A context-dependent perspective to understand the relation between parent-child physiological synchrony and child socioemotional adjustment.

Physiological synchrony is an important biological process during which parent-child interaction plays a significant role in shaping child socioemotional adjustment. The present study held a context-dependent perspective to examine the conditional association between parent-child physiological synchrony and child socioemotional adjustment (i.e., relationship quality with parents and child emotion regulation) under different (i.e., from highly unsupportive to highly supportive) emotional contexts. One hundred and fifty school-age Chinese children (Mage = 8.64 years, 63 girls) and their primary caregivers participated in this study. After attaching electrocardiogram (ECG) electrodes, parent-child dyads were instructed to complete a 4-minute conflict discussion task. Parent-child physiological synchrony was calculated based on the within-dyad association between parents' and children's respiratory sinus arrhythmia (RSA) levels across eight 30-second epochs. Parental emotional support, child relationship quality with parents, and child emotion regulation during the discussion task were coded by trained research assistants. Supporting our hypotheses, parental emotional support moderated the relations of parent-child RSA synchrony with both child relationship quality with parents and child emotion regulation. Furthermore, the Johnson-Neyman technique of moderation indicated that the associations between parent and child RSA synchrony and child socioemotional adjustment indicators shifted from negative to positive as the parental emotional support became increasingly high. Our findings suggest that parent-child physiological synchrony may not be inherently adaptive or maladaptive, highlighting the importance of understanding the function of parent-child physiological synchrony under specific contexts. RESEARCH HIGHLIGHTS: Physiological synchrony may not be inherently adaptive or maladaptive, and the meanings of parent-child physiological synchrony might be contingent on contextual factors. Parental emotional support moderated the relations between parent-child respiratory sinus arrhythmia (RSA) synchrony and child socioemotional adjustment indicators (i.e., child relationship quality with parents and child emotion regulation). More positive/less negative parent-child RSA synchrony was associated with better child socioemotional adjustment under a supportive emotional context, whereas with poorer child socioemotional adjustment under an unsupportive emotional context. These findings highlight the significance of considering the emotional context in physiological synchrony studies.

SIGIS-SIAMS-SIE position statement of gender affirming hormonal treatment in transgender and non-binary people.

PURPOSE: Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable evolution and change in attitude as regards to gender nonconforming people. METHODS: According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS-SIAMS-SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS-SIAMS-SIE Guideline Board. RESULTS: In the present document by the SIGIS-SIAMS-SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care. CONCLUSION: In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.

Psychological adjustment outcomes among pediatric brain tumor survivors: A meta-analysis.

BACKGROUND: Pediatric brain tumor survivors (PBTS) are at significant risk for psychological adjustment difficulties, including greater depressive and anxious symptomology. Systematic reviews have identified this heightened risk among youth with medical conditions, but these reviews have not been specific to PBTS. Therefore, the current study aimed to directly examine the psychological adjustment of PBTS as compared to healthy peers. PROCEDURE: A systematic review and meta-analysis was conducted using PubMed, PsychInfo, and Academic Search Premier databases. The search yielded 2833 articles, with 22 articles meeting inclusion criteria. RESULTS: A statistically significant overall medium effect size (Hedge's g = 0.32) indicated that PBTS exhibited poorer overall psychological adjustment relative to healthy comparison groups. Studies that included younger children were associated with larger between-group differences. When evaluating specific outcomes, PBTS had relatively higher levels of depressive symptoms (Hedge's g = 0.36), anxious symptoms (Hedge's g = 0.11), and general distress (Hedge's g = 0.22), but not more externalizing problems. CONCLUSIONS: The present study confirmed that PBTS are indeed at greater risk for psychological adjustment difficulties relative to healthy comparison groups. These findings highlight the importance of psychosocial screening among this population. Given that depressive symptoms were the most elevated relative to healthy peers, investigation of such symptomatology among PBTS is particularly important.

A 2-year longitudinal study of neuropsychological functioning, psychosocial adjustment and rehospitalisation in schizophrenia and major depression.

