Search

This study assessed the efficacy of the marriage checkup, as adapted to integrated primary care settings and active-duty military couples, for improving relationship health and depressive symptoms.Married couples (N = 244, Mage = 32.4, 67.6% Caucasian) in which at least one member was active-duty Air Force were recruited from bases across the U.S. via online advertisement, emails sent from medical clinics to enrolled beneficiaries, social media posts, and flyers, and randomly assigned to active treatment or waitlist control. Treatment and control couples were linked in pairs sequentially and pairs completed nine sets of questionnaires at baseline, 1-, and 6-month posttreatment. Outcome measures included the Couples Satisfaction Index, Intimate Safety Questionnaire, Responsive Attention Scale, Partner Compassion Scale, Communication Skills Test, and the Center for Epidemiologic Studies Depression Scale.A three-level multilevel model indicated, after adjustment for multiple comparisons, treatment couples experienced statistically significant small-to-moderate improvements compared to the control group (Cohen's d from 0.21 to 0.55) at 1 month that were sustained at 6 months for relationship satisfaction, responsive attention, compassion toward their partners, communication skills, intimate safety, and depressive symptoms.A longitudinal randomized control trial of the MC supports the hypothesis that the MC significantly improves relationship satisfaction, intimacy, communication, partner compassion, responsive attention, and depressive symptoms. Implications for theory, treatment, and dissemination are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This pilot randomized control trial (RCT) tested “Do More, Feel Better” (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: 1. the feasibility of training older lay volunteers to fidelity; and 2. the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB. Fifty-six depressed clients were randomized to receive 9 sessions of DMFB or Behavioral Activation delivered by social workers (MSW BA). Research assessments of overall client activity level (BADS) and depression severity (HAM-D) were conducted at baseline and weeks 3, 6, and 9. Eighty-one percent of lay volunteers who underwent training were formally certified in DMFB. Depressed clients receiving each intervention reported high levels of satisfaction and showed large and clinically significant changes in 9-week activity level (d ≥ 1.35) and depression severity (d ≥ 3.34). Differences between treatment groups were very small for both activity level (dMSW = 0.16; 95% CI, -0.70 to 1.02) and depression (dMSW = 0.14; 95% CI, -0.63 to 0.91). Increases in activity level were associated with decreases in depression (β = -0.42; 95% CI, -0.55 to -0.30). Both interventions appeared to work as intended by increasing activity level and reducing depression severity. “Do More, Feel Better” shows the potential of evidence-based behavioral interventions delivered by supervised lay volunteers, and can help address the insufficient workforce available to meet the mental health needs of community-dwelling older adults.

PURPOSE: To develop and psychometrically evaluate a brief measure of the telemental health experience among people receiving psychiatric and psychological care—the Telepsych User Experience Scale (TUES). METHODS: The TUES was administered at 6 months to 364 study participants who screened positive for PTSD and/or bipolar disorder and used telepsych services. The factor structure of the TUES was examined using confirmatory and exploratory factor analyses. Psychometric testing of the final scale examined 1) internal reliability, 2) criterion validity, 3) convergent validity, and 4) test-retest reliability using omega coefficients, negative binomial regression, and correlations, respectively. A week after the 12-month follow-up survey was completed, a retest was administered to 29 patients to assess reliability. FINDINGS: Factor analytic methods indicated a single latent factor (user experience) and correlated error variance (method effect of item wording) for two items. To enhance clinical utility, we removed the two negatively worded items, resulting in a five-item scale. Confirmatory analyses indicated excellent fit of the final model, which retained the best performing items from each hypothesized construct. The TUES demonstrated evidence of internal consistency (omega = .88-.90), convergent validity, (r = .58) and criterion validity through telepsych engagement (Incidence Rate Ratio = 1.19, P < .001), though test-retest reliability was unacceptable (r = .41). CONCLUSION: The TUES is a pragmatic instrument with evidence of validity and internal reliability. Replication is necessary, but this initial psychometric evaluation suggests the TUES is a promising, brief yet comprehensive measure of telemental health user experience with clinical populations in rural settings.

Purpose Compared to urban areas, rural populations are less likely to engage in mental health care. Using data from the Study to Promote Innovation in Rural Integrated Telepsychiatry, we examined the effect of rurality on engagement in mental health treatment as well as the role of potential mediators. Methods Data were obtained from medical records and surveys. We defined rurality using the rural-urban commuting area codes. Baseline mediators included the Endorsed and Anticipated Stigma Inventory and the Assessment of Perceived Access to Care. Engagement outcomes included number of psychotherapy visits and self-reported medication use. We used path analysis to examine the relationship between rurality and engagement and the influence of mediating variables. Findings Rural participants were less likely to initiate psychotherapy (OR = 0.49; adjusted P = .036), although rurality was not associated with number of psychotherapy sessions or medication use. Rurality was associated with a small elevation in negative beliefs about mental health, but this potential mediator was not associated with engagement. Rurality was negatively associated with lower perceived need for treatment (OR = 0.67, adjusted P = .040), which was in turn positively associated with initiating psychotherapy (OR = 1.99, adjusted P = .001). Conclusions Neither rurality itself nor the potential mediators had a large effect on engagement. Federally Qualified Health Centers offering colocated and/or integrated mental health care appear to be mostly mitigating rural-urban disparities in mental health engagement. Improving rates of psychotherapy initiation for rural patients should remain a policy goal.

