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Background: Incarcerated perinatal populations report high rates of substance use in the United States (US). Despite this, substance use disorder (SUD) treatment is not routinely available in carceral settings and state policies related to the provision of substance use screening and treatment are unknown. Methods: We conducted a systematic search in WestLaw through the end of the 2020 legislative session combining the terms "pregnant" and "postpartum" with terms for incarceration and related terms. The search returned 453 statutes from 43 states. A deductive codebook of various maternal health topics was developed. Legislative texts related to SUD screening and treatment were extracted for textual analysis. Results: Of the 43 states identified as having at least 1 state statute pertaining to pregnant or postpartum incarcerated people, 7 states had statutes relevant to SUD screening and treatment. Statutes related to substance use screening, education, treatment and diversion programs, program eligibility, aftercare and release planning, and funding appropriations. Conclusions: The majority of states across the U.S. lack legislation that address SUD screening and treatment among incarcerated perinatal populations. Given the known limited access to SUD treatment for perinatal populations in custody, increasing legislative statutes could increase access to essential care. [ABSTRACT FROM AUTHOR]

Perceived emotion invalidation is linked to the development or worsening of a variety of emotional and physical health conditions. However, prior studies are largely cross-sectional and whether there are day-to-day effects of generally feeling invalidated is unknown. We examined the relations between perceived emotion invalidation and momentary affect, average daily affect, and the experience of daily stressors among a sample of young adults using ecological momentary assessment (EMA). Participants (n = 86) completed measures of perceived emotion invalidation and emotional reactivity at baseline then completed one week of EMA including: (1) 7x/day reports of current affect and social context and (2) 1x/day index of experienced stressors and their intensity. Higher perceived emotion invalidation predicted lower momentary positive affect. Perceived invalidation also interacted with social context such that higher emotion invalidation predicted greater negative affect when participants were with non-close others (i.e., co-workers, acquaintances). Only participants with high perceived emotional invalidation experienced increased stress alongside heightened daily negative affect. These results provide preliminary evidence that feeling emotionally invalidated may predict affective experiences, including how emotions are momentarily experienced and how life stressors are interpreted when they are later reflected on. [ABSTRACT FROM AUTHOR]

Nearly all people in prison have experienced trauma, and many meet the criteria for posttraumatic stress disorder (PTSD). Untreated PTSD increases the risk of substance use problems after release, contributing to a well‐documented cycle of trauma, addiction, and incarceration. However, evidence‐based, trauma‐focused therapy for PTSD is rarely offered in prisons, and there is little research that can guide implementation efforts. In preparation for an effectiveness–implementation hybrid II pilot trial examining group‐delivered cognitive processing therapy (CPT) in prisons, we conducted a formative evaluation using interviews structured according to the consolidated framework for implementation research (i.e., CFIR). Participants were correction center leadership, treatment staff, health care staff, and security staff (n = 22) and incarcerated persons (n = 14; 57.1% female). We found that CPT was highly compatible with residents' needs and the centers' available resources, culture, existing programs, and current workflow. CPT was also acceptable to all stakeholders. Potential barriers were the lower relative priority for CPT compared with programs that are reinforced at the system level, limited staff time to deliver CPT, limited staff knowledge about PTSD, and center features that could distract from CPT groups and/or training or be countertherapeutic. Taken together, CPT is a promising trauma‐focused therapy for corrections, but these findings underscore the importance of identifying and matching potential barriers to effective implementation strategies a priori and work in the policy arena to promote sustainability. [ABSTRACT FROM AUTHOR]