Neuropsychological functioning turns out to be a rate-limiting factor in psychiatry. However, little is known when comparing neuropsychological and psychosocial functioning in inpatients with schizophrenia or severe depression in their treatment pathways including add-on psychoeducation or the latter combined with cognitive behavioral therapy up to 2-year follow-up. To evaluate this question, we investigated these variables in two randomised controlled trials including 196 patients with DSM-IV schizophrenia and 177 patients with major depression. Outcome measures were assessed in the hospital at pre- and posttreatment and following discharge until 2-year follow-up. We focused on neuropsychological and psychosocial functioning regarding its differences and changes over time in data of two pooled trials. There were significant time effects indicating gains in knowledge about the illness, short and medium-term memory (VLMT) and psychosocial functioning (GAF), however, the latter was the only variable showing a time x study/diagnosis interaction effect at 2-year follow-up, showing significant better outcome in depression compared to schizophrenia. Moderator analysis showed no changes in psychosocial and neuropsychological functioning in schizophrenia and in affective disorders due to age, duration of illness or sex. Looking at the rehospitalisation rates there were no significant differences between both disorders. Both groups treated with psychoeducation or a combination of psychoeducation and CBT improved in neuropsychological and psychosocial functioning as well as knowledge about the illness at 2-year follow-up, however, patients with major depression showed greater gains in psychosocial functioning compared to patients with schizophrenia. Possible implications of these findings were discussed.

International Comparisons of Emotionally Reactive Problems in Preschoolers: CBCL/1½-5 Findings from 21 Societies.

Our goal was to conduct international comparisons of emotion regulation using the 9-item Emotionally Reactive (ER) syndrome of the Child Behavior Checklist for Ages 1½-5. We analyzed parent ratings for 17,964 preschoolers from 21 societies, which were grouped into 8 GLOBE study culture clusters (e.g., Nordic, Confucian Asian). Omnicultural broad base rates for ER items ranged from 8.0% to 38.8%. Rank ordering for mean item ratings varied widely across societies (omnicultural Q = .50) but less so across culture clusters (M Q = .66). Societal similarity in mean item rank ordering varied by culture cluster, with large within-cluster similarity for Anglo (Q = .96), Latin Europe (Q = .74), Germanic (Q = .77), and Latin American (Q = .76) clusters, but smaller within-cluster similarity for Nordic, Eastern Europe, and Confucian Asian clusters (Qs = .52, .23, and .44, respectively). Confirmatory factor analyses of the ER syndrome supported configural invariance for all 21 societies. All 9 items showed full to approximate metric invariance, but only 3 items showed approximate scalar invariance. The ER syndrome correlated . 65 with the Anxious/Depressed (A/D) syndrome and .63 with the Aggressive Behavior syndrome. ER items varied in base rates and factor loadings, and societies varied in rank ordering of items as low, medium, or high in mean ratings. Item rank order similarity among societies in the same culture cluster varied widely across culture clusters, suggesting the importance of cultural factors in the assessment of emotion regulation in preschoolers.

A round peg in a square hole: strategy-situation fit of intra- and interpersonal emotion regulation strategies and controllability.

Although the importance of contextual factors is often recognised, research on emotion regulation strategies (ERS) has mainly focused so far on the effectiveness of ERS across situations. In the present research, we tested the strategy-situation fit hypothesis, which does not assume general effectiveness of ERS but instead stresses the importance of the congruency between ERS and the contexts in which they are used. Using a longitudinal Ambulatory Assessment dataset (N = 138), we found that controllability of a situation positively moderated the effectiveness of interpersonal ERS, such that, e.g. providing feedback to others was significantly associated with less positive feelings but only in less controllable situations. Intrapersonal ERS were negatively moderated by controllability, such that downplaying a negative situation was associated with less negative feelings in less controllable situations. Finally, favouring interpersonal over intrapersonal ERS was also positively moderated by controllability, demonstrating the situational fit of ERS in daily life.

A predictive model of resilience among family caregivers supporting relatives with traumatic brain injury (TBI): A structural equation modelling approach.