To inform research and practice with distressed couples, the current study was designed to examine patterns of change among distressed, help-seeking couples prior to receiving an intervention. Data from this study originate from 221 couples assigned to the waitlist control condition of a randomized controlled trial for couples seeking online help for their relationship. All couples self-selected into the online program and agreed to withhold seeking additional services for their relationship during the waitlist period. In contrast with prior findings, results from the current study indicated a general pattern of mean improvement in both self-reported relationship functioning (e.g., increased relationship satisfaction, partner emotional support) and self-reported individual functioning (i.e., decreased psychological distress, anger) over the six-month waitlist period. Nonetheless, the majority of couples continued to remain relationally distressed despite these improvements. Findings from the study indicate that distressed couples can, in fact, exhibit some degree of improvement absent of intervention. At the same time, overall levels of distress remained elevated, indicating that these improvements are not sufficient to result in high levels of functioning and suggesting that many distressed couples may benefit from empirically supported programs to realize greater gains. These results also highlight and underscore the importance of including control conditions in studies examining the efficacy of relationship interventions with distressed couples to ensure that any observed improvements in relationship functioning are attributable to the intervention rather than to naturally occurring changes.Con el fin de orientar la investigación y la práctica con parejas con distrés, se diseñó el presente estudio para analizar patrones de cambio entre parejas con distrés que buscan ayuda antes de recibir una intervención. Los datos de este estudio surgen de 221 parejas asignadas al grupo comparativo de lista de espera de un ensayo controlado aleatorizado para parejas que buscaban ayuda virtual para su relación. Todas las parejas eligieron ellas mismas estar en el programa virtual y acordaron dejar de buscar otros servicios para su relación durante el periodo de lista de espera. A diferencia de los resultados anteriores, los de este estudio indicaron un patrón general de mejoría promedio tanto en el funcionamiento relacional autoinformado (p. ej.: mayor satisfacción con la relación y apoyo emocional de la pareja) como en el funcionamiento individual autoinformado (p. ej.: menos distrés psicológico y enfado) durante el periodo de seis meses en lista de espera. Sin embargo, a pesar de estas mejorías, la mayoría de las parejas continuó teniendo distrés relacional. Los resultados del estudio indican que las parejas con distrés pueden, de hecho, mostrar algún grado de mejoría sin intervención. Al mismo tiempo, los niveles generales de distrés se mantuvieron elevados, lo cual indica que estas mejorías no son suficientes para dar como resultado niveles altos de funcionamiento, y sugiere que muchas parejas con distrés pueden beneficiarse de programas basados en la experiencia para lograr mayores avances. Estos resultados también destacan y subrayan la importancia de incluir grupos comparativos en los estudios que analizan la eficacia de las intervenciones en las relaciones de parejas con distrés a fin de garantizar que las mejorías observadas en el funcionamiento relacional sean atribuibles a la intervención en lugar de a los cambios que se producen naturalmente.为了更好地服务针对关系不良的伴侣展开的研究和实践，本研究旨在调查在接受干预之前，关系不和谐、正寻求帮助的伴侣其关系变化的模式。此项研究的数据来源于221对伴侣，他们正为他们的关系寻求在线帮助。这些伴侣们被分配到一项随机对照试验的等待名单控制条件下。所有的受试伴侣都是自己选择进入的在线项目，并同意在候补名单期间不去为他们的关系寻求其他的服务。与以往做过的调查研究结果相反，本研究的结果表明，在六个月的等待名单期间，自我报告的关系功能(如提升了的关系满意度、伴侣情感支持)和自我报告的个人功能(如心理痛苦减少、愤怒)都发生改变，呈现出一般的模式。然而，尽管有这些改善，大多数伴侣其关系仍然处于不如意的困境。研究结果表明，事实上，在没有干预的情况下，关系不良的伴侣可以表现出某种程度的改善。与此同时，关系不和谐的总体水平仍然升高，这表明这些改善并不足以导致高水平的功能，也表明许多关系不良的伴侣可以从实证支持的项目中获益，以实现更大的收益。这些结果也突出和强调了在研究中包括控制条件的重要性，以确保任何观察到的关系功能的改善是归因于干预，而不是自然发生的变化。.

BACKGROUND: Measurement-based care is an effective clinical strategy underutilized for bipolar disorder partly due to lacking a widely adopted patient-reported manic symptom measure. OBJECTIVE: To report development and psychometric properties of a brief patient-reported manic symptom measure. DESIGN: Secondary analysis of data collected in a randomized effectiveness trial comparing two treatments for 1004 primary care patients screening positive for bipolar disorder and/or PTSD. PARTICIPANTS: Two analytic samples included 114 participants with varied diagnoses and test-retest data, and 179 participants with psychiatrist-diagnosed bipolar disorder who had two or more assessments with the nine-item Patient Mania Questionnaire-9 [PMQ-9]). MAIN MEASURES: Internal and test-retest reliability, concurrent validity, and sensitivity to change were assessed. Minimally important difference (MID) was estimated by standard error of measurement (SEM) and by standard deviation (SD) effect sizes. KEY RESULTS: The PMQ-9 had high internal reliability (Cronbach’s alpha = 0.88) and test-retest reliability (0.85). Concurrent validity correlation with manic symptom measures was high for the Internal State Scale-Activation Subscale (0.70; p

Valid measures of perceived access are needed to measure whether health care systems are providing adequate access. This research reports on the psychometric properties of the Assessment of Perceived Access to Care (APAC), which was administered to 1004 Community Health Center patients screening positive for psychiatric disorders. Known-group validity was good, with 6 of the 8 hypothesized associations between social determinants of access and perceived access being significant (P < .01). Better access was significantly (P < .01) correlated with more outpatient mental health visits, indicating good convergent validity. The test-retest Pearson correlation coefficient (0.64) was statistically significant (P < .01). The APAC has acceptable psychometric properties.