BACKGROUND: Incarcerated perinatal populations report high rates of substance use in the United States (US). Despite this, substance use disorder (SUD) treatment is not routinely available in carceral settings and state policies related to the provision of substance use screening and treatment are unknown. METHODS: We conducted a systematic search in WestLaw through the end of the 2020 legislative session combining the terms "pregnant" and "postpartum" with terms for incarceration and related terms. The search returned 453 statutes from 43 states. A deductive codebook of various maternal health topics was developed. Legislative texts related to SUD screening and treatment were extracted for textual analysis. RESULTS: Of the 43 states identified as having at least 1 state statute pertaining to pregnant or postpartum incarcerated people, 7 states had statutes relevant to SUD screening and treatment. Statutes related to substance use screening, education, treatment and diversion programs, program eligibility, aftercare and release planning, and funding appropriations. CONCLUSIONS: The majority of states across the U.S. lack legislation that address SUD screening and treatment among incarcerated perinatal populations. Given the known limited access to SUD treatment for perinatal populations in custody, increasing legislative statutes could increase access to essential care. [ABSTRACT FROM AUTHOR]

Although incarcerated women are a highly victimized population, therapy for sexual violence victimization (SVV) sequela is not routinely offered in prison. SHARE is a group therapy for SVV survivors that was successfully implemented and sustained in a women's correction center. Here, we aimed to identify implementation factors and strategies that led to SHARE's success and describe incarcerated women's perspectives on the program. We conducted a retrospective process evaluation using interviews structured according to EPIS, a well‐established implementation science framework. Participants (N = 22) were incarcerated women, members of the SHARE treatment team, and members of the correction center's leadership, therapeutic team, and volunteer program. Factors that facilitated SHARE implementation varied by EPIS phase and organization. Positive inter‐organizational and interpersonal relationships were key across phases, as were the synergies between both the strengths and needs of each organization involved in implementation. Incarcerated women reported a strong need for SHARE and did not report any concerns about receiving trauma therapy in a carceral setting. Therapy for SVV sequelae, including exposure‐based therapy, is possible to implement and sustain in carceral settings. Community–academic partnerships may be a particularly feasible way to expand access to SVV therapy for incarcerated women. Highlights: Described implementing a group therapy for survivors of sexual violence within a women's prison.Evaluated contextual factors and strategies that led to successful sustainment of the group.Includes views of incarcerated women, members of the treatment team, and prison leadership.Found personal and organizational partnerships were key to effecting and sustaining the program.Incarcerated women noted a need for trauma therapy and felt prison was a suitable setting for it. [ABSTRACT FROM AUTHOR]

Incarcerated women evidence high rates of both interpersonal trauma and mental illness. In particular, the rates of sexual violence victimization are so high that some researchers have suggested that sexual abuse may be a pathway to prison for women, likely through the development of mental illness, including substance abuse. This review article summarizes the literature on sexual victimization (n = 32 articles; 28 independent studies) and mental illness (n = 11 articles; 8 independent studies) prevalence among samples of incarcerated women (N s ≥ 100) in context of methodological choices within included articles. Best estimates for sexual victimization from studies using established survey methods were as follows: 50–66% for child sexual abuse, 28–68% for adult sexual abuse, and 56–82% for lifetime sexual assault. Although data directly comparing prevalence of sexual victimization among incarcerated women to prevalence for other groups are limited, the existing data indicate that incarcerated women have significantly greater exposure than incarcerated men and community samples of women. Moreover, compared to findings from the National Comorbidity Survey-Replication, incarcerated women evidence greater prevalence of most lifetime and current mental illnesses, especially depressive disorders, post-traumatic stress disorder, and substance use disorders. Surprisingly, only two independent studies have investigated the overlap between sexual victimization and mental illness in samples of incarcerated women. Both studies found disproportionally high rates of mental illness among victims of sexual violence. Suggestions and implications for research, policy, and practice are discussed. [ABSTRACT FROM AUTHOR]

