Perceptions of relationship satisfaction and addictive behavior: Comparing pornography and marijuana use

Background and aims: Research indicates that excessive pornography use can negatively impact romantic relationships. However, it is unclear whether these negative outcomes are different than negative outcomes produced by other compulsive or addictive behaviors, such as drug use. This study compared perceptions of relationship outcomes from either a romantic partner's excessive marijuana or pornography use. Furthermore, this study experimentally manipulated four factors potentially related to perceptions of relationship satisfaction and addictive behavior. Methods: A total of 186 college-aged women read 16 scenarios describing heterosexual romantic relationships in which one partner used either pornography or marijuana. Each scenario varied on four variables: relationship commitment, secrecy of partner's behavior, frequency of partner's behavior, and context of partner's behavior. Results Results suggest that partner pornography and marijuana use are perceived to impact romantic relationships similarly and are influenced by similar factors, such as greater frequency, higher secrecy, and partner's availability for interaction. Conclusions: Such findings are consistent with recommendations by professionals that compulsive pornography use be considered worthy of treatment intervention

Gender and racial/ethnic disparities in rates of publishing and inclusion in scientific-review processes

Sexism and racism in academia have contributed to women and people of color being underrepresented at increasing levels of the academic hierarchy. We investigated whether people with socially marginalized identities experience disparities regarding rates of publishing and inclusion in the scientific-review process. Using a sample of academics in psychology departments at research-focused universities in the United States (n = 885), we found gender disparities for PhD holders and racial/ethnic disparities for graduate students. Specifically, female PhD holders and graduate students of color reported fewer publications and were less likely to be included in the scientific-review process compared with male PhD holders and White graduate students, respectively. Differences in research activity by gender and race/ethnicity in a contemporary sample of psychologists reflected a 'leaky pipeline' that persists in psychology department

Need, Access, and the Reach of Integrated Care: A Typology of Patients

Introduction: In this paper, we report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also describe the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). Method: A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. Results: Hierarchical and k-means cluster analyses revealed three groups: (1) Well-served patients, characterized by high perceived need for services, high service utilization, and low barriers to service use (40%); (2) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (3) Subclinical patients, characterized by low perceived need, low service utilization, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. Discussion: We found primary care patients could be grouped into three categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health settings. IBHC may be a promising approach for extending the reach of mental health care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service delivery model

Effects of Language Concordance and Interpreter Use on Therapeutic Alliance in Spanish-Speaking Integrated Behavioral Health Care Patients

The discrepancy between the growing number of Spanish speakers in the U.S. and the availability of bilingual providers creates a barrier to accessing quality mental health care. Use of interpreters provides one strategy for overcoming this linguistic barrier; however, concerns about whether sessions with interpreters, versus bilingual providers, impede therapeutic alliance remain. The current study explored associations between the use of interpreters and therapeutic alliance in a sample of 458 Spanish-speaking patients seen for integrated behavioral health visits at primary care clinics. Patients completed a brief (4 item) therapeutic alliance scale at their behavioral health appointment. In addition, to supplement the quantitative study data, a pilot study of 30 qualitative interviews was conducted with a new sample of 10 Spanish-speaking patients, 10 behavioral health consultants (BHCs), and 10 trained interpreters. Quantitative results showed that interpreter use did not relate to therapeutic alliance, even when controlling for relevant demographic variables. However, qualitative interviews suggested major themes regarding the relative benefits and challenges of using interpreters for patients, interpreters, and BHCs. In interviews, patients expressed a strong preference for bilingual providers. Benefits included greater privacy, sense of trust, and accuracy of communication. However, in their absence, interpreters were seen as increasing access to services and facilitating communication with providers, thereby addressing the behavioral health needs of patients with limited English proficiency. BHCs and interpreters emphasized the importance of interpreter training and a good collaborative relationship with interpreters to minimize negative effects on the quality of care

Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings

Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen’s d values \u3e .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos

Diagnoses, Intervention Strategies, and Rates of Functional Improvement in Integrated Behavioral Health Care Patients

Objective—Compared with more traditional mental health care, integrated behavioral health care (IBHC) offers greater access to services and earlier identification and intervention of behavioral and mental health difficulties. The current study examined demographic, diagnostic, and intervention factors that predict positive changes for IBHC patients. Method—Participants were 1,150 consecutive patients (mean age = 30.10 years, 66.6% female, 60.1% Hispanic, 47.9% uninsured) seen for IBHC services at 2 primary care clinics over a 34-month period. Patients presented with depressive (23.2%), anxiety (18.6%), adjustment (11.3%), and childhood externalizing (7.6%) disorders, with 25.7% of patients receiving no diagnosis. Results—The most commonly delivered interventions included behavioral activation (26.1%), behavioral medicine-specific consultation (14.6%), relaxation training (10.3%), and parent-management training (8.5%). There was high concordance between diagnoses and evidence-based intervention selection. We used latent growth curve modeling to explore predictors of baseline global assessment of functioning (GAF) and improvements in GAF across sessions, utilizing data from a subset of 117 patients who attended at least 3 behavioral health visits. Hispanic ethnicity and being insured predicted higher baseline GAF, while patients with an anxiety disorder had lower baseline GAF than patients with other diagnoses. Controlling for primary diagnosis, patients receiving behavioral activation or exposure therapy improved at faster rates than patients receiving other interventions. Demographic variables did not relate to rates of improvement. Conclusion—Results suggest even brief IBHC interventions can be focused, targeting specific patient concerns with evidence-based treatment components

Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort.

IntroductionSleep is essential for overall health and well-being, yet more than one-third of adults report inadequate sleep. The prevalence is higher among people with psoriasis, with up to 85.4% of the psoriatic population reporting sleep disruption. Poor sleep among psoriasis patients is particularly concerning because psoriasis is independently associated with many of the same comorbidities as sleep dysfunction, including cardiovascular disease, obesity, and depression. Given the high prevalence and serious consequences of disordered sleep in psoriasis, it is vital to understand the nature of sleep disturbance in this population. This study was designed to help meet this need by using survey data from Citizen Pscientist, an online patient portal developed by the National Psoriasis Foundation.MethodsOur analysis included 3118 participants who identified as having a diagnosis by a physician of psoriasis alone or psoriasis with psoriatic arthritis. Demographic information, psoriasis severity and duration, sleep apnea status, smoking and alcohol consumption, itch timing, and sleep characteristics were included. Two separate multivariate logistic regression models in STATA were used to determine whether the presence of psoriatic arthritis, age, gender, body mass index, comorbid sleep apnea, psoriasis severity, timing of worst itch