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This study simulated the impact of granting prescriptive authority to licensed psychologists on shortages of mental health providers with prescriptive authority. We used national and state-level secondary data to construct a policy simulation. Mental health prescribing need and the number of mental health prescribers were estimated at the national and state levels, and the provider shortage was calculated as the difference between these two values. The simulated policy intervention added 10% of psychologists to the prescriber group to estimate the associated reduction in prescriber shortages. Probabilistic uncertainty and sensitivity analyses were conducted using 10,000 Markov trials in which all model parameters varied randomly based on their associated uncertainty. The simulated policy value was allowed to vary between 5% and 15%. The prescriber shortage was predicted to fall by 4.34% (95% CI [0.75%, 16.58%]) nationally, though this varied widely by state, ranging from 1.10% [0.20%, 3.82%] in North Dakota to 26.44% [2.89%, 570.29%] in Washington, DC. Uncertainty and sensitivity analyses demonstrated that variability in the provider shortage reduction was primarily driven by the percentage of psychologists becoming licensed to prescribe. Our results suggest that granting prescriptive authority to licensed psychologists would reduce the shortage of mental health professionals with prescriptive authority. Further work is needed to examine the potential implications for other mental health providers. [ABSTRACT FROM AUTHOR]

This study compared 143 law enforcement officers with a history of serious misconduct and 429 matched comparators who had completed the Candidate and Officer Personnel Survey–Revised (COPS–R), an inventory developed specifically for psychological evaluation of public safety candidates. Most had also completed the Personality Assessment Inventory (PAI), which allowed for scoring of scales and indices from the PAI Police and Public Safety Report (PAI-PPSR), as well as the recently developed PAI-Plus. Correlations and t tests indicated significant small group differences on seven COPS–R scales and one PAI-Plus index. Analyses were repeated for officers with substance use-related problems compared with nonproblem officers. These identified four COPS–R and two PAI-PPSR scales that were significant predictors. Relative risk ratio analyses indicated the clinical utility of these scales at certain cutoff scores in predicting serious misconduct in law enforcement officers and candidates. Public Significance Statement: Results of this study indicated that certain scales on the Candidate and Officer Personnel Survey–Revised (COPS–R) and the Personality Assessment Inventory (PAI) were able to predict serious misconduct in law enforcement officer candidates. These findings will help to guide the interpretation of test scores in law enforcement prehiring psychological screenings. [ABSTRACT FROM AUTHOR]

Despite ongoing controversy surrounding prescriptive authority for psychologists, few studies have been conducted on the practices or acceptance of prescribing psychologists. The current study had three aims. The first was to evaluate how prescribing psychologists are perceived by themselves and by their colleagues in various medical professions. The second aim was to understand the practice patterns of prescribing psychologists, while the last was to explore factors associated with perceptions of prescribing psychologists among medical professionals. Thirty prescribing psychologists and 24 of their medical colleagues completed surveys evaluating perceptions and practices of prescribing psychologists. Results demonstrated that prescribing psychologists were overwhelmingly perceived positively by their medical colleagues across various domains. Basic elements of the practice of the prescribing psychologist are described. Conclusions, limitations, and suggestions for further research are discussed. [ABSTRACT FROM AUTHOR]

Six states (New Mexico, Louisiana, Illinois, Iowa, Idaho, and Colorado) grant prescriptive authority to qualified psychologists, and research has shown that these policies are associated with a reduction in suicides. In this study, we assess the cost-effectiveness of these policies in reducing suicide rates. This study used a Markov model with a time horizon of 20 years to estimate the incremental net monetary benefit (INMB) of the policy from the societal perspective with a simulated cohort of 100,000 people. Transition probabilities and utilities were collected from the literature, and costs were assessed using a mixed macro- and microcosting approach. Using this approach, we found that the 20-year INMB for the policy was estimated to be $12.81 million (U.S. dollars) per quality-adjusted life year (QALY). The probability of cost-effectiveness was greater than 50% at a willingness-to-pay threshold as low as $10,000 per QALY. The probability of cost-effectiveness was only modestly associated with the implementation costs of the policy but was sensitive to the estimated effect of the policy intervention. The models estimated in this study support prescriptive authority for psychologists as a cost-effective strategy for reducing state-level suicide rates. A considerable amount of research is needed to understand the impact of this policy with finer granularity. Public Significance Statement: Prescriptive authority for psychologists may be a cost-effective means to reduce suicide deaths at the policy level. However, this study also highlights several important knowledge gaps that should be addressed regarding the patient outcomes associated with psychologist prescriptive authority. [ABSTRACT FROM AUTHOR]