Highlights • Current neurocircuitry models of PTSD do not account for developmental effects. • Found significant interactions between development and trauma exposure on RSN FC. • Women and girls had opposite FC patterns in regions related to emotion regulation. • Development must be considered when interpreting trauma-related FC differences. Abstract Current neurocircuitry models of PTSD do not account for developmental effects, despite that early life assaultive violence is a potent risk factor for PTSD. Here, we preliminarily evaluated developmental stage as a moderator of the effect of early life assaultive violence on resting-state connectivity amongst regions associated with emotion generation and regulation using fMRI. Participants were adult women (n = 25) and adolescent girls (n = 36) who had or had not experienced early life assaultive violence. We found significant interactions between developmental stage and trauma exposure on resting-state functional connectivity (FC). Left amygdala connectivity with the left ventral anterior cingulate gyrus (BA 32) was reduced among trauma-exposed compared to control adolescents, but increased among trauma-exposed compared to control adults. A corresponding pattern of results was identified for FC between rostral anterior cingulate gyrus seed region and a similar right ventral anterior superior frontal gyrus cluster. Increased FC in both regions for assaulted adult women scaled positively with self-reported emotion regulation difficulties. Our results should be viewed tentatively due to sample limitations, but provide impetus to examine whether neurocircuitry models of PTSD may be strengthened by accounting for developmental stage. [ABSTRACT FROM AUTHOR]

Emotion invalidation is theoretically and empirically associated with mental and physical health problems. However, existing measures of invalidation focus on past (e.g., childhood) invalidation and/or do not specifically emphasize invalidation of emotion. In this article, the authors articulate a clarified operational definition of emotion invalidation and use that definition as the foundation for development of a new measure of current perceived emotion invalidation across a series of five studies. Study 1 was a qualitative investigation of people's experiences with emotional invalidation from which we generated items. An initial item pool was vetted by expert reviewers in Study 2 and examined via exploratory factor analysis in Study 3 within both college student and online samples. The scale was reduced to 10 items via confirmatory factor analysis in Study 4, resulting in a brief but psychometrically promising measure, the Perceived Invalidation of Emotion Scale (PIES). A short-term longitudinal investigation (Study 5) revealed that PIES scores had strong test-retest reliability, and that greater perceived emotion invalidation was associated with greater emotion dysregulation, borderline features and symptoms of emotional distress. In addition, the PIES predicted changes in relational health and psychological health over a 1-month period. The current set of studies thus presents a psychometrically promising and practical measure of perceived emotion invalidation that can provide a foundation for future research in this burgeoning area. (PsycINFO Database Record (c) 2018 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

In the current study, we tested the effects of core body temperature increases (e.g. heat stress) on affect, self-reported physical discomfort, and subsequent self-control in male smokers and nonsmokers using a novel passive heat stress paradigm, within a distress tolerance framework. Twenty-eight men (14 smokers), completed both heat stress and control sessions in randomized order. Results revealed that increases in core body temperature were associated with increased anxiety, irritability, and body discomfort as well as decreased happiness, with stronger effects for smokers. Smokers and nonsmokers both evidenced less self-control during the heat session and did not differ on this measure, nor on a measure of interoceptive sensitivity. The current study indicates that heat stress is a viable method for studying distress tolerance in men, and suggests the value in examining dynamic changes in self-control as a function of distress. Implications will be discussed for distress tolerance in general and smokers in specific. [ABSTRACT FROM AUTHOR]

The article focuses on the need to improve corrections-based health care in the United States. It states under 0.1 percent of National Institutes of Health (NIH)-funded research grants focus on justice-focused health research and mentions two NIH-funded training programs focusing on prison populations provide mentored research opportunities. It talks about health disparities that mass incarcerations in the U.S. have created and the need for more funding for multidisciplinary training programs.

Research on nonsuicidal self-injury (NSSI) has moved beyond examination of factors that associate with the mere presence or absence of the behavior, and into more nuanced examination of which discrete features of NSSI behavior relate to pathology. This study examined two features of NSSI, frequency of occurrence and recency, as cross-sectional predictors of psychopathology in a large community sample of adults with a history of NSSI ( N = 315). Results of 2 × 2 factorial ANOVAs testing the interactive effects of NSSI frequency (clinical, subclinical) and recency (current, past) revealed that current NSSI was consistently associated with poorer emotional and behavioral health (e.g., greater symptoms of depression, panic, and anxiety, worse emotion regulation, greater alcohol misuse). Results for NSSI frequency were more variable, though preliminary evidence suggested significant interactions of current NSSI and clinical frequency on emotion dysregulation, general anxiety, and panic. Possible clinical and empirical implications of the NSSI disorder frequency criteria proposed in DSM-5 are discussed. [ABSTRACT FROM AUTHOR]