Constructs from positive psychology were employed to create an explicit model of caregiver resilience. Predictive and mediating relationships among resilience and related variables (personality, coping, self-efficacy, hope, social support) were then tested for their association with burden and psychological adjustment among family members caring for relatives with severe TBI. Family participants (n = 131) from six rehabilitation units from New South Wales and Queensland completed assessments which elicited explanatory (Eysenck Personality Questionnaire, Ways of Coping Questionnaire), mediating (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey), and caregiver outcome (Caregiver Burden Scale, Mental Health sub-Scale-SF36, General Health Questionnaire, and Positive and Negative Affect Scale) variables. Structural Equation Modeling (SEM) showed that resilience had a direct effect on positive affect in caregivers. Resilience also played a protective role in relation to two variables associated with caregiver vulnerability: an indirect association with caregiver burden mediated through social support; a direct effect on hope, which, in turn, was associated with positive mental health. Positive mental health then played a buffering role in relation to psychological distress and negative affect. Resilience, in combination with other psychological attributes, was associated with reduced morbidity among family caregivers after severe TBI.

Trajectories of Observed Shyness and Psychosocial Adjustment in Children.

Shyness can manifest as inhibition, fear, and avoidance in the context of social novelty and situations of perceived social evaluation. In the present study, 130 children (Mage = 7.6 years, SD = 1.8) participated in a videotaped self-presentation task across three separate visits spanning approximately 3 years in early and middle childhood. Children's observed shyness was best characterized by two trajectories, including a high-stable class (19%) and a low-stable class (81%). Girls were more likely than boys to follow a pattern of high-stable observed shyness. Further, children in the high-stable observed shyness class were rated by parents and teachers as more socially anxious relative to children in the low-stable class, and boys in the high-stable observed shyness class were rated by their teachers as displaying more depressive symptoms relative to girls. These findings suggest that a subset of children display stable behavioral shyness, and this is correlated with psychosocial functioning.

The adjustment process of young Bedouin women who were child brides.

Qualitative study explores the adjustment process of young Bedouin women in Israel who were minors and legally underage when they married. Child brides have always existed in Bedouin society, which sees marriage as a social and religious framework that protects the girl. This study's participants, 30 young women who were 13-17 when they married, shed light on the long and continuing process of adjustment, the sharp transitions in their lives, and their cognitive assimilation of married life. Their stories allow a glimpse of how a generation of young women within a traditional, strongly patriarchal society is starting to challenge accepted traditional practices. The case of Bedouin society may be relevant to other traditional societies, to indigenous peoples, and in general to the issue of child marriage that is so widespread globally. Child brides, a worldwide phenomenon, have always existed in Bedouin society, which sees marriage as a social and religious framework that protects the girl and her family from dishonor. Such marriages continue despite legal prohibition. This qualitative study in the phenomenological tradition explores the adjustment process of young Bedouin women in Israel who were legally underage when they married. The participants, 30 young women who married at ages 13-17, were recruited from the case loads of social workers in southern Israel. Data were obtained through in-depth semistructured interviews. The data shed light on the women's long and continuing process of adjustment, the sharp transitions in their lives, and their cognitive assimilation of married life and motherhood. Optimism that everything will work out and individual and family resilience are important factors, but the adjustment process is different for each of two groups of the participants: In one group, the girl met her prospective husband before marriage, was engaged for at least 6 months, and was prepared by her family for marriage and intimate relations. In the second group, the girl did not know the prospective husband, was engaged very briefly (up to 1 month), was not prepared for marriage, and was not asked for her opinion or consent. For the second group, the adjustment process was longer and more difficult. The stories of both groups reveal how a generation of young women within a traditional, strongly patriarchal society is starting to challenge traditional practices, including the husband's dependence on his family and the mother-in-law's interference, although ultimately they conform to their society's norms. Social services need to be aware of the processes these young women are undergoing and to build suitable intervention programs for them, their spouses, and their families. Also needed is a program that will explain to girls and their families the implications of marriage at a young age. The case of Bedouin society may be relevant to other traditional societies, to indigenous peoples, and to the global issue of child marriage. This article contributes to global knowledge by presenting the world of these young women, members of a society that is undergoing powerful changes that have weakened the traditional establishment but that still clings to such values as honor and male supremacy.

DNA Methylation Across the Serotonin Transporter Gene Following Marital Separation: A Pilot Study.