Current research into Cognitive Processing Therapy (CPT) examines how and for whom CPT works best, with a focus on understanding treatment outcomes in special populations. Session timing appears to have an effect on CPT outcomes in civilian samples, but the role of timing in CPT has not yet been investigated in a military sample. Thus, this study examines the relationships between session frequency and consistency and changes in symptoms and dropout in a trial of CPT in the military. Participants included 135 active duty service members who sought treatment for posttraumatic stress disorder (PTSD; Mage = 32.6 years; 89.6% male; 41.5% White, 26.7% Black, 23.0% Hispanic). Service members participated in 12 sessions of individual CPT intended to be scheduled twice per week, and completed follow-up assessments at 2 weeks and 6 months post-treatment. Results indicated that participants attended sessions about every 6.5 days and that session frequency and consistency were not related to rate of change in PTSD or depression outcomes. Session frequency was related to dropout, such that longer time between sessions was related to increased dropout. These results suggest that the positive outcomes seen after CPT are stable despite the unique challenges in logistics seen with military service members.

Importance: In-person schooling has been disrupted for most school-aged youth during the COVID-19 pandemic, with low-income, Black, and Hispanic populations most likely to receive fully remote instruction. Disruptions to in-person schooling may have negatively and inequitably affected children's mental health. Objective: To estimate the association between school closures and child mental health outcomes and how it varies across sociodemographic factors. Design, Setting, and Participants: This cross-sectional population-based survey study included a nationally representative sample of US adults aged 18 to 64 years with at least 1 child in the household. The survey was administered between December 2 and December 21, 2020, via web and telephone in English and Spanish. Participants were recruited from the NORC AmeriSpeak panel, an address-based panel with known probability sampling and coverage of 97% of US households. Exposures: Schooling modality (in person, fully remote, or hybrid), household income, age. Main Outcomes and Measures: Child mental health difficulties were measured with the parent-report version of the Strengths and Difficulties Questionnaire, with small, medium, and large effect sizes defined as 1.3-, 3.3-, and 5.2-point differences, respectively. Results: A total of 2324 adults completed the survey. Overall, 1671 respondents (71.9%) were women, 244 (10.5%) were Black, 372 (16.0%) were Hispanic, and 421 (18.1%) had a high school education or less. Children attending school in-person had higher household incomes (mean difference, $9719; 95% CI, $4327 to $15 111; P < .001) and were more likely to be White compared with those attending remotely (366 of 556 [65.8%] vs 597 of 1340 [44.5%]; P < .001). Older children in remote schooling had more mental health difficulties than those attending in-person schooling (standardized effect size, 0.23 [95% CI, 0.07 to 0.39] per year older; P = .006), corresponding to small effect sizes in favor of in-person schooling for older children and very small effect sizes favoring remote schooling for younger children. Children from families with higher income benefitted more from attending schools in-person compared with their peers from families with lower income (B = -0.20 [95% CI, -0.10 to -0.30] per $10 000-increase in annual income; P < .001), although this advantage was not apparent for children attending hybrid school (B = -0.05 [95% CI, -0.16 to 0.06] per $10 000-increase in annual income; P = .34), and directionally lower but not significantly different for children attending remote school (B = -0.12 [95% CI, -0.04 to -0.20] per $10 000-increase in annual income; P < .001). Learning pods fully buffered the associations of hybrid schooling (d = -0.25; 95% CI, -0.47 to -0.04) but not remote schooling (d = 0.04; 95% CI, -0.10 to 0.18) with negative mental health outcomes. Conclusions and Relevance: The findings of this study suggest that older and Black and Hispanic children as well as those from families with lower income who attend school remotely may experience greater impairment to mental health than their younger, White, and higher-income counterparts. Ensuring that all students have access to additional educational and mental health resources must be an important public health priority, met with appropriate funding and workforce augmentation, during and beyond the COVID-19 pandemic.

ImportanceOnly one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings.ObjectiveTo compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics.Design, Setting, and ParticipantsThis pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months.InterventionsTwo approaches were compared: (1) telepsychiatry/telepsychology–enhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing.Main Outcomes and MeasuresSurvey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects.ResultsOf 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 3 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (β = 1.7; 95% CI, 0 to 3.4; P = .05). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d = 0.79; 95% CI, 0.65 to 0.94; TER: Cohen d = 0.87; 95% CI, 0.73 to 1.02). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (β = 2.0; 95% CI, −1.6 to 5.7; P = .28).Conclusions and RelevanceIn this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable.Trial RegistrationClinicalTrials.gov Identifier: NCT02738944

Studies of developmental trajectories of depression are important for understanding depression etiology. Existing studies have been limited by short time frames and no studies have explored a key factor: differential patterns of responding to life events. This article introduces a novel analytic technique, growth mixture modeling with structured residuals, to examine the course of youth depression in a large, prospective cohort (N = 11,641, ages 4-16.5, 96% White). Age-specific critical points were identified at ages 8 and 13 where depression symptoms spiked for a minority of children. Most depression risk was due to dynamic responses to environmental events, drawn not from a small pool of persistently depressed children, but a larger pool of children who varied across higher and lower symptom levels.

