Anxiety, Depression, and the Interpersonal Theory of Suicide in a Community Sample of Adults with Autism Spectrum Disorder

Florida State University

The present study examines occurrence of depression, anxiety, and suicidality in adults with autism spectrum disorder (ASD), relationships between social difficulties and mental health, and application of the Interpersonal Theory of Suicide in this population. Ninety-eight adults with ASD completed an online survey. Data were analyzed using bivariate correlations, independent samples t-tests, and simple mediational analyses. A substantial proportion reported a lifetime history of anxiety (63%), depression (55%), and suicide attempts (19%), as well as recent suicidal ideation (12%). Social difficulty was associated with higher psychiatric concerns. Thwarted belongingness and perceived burdensomeness were associated with social dissatisfaction, current suicidal ideation, and history of depression. Results suggest the need for widespread screening and intervention services for co-occurring psychiatric conditions in this population.

Publication
Archives of Suicide Research
Publication Year
2019

Stroke Survivors’ Perspectives on Post-Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home

University of Houston

Patients and caregivers have not typically been involved in the selection of a post-acute care (PAC) provider. In 2015, the Centers for Medicare & Medicaid Services proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision making among patients and their clinicians. The purpose of this study was to examine stroke survivors’ perspectives on their involvement in selecting a PAC provider and their goal setting and their satisfaction with the rehabilitation stay and their discharge advice for stroke survivors, prior to 2015. This qualitative study utilized semistructured interviews. Thematic content analysis was performed on interviews involving 18 stroke survivors (mean age = 68 years) related to their involvement in planning for their inpatient rehabilitation facility or skilled nursing facility stay, goal setting, and discharge needs. More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported that they were not involved in rehabilitation goal setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors, participants recommended additional information on health care services, interventions, and insurance coverage. Despite recommendations to include stroke patients in PAC selection and goal setting, many former inpatient rehabilitation facility and skilled nursing facility patients report not being involved in either aspect of care.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A273).

Publication
Journal of Neurologic Physical Therapy
Publication Year
2019

Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Black and Hispanic Patients

Miami University of Ohio

Understanding and addressing racial and ethnic disparities in the quality of post-acute care in skilled nursing facilities is an important health policy issue, particularly as the Medicare program initiates value-based payments for these institutions. Our final cohort included 649,187 Medicare beneficiaries in either the fee-for-service or Medicare Advantage programs, who were 65 and older and were admitted to a skilled nursing facility following an acute hospital stay, from 8,375 skilled nursing facilities. We examined the quality of care in skilled nursing facilities that disproportionately serve minority patients compared to non-Hispanic whites. Three measures, all calculated at the level of the facility, were used to assess quality of care in skilled nursing facilities: (a) 30-day rehospitalization rate; (b) successful discharge from the facility to the community; and (c) Medicare five-star quality ratings. We found that African American post-acute patients are highly concentrated in a small number of institutions, with 28% of facilities accounting for 80% of all post-acute admissions for African American patients. Similarly, just 20% of facilities accounted for 80% of all admissions for Hispanics. Skilled nursing facilities with higher fractions of African American patients had worse performance for three publicly reported quality measures: rehospitalization, successful discharge to the community, and the star rating indicator. Efforts to address disparities should focus attention on institutions that disproportionately serve minority patients and monitor unintended consequences of value-based payments to skilled nursing facilities.

Publication
Journal of Gerontology and Biological Sciences
Publication Year
2019

Social mobility: The necessary focus of St. Louis investment in Black males (Race and Opportunity Lab Brief Report No. 1)

Washington University in St. Louis

The tragic killing of Michael Brown on August 9, 2014, at the hand of Darren Wilson, a Ferguson, Missouri, police officer, further highlighted the long-standing disparities in health, education, employment, and overall well-being disproportionately burdening Black boys and young men in the St. Louis region (city and county). Since Brown’s death, we have observed a continuous environment of civil unrest and weakened confidence in the region’s welfare and economic future. An examination of reports and media discussions following the incidents in Ferguson reveal actions that have rightly centered on attending to structural determinants, racism, and equity (U.S. Department of Justice, 2015). Notably absent, however, was a central focus on the economic opportunity and overall well-being of Black boys and young men in the St. Louis region.

Publication
Center for Social Development
Publication Year
2019

Study protocol: A multisite trial of Work-Related Cognitive behavioral therapy for unemployed persons with social anxiety

University of Denver

This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.