Research into factors for suicide has revealed relations between trauma exposure and suicidality (e.g., Bridge, Goldstein, & Brent, ; Joiner, Sachs-Ericson, Wingate, Brown, Anestis, & Selby, ) wherein painful and provocative experiences (e.g., nonsuicidal self-injury [NSSI]) are an important link (e.g., Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner, ; Smith, ). No prior research has assessed the relationship between functions of NSSI and suicidality among childhood trauma survivors. Participants who endorsed childhood trauma exposure (N = 121; Mage  = 18.69, range 18-22) completed measures of posttraumatic stress disorder (PTSD) symptoms, NSSI, and suicidality. Multiple regressions assessing whether the four functions of NSSI predicted suicide ideation and past attempts after controlling for PTSD symptom severity found that only social negative reinforcement was associated with SI (β = .304, SE = .243, t = 2.23, p = .028), while only automatic negative reinforcement was associated with past attempts (β = .470, SE = .066, t = 2.25, p = .028). Findings highlight the importance of assessing NSSI functions when assessing suicidality among trauma survivors. [ABSTRACT FROM AUTHOR]

Incarcerated women experience high rates of sexual victimization and mental illness. The current study evaluated outcomes from an eight-session exposure-based group treatment with incarcerated women who had experienced sexual victimization. A total of 52 women participated in nine separate groups over a 2-year period. Participants reported statistically significant reductions in posttraumatic stress disorder, depression, and generalized anxiety disorder symptoms from pretreatment to posttreatment (large effect sizes; all η2 > .20). Among participants with pretreatment and posttreatment data (n = 36), approximately 70% showed clinical significant reductions and/or were considered recovered (e.g., no longer above the clinical cutoff) on at least one of the three diagnostic measures. [ABSTRACT FROM PUBLISHER]

Behavioral motivation is regulated through the behavioral inhibition system (BIS) and the behavioral approach system (BAS), which underlie responses to emotional stimuli and are thought to influence emotion dysregulation. Research shows that mindfulness may increase the efficacy of emotion regulation among those with psychological symptoms, but the relationships between behavioral motivation and mindfulness have been only minimally explored. This study examines relationships between behavioral motivation systems and emotion dysregulation as mediated by mindfulness facets. Mediation was tested in a sample of 246 college students ( M age = 19.28, 61.8% female, 81.3% Caucasian) using a multiple mediator bootstrapping method. Results revealed an indirect relationship between BIS sensitivity and increased emotion dysregulation through underutilization of three distinct mindfulness skills: act with awareness, non-judging, and non-reactivity. Mindfulness facets did not mediate relationships between BAS sensitivity and emotion dysregulation, though BAS Reward Responsiveness directly predicted increased emotion dysregulation while BAS Drive was marginally associated with decreased emotion dysregulation. Findings delineate specific relationships between BIS/BAS, mindfulness skills, and emotion dysregulation while suggesting mindfulness training may be useful for BIS sensitive individuals. [ABSTRACT FROM AUTHOR]

Potential mechanisms underlying the pathway between borderline personality features and indices of social support have yet to be elaborated, despite that social difficulties are a hallmark feature of borderline personality disorder (BPD). We hypothesized that rejection sensitivity, or the tendency to anxiously anticipate and readily perceive social rejection, might be one mechanism leading to the negative social impact associated with BPD symptoms. To test this hypothesis, a sample of college students (N=165) completed self-report measures in the laboratory. With rejection sensitivity in the model, borderline features did not directly predict number of social supports. However, borderline features indirectly predicted decreased number of social supports via increased rejection sensitivity. Conversely, borderline features directly predicted social support satisfaction but did not evidence an indirect effect through rejection sensitivity. The results of this research suggest that rejection sensitivity is an important individual difference by which borderline features leads to the lower levels of social support demonstrated in past research. Future directions, such as examining potential mediators of social support perception, are discussed. [ABSTRACT FROM AUTHOR]