Investment in workplace wellness programs is increasing despite concerns about lack of clinical benefit and return on investment (ROI). In contrast, outcomes from workplace mental health programs, which treat mental health difficulties more directly, remain mostly unknown.To determine whether participation in an employer-sponsored mental health benefit was associated with improvements in depression and anxiety, workplace productivity, and ROI as well as to examine factors associated with clinical improvement.This cohort study included participants in a US workplace mental health program implemented by 66 employers across 40 states from January 1, 2018, to January 1, 2021. Participants were employees who enrolled in the mental health benefit program and had at least moderate anxiety or depression, at least 1 appointment, and at least 2 outcome assessments.A digital platform that screened individuals for common mental health conditions and provided access to self-guided digital content, care navigation, and video and in-person psychotherapy and/or medication management.Primary outcomes were the Patient Health Questionnaire-9 for depression (range, 0-27) score and the Generalized Anxiety Disorder 7-item scale (range, 0-21) score. The ROI was calculated by comparing the cost of treatment to salary costs for time out of the workplace due to mental health symptoms, measured with the Sheehan Disability Scale. Data were collected through 6 months of follow-up and analyzed using mixed-effects regression.A total of 1132 participants (520 of 724 who reported gender [71.8%] were female; mean [SD] age, 32.9 [8.8] years) were included. Participants reported improvements from pretreatment to posttreatment in depression (b = -6.34; 95% CI, -6.76 to -5.91; Cohen d = -1.11; 95% CI, -1.18 to -1.03) and anxiety (b = -6.28; 95% CI, -6.77 to -5.91; Cohen d = -1.21; 95% CI, -1.30 to -1.13). Symptom change per log-day of treatment was similar post-COVID-19 vs pre-COVID-19 for depression (b = 0.14; 95% CI, -0.10 to 0.38) and anxiety (b = 0.08; 95% CI, -0.22 to 0.38). Workplace salary savings at 6 months at the federal median wage was US $3440 (95% CI, $2730-$4151) with positive ROI across all wage groups.Results of this cohort study suggest that an employer-sponsored workplace mental health program was associated with large clinical effect sizes for employees and positive financial ROI for employers.

Introduction Health informatics-supported strategies for training and ongoing support may aid the delivery of evidence-based psychotherapies. The objective of this study was to describe the development, implementation, and practice outcomes of a scalable health informatics-supported training program for behavioral activation for patients who screened positive for posttraumatic stress disorder and/or bipolar disorder. Method We trained 34 care managers in 12 rural health centers. They used a registry checklist to document the delivery of 10 behavioral activation skills for 4,632 sessions with 455 patients. Care managers received performance feedback based on registry data. Using encounter-level data reported by care managers, we described the implementation outcomes of patient reach and care manager skill adoption. We used cross-classified multilevel modeling to explore variation in skill delivery accounting for patient characteristics, provider characteristics, and change over time. Results Care managers engaged 88% of patients in behavioral activation and completed a minimum course for 57%. The average patient received 5.9 skills during treatment, with substantial variation driven more by providers (63%) than patients (29%). Care managers significantly increased the range of skills offered to patients over time. Discussion The registry-based checklist was a feasible training and support tool for community-based providers to deliver behavioral activation. Providers received data-driven performance feedback and demonstrated skill improvement over time, promoting sustainment. Future research will examine patient-level outcomes. Results underscore the potential public health impact of a simple registry-based skills checklist coupled with a scalable remote training program for evidence-based psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

IMPORTANCE: As schools consider reopening for in-person instruction prior to availability of a coronavirus disease 2019 (COVID-19) vaccine, families may be weighing their priorities regarding school attendance. OBJECTIVE: To characterize the association of planned in-person school attendance during the COVID-19 pandemic with factors, including family socioeconomic characteristics, and parent attitudes and beliefs about their child’s school attendance. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey study. Data were collected from June 2, 2020, to June 5, 2020, weighted to reflect population norms, and analyzed using ordered probit regression. A sample of US parents (of children ages 5-17 years) were recruited using a nonprobability survey panel with stratification by socioeconomic characteristics. MAIN OUTCOMES AND MEASURES: The main outcome was parent-reported plan to send their child to school or keep their child home, conditional on their school opening for in-person instruction. Additional measures assessed family socioeconomic characteristics, medical vulnerability, worry about COVID-19 and multisystem inflammatory syndrome, confidence in their child’s school, and homeschooling difficulties. RESULTS: The sample of 730 parents was balanced by parent sex (53% women) with successful oversampling for Black (28%; n = 201) and Hispanic (27%; n = 200) participants. In estimates weighted to US population norms, 31% (95% CI, 27% to 34%) of participants indicated they would probably or definitely keep their child home this fall, and 49% indicated that they would probably or definitely send their child to school this fall. Factors associated with planning to keep children home included lower income (38% with incomes

Objective To determine latent classes of treatment receipt among people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) and describe each class by demographics, disease characteristics, and psychiatric diagnoses. Method Participants were National Epidemiologic Survey on Alcohol and Related Conditions-III respondents with lifetime PTSD and SUD (n = 1,349; mean age 40.3; 62.5% female; 30.9% non-White or Hispanic-White). Cross-sectional data were collected using the DSM-5 Alcohol Use Disorder and Associated Disabilities Interview Schedule. Latent class analysis was used to identify subgroups of participants with different patterns of treatment receipt. Results Of the patients, 36% received at least 1 SUD treatment while 84% received at least 1 mental health (MH) treatment. Six latent classes were identified: no treatment (17.3%), outpatient MH (34.0%), outpatient + inpatient MH (17.9%), SUD (7.3%), SUD + outpatient MH (15.7%), and SUD + outpatient MH + inpatient MH (7.7%). The SUD treatment classes evidenced greater social instability, had higher alcohol use disorder symptom severity, and used more drug types than the non-SUD classes. Classes receiving inpatient MH treatment had a greater incidence of additional comorbid conditions and suicidal behaviors. Across all 6 classes, most respondents met diagnostic criteria for chronic PTSD (overall: 68.9%) while fewer met diagnostic criteria for chronic SUD (overall: 38.7%). Conclusions Most people with lifetime PTSD and SUD have sought either SUD or MH treatment or both, with substantially greater receipt of MH treatment. This comorbid group has complex clinical presentations that differ depending upon treatment subgroup, and for most, their PTSD persisted despite high rates of treatment engagement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