Publication
Contemporary Clinical Trials Communications
Publication Year
2019

Value-driven attentional capture is modulated by the contents of working memory: An EEG study

Johns Hopkins University

Attention and working memory (WM) have previously been shown to interact closely when sensory information is being maintained. However, when non-sensory information is maintained in WM, the relationship between WM and sensory attention may be less strong. In the current study, we used electroencephalography to evaluate whether value-driven attentional capture (i.e., allocation of attention to a task-irrelevant feature previously associated with a reward) and its effects on either sensory or non-sensory WM performance might be greater than the effects of salient, non-reward-associated stimuli. In a training phase, 19 participants learned to associate a color with reward. Then, participants were presented with squares and encoded their locations into WM. Participants were instructed to convert the spatial locations either to another type of sensory representation or to an abstract, relational type of representation. During the WM delay period, task-irrelevant distractors, either previously-rewarded or non-rewarded, were presented, with a novel color distractor in the other hemifield. The results revealed lower alpha power and larger N2pc amplitude over posterior electrode sides contralateral to the previously rewarded color, compared to ipsilateral. These effects were mainly found during relational WM, compared to sensory WM, and only for the previously rewarded distractor color, compared to a previous non-rewarded target color or novel color. These effects were associated with modulations of WM performance. These results appear to reflect less capture of attention during maintenance of specific location information, and suggest that value-driven attentional capture can be mitigated as a function of the type of information maintained in WM.

Publication
Cognitive, Affective, & Behavioral Neuroscience
Publication Year
2019

From the Long Arm of the State to Eyes on the Street: How Poor African American Mothers Navigate Surveillance in the Social Safety Net

The University of Chicago

Drawing on interviews and ethnographic observation, this article examines how poor African American mothers in Houston, Texas, experience seeking help from the safety net, focusing on mothers’ perceptions and interpretation of the application process. Compared to welfare, seeking help from nonprofits and churches involved little formal surveillance and there was no punitive mechanism involved if mothers did not adhere to the minimal conditions required for participation. Mothers framed this as a preferable option to welfare, which they characterized as intrusive and punitive. However, the absence of formal surveillance practices in nonprofits did not mitigate the need to discern between the deserving and undeserving poor, nor did it ameliorate women’s sense of stigma around seeking help. Mothers were thus ambivalent about utilizing these resources. Further, it was mothers, not welfare caseworkers, who sometimes took on a surveilling role in these settings, scrutinizing themselves and other women and distancing themselves from those they deemed as undeserving. By taking up the same cultural logics of deservingness produced through welfare surveillance and applying them elsewhere, mothers were able to shore up their own sense of personhood and moral worthiness in an environment that threatened both. Yet, the strategies mothers used to distance themselves from others they cast as undeserving may unintentionally reproduce the notion that poor people must be scrutinized when seeking assistance. This logic reinforces the rationale for the surveillance mothers lament and resist in the welfare system.

Publication
Journal of Contemporary Ethnography
Publication Year
2019

A conceptual model of mental health service utilization among young adults at clinical high-risk for developing psychosis

New York University

Objective: Research has shown that young adults at clinical high risk (CHR) for developing psychosis have difficulties seeking, accessing, and staying engaged with mental health services. The present study explored perspectives on engagement with mental health services among young adults at CHR. Method: In-depth interviews were conducted with 30 participants at CHR, ages 18-30, from an Eastern U.S. state. Grounded theory methodology was used to analyzed qualitative data. Results: Six major categories emerged from the data reflecting participants’ perspectives of engagement with services. Contextual factors such as social, community, and online networks mattered to young adults, and individual factors such as level of awareness, stigma, emotions, and environmental factors emerged as critical. These factors suggested a conceptual model of service utilization among young adults at clinical high risk for developing psychosis that builds upon and extends existing conceptual frameworks of service use among young adults. Conclusion and Implications for Practice: A conceptual model of service utilization among young adults at CHR emerged from that data that can inform interventions aimed at improving engagement in services and reduce the amount of time young adults at CHR remain untreated for emerging psychological problems. Furthermore, this study highlights the unique contribution of mental health service use messages received from online networks and a possible relationship between hierarchical stigma and service use.

Publication
Psychiatric Rehabilitation Journal
Publication Year
2019

“What Does It Matter How We Define It?”: Exploring Definitions of DMST Among Service Providers and Victims/Survivors

The University of North Carolina at Chapel Hill

Domestic minor sex trafficking (DMST) is one of the most prevalent yet hidden forms of child abuse in the United States. DMST victims are diverse in age, race, and socioeconomic status. Many DMST victims are involved in state-level systems including the child welfare and/or juvenile justice system. State-level systems are federally mandated to identify children who are at risk or survivors of DMST. Unfortunately, DMST victim/survivor identification is inconsistent and often ineffective and is based on service providers’ and DMST victims’/survivors’ de facto definitions of DMST. This study presents exploratory, qualitative findings regarding service provider and DMST victim/survivor de facto definitions of DMST. In addition, it explores how these definitions are different from and/or similar to extant federal and state legal definitions. Content analysis revealed three key qualitative themes, including force/fraud/coercion, commercialization, and DMST as a form of child sexual abuse. Importantly, DMST victim/survivor and service provider definitions of DMST are different, which may be contributing to ineffective DMST victim/survivor identification protocols. Furthermore, there are several important differences between participants’ definitions of DMST and extant federal and state legal definitions. Implications for policy and practice are discussed.