Background: Prisons face challenges in meeting the unique health care needs of women, especially those who are pregnant. This retrospective chart review sought to describe the maternal and infant health outcomes of incarcerated women who received prenatal care while in an Arkansas prison. Methods: Using a hospital-based electronic medical records (EMR) system, we examined the maternal health history and current pregnancy characteristics of 219 pregnant women who received prenatal care while incarcerated from June 2014 to May 2019. We also examined labor and delivery characteristics and postpartum and infant birth outcomes for the 146 women from this cohort who delivered a living child while still incarcerated. Results: Most records indicated complex health histories with several chronic illnesses, mental health diagnoses, history of substance use, and lifetime medical complications. Despite comorbid illness, substance use disorder (SUD), trauma-history, and post-traumatic stress disorder (PTSD) prevalence was lower than expected. Previous and current obstetrical complications were common. Although the Neonatal Intensive Care Unit (NICU) admission rate (41%) was high, few infants required extensive treatment intervention. Postpartum complications were rare; however, a small portion of women who gave birth in custody experienced severe complications and were re-admitted to the hospital post-discharge. Conclusions: Incarcerated pregnant women and their infants are a marginalized population in great need of health care advocacy. To optimize maternal-infant outcomes, carceral agencies must recognize the health needs of incarcerated pregnant women and provide appropriate prenatal care. Expansion of carceral perinatal care to include screening for SUD and psychiatric symptoms (e.g., PTSD) and referral to appropriate care is highly encouraged. Policies related to NICU admission for non-medical reasons should be further examined. Significance: What is already known on this subject? Pregnant incarcerated women are at high risk for poor perinatal outcomes; however, knowledge of maternal and infant outcomes remains limited. Studies that exist are limited to a small number of outcomes and focus on immediate birth outcomes (e.g., prematurity, birthweight, NICU admission) with little data related to maternal and infant complications experienced during labor, delivery and postpartum, and infant diagnoses at delivery and discharge. What this study adds? Our study adds to what is known about the outcomes of incarcerated pregnant women by documenting their overall maternal health, previous and current pregnancy characteristics, and maternal and infant outcomes inclusive of the prenatal, labor and delivery, and postnatal periods. [ABSTRACT FROM AUTHOR]

People who are incarcerated are likely to meet criteria for at least one substance use disorder and need access to treatment. Access to such interventions was limited prior to the COVID-19 pandemic and has almost certainly been restricted further due to implementation of procedures intended to stop the spread of the virus. In this brief commentary, we discuss how COVID-19 has revealed the already tenuous access that people who are incarcerated have to behavioral health services, and the pitfalls of reliance on the U.S. carceral system as a response to addiction. [ABSTRACT FROM AUTHOR]

Incarcerated women report high rates of sexual victimization. Interviews with 63 previously incarcerated women survivors of sexual violence explored perceptions toward receiving trauma-focused therapy while incarcerated and postrelease trauma-focused therapy utilization. Nearly all participants (97%) recommended that trauma-focused therapy be available to incarcerated women. Most believed that prisons are acceptable places to receive trauma-focused therapy, without qualification (65%); some reported mixed feelings or indicated acceptability but identified factors that would increase acceptability (33%). Notably, most were currently experiencing trauma-related symptoms, but few had attended trauma-focused therapy following release. Findings indicate that access to prison-based trauma-focused therapy is necessary and acceptable. [ABSTRACT FROM AUTHOR]