Statistical analyses investigating latent structure can be divided into those that estimate structural model parameters and those that detect the structural model type. The most basic distinction among structure types is between categorical (discrete) and dimensional (continuous) models. It is a common, and potentially misleading, practice to apply some method for estimating a latent structural model such as factor analysis without first verifying that the latent structure type assumed by that method applies to the data. The taxometric method was developed specifically to distinguish between dimensional and 2-class models. This study evaluated the taxometric method as a means of identifying categorical structures in general. We assessed the ability of the taxometric method to distinguish between dimensional (1-class) and categorical (2-5 classes) latent structures and to estimate the number of classes in categorical datasets. Based on 50,000 Monte Carlo datasets (10,000 per structure type), and using the comparison curve fit index averaged across 3 taxometric procedures (Mean Above Minus Below A Cut, Maximum Covariance, and Latent Mode Factor Analysis) as the criterion for latent structure, the taxometric method was found superior to finite mixture modeling for distinguishing between dimensional and categorical models. A multistep iterative process of applying taxometric procedures to the data often failed to identify the number of classes in the categorical datasets accurately, however. It is concluded that the taxometric method may be an effective approach to distinguishing between dimensional and categorical structure but that other latent modeling procedures may be more effective for specifying the model. [ABSTRACT FROM AUTHOR]

Two paths have been suggested for the future evolution of professional psychology. Prescribing psychology has already been legally authorized in two states, the military, and the Indian Health Service. Primary care psychology does not require legal recognition and has been slowly growing as a career option for psychologists across the nation. Both paths have their obstacles and limitations, but both are also associated with great potential. This article provides a brief summary of the strengths and weaknesses of each path and suggests an integrated perspective for planning the future of the profession. Each is seen as complementary to the other and providing a basis for pursuing the other. [ABSTRACT FROM AUTHOR]

After 100 years of discussion, response bias remains a controversial topic in psychological measurement. The use of bias indicators in applied assessment is predicated on the assumptions that (a) response bias suppresses or moderates the criterion-related validity of substantive psychological indicators and (b) bias indicators are capable of detecting the presence of response bias. To test these assumptions, we reviewed literature comprising investigations in which bias indicators were evaluated as suppressors or moderators of the validity of other indicators. This review yielded only 41 studies across the contexts of personality assessment, workplace variables, emotional disorders, eligibility for disability, and forensic populations. In the first two contexts, there were enough studies to conclude that support for the use of bias indicators was weak. Evidence suggesting that random or careless responding may represent a biasing influence was noted, but this conclusion was based on a small set of studies. Several possible causes for failure to support the overall hypothesis were suggested, including poor validity of bias indicators, the extreme base rate of bias, and the adequacy of the criteria. In the other settings, the yield was too small to afford viable conclusions. Although the absence of a consensus could be used to justify continued use of bias indicators in such settings, false positives have their costs, including wasted effort and adverse impact. Despite many years of research, a sufficient justification for the use of bias indicators in applied settings remains elusive. [ABSTRACT FROM AUTHOR]

Many languages and cultures have labels for individuals who have achieved a superior state of functioning, sometimes referred to as enlightenment or wisdom. This conceptualization of optimal functioning as a distinct state is implicit to several well-known psychological models, as well. This study evaluated whether self-reported strengths of character revealed evidence of such a state. A sample of 83,576 US residents completed the Values in Action Inventory of Strengths (Peterson & Seligman, 2004). On the basis of multiple statistical tests, the results consistently indicated that level of functioning is dimensional, rather than categorical. The findings do not provide support for the existence of a distinct state of superior functioning. [ABSTRACT FROM AUTHOR]

The taxometric method effectively distinguishes between dimensional (l-class) and taxonic (2-class) latent structure, but there is virtually no information on how it responds to polytomous (3-class) latent structure. A Monte Carlo analysis showed that the mean comparison curve fit index (CCFI; Ruscio, Haslam, & Ruscio, 2006) obtained with 3 taxometric procedures--mean above minus below a cut (MAMBAC), maximum covarianee (MAXCOV), and latent mode factor analysis (L-Mode)--accurately identified 1-class (dimensional) and 2-class (taxonic) samples and produced taxonic results when applied to 3-class (polytomous) samples. Prom these results it is concluded that using the simulated data curve approach and averaging across procedures is an effective way of distinguishing between dimensional (1-class) and categorical (2 or more classes) latent structure. [ABSTRACT FROM AUTHOR]