Publication
Journal of Human Trafficking
Publication Year
2019

Increasing Schedule Predictability in Hourly Jobs: Results From a Randomized Experiment in a U.S. Retail Firm

University of Chicago

For hourly workers, schedule predictability often depends on how far in advance schedules are posted. This article presents results from a process evaluation of an intervention to increase advance schedule notice in hourly retail jobs. The authors open up the black box of implementation to understand managers’ experiences posting schedules further in advance and employees’ ability to anticipate working time. Although schedules were posted further in advance in treatment than control stores, the intervention did not improve schedule anticipation. The findings demonstrate the value of attending to the “dual agenda” of assessing workplace interventions from the perspective of both employers and employees.

Publication
Work and Occupations
Publication Year
2019

Optimism/hope associated with low anxiety in patients with advanced heart disease controlling for standardized cardiac confounders

Florida State University

Anxiety is an under-investigated comorbidity in heart disease patients. Optimism/hope is a character strength that indicates confidence or favorable expectation about the future. Previous research has consistently reported optimal health outcomes among optimists. However, many studies have lacked adjustment for medical confounders and/or used small clinical samples. To bridge this gap, we tested the hypothesis that optimism/hope was inversely related to anxiety in 400+ patients with advanced heart disease during the stressful waiting period prior to open-heart surgery. The findings supported the hypothesis after controlling for general health, illness impact, behavioral risks, and cardiac medical indices used by surgeons.

Publication
Journal of Health Psychology
Publication Year
2019

Identifying risk and protective factors related to depressive symptoms among Northern Plains American Indian women cancer survivors

University of Iowa

Cancer is the leading cause of death among American Indian and Alaska Native (AIAN) women, and depressive symptoms have been linked to higher mortality, but research on depressive symptoms among AIAN cancer patients has been scant. The purpose of this exploratory study was, using the Framework of Historical Oppression, Resilience, and Transcendence, to examine risk and protective factors related to depressive symptoms in American Indian (AI) women cancer survivors. We examined the relationships of adverse childhood experiences (ACE), perceived health status, resilience, and social support with depressive symptoms in Northern Plains AI women cancer survivors. We used a cross-sectional design with purposive sampling of 73 female cancer survivors (aged 18 years or older) between June 2014 and February 2015. Hierarchical multiple regression was used to test three sets of variables in relation to depressive symptoms: (1) sociodemographics, (2) risk factors (ACE and perceived health), and (3) protective factors (psychological resilience and social support). Approximately 47 percent of participants had probable depressive symptoms. Depressive symptoms were inversely associated with perceived health, psychological resilience, and social support. These results support bolstering existing social support among AI cancer patients and survivors as well as prevention and intervention efforts that strengthen resilience.

Publication
Women & Health
Publication Year
2019

“Using Crowd-Sourced Data to Explore Police-Related-Deaths in the United States (2000–2017): The Case of Fatal Encounters”

Princeton University

We evaluated the Fatal Encounters (FE) database as an open-source surveillance system for tracking police-related deaths (PRDs). We compared the coverage of FE data to several known government sources of police-related deaths and police homicide data. We also replicated incident selection from a recent review of the National Violent Death Reporting System. FE collected data on n = 23,578 PRDs from 2000–2017. A pilot study and ongoing data integration suggest greater coverage than extant data sets. Advantages of the FE data include circumstance of death specificity, incident geo-locations, identification of involved police-agencies, and near immediate availability of data. Disadvantages include a high rate of missingness for decedent race/ethnicity, potentially higher rates of missing incidents in older data, and the exclusion of more comprehensive police use-of-force and nonlethal use-of-force data—a critique applicable to all extant data sets. FE is the largest collection of PRDs in the United States and remains as the most likely source for historical trend comparisons and police-department level analyses of the causes of PRDs.

Publication
journal of Open Health Data
Publication Year
2019

Linking Fidelity of Implementation to Outcomes in Real-World Settings

New York University

This post is one in a series highlighting MDRC’s methodological work. Contributors discuss the refinement and practical use of research methods being employed across our organization.

