depression and anxiety are typically managed in primary care settings rather than specialty care. The aim of this study was to determine the efficacy of a novel, measurement-driven psychiatric treatment platform delivered via an online telemental health platform as compared to treatment as usual (TAU). Methods The TAU dataset and the telemental health platform (Brightside) dataset were constructed based on the total populations of adult patients receiving care for depression from January 2018 through December 2020 (November 2018 through March 2021 for the Brightside group). Patients in both groups had a primary mental health diagnosis of depression and the presence of a positive screen for depression as measured by the Patient Health Questionnaire-9 (PHQ-9) upon initiation of treatment. HITLAB, an independent digital health verification and testing lab, conducted comparative analyses of the two groups using the Chi-square test of independence. Results Close to 80% of telemental health platform patients experienced a reduction of 5 or more points from their baseline PHQ-9 score as compared to 52% of TAU patients. The mean reduction in PHQ-9 score was slightly higher in the Brightside group (-11.5) versus the TAU group (-10.1). Chi-square tests of independence [x2 (1, n=6281) = 256.75, p≤0.001] for meaningful reduction and for remission [x2 (1, n=6281) = 105.50 p≤0.001] were highly significant. Conclusion The telemental health platform patients performed significantly better than those under psychiatric TAU in terms of reduction in symptoms of depression in adults.

Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study.

BACKGROUND: Suicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide. OBJECTIVE: This study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission. METHODS: Participants included 8581 US-based adults (8366 in the treatment group and 215 in the control group) seeking treatment for depression, anxiety, or both. The treatment group included patients who had completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers prescribed psychiatric medications for each patient during their first session and received regular data on participants. They also received decision support at treatment onset via the digital platform, which leveraged an empirically derived proprietary precision-prescribing algorithm to give providers real-time care guidelines. Participants in the control group consisted of individuals who completed the initial enrollment data and completed surveys at baseline and 12 weeks but did not receive care. RESULTS: Greater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=0.24-0.37) with SI at baseline. Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=-0.16) and 12 weeks (r=-0.10) but less improvement over time (r=-0.12 and -0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts. CONCLUSIONS: The results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed.

A Dyadic Study of Impacts of Sexual Assault Disclosure on Survivors' Informal Support Relationships.

After a sexual assault, victims often disclose their assault to an informal support provider (SP) to receive social support. Ample research exists on social reactions of informal SPs to disclosure and how those reactions affect the victim both positively and negatively, but little research exists on how the disclosure impacts a survivor's support relationships both in the short and in the long term. This qualitative interview study examined 45 ethnically diverse informal support dyads where women disclosed sexual assault to an informal SP (e.g., friend, family, significant other). Assault disclosure was examined to determine its impact on relationship quality of survivors and their SPs. Results revealed positive and negative effects on survivor-SP relationships of assault disclosure and social reactions. In almost all matched pairs (91%), the survivor, SP, or both remarked on how the relationship had changed following disclosure. Family member SPs spoke of survivors' risk-taking and poor relationship choices. Significant others spoke of the toll of supporting survivors who sometimes left their needs unmet and strained their relationships with survivors. Friend SPs often appraised how the survivor engaged in other types of relationships, but overall felt that their relationships had become stronger or closer as a result of the disclosure. Implications of this study include acknowledging that informal supporters, particularly significant others, can experience adverse effects after disclosure, and that help is needed not only for survivors but also for their informal support sources. Future research should continue to investigate both the short-term and longitudinal impacts of sexual assault disclosure on survivors' informal support relationships.