The current behavioral tasks assessing distress tolerance measure tolerance to frustration and tolerance to physical discomfort, but do not explicitly assess tolerance to negative emotion. We closely evaluated the conceptual distinctions between current behavioral tasks and self-report tasks assessing distress tolerance, and then developed a new behavioral distress tolerance task called the Emotional Image Tolerance (EIT) task. The EIT task retains elements of existing behavioral tasks (e.g., indices of persistence) while augmenting the reliability and content sufficiency of existing measures by including multiple trials, including a variety of negative affect stimuli, and separating overall task persistence from task persistence after onset of distress. In a series of three studies, we found that the EIT correlated with extant behavioral measures of distress tolerance, the computerized mirror-tracing task and a physical cold pressor task. Across all of the studies, we also evaluated whether the EIT correlated with self-report measures of distress tolerance and measures of psychopathology (e.g., depression, anxiety, and binge eating). Implications for the refinement of the distress tolerance construct are discussed. [ABSTRACT FROM AUTHOR]

The Facial Action Coding System (Ekman & Friesen) has shown promise as a behavioral measure of emotional experience. The current study examined the degree of (de)synchrony between self-reported and facial expressions of fear, disgust, and sadness in response to a traumatic event–relevant film among individuals who had experienced a traumatic motor vehicle accident. Given high rates of comorbidity between posttraumatic stress symptoms (PTSS) and depressive symptoms, the potential impacts of both PTSS and depressive symptoms on emotional responding were examined. Results demonstrated synchrony between self-reported and facial expressions of disgust and sadness; however, no association between measures of fear was observed. Furthermore, depressive symptoms were associated with greater fear responding and PTSS were associated only with self-reported fear. Together, results support the importance of examining discrete negative emotions, rather than broad valence categories, when examining fear-based responding in traumatic event–exposed populations. Additional research examining the psychometric properties of the Facial Action Coding System as a measure of discrete emotional experiences among traumatic event–exposed individuals is needed to advance multimodal assessment approaches that yield incremental information for understanding emotional responding in this population. [ABSTRACT FROM AUTHOR]

How visual qualities of a food impact perceptions of the amount of food present and consumed have been studied. Previous research has investigated many factors affecting these perceptions, including the height of a glass, the size of a serving bowl, and other food intake cues. We investigated how the number of pieces a serving is divided into impacts perceptions of the amount of food present and consumed. Results indicate that dividing a fixed portion into a greater number of pieces leads people to perceive a greater amount of food in the serving. [ABSTRACT FROM AUTHOR]

Individuals involved in the criminal justice (CJ) system continue to be at disproportionate risk for HIV infection, and often have a greater prevalence of substance use and sexual related risk behaviors relative to their non-CJ involved peers. Pre-exposure prophylaxis (PrEP), a once daily antiretroviral medicine, is an evidence-based approach for reducing the risk of contracting HIV but limited data exist regarding the use of PrEP among CJ populations, especially in the U.S. South. This study was conducted at the Pulaski County Regional Detention Facility (PCRDF) in Little Rock, Arkansas (AR), the largest county jail in the state. We explored knowledge about PrEP and HIV, perceptions about PrEP feasibility in both the jail and community settings and barriers to PrEP program implementation, through in-depth qualitative interviews with 21 jail detainees. We purposively sampled individuals based on specific self-reported risk behavior, including sexual risk (both heterosexual and same-sex) and drug related risk (e.g. IDU), among all eligible individuals. We identified five primary themes from the interviews: 1) accessing healthcare during community reentry was a low priority; 2) perception of risk and interaction with people with HIV was low; 3) there are many barriers to disclosing HIV risk behaviors in jail settings; 4) knowledge of PrEP is low but willingness to use is high; and 5) multiple barriers exist to PrEP uptake post-release. Our findings are contextually unique and therefore have important implications for future implementation of PrEP access either within jail settings or linkage to PrEP post release. [ABSTRACT FROM AUTHOR]

Although the number of people incarcerated in the United States has grown dramatically, research on how incarceration affects individuals and the communities they return to has lagged behind. This may be because of the unique challenges of doing research within carceral systems and the relatively small number of investigators who are competent to undertake these efforts. We provide a primer for investigators with limited experience conducting research in carceral settings and highlight considerations and recommendations that may aid those conducting health research with incarcerated persons. We follow this with an illustrative case example exemplifying how the considerations apply to recent health research that our team conducted on mental illness prevalence in a large regional jail. Understanding how to effectively conduct research with criminal justice populations and systems is the first step in beginning to understand the effects of mass incarceration as a driver of health disparities and health inequity. [ABSTRACT FROM AUTHOR]