Publication
MDRC
Publication Year
2019

Hybrid Models for Social Change: Legitimacy Among Community-Based Nonprofit Organizations

The University of Chicago

Community-based hybrid nonprofits, defined as organizations that combine social services with organizing or advocacy, play a crucial role at the neighborhood level. Considering their nonconformity to conventional organizational forms, they face specific challenges and advantages in achieving their combined advocacy and service mission. Using neo-institutional theory to provide context to our data, this qualitative study of 18 nonprofits working in one neighborhood examines how hybrid nonprofits are categorized as well as processes for legitimacy for these organizations. We find that at the neighborhood level, hybrid nonprofits are identified as “grassroots” by both hybrids and non-hybrids alike and draw on this “grassroots” identity to achieve legitimacy. We examine the settings for this “grassroots” legitimacy and its challenges and conditions. Through cultivating a better understanding of community-based hybrid nonprofits, this study adds to the literature on how nonprofits provide services and organize at the neighborhood level.

Publication
International Journal of Voluntary and Nonprofit Organizations 
Publication Year
2019

Unwanted Sexual Experiences in University Settings: Survivors’ Perspectives on Effective Prevention and Intervention Strategies

Johns Hopkins School of Nursing

Unwanted sexual incidents on university campuses pose significant public health and safety risks for students. This study explored survivors’ perspectives on secondary prevention of campus sexual assault and effective strategies for intervention programs for unwanted sexual incidents in university settings. Twenty-seven student survivors of unwanted sexual experiences participated in semi-structured in-depth interviews. Data were analyzed using thematic analysis and a constructionist perspective. The findings were contextualized using the ecological model. Barriers to reporting included concerns about one’s story not being believed, personal minimization of the incident, belief that no action will be taken after reporting, confidentiality concerns, and other perceived costs of reporting. Survivors provided valuable insight on potentially effective prevention and intervention strategies to address the problem of unwanted sexual incidents on university campuses. These findings may be useful for prevention and intervention policies and programs in university settings and for providers who assist survivors of unwanted sexual experiences.

Publication
Journal of Aggression, Maltreatment & Trauma
Publication Year
2019

Perceptions of belongingness and social support attenuate PTSD symptom severity among firefighters: A multistudy investigation

Florida State University

Firefighters experience high rates of posttraumatic stress disorder (PTSD). It is imperative to identify malleable factors that protect against the development of PTSD symptoms among this population. We examined whether perceptions of belongingness broadly (Study 1) and social support from supervisors, coworkers, and family/friends specifically (Study 2) are associated with lower PTSD symptom severity among firefighters. Study 1 included 840 U.S. firefighters (91.1% male); participants completed the Interpersonal Needs Questionnaire and PTSD Checklist—Civilian Version. Study 2 included 200 U.S. women firefighters exposed to a Criterion A traumatic event; participants completed the Generic Job Stress Questionnaire, Life Events Checklist for Diagnostic and Statistical Manual of Mental Disorders–5, and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–5. Linear regression analyses were conducted, adjusting for the number of years participants served as firefighters. Greater belongingness broadly (Study 1; b = −0.740, p < .001) as well as social support specifically (Study 2) from supervisors (b = −4.615, p < .001), coworkers (b = −4.465, p = .001), and family/friends (b = −3.206, p = .021) were associated with less severe PTSD symptoms. When all sources of social support were entered into a single model, only support from supervisors was significantly associated with lower overall PTSD symptom severity (b = −4.222, p = .004). Belongingness and social support may protect against the development of PTSD among firefighters. Supervisor social support may be particularly salubrious, suggesting that top-down mental wellness promotion within the fire service may be indicated to protect firefighters against PTSD.

Publication
Psychological Services
Publication Year
2019

Preferences for Communicating about Breast Cancer Screening Among Racially/Ethnically Diverse Older Women

University of Houston

Differences exist across breast cancer screening guidelines regarding frequency of screening and age of discontinuation for older women (≥70 years) at average risk for breast cancer. These differences highlight concerns about the benefits and harms of screening, and may negatively impact older women’s ability to make informed screening decisions. This study examined preferences for communicating about screening mammography among racially/ethnically diverse, older women. In-depth interviews were conducted with 59 women with no breast cancer history. Non-proportional quota sampling ensured roughly equal numbers on age (70–74 years, ≥75 years), race/ethnicity (non-Hispanic/Latina White, non-Hispanic/Latina Black, Hispanic/Latina), and education (≤high school diploma, >high school diploma). Interviews were audio-recorded, transcribed, and analyzed using NVivo 10. Thematic analyses revealed that rather than being told to get mammograms, participants wanted to hear about the benefits and harms of screening mammography, including overdiagnosis. Participants recommended that this information be communicated via physicians or other healthcare providers, included in brochures/pamphlets, and presented outside of clinical settings (e.g., in senior groups). Results were consistent regardless of participants’ age, race/ethnicity, or education. Findings revealed that older women desire information about the benefits and harms of screening mammography, and would prefer to learn this information through discussions with healthcare providers and multiple other formats.