Professional psychologists are often confronted with the task of making binary decisions about individuals, such as predictions about future behavior or employee selection. Test users familiar with linear models and Bayes's theorem are likely to assume that the accuracy of decisions is consistently improved by combination of outcomes across valid predictors. However, neither statistical method accurately estimates the increment in accuracy that results from use of additional predictors in the typical applied setting. It was demonstrated that the best single predictor often can perform better than do multiple predictors when the predictors are combined using methods common in applied settings. This conclusion is consistent with previous findings concerning G. Gigerenzer and D. Goldstein's (1996) "take the best" heuristic. Furthermore, the information needed to ensure an increment in fit over the best single predictor is rarely available. [ABSTRACT FROM AUTHOR]

The Department of Defense Psychopharmacology Demonstration Project was an important precursor to the gaining of prescriptive authority for psychologists at the state level. However, there has been limited progress in this area within the military since that program's discontinuation. The authors discuss the unique challenges faced with regard to providing adequate psychiatric care in Iraq, including excessive reliance on nonpsychiatric physicians and physician assistants for psychiatric services, the risks associated with transporting personnel to psychiatric services, and issues in continuity of care. Increasing the number of military psychologists able to prescribe would improve the level and quality of care available for service members and potentially have a positive impact on prescriptive authority for psychologists at the state level. [ABSTRACT FROM AUTHOR]

Much of the critical discussion of prescriptive authority for psychologists has focused on the question of whether this is the right direction for the profession. The authors contend that discourse on prescriptive authority should progress to identification of the challenges that lie ahead for psychology as a prescribing profession, with the goal of anticipating and addressing those challenges as early in the process as possible. The authors identify a number of such potential challenges, including both general issues of professional identity and more practical concerns. In some cases, the authors express their opinions on these matters, but more generally their intention is to spur reasoned discussion of the issues psychologists will face. [ABSTRACT FROM AUTHOR]

To date, relatively few studies have been published evaluating the validity or incremental validity of the content scales from the adolescent version of the Minnesota Multiphasic Personality Inventory (MMPI-A; J. N. Butcher et al., 1992). A sample of 629 psychiatric inpatient adolescents who had completed the MMPI-A was used to evaluate the ability of selected clinical and content scales to predict conceptually related clinical variables. Criteria were based on clinician ratings, admission and discharge diagnoses, and chart reviews. Results from hierarchical multiple and logistic regression analyses indicated the content scales offered incremental validity over the clinical scales and supported the use of the content scales as an adjunct to the traditional clinical scales. [ABSTRACT FROM AUTHOR]

This study aimed to describe the beliefs associated with the intention to become licensed to prescribe among psychologists in Pennsylvania using the theory of planned behavior. We conducted a survey (March–May 2023) of attitudes, subjective norms, and perceived control among members of the Pennsylvania Psychological Association, generating a response rate of 24.2% (n = 284). The primary outcome was how likely the respondent was to become licensed to prescribe if authorizing legislation passes in Pennsylvania, followed by an open-ended question about their rationale. The association between the likelihood of becoming a prescriber and the attitudes, subjective norms, and perceived control about prescribing was estimated using logistic regression, adjusting for demographic and professional information. Results were calculated as average marginal effects (AME) and corresponding 95% confidence interval. Open-ended responses were assessed using inductive thematic coding. Approximately 35% of psychologists reported being likely to become a prescriber. Direct social norms were associated with a 15.4 percentage-point increase ([0.12, 0.19]) in the probability of becoming a prescriber, and indirect attitudes were associated with a 9.7 percentage-point increase ([0.06, 0.14]). These results were supported by the qualitative themes that emerged: Personal Reasons, Professional Reasons, and Improving Patient Care. These themes included concerns about age, changing professional psychology, medication, increasing access to care, and licensure requirements. Psychologists' attitudes and social norms about prescribing psychology are key indicators of their intention to become licensed to prescribe. These findings could inform interventions to improve licensure rates and policymakers considering the adoption of psychologist prescriptive authority. Public Significance Statement: This study suggests that the intention of psychologists in Pennsylvania to become licensed prescribers is motivated by their attitudes about prescribing and if they believe most people think prescribing would be good. Psychologists were primarily concerned about a mix of personal, professional, and patient issues related to prescribing. These findings could (1) inform the development of an educational intervention to improve prescribing licensure rates and (2) provide additional considerations for policymakers exploring the adoption of prescriptive authority for psychologists in their state. [ABSTRACT FROM AUTHOR]