Recent work has extended the idea of implicit self-theories to the realm of emotion to assess beliefs in the malleability of emotions. The current article expanded on prior measurement of emotion beliefs in a scale development project. Items were tested and revised over rounds of data collection with both students and nonstudent adult online participants. Exploratory and confirmatory factor analyses revealed a three-factor structure. The resulting scale, the Emotion and Regulation Beliefs Scale, assesses beliefs that emotions can hijack self-control, beliefs that emotion regulation is a worthwhile pursuit, and beliefs that emotions can constrain behavior. Preliminary findings suggest that the Emotion and Regulation Beliefs Scale has good internal consistency, is conceptually distinct from measures assessing individuals’ beliefs in their management of emotions and facets of emotional intelligence, and predicts clinically relevant outcomes even after controlling for an existing short measure of beliefs in emotion controllability. [ABSTRACT FROM PUBLISHER]

Managing complex psychiatric disorders like PTSD and bipolar disorder is challenging in Federally Qualified Health Centers (FQHCs) delivering care to U.S residents living in underserved rural areas. This protocol paper describes SPIRIT, a pragmatic comparative effectiveness trial designed to compare two approaches to managing PTSD and bipolar disorder in FQHCs. Treatment comparators are: 1) Telepsychiatry Collaborative Care, which integrates consulting telepsychiatrists into primary care teams, and 2) Telepsychiatry Enhanced Referral, where telepsychiatrists and telepsychologists treat patients directly. Because Telepsychiatry Enhanced Referral is an adaptive intervention, a Sequential, Multiple Assignment, Randomized Trial design is used. Twenty-four FQHC clinics without on-site psychiatrists or psychologists are participating in the trial. The sample is patients screening positive for PTSD and/or bipolar disorder who are not already engaged in pharmacotherapy with a mental health specialist. Intervention fidelity is measured but not controlled. Patient treatment engagement is measured but not required, and intent-to-treat analysis will be used. Survey questions measure treatment engagement and effectiveness. The Short-Form 12 Mental Health Component Summary (SF-12 MCS) is the primary outcome. A third (34%) of those enrolled (n = 1004) are racial/ethnic minorities, 81% are not fully employed, 68% are Medicaid enrollees, 7% are uninsured, and 62% live in poverty. Mental health related quality of life (SF-12 MCS) is 2.5 standard deviations below the national mean. We hypothesize that patients randomized to Telepsychiatry Collaborative Care will have better outcomes than those randomized to Telepsychiatry Enhanced Referral because a higher proportion will engage in evidence-based treatment. [ABSTRACT FROM AUTHOR]

Multivariate pattern analysis (MVPA) of functional magnetic resonance imaging (fMRI) data has critically advanced the neuroanatomical understanding of affect processing in the human brain. Central to these advancements is the brain state, a temporally-succinct fMRI-derived pattern of neural activation, which serves as a processing unit. Establishing the brain state’s central role in affect processing, however, requires that it predicts multiple independent measures of affect. We employed MVPA-based regression to predict the valence and arousal properties of visual stimuli sampled from the International Affective Picture System (IAPS) along with the corollary skin conductance response (SCR) for demographically diverse healthy human participants (n = 19). We found that brain states significantly predicted the normative valence and arousal scores of the stimuli as well as the attendant individual SCRs. In contrast, SCRs significantly predicted arousal only. The prediction effect size of the brain state was more than three times greater than that of SCR. Moreover, neuroanatomical analysis of the regression parameters found remarkable agreement with regions long-established by fMRI univariate analyses in the emotion processing literature. Finally, geometric analysis of these parameters also found that the neuroanatomical encodings of valence and arousal are orthogonal as originally posited by the circumplex model of dimensional emotion. [ABSTRACT FROM AUTHOR]