BACKGROUND: Marital separation and divorce are stressful life transitions associated with increased risk for a range of poor mental and physical health outcomes. A key task for research in this area is to identify individual differences that may index risk for these adverse outcomes. PURPOSE: To examine the association between DNA methylation across the serotonin transporter gene (SLC6A4) and self-reported emotional distress following marital separation. METHODS: Genomic DNA methylation (from buffy coat fractions of whole blood) was quantified in a sample of 47 adults following a recent marital separation; concurrent with the blood draw, participants completed questionnaires on their psychological adjustment to the separation experience. RESULTS: Relatively greater methylation of SLC6A4 was associated with less subjective separation-related psychological distress, and this association held after accounting for participants' age, length of the relationship, time since the separation, and SLC6A4 genotype, b = -211.99, SE = 94.91, p = .03, 95% CI: -402.22, -25.21. Significantly stronger negative associations were observed between methylation and psychological adjustment among participants who had more recently separated from their former partner. CONCLUSIONS: Although results derived from small samples must be considered preliminary and hypothesis generating, the current study raises new questions about the role of DNA methylation and psychosocial adaptation to stressful life events such as divorce, and the findings can inform future studies in this research area.

Ventral prefrontal cortex and emotion regulation in aging: A case for utilizing transcranial magnetic stimulation.

OBJECTIVES: The ventrolateral prefrontal cortex (vlPFC) has been speculated to play an important role in complex processes that allow emotional factors to influence human cognition. Accumulating evidence from human neuroimaging studies, in conjunction with studies of patients with lesions and animal models, shed light on the role of the vlPFC in emotion regulation (ER). This review aims to discuss and integrate recent findings related to vlPFC's role in ER in the context of aging, drawing from diverse sources, and suggest future directions for research utilizing transcranial magnetic stimulation (TMS). METHODS/DESIGN: We summarize findings from the existing literature investigating the neural basis of frontal-lobe mediated ER and then highlight major findings from recent studies directly comparing healthy younger and older adult groups. We conclude by pointing to unaddressed questions worth pursuing in future research. RESULTS AND DISCUSSION: We propose future research directions utilizing TMS to answer key unaddressed questions. Moreover, we discuss the potential advantages, challenges, and limitations of using TMS as a complement to the existing neuroimaging methods in ER.

Illness Perception Mediates the Relationship Between the Severity of Symptoms and Perceived Health Status in Patients With Behçet Disease.

OBJECTIVE: The aim of this study was to investigate the relationship between psychological representations of illness, perceived health status, and self-assessment of symptom severity in patients with Behçet disease, a rare long-term incurable condition with unclear etiology. METHODS: Using cross-sectional survey design, data on self-administered questionnaires on illness perception, health status, symptoms severity, and demographic characteristics were collected from 273 patients with Behçet disease (age range, 18-65 years). The data were subjected to mediation analysis to test whether cognitive and emotional components of illness perception mediate the relationship between the severity of symptoms and heath status. RESULTS: The results support our hypotheses that cognitive components of illness perception (perceived consequences and identity of the illness) mediate the link between symptom activity and pain, whereas emotional components of the illness (emotional representations about the illness) mediate the relationship between disease activity and perceived energy level. CONCLUSIONS: The robustness of these mediation effects suggests potential directions for clinical psychologists and health care practitioners in developing support programs. We supplement our study with Open Access database containing information about type of medication, comorbid mood disorder, and detailed measurement of the severity of BD symptoms for sharing and accumulating multidisciplinary knowledge aiming to support the development of interventions. Addressing psychological aspects of BD will help to manage complex patients effectively.

Acculturation and adjustment of migrants reporting trauma: The contextual effects of perceived ethnic density.

Little is known about the relation between acculturation and socioecological contexts of migrants with a personal trauma history living in the community. This study represents an extension of our previous work and aimed to unpack the perceived neighborhood ethnic density (ED) effect and examine the moderating role of ED on the acculturation-adjustment relation in a community sample of migrants with trauma (N = 99) from developing countries residing in Montreal, Canada. ED was protective against general psychological distress but did not predict posttraumatic symptoms. The ED effect was mediated via degree of acculturation to the French-Canadian mainstream cultural context, rather than heritage acculturation, social support, or discrimination. Moreover, protective effects of French-Canadian mainstream acculturation for depressive symptoms and life satisfaction were found under high but not low ED conditions. Similarities and differences with our previous research as well as theoretical and prevention implications are discussed from a person-environment interaction perspective.