Few studies have examined the practices of prescribing psychologists, and the extant literature suffers from small sample sizes due to the nature of the profession. The current study was based on data from 43 prescribing psychologists, the largest sample of prescribing psychologists examined to date. It was found that prescribing psychology is distinctive from both traditional psychological and psychiatric practice. Prescribing psychologists tend to work in multiple settings. Although respondents espoused a preference for combination therapy, monotherapy--whether medication or psychotherapy--remains the dominant option. Prescribing psychologists reported minimal interaction with pharmaceutical drug representatives. It is also prescribing psychologists' sense that nonprescribers in their community experience them in positive ways. Future studies should further address patient treatment themes within this practice, as well as looking into changes in interactions with pharmaceutical representatives. [ABSTRACT FROM AUTHOR]

Hatcher (2011, The internship supply as a common-pool resource: A pathway to managing the imbalance problem, Training and Education in Professional Psychology, 5, pp. 126-140.) has advanced the discussion of the internship imbalance in health care psychology by refraining the issue in economic terms. Expanding on his analysis, it is suggested that the source of the imbalance may be traced to elements of the accreditation guidelines that create an economic disparity between doctoral versus internship programs in professional psychology. The various potential responses to the internship imbalance are considered in light of this issue. [ABSTRACT FROM AUTHOR]

In their comment, M. L. Rohling et al. (2011) accused us of offering a "misleading" review of response bias. In fact, the additional findings they provided on this topic are relevant only to bias assessment in 1 of the domains we discussed, neuropsychological assessment. Furthermore, we contend that, even in that 1 domain, the additional findings they described do not merit revision of our conclusion that the data are insufficient for evaluating the status of bias indicators. We remain hopeful that our review will spur researchers to publish additional tests of the validity of bias indicators in real-world settings and reduce the reliance on analogue studies as an evidence base for their use. [ABSTRACT FROM AUTHOR]

This article presents a commentary note on an article by researcher D.O. Antonuccio and his colleagues on professional psychology. Considering the frequency of polypharmacological treatment relative to the evidence for its safety and incremental efficacy, as well as the widespread use of antidepressants with their meager advantage over placebo, one of the most important contributions psychologists seeking prescriptive authority can make to the practice of pharmacotherapy is the promulgation of a judicious approach to prescribing. Two measure points are raised concerning the article. First, Antonuccio and his colleagues have focused on the pharmaceutical industry as a reason for the excessive use of medication. The second point is that it is important to acknowledge and use those features specific to psychology that should serve as resistance factors against the overreliance on medication.

Opinion. Comments on the article, `In Praise of the Null Hypothesis Statistical Test' (NHST), written by R.L. Hagen, which appeared in the January 1997 issue of the `American Psychologist.' How the author felt about the article; Five aspects of the article addressed by the author; Details on the article.

Objective: To explore the relationship between posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in veterans with spinal cord injury and to compare those results with results found in veterans who had sustained other traumatic injuries. Method: To investigate the relationship between PTSD and MDD in persons with spinal cord injury, the authors examined whether individuals endorsed overlapping items on measures of both disorders, evaluated the contribution of overlapping items to comorbid diagnosis, and conducted an exploratory factor analysis. Results: The overlapping symptoms between the 2 disorders did not fully explain the high rate of comorbidity, although participants who endorsed a symptom common to MDD and PTSD on 1 measure were likely to endorse the corresponding item on another measure. In both samples, items loaded on separate PTSD and MDD factors. Conclusion: MDD and PTSD appear to represent independent reactions to trauma in those individuals who had experienced either a nonspinal cord injury or a spinal cord injury. This research also provides an initial investigation of some of the possible ways that MDD and PTSD are related by addressing psychometric issues inherent in their measurement. [ABSTRACT FROM AUTHOR]