BackgroundEarly-onset depression during childhood and adolescence is associated with a worse course of illness and outcome than adult onset. However, the genetic factors that influence risk for early-onset depression remain mostly unknown. Using data collected over 13 years, we examined whether polygenic risk scores (PRS) that capture genetic risk for depression were associated with depression trajectories assessed from childhood to adolescence.MethodsData came from the Avon Longitudinal Study of Parents and Children, a prospective, longitudinal birth cohort (analytic sample=7,308 youth). We analyzed the relationship between genetic susceptibility to depression and three time-dependent measures of depressive symptoms trajectories spanning 4 to 16.5 years of age (class, onset, and cumulative burden). Trajectories were constructed using a growth mixture model with structured residuals. PRS were generated from the summary statistics of a genome-wide association study of depression risk using data from the Psychiatric Genomics Consortium, UK Biobank, and 23andme, Inc. We used MAGMA to identify gene-level associations with these measures.ResultsYouth were classified into 6 classes of depressive symptom trajectories: high/renitent (26.5% of youth), high/reversing (5.8%), childhood decrease (6.1%), late childhood peak (3%), adolescent spike (2.5%), and minimal symptoms (56.1%). PRS discriminated between youth in the late childhood peak, high/reversing, and high/renitent classes compared to the minimal symptoms and childhood decrease classes. No significant associations were detected at the gene level.ConclusionsThis study highlights differences in polygenic loading for depressive symptoms across childhood and adolescence, particularly among youths with high symptoms in early adolescence, regardless of age-independent patterns.

Objective To describe clinical diagnoses from telepsychiatrist consultation in safety net primary care settings for adult patients screening positive for bipolar disorder, PTSD, or both. Methods Patients were administered the PTSD Checklist (PCL-6) and the Composite International Diagnostic Interview 3.0 (CIDI) for bipolar disorder. Positive screening result definitions were PCL-6 score of ≥14 and CIDI positive stem question responses and score of ≥8. Patient characteristics were assessed by survey. Psychiatrists consulted in primary care via telehealth and recorded clinical diagnoses. Results Among 767 patients attending consultation with a telepsychiatrist, 495 (65%) screened PCL-6 positive only, 249 (32%) screened both PCL-6 and CIDI positive, and 23 (3%) screened CIDI positive. Approximately two-thirds screening PCL-6 positive were diagnosed with PTSD, and most had comorbid mood disorder diagnoses, with bipolar disorder diagnosis occurring more often in those screening CIDI positive compared to negative (42% vs. 15%). Positive predictive values were 64.9% for PCL-6 and 43.8% for CIDI. Conclusion Most individuals screening positive for PTSD and/or bipolar disorder had two or more psychiatric diagnoses; misclassification exists for both instruments but was greater for CIDI. Psychiatrist consultation early in treatment for individuals screening positive on the PCL-6 and/or CIDI could help clarify diagnoses and improve treatment planning.

Studies of developmental trajectories of depression are important for understanding its etiology. Existing studies have been limited by short time frames and no studies have explored a key factor: differential patterns of responding to life events. This paper introduces a novel analytic technique, growth mixture modeling with structured residuals, to examine the course of youth depression symptoms in a large, prospective cohort (N=11,641, ages 4-16.5). Age-specific critical points were identified at ages 10 and 13 where depression symptoms spiked for a minority of children. However, most depression risk was due to dynamic responses to environmental events, drawn not from a small pool of persistently depressed children, but a larger pool of children who varied across higher and lower symptom levels.

The association between relationship functioning and depressive symptoms is well established. This study examined the effects of the Marriage Checkup, a brief two-session Assessment and Feedback relationship intervention, on depressive symptoms. Two hundred and nine married couples participated in the Marriage Checkup and were randomized into Treatment (N = 108) and Waitlist-Control Conditions (N = 101). Compared to the control condition, intervention participants reported significant improvements in depressive symptoms (d = 0.55), with an even greater effect for those who were reporting more severe baseline depression symptoms (d = 0.67). These outcomes are comparable to those within long-term individual psychotherapy, couple therapy, and pharmacology trials, making this the briefest intervention to date to demonstrate significant improvements in depressive symptoms. Clinical implications are discussed.

Objective The current study sought to examine the relationship between changes in distress for items on in-vivo exposure hierarchies and posttraumatic stress disorder (PTSD) symptom change over the course of exposure therapy. Methods Active duty army soldiers (N = 108) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of PTSD stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. The relationships between in-vivo exposure distress, imaginal exposure distress, and PTSD symptoms, were examined in a factor of curves model for participants in the treatment conditions. Results Analyses revealed that, when controlling for one another, changes in in-vivo exposure distress were significantly associated with changes in PTSD symptoms (β = 0.75, 95% CI [0.60, 0.90]), while changes in imaginal exposure distress were not (β = 0.03, 95% CI [-0.27, 0.33]). The model also revealed that after accounting for the shared variation in trajectories of change, symptom clusters did not have unique variation, meaning that symptom clusters did not change independently. Conclusion Results suggest the possibility that in-vivo exposures are more closely tied to changes in overall PTSD symptoms than imaginal exposures during exposure therapy. Furture research should incorporate more frequent measurement of in-vivo exposure distress to better elucidate these relations over the course of treatment.