Publication
Health Communication
Publication Year
2019

Child, Family, and Case Characteristics Associated With Reentry Into Out-of-Home Care Among Children and Youth Involved With Child Protection Services

University of Denver

Many children and youth with child protection services (CPS) involvement enter out-of-home care. The aims of this study were to examine rates of reentry and risk factors associated with reentry into out-of-home care among children and youth involved in the child protection (reported for abuse/neglect) and youth-in-conflict (reported for behavioral issues) programs. This study used administrative data from Colorado’s Statewide Automated Child Welfare Information System, which contains information on all children and youth who enter Colorado’s CPS. Of the 14,461 children and youth in the child protection program and 2,353 children and youth in the youth-in-conflict program, 14.7% and 35.1%, respectively, reentered into out-of-home care. Families’ prior history of CPS involvement and current CPS case characteristics better explained reentry into out-of-home care than child and family demographic characteristics alone. Understanding risk factors associated with reentry into out-of-home care is critical to inform the prevention of child maltreatment recurrence and ensure the safety, permanency, and well-being of children and youth.

Publication
Child Maltreatment
Publication Year
2019

Examining How Factors Associated with Patients, Physicians, Hospitals, and Surrounding Communities Affect Primary and Repeat Cesarean Delivery Through a Social-Ecological Lens

City University of New York School of Public Health

Childbirth is one of the most common reasons for hospitalization in the U.S., and Cesarean delivery (i.e., surgical childbirth) is costlier and has a higher likelihood of birth-related complications, maternal rehospitalization, and postpartum medical care utilization than vaginal delivery. The rate of Cesarean delivery in the United States (U.S.) has increased in recent years by over 60%, from 20.7% of all births in 1996 to 32.9% of all births in 2011. As Although this increasing trend of Cesarean delivery incidence has also been seen in other countries, the rate of Cesarean delivery has been rising more steadily within the U.S. than nearly anywhere else. While Cesarean delivery has been established as the safer delivery option for women with certain high-risk pregnancy complications that could put mother and/or baby in danger during vaginal delivery, the increasing rate of Cesarean delivery in the U.S. has not been accompanied with a concomitant decrease in maternal and neonatal morbidity and mortality. Therefore, it has been suggested that at least some Cesarean deliveries performed may be clinically unnecessary, and may put pregnant women at an avoidable higher risk of adverse health outcomes. Numerous factors across multiple levels of organization have been linked to influencing the likelihood of a pregnant woman receiving a Cesarean delivery. Firstly, a robust body of evidence has linked numerous clinical facets of pregnancy, either related to maternal health specifically (e.g., gestational diabetes) or fetal health presentations (e.g., fetal malpresentation), to increased Cesarean delivery likelihood. Additionally, certain sociodemographic characteristics, such as being of older age or being of black/African-American race, have been linked to a higher risk of having a Cesarean delivery. Numerous factors beyond the pregnant woman herself, however, have also been linked to the likelihood of a Cesarean delivery occurring, through a social-ecological framework. Practice-related (e.g., clinical experience, medical school location) and sociodemographic characteristics (e.g., age, gender) of the physician presiding over the birth have been shown to affect Cesarean delivery occurrence. Furthermore, aspects of the hospital where the birth occurs related to maternity health-related practices (e.g., vaginal birth after Cesarean occurrence) and ownership/affiliation (e.g., teaching status, private ownership) have been associated with influencing Cesarean delivery likelihood in numerous studies. Lastly, while there is a dearth of information as to how the health of communities where pregnant women live specifically affect Cesarean delivery likelihood, the sociodemographic profile of communities have been linked to other adverse pregnancy outcomes (e.g., preterm birth, low birthweight). As such, this dissertation research examined: 1) the role of sociodemographic and maternal health-related characteristics of communities related to overall and maternal health characterize in influencing Cesarean delivery incidence across ZIP codes in New York State (NYS); 2) how characteristics associated with pregnant women, physicians, hospitals and patient residential communities affect primary Cesarean delivery risk in pregnant women in NYS; and, 3) how the factors aforementioned in step 2 above affect repeat Cesarean delivery risk in pregnant women in NYS.

Publication
Cuny Academic Works
Publication Year
2019