Family socioeconomic status and emotional adaptation among rural-to-urban migrant adolescents in China: The moderating roles of adolescent's resilience and parental positive emotion.

Low family socioeconomic status (SES) is closely related to increased risk of emotional maladaptation among adolescents. Although previous studies have found that low family SES is a significant and common experience for most rural-to-urban migrant adolescents in China, little research has examined the association between family SES and emotional adaptation or identified the protective factors that may minimise emotional maladaptation among these adolescents. The present study examined the associations between family SES and three indices of emotional adaptation (emotion regulation, life satisfaction and depression) and the moderating effects of adolescents' resilience and parental positive emotion (PE) among 486 Chinese rural-to-urban migrant adolescents. The results suggest that family SES was significantly associated with migrant adolescents' emotional outcomes, to varying degrees. Moreover, both adolescents' resilience and PE moderated the associations between family SES and emotional outcomes, although the protective effects of the two moderators differed on the three emotional outcomes. These findings shed light into designing intervention and prevention programs to reduce emotional maladaptation among migrant adolescents.

Facilitating Family Life Review during a Relocation to Assisted Living: Exploring Contextual Impact on Family Adjustment.

OBJECTIVES: The purpose of this study was to explore how contextual aspects of participants' lives before and throughout relocation to assisted living (ALF) informed family experience of family life review (FLR). METHOD: Fourteen families participated in a single FLR session within 6 months of the older adults' relocation. Semi-structured interviews, conducted one-month following the FLR session, were analyzed using the constant comparative method. Demographic and relational variables provided context for assessing how individual and family dynamics influenced the family relocation process. RESULTS: Techniques were used during the three phases of FLR (introduction, validation, consolidation) to encourage openness and mutual dialogue between family members. Health-related limitations challenged older adults' understanding and openness during the FLR. Mental health concerns linked to older adults' outlook on life, comfort in conversation during the FLR, and reflection of lifelong social ties. Family involvement and dynamics influenced how families communicated about their mutual narrative and the relocation transition. CONCLUSION: FLR is an adaptable intervention to assist older adults and their family during a transition to ALF. Although contextual challenges impacted how families experienced the FLR, they enjoyed FLR as a unifying event that promoted mutual understanding. CLINICAL IMPLICATIONS: The use of FLR facilitates enhanced understanding and communication during relocation. Older adults' health status as well as family dynamics need to be assessed prior to organizing a FLR to accommodate each families' unique needs.

Development of the Autosomal Dominant Polycystic Kidney Disease Impact Scale: A New Health-Related Quality-of-Life Instrument.

BACKGROUND: The impact of autosomal dominant polycystic kidney disease (ADPKD) on health-related quality of life (HRQoL) is not well understood due to a lack of instruments specific to the condition. STUDY DESIGN: Content for a new self-administered patient-reported outcome (PRO) questionnaire to assess ADPKD-related HRQoL was developed through clinical expert and patient focus group discussions. The new PRO instrument was administered to study patients with ADPKD to evaluate its reliability and validity. SETTING & PARTICIPANTS: 1,674 adult patients with ADPKD participated in this research: 285 patients in focus groups to generate questionnaire content, 15 patients in debriefing interviews to refine the PRO questionnaire, and 1,374 patients to assess the performance and measurement properties of the PRO questionnaire. OUTCOME: A new PRO questionnaire. RESULTS: The ADPKD Impact Scale (ADPKD-IS), consisting of 14 items representing 3 conceptual domains (physical, emotional, and fatigue) plus 4 additional questions, was developed. The instrument's reliability (regarding internal consistency and test-retest consistency) and validity (content and construct) were supported. LIMITATIONS: Need for more responsiveness testing when more data from clinical use become available over time. Complex concepts such as ADPKD-related pain and impact on a patient's HRQoL need further evaluation. CONCLUSIONS: The ADPKD-IS is a new patient-centric tool that reliably and validly provides a standardized method for assessing HRQoL and overall disease burden in patients with ADPKD.

Altered frontal-amygdala effective connectivity during effortful emotion regulation in bipolar disorder.