This study aimed to compare patient outcomes between prescribing psychologists, psychiatrists, and primary care physicians (PCPs). Private insurance claims (2005-2021; n = 307,478) were used to conduct an active comparator, new user longitudinal cohort study developed using target trial emulation. Inverse propensity for treatment weighting was used to adjust for baseline differences in a range of sociodemographic, clinical, and contextual patient factors. Differences in the 1-year rate of health care visits for adverse drug events (ADEs), psychiatric emergency department (ED) utilization, medication adherence, and psychotropic polypharmacy were identified between prescribing psychologists and the other provider types using doubly robust Cox proportional hazards models. Compared to patients of psychiatrists, patients of prescribing psychologists had a 24% lower rate of ADEs (95% CI [0.60, 0.96]), a 20% lower rate of psychotropic polypharmacy (95% CI [0.74, 0.86]), and similar rates of psychiatric ED utilization and medication nonadherence. Compared to patients of PCPs, patients of prescribing psychologists had 138% higher rates of psychiatric ED utilization (95% CI [1.67, 3.39]), 175% higher rates of psychotropic polypharmacy (95% CI [2.53, 2.99]), 28% lower rates of medication nonadherence (95% CI [0.66, 0.78]), and similar rates of ADEs. Using robust pharmacoepidemiological methods, we noted that among mental health specialists, prescribing psychologists appear to be as safe and efficacious as psychiatrists in a large sample of privately insured patients. Notable differences in safety and efficacy when compared to PCPs may be attributable to differences between specialty and primary care. Future research on prescribing psychologists should move toward studies of care quality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

To describe the characteristics of patients receiving psychotropic medication from prescribing psychologists, psychiatrists, and primary care physicians. This descriptive study was conducted using private insurance claims of patients from New Mexico and Louisiana receiving psychotropic medications (anticonvulsants, antidepressants, antipsychotics, hypotensive agents, anxiolytics/sedatives/hypnotics, and stimulants) from 2004 to 2021 ( N = 307,478). Patient characteristics were captured during the 6 months prior to their first psychotropic medication using administrative information, diagnosis and procedure codes, and medication data. Logistic regression models estimated the associations of patient characteristics with prescriber type. Additional logistic regression models estimated the association of prescriber type with medication classes prescribed. Patients were most likely to see specialists (psychologists or psychiatrists) if they had bipolar disorder (average marginal effect and 95% CI 0.214 [0.196, 0.231]), schizophrenia/psychotic disorders (0.118 [0.097, 0.138]), or had 1-4 visits of psychotherapy (0.267 [0.258, 0.026]). Specialist patients were most likely to see a prescribing psychologist if they had 1-4 visits of psychotherapy (0.196 [0.183, 0.210]) or had insomnia (0.309 [0.203, 0.415]). Prescribing psychologists were more likely to prescribe antidepressants (0.028 [0.011, 0.045]) and less likely to prescribe antipsychotics (-0.016 [-0.020, -0.012]) than psychiatrists. Primary care physicians were less likely to prescribe all psychotropic medications except antidepressants (0.011 [0.002, 0.019]) and anxiolytics (0.074 [0.067, 0.080]). Prescribing psychologists treat patients who are more similar to those of psychiatrists than patients of primary care physicians; they are less likely to prescribe antipsychotics and more likely to prescribe antidepressants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The taxometric method effectively distinguishes between dimensional (1-class) and taxonic (2-class) latent structure, but there is virtually no information on how it responds to polytomous (3-class) latent structure. A Monte Carlo analysis showed that the mean comparison curve fit index (CCFI; Ruscio, Haslam, & Ruscio, 2006) obtained with 3 taxometric procedures-mean above minus below a cut (MAMBAC), maximum covariance (MAXCOV), and latent mode factor analysis (L-Mode)-accurately identified 1-class (dimensional) and 2-class (taxonic) samples and produced taxonic results when applied to 3-class (polytomous) samples. From these results it is concluded that using the simulated data curve approach and averaging across procedures is an effective way of distinguishing between dimensional (1-class) and categorical (2 or more classes) latent structure., (PsycINFO Database Record (c) 2010 APA, all rights reserved.)

The increased use of effect sizes in single studies and meta-analyses raises new questions about statistical inference. Choice of an effect-size index can have a substantial impact on the interpretation of findings. The authors demonstrate the issue by focusing on two popular effect-size measures, the correlation coefficient and the standardized mean difference (e.g., Cohen's d or Hedges's g), both of which can be used when one variable is dichotomous and the other is quantitative. Although the indices are often practically interchangeable, differences in sensitivity to the base rate or variance of the dichotomous variable can alter conclusions about the magnitude of an effect depending on which statistic is used. Because neither statistic is universally superior, researchers should explicitly consider the importance of base rates to formulate correct inferences and justify the selection of a primary effect-size statistic., (Copyright 2006 APA.)