Telephone-Delivered Cognitive Behavioral Therapy for Insomnia in Patients with Cancer: A Randomized Controlled Trial

This study examined the efficacy and feasibility of a brief telephone-delivered CBT-I (TeleCBT-I) intervention in cancer patients compared to a control group. The study used a randomized controlled trial design. The TeleCBT-I program consisted of a brief four-week CBT-I program adapted for cancer patients. Patients completed assessment measures at pre-treatment, post-treatment and one-month follow-up. Out of 184 patients screened, 39 were randomly assigned, and 35 (TeleCBT-I, n = 19; Control, n = 16) completed pre- and post-treatment measures and were included in the analyses. Compared to control group, the TeleCBT-I group reported decreased insomnia severity symptoms (p \u3c .014), improved sleep quality (p \u3c .023), and reduced dysfunctional beliefs about sleep (p = .039) at post-treatment with sustained treatment effects at one-month follow-up. Sleep measures yielded large effect sizes (Hedges\u27 g, 0.84-2.7). Although the TeleCBT-I group indicated improvements in fatigue, general functioning, physical well-being, functional well-being, and physical quality of life, effects at follow-up were observed only for fatigue, functional well-being and physical quality of life. No effects were found on depression at any of the time points. In terms of feasibility, TeleCBT-I demonstrated high adherence, high homework completion and high overall satisfaction. These results advance the empirical evidence of CBT-I in cancer patients and support the use of telephone-delivered CBT-I to widely disseminate and implement among patients with cancer

A Pilot Trial of Universal School-Based Mental Health Screening in El Salvador: Traumatic Stress in an Underresourced School Environment

Salvadoran youth have an elevated risk of trauma exposure and related mental health problems. However, investigations of childhood trauma exposure and mental health sequelae in El Salvador are limited. The present study aimed to (a) explore the prevalence of exposure to potentially traumatic events and symptoms of posttraumatic stress, anxiety, and depression and (b) evaluate the associations between specific trauma types and emotional functioning among Salvadoran youth. A total of 1,296 youth aged 8–21 years from seven public schools completed self-report measures of trauma exposure, posttraumatic stress symptoms (PTSS), anxiety, and depression. Participants reported high levels of trauma exposure, endorsing an average of 3.62 (SD = 2.32) trauma types. In total, 34.5% of participants reported clinically elevated PTSS; fewer youths reported elevated depressive (8.7%) and anxiety symptoms (8.6%). Although boys reported exposure to more trauma types than girls, d = 0.22, girls were more likely to endorse elevated PTSS, V = .11; anxiety, V = .06; and depression, V = .10. Adolescents reported exposure to more trauma types than younger children, d = 0.23, and were more likely to endorse elevated PTSS, V = .07; anxiety, V = .13; and depression, V = .16. Undergoing a frightening medical procedure, OR = 2.30; female sex, OR = 1.92; witnessing domestic violence, OR = 1.70; and experiencing war between gangs, OR = 1.61, were strong predictors of elevated PTSS. This broad, school-based screening was a critical step toward better understanding the rate of trauma exposure and trauma-related symptoms among Salvadoran youth

Health and Wellness Photovoice Project: Engaging Consumers With Serious Mental Illness in Health Care Interventions

People with serious mental illnesses (SMI) are at increased risk for cardiovascular disease and premature mortality. We used photovoice in two supportive housing agencies to engage consumers with SMI to inform the implementation of health care interventions. Sixteen consumers participated in six weekly sessions in which they took photographs about their health and discussed the meanings of these photographs in individual interviews and group sessions. We identified several implementation themes related to consumers’ preferences. Peer-based approaches were preferred more than clinician-driven models. Participants expressed a desire to learn practical skills through hands-on activities to modify health behaviors. Consumers expressed a desire to increase their physical activity. Participants revealed in their photographs and narratives the important role that communities’ food environments play in shaping eating habits. In this article, we show how photovoice can generate valuable community knowledge to inform the translation of health care interventions in supportive housing agencies

Examination of Attitude-Behavior Discrepancy in Familism and its Relation to Symptoms of Depression among Latinos

This research examines the discrepancy between attitudinal and behavioral familism and its relation to depressive symptoms. The overarching hypothesis was that discrepancy between family values and the actual experiences of those values influences psychological health. Previous research has primarily focused on self-report measures of familial attitudes, and not whether these values are actually experienced by the individual. To address this gap in the literature, this study developed a new behavioral familism scale. A total of 431 Latinos and non-Latino Whites from a large university in Florida participated in this study. Overall, the new behavioral familism scale demonstrated good psychometric properties. Test-retest reliability was established with a sample of 109 participants who completed the measures twice, two weeks apart. Test-retest reliability was high (r = .85) and excellent (ICC = .92) for the total composite score. The internal consistency was examined with a sample of 323 participants. Results showed good internal consistency for the total composite score (Cronbach Alpha = .85). The convergent validity was evaluated with another measure of familism, as well as measures of perceived social support and family environment. Correlation analyses indicated significant positive relationships with all related measures in the expected direction. The divergent validity was evaluated with measures of social desirability and acculturation. Correlation analyses indicated non-significant and low relationships with both measures as expected. Polynomial regression and response surface analyses demonstrated that discrepancy between attitudinal and behavioral familism scores predicted symptoms of depression in a sample of 118 Latinos. Specifically, this study found that depressive symptoms increased as the discrepancy between the total composite scores of attitudinal and behavioral familism increased in either direction. Furthermore, the discrepancy in the family interconnectedness subscale indicated that symptoms of depression increased when attitudinal family interconnectedness was higher than behavioral family interconnectedness, but not when the relationship was reversed. Discrepancies between attitudinal and behavioral familism total composite scores and subscales did not predict symptoms of anxiety. These findings highlight the importance of understanding the role that culturally specific variables, such as familism, play in the psychological health of Latinos