OBJECTIVES: Sufficient prefrontal top-down control of limbic affective areas, especially the amygdala, is essential for successful effortful emotion regulation (ER). Difficulties in effortful ER have been seen in patients with bipolar disorder (BD), which could be suggestive of a disturbed prefrontal-amygdala regulation circuit. The aim of this study was to investigate whether BD patients show abnormal effective connectivity from the prefrontal areas to the amygdala during effortful ER (reappraisal). METHODS: Forty participants (23 BD patients and 17 healthy controls [HC]) performed an ER task during functional magnetic resonance imaging. Using dynamic causal modeling, we investigated effective connectivity from the dorsolateral prefrontal cortex (DLPFC) and ventrolateral prefrontal cortex (VLPFC) to the amygdala, as well as connectivity between the DLPFC and VLPFC during reappraisal. RESULTS: Both BD patients and HC showed decreased negative affect ratings following reappraisal compared to attending negative pictures (P < .001). There were no group differences (P = .10). There was a differential modulatory effect of reappraisal on the connectivity from the DLPFC to amygdala between BD patients and HC (P = .04), with BD patients showing a weaker modulatory effect on this connectivity compared to HC. There were no other group differences. CONCLUSION: The disturbance in BD patients in effective connectivity from the DLPFC to the amygdala while reappraising is indicative of insufficient prefrontal control. This impairment should be studied further in relation to cycling frequency and polarity of switches in BD patients.

Interoception and Its Interaction with Self, Other, and Emotion Processing: Implications for the Understanding of Psychosocial Deficits in Borderline Personality Disorder.

PURPOSE OF REVIEW: We review evidence for the potential importance of interoception, i.e., the processing of signals arising from inside the body, for deficient psychosocial functioning in borderline personality disorder (BPD). RECENT FINDINGS: Evidence suggests that variability in interoception interacts with higher-order psychological functions such as self, other, and emotion processing. These domains are characteristically impaired in BPD, suggesting a likely causal role of disturbed interoception in the etiology of the disorder. The inability to identify and describe one's own emotional states represents a proxy of impaired interoception which might further mediate between the perception of inner physiological conditions and psychosocial functioning in BPD. There is preliminary evidence explaining how early life stress might adversely affect central interoceptive representation and psychosocial functioning in BPD. Based on these findings and the specific pattern of disturbances in BPD, we propose the crucial role of interoception in an integrated biobehavioral model for BPD.

The relative importance of parent-child dynamics and minority stress on the psychological adjustment of LGBs in China.

This cross-sectional study examined how minority stress (i.e., internalized homonegativity, self-concealment, and rejection sensitivity) and positive parent-child relationship dynamics (i.e., respect for parents and perceived parental support for sexual orientation) were associated with the psychological adjustment of lesbian, gay, and bisexual (LGB) individuals in China. Based on survey responses from 277 self-identified Chinese LGB young adults, results from structural equation modeling showed that minority stress was not a significant predictor of psychological maladjustment, whereas respect for parents and perceived parental support for sexual orientation were associated with positive psychological adjustment. Tests of gender differences partially confirmed whether Confucian traditions may burden sexual minority men more than women. Gender differences were found in the correlations between minority stress and each measure of positive parent-child relationship dynamics. However, the associations between independent variables and psychological maladjustment were not different between men and women in the sample. Our results suggest that culture-specific variables, such as parent-child factors within the context of China, may be especially important when working with LGB individuals in research and clinical practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Associations Among Depressive Symptoms, Wellness, Patient Involvement, Provider Cultural Competency, and Treatment Nonadherence: A Pilot Study Among Community Patients Seen at a University Medical Center.

Treatment nonadherence is a pernicious problem associated with increasing rates of chronic diseases, escalating healthcare costs, and rising mortality in some patients. Although researchers have suggested numerous factors related to treatment nonadherence, several understudied aspects warrant attention, such as primary-care settings, provider cultural competence, and patient involvement. Adding to the research base, the present pilot study examined 88 primarily Black American and White American community patients from a large university medical center in the southern part of the United States. The study explored two research questions: (a) To what extent are there associations among depressive symptoms, wellness, patient involvement, cultural competency, and treatment nonadherence in a racially diverse community patient population? And (b) to what extent do the study exploratory variables and background characteristics predict treatment nonadherence, both separately and jointly? Depressive symptoms, the patient's perception of a provider's cultural competence, and marital/partnered status were found to be statistically significantly associated with treatment nonadherence, but not entirely in the directions expected.