Rationale The transition to college presents a period of vulnerability to mental illness, and opportunity for positive psychosocial development. Objective The present study sought to build an explanatory person-centered and contextualized model of student wellbeing in the transition to college. Method Participants were entering first year undergraduate students at a large public university in the United States (n = 5509). Online survey data were collected at three time points across the academic year, with outcomes of depression and anxiety, thriving, and grade point average, and predictors including resilient coping, self-compassion, social support, school connections and the acute and chronic stressors experienced during the transition to college. Latent growth curves were used to examine trajectories of change in depression and anxiety, and a cross-lagged panel model was used to describe a system of how all measured variables influenced each other over time. Results There were four main findings. On average, students experienced moderate increases in depression and anxiety from the summer before college through the spring, with wide variability across students and no clear patterning by demographic groups. Second, self-compassion was the strongest and most consistent predictor of successful transitions. Third, chronic stressors were strongly predictive of more negative outcomes, and self-compassion and coping skills did not buffer their effects. Finally, people most likely to experience chronic stressors over the school year included women, people who identify as sexual minorities and first-generation students. Conclusions Programming to support entering college students should seek to foster self-compassion, while also limiting chronic stressors and reducing their inequitable distribution across the student population.

Given the significant negative impact of relationship distress on the health and well being of members of the military, preventative and accessible care is needed in order to provide crucial relationship support to service members and their families. This paper presents the rationale, key considerations, and feasibility for adapting the Marriage Checkup (MC), a brief intervention for enhancing marital resiliency, for use by internal behavioral health consultants (IBHCs) working in an integrated primary care clinic serving an active duty military population. We detail the adapted MC protocol, which was revised to contain military-centric content and fit into the fast-paced environment of primary care (e.g., streamlined to fit within three 30-minute appointments). IBHCs working in primary care were trained to offer the intervention at two air force bases. Twenty couples and 1 individual have completed the MC and a 1-month follow-up assessment. The MC intervention appeared to be well-received by both couples and IBHCs. In this paper, we provide specific guidance for clinicians and providers who are interested in integrating the Marriage Checkup into their practice.

In this study, we examined mediators of a brief couples intervention. Intimate safety, acceptance, and activation were examined in 2 roles: their contribution to marital satisfaction gains in the first 2 weeks after treatment (contemporaneous effects), and how early changes in the mediators influenced longer term changes in marital satisfaction over 2 years of follow-up (lagged effects). Married couples (N = 215) were randomized to either an intervention group or a wait-list control group and followed for 2 years. Latent change-score models were used to examine contemporaneous and time-lagged mediation. A booster intervention in the 2nd year was used for a replication study. Changes in intimate safety and acceptance were uniquely associated with contemporaneous treatment effects on relationship satisfaction in Year 1, but only acceptance was uniquely associated with contemporaneous effects in Year 2. With respect to lagged effects, early changes in acceptance partially mediated later changes in marital satisfaction in Year 1, whereas the same effect for intimate safety was marginally significant. These lagged paths were moderate in size and indirect effects were small. No lagged effects were significant in Year 2. Change in activation was not significant as either a contemporaneous or a lagged predictor of change in relationship satisfaction. We found moderate support for acceptance and more limited support for intimate safety as mediators of short- and long-term treatment response, suggesting that these processes play an important role in sustaining marital health.

Recognizing that health outcomes are influenced by and occur within multiple social and physical contexts, researchers have used multilevel modeling techniques for decades to analyze hierarchical or nested data. Cross-Classified Multilevel Models (CCMM) are a statistical technique proposed in the 1990s that extend standard multilevel modeling and enable the simultaneous analysis of non-nested multilevel data. Though use of CCMM in empirical health studies has become increasingly popular, there has not yet been a review summarizing how CCMM are used in the health literature. To address this gap, we performed a scoping review of empirical health studies using CCMM to: (a) evaluate the extent to which this statistical approach has been adopted; (b) assess the rationale and procedures for using CCMM; and (c) provide concrete recommendations for the future use of CCMM. We identified 118 CCMM papers published in English-language literature between 1994 and 2018. Our results reveal a steady growth in empirical health studies using CCMM to address a wide variety of health outcomes in clustered non-hierarchical data. Health researchers use CCMM primarily for five reasons: (1) to statistically account for non-independence in clustered data structures; out of substantive interest in the variance explained by (2) concurrent contexts, (3) contexts over time, and (4) age-period-cohort effects; and (5) to apply CCMM alongside other techniques within a joint model. We conclude by proposing a set of recommendations for use of CCMM with the aim of improved clarity and standardization of reporting in future research using this statistical approach.