The Development Of The Dsm-5 Cultural Formulation Interview-Fidelity Instrument (Cfi-Fi): A Pilot Study

This paper reports on the development of the Cultural Formulation Interview-Fidelity Instrument (CFI-FI) which assesses clinician fidelity to the DSM-5 Cultural Formulation Interview (CFI). The CFI consists of a manualized set of standard questions that can precede every psychiatric evaluation. It is based on the DSM-IV Outline for Cultural Formulation, the cross-cultural assessment with the most evidence in psychiatric training. Using the New York sample of the DSM-5 CFI field trial, two independent raters created and finalized items for the CFI-FI based on six audio-taped and transcribed interviews. The raters then used the final CFI-FI to rate the remaining 23 interviews. Inter-rater reliability ranged from.73 to 1 for adherence items and.52 to 1 for competence items. The development of the CFI-FI can help researchers and administrators determine whether the CFI has been implemented with fidelity, permitting future intervention research. © Meharry Medical College

Developing Research Collaborations In An Academic Clinical Setting: Challenges And Lessons Learned

Research collaboration in “real world” practice settings may enhance the meaningfulness of the findings and reduce barriers to implementation of novel intervention strategies. This study describes an initiative to integrate research into a hospital-based outpatient psychiatric clinic within an academic medical center, focusing on collaborative processes across three research projects. We report on the varied outcomes of the projects and utilize data from two focus groups to identify the key elements that contributed to the challenges and successes. We identify barriers to practice-research collaborations that emerged even when the initial circumstances of the partnership were favorable. These barriers include the presence of varied agendas across clinicians and investigators, resource constraints, limited staff buy-in, and staff turnover. In highlighting the lessons learned in this collaborative process, we hope to facilitate successful partnerships in other clinical settings

Toward A Cultural Adaptation Of Pharmacotherapy: Latino Views Of Depression And Antidepressant Therapy

Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) show low engagement in antidepressant therapy, whether engagement is defined as pharmacotherapy access, medication initiation, pill-taking, or treatment retention. One potential reason for this disparity in depression care is the low cultural congruence of pharmacotherapy for this population. To examine Latinos’ views of depression and antidepressant therapy, we conducted qualitative interviews with 30 Latino outpatients initiating antidepressants prior to their first treatment visit using the semistructured Treatment Adherence and Retention Questionnaire. These baseline interviews were randomly selected from data collected for a randomized controlled trial testing a novel intervention to enhance engagement by depressed Latino outpatients. Participant narratives were analyzed using open coding and the iterative analytical approach derived from grounded theory. Patient views about depression addressed stigmatizing views held by others in their social circle. Most participants directly refuted these views by providing alternate explanations to depression experiences. Antidepressant therapy narratives also revealed marked stigmatization, but participants tended not to refute these views. Instead, patients expressed concerns about antidepressants and showed marked ambivalence about seeking psychiatric care. Participants, however, did suggest ways in which clinicians and patients might collaborate to address their concerns about antidepressants. Some cultural views, such as concerns about addiction to or dependence on medication, may be negotiable barriers to treatment. Prescribing clinicians should address cultural views and concerns in order to improve Latino engagement in antidepressant therapy. © 2015, SAGE Publications. All rights reserved

Resources and Recommendations for Engaging Children and Adolescents in Telemental Health Interventions During COVID-19 and Beyond

The rapid spread of the novel coronavirus (COVID-19) in the past several months has created unprecedented challenges across multiple domains of life. In an attempt to slow the spread of the virus and minimize the dangers associated with overburdening health care systems, authorities across the United States have implemented physical distancing measures, asking people to stay at home and avoid nonessential travel and outings. In order to continue providing services while adhering to physical distancing measures, many mental health care providers have transitioned to providing therapy via telehealth technology, but are unsure of how to adapt procedures and materials. In particular, youth-focused providers may be uncertain how to shift therapy online while keeping children and adolescents actively engaged during sessions. We aim to provide guidance to youth focused practitioners who are considering transitioning therapy services to a telehealth format. We have developed these recommendations based on our experience providing home- and school-based telemental health services, as well as training predoctoral clinical psychology interns to do so through the Telehealth Outreach Program (TOP) within the mental Health Disparities and Diversity Program at the medical University of South Carolina (mUSC). Although TOP was not formally established until 2015, practitioners from mUSC have been delivering evidence-based mental health treatments to underserved children and adolescents through telehealth technology since 2011 (see Jones et al., 2014, and Stewart, Orengo-Aguayo, Gilmore, et al., 2017, for more detail)