Couples with the greatest need for relationship health maintenance and intervention are often least able to afford and access it; therefore, accessible, affordable, effective, and brief interventions are needed to improve relationship health for those who need it most. Consequently, this paper examined whether a brief relationship intervention could be effectively implemented with a low-income, underserved population. All enrolled participants (N = 1,312) received the Relationship Checkup, which consists of an assessment and a feedback session delivered in their homes or at a local clinic at their request. Measures assessed relationship satisfaction, communication, psychological and physical aggression, and intimacy at baseline and 1-month follow-up, and program and relationship satisfaction at 6-month follow-up. All participants reported significant improvements on all outcomes with small effect sizes. However, moderation analyses suggested that distressed couples reported significantly larger effects across the board. Overall, participants reported that they were highly satisfied with the intervention both immediately after its delivery and 6 months later. Findings provide preliminary support for the effectiveness of this brief checkup and point to the utility of offering these kinds of low-cost brief interventions in flexible formats for those who might have the most difficulty accessing them.Las parejas más necesitadas de mantenimiento e intervención para la salud de sus relaciones son con frecuencia las menos equipadas para costear y obtenerlos; por lo tanto, las intervenciones accesibles, asequibles, efectivas y breves son necesarias para mejorar la salud de las relaciones de aquéllos que más lo necesitan. Por consiguiente, este artículo examinó si sería posible implementar una intervención breve para relaciones con una población subatendida de bajo ingreso. Todos los participantes inscritos (N = 1312) recibieron un Control de Relación, que consiste en una evaluación y una sesión de comentarios realizadas en sus hogares o en una clínica local a petición de ellos. Las medidas evaluaron la satisfacción en la relación, comunicación, agresión psicológica y física, e intimidad en la línea de base y en un seguimiento después de un mes, así como satisfacción con el programa y con la relación en un seguimiento después de seis meses. Todos los participantes informaron mejoras sustanciales en todos los resultados con tamaños de efecto pequeños. Sin embargo, análisis de moderación sugirieron que las parejas angustiadas informaron efectos considerablemente mayores en todos los renglones. En general, los participantes informaron que estaban sumamente satisfechos con la intervención tanto inmediatamente después de realizarse como seis meses después. Los hallazgos proporcionan apoyo preliminar a la efectividad de este control breve y señalan la utilidad de ofrecer estos tipos de intervenciones breves de bajo costo en formatos flexibles para aquéllos que podrían tener mayores dificultades para obtenerlos.最需要关系健康支持和干预的伴侣往往是最没有能力负担以及获取支持和干预的。因此,我们需要方便,便宜,有效并且简短的干预来改善最需要帮助的人们的关系健康。本文考察了一个简短的关系干预是否可以有效在低收入弱势人群中实施。所有参与者(N = 1312)都接受了关系检查。关系检查由在其家中或当地门诊进行的一项评估和一个反馈环节构成。我们评估了在基线和一个月后续追踪调查中关系满意度,沟通,心理和身体攻击性,以及亲密程度,以及项目和6个月后续追踪关系满意度。所有参与者都报告了在各个方面较小影响的显著改善。然而,节制分析表明受困扰的伴侣在各个方面报告较显著效果。总而言之,参与者报告他们对于干预的即时效果和6个月后续效果都高度满意。研究发现为该简短检查有效性提供初步支持并指出为有困难获取帮助的人群以灵活方式提供这种低成本简短干预的用处。.

This study examined the qualitative differences between the types of strengths identified by satisfied versus distressed couples seeking a Marriage Checkup. We hypothesised that distressed couples would nominate less intimate strengths, while satisfied couples would nominate more intimate strengths. We found that distressed partners were significantly more likely to nominate items from a Parallel Support category, whereas satisfied women, but not men, were significantly more likely to nominate items from an Intimate/Affectionate category. These findings suggest that an indicator of developing couple distress is the point where couples begin to focus their attention on less emotionally vulnerable relationship aspects.

Studies regarding the effectiveness of homework assignments in cognitive-behavioral treatments have demonstrated mixed results. This study investigated predictors of compliance with homework recommendations and the time-varying relationship of recommendation completion with treatment response in a brief couples intervention (N=108). More satisfied couples and couples with more motivation to change completed more recommendations, whereas couples with children completed fewer. The association between recommendation completion and treatment response varied with the passage of time, with the strongest effect observed six-months after the intervention, but no discernible differences at one year post-intervention. Couples that completed more recommendations experienced more rapid treatment gains, but even those couples doing substantially fewer recommendations ultimately realized equivalent treatment effects, although they progressed more slowly. Implications are discussed.

Many states and sports leagues are instituting concussion policies aimed at reducing risk of morbidity and mortality; many include mandates about the provision of concussion education to youth athletes. However, there is limited evidence if educational materials provided under these typically vague mandates are in fact effective in changing concussion risk-related behavior or any cognition predictive of risk-related behavior. The purpose of this pilot randomized controlled study was to conduct a theory-driven evaluation of three publically available concussion education materials: two videos and one informational handout. Participants were 256 late adolescent males from 12 teams in a single league of ice hockey competition in the United States. Randomization of educational condition occurred at the team level. Written surveys assessing postimpact symptom reporting behavior, concussion knowledge, and concussion reporting cognitions were completed by participants immediately before receiving their educational intervention, 1 day after, and 1 month after. Results indicated no change in any measure over any time interval, with the exception of perceived underreporting norms. In one of the video conditions, perceived underreporting norms increased significantly 1 day after viewing the video. Possible content and viewing environment-related reasons for this increase are discussed. Across all conditions, perceived underreporting norms increased 1 month after intervention receipt, raising the possibility that late in the competitive season underreporting may be perceived as normative. The need for the development of theory-driven concussion education materials, drawing on best practices from health behavior scholars, is discussed.

Objective:This study assessed the efficacy of the Marriage Checkup (MC) for improving relationship health and intimacy.Method:Cohabiting married couples (N!215,M age women!44.5 years, men! 47 years, 93.1% Caucasian) recruited from a northeastern U.S. metropolitan area through print and electronic media were randomly assigned to MC treatment or wait-list control. Treatment but not control couples participated in assessment and feedback visits, at the beginning of the study and again 1 year later. All couples completed 9 sets of questionnaires over 2 years. Outcome measures included the Quality of Marriage Index, the Global Distress subscale of the Marital Satisfaction Inventory‐Revised, the Intimate Safety Questionnaire, and the Relational Acceptance Questionnaire.Results:A latent growth curve model indicated significant between-group differences in intimacy at every measurement point after baseline (dranged from .20 to .55,M d !.37), significant between-group differences in women’s felt acceptance for every measurement point after baseline (dranged from .17 to .47,M d !.34), significant between-group differences in men’s felt acceptance through the 1-year 2-week follow-up (d across follow-up ranged from .11 to .40,M d !.25), and significant between-group differences in relationship distress through 1-year 6-month follow-up (dacross follow-up ranged from .11 to .39,M d ! .23).Conclusions:Longitudinal analysis of the MC supports the hypothesis that the MC significantly improves intimacy, acceptance, and satisfaction. Implications for dissemination are discussed.

Objective This study examined the effectiveness of the Marriage Checkup (MC), adapted for independent practice. Method A total of 233 couples were recruited from 2 metropolitan areas of Denmark and randomized to the MC adapted for independent practice (MC-P, n = 116) or a waitlist condition (WL, n = 117). Self-report measures of relationship health were obtained online at 3 (WL) or 6 (MC-P) time points across 54 weeks. MC-P couples received 2 checkups (Week 7 and 51). WL couples received tickets to a movie night (Week 10). Data were analyzed using multilevel growth models. Results Following the first checkup, small intervention effects were found on 3 of 4 outcome measures. Between the checkups, the effects on 2 of 3 measures first leveled off then reappeared. Following the second checkup, intervention effects in the small to medium range were found on all 4 measures including the Brief Marital Satisfaction Inventory (Cohen's d = 0.48), the Couple Satisfaction Index (d = 0.20), the Responsiveness and Attention Scale (d = 0.43), and the Intimate Safety Questionnaire (d = 0.21). Conclusions Couples receiving 2 annual checkups across 54 weeks experienced small to medium effects on relationship health when compared to controls. These are the first and preliminary results on a model for conducting regular relationship health checkups in a real-world therapeutic setting. Future studies are needed to investigate the comparative and long-term effects of this approach. (PsycINFO Database Record

Positive parenting practices have been shown to be essential for healthy child development, and yet have also been found to be particularly challenging for parents to enact and maintain. This paper explores an innovative approach for increasing positive parenting by targeting specific positive emotional processes within marital relationships. Couple emotional acceptance is a powerful mechanism that has repeatedly been found to improve romantic relationships, but whether these effects extend to the larger family environment is less well understood. The current longitudinal study examined the role of improved levels of acceptance in mother’s and father’s positive parenting after a couple intervention. Participants included 244 parents (122 couples) in the Marriage Checkup (MC) study, a randomized, controlled, acceptance-based, intervention study. Data indicated that both women and men experienced significantly greater felt acceptance two-weeks after the MC intervention, treatment women demonstrated greater positive parenting two weeks after the intervention, and all treatment participants’ positive parenting was better maintained than control couple’s six months later. Importantly, although mothers’ positive parenting was not influenced by different levels of felt acceptance, changes in father’s positive parenting were positively associated with changes in felt acceptance. As men felt more accepted by their wives, their levels of positive parenting changed in kind, and this effect on positive parenting was found to be mediated by felt acceptance two weeks after the MC. Overall, findings supported the potential benefits of targeting couple acceptance to generate positive cascades throughout the larger family system.

Concussions from sport present a substantial public health burden given the number of youth, adolescent and emerging adult athletes that participate in contact or collision sports. Athletes who fail to report symptoms of a suspected concussion and continue play are at risk of worsened symptomatology and potentially catastrophic neurologic consequences if another impact is sustained during this vulnerable period. Understanding why athletes do or do not report their symptoms is critical for developing efficacious strategies for risk reduction. Psychosocial theories and frameworks that explicitly incorporate context, as a source of expectations about the outcomes of reporting and as a source of behavioral reinforcement, are useful in framing this problem. The present study quantifies the pressure that athletes experience to continue playing after a head impact--from coaches, teammates, parents, and fans--and assesses how this pressure, both independently and as a system, is related to future concussion reporting intention. Participants in the study were 328 male and female athletes from 19 teams competing in one of seven sports (soccer, lacrosse, basketball, softball, baseball, volleyball, field hockey) at four colleges in the northeast region of the United States. Results found that more than one-quarter of the sample had experienced pressure from at least one source to continue playing after a head impact during the previous year. Results of a latent profile mixture model indicated that athletes who experienced pressure from all four of the measured sources were significantly more likely to intend to continue playing in the future than were athletes who had not experienced pressure from all sources, or only pressure from coaches and teammates. These findings underscore the importance of designing interventions that address the system in which athletes make decisions about concussion reporting, including athletes' parents, rather than focusing solely on modifying the individual's reporting cognitions.

Communication between coaches and athletes about concussion safety can reinforce or undermine a sport culture in which concussion under-reporting is often endemic.This study tested a model in which self-reported coach communication about concussion safety was predicted by factors including concussion knowledge, attitudes and beliefs, sex of the coach, and sex of the team coached. Participants were 997 coaches of contact and collision sports teams competing in National Collegiate Athletic Association Division I, II, or III.Concussion attitudes and beliefs were the strongest predictors of communication, and the small effect of knowledge on communication was transmitted nearly entirely through its effect on attitudes and beliefs. Much of the variability in communication was attributable to the sex of the coach and the sex of the team coached.These results serve as a starting point for the design of coach-targeted interventions that encourage communication about health and safety with athletes.

This study employed a novel methodological design to explore how couples transition out of a disagreement that they do not have time to resolve. Thirty college-aged dating couples participated in a 20-minute interaction with their partner where they were required to transition from a conflict conversation to the story of how they met, in a time-limited paradigm. Independent coders coded transition styles and couples completed self-report measures of relationship satisfaction pre, post, and at 6-month follow-up. We identified four transition styles: Mutual Avoidant, Mutual Collaborative, Abrupt/Controlling, and Resign/Withdraw. Couples with a Resign/Withdraw style deteriorated over time compared to couples with the other three styles. Further, couples also varied in terms of transition qualities, including how easily they disengaged and how deeply meaningful the conversation was. Ease of transition was associated with increases in relationship satisfaction at 6 months, whereas depth was associated with decreases in relationship satisfaction both immediately after the interaction and at 6 months. Implications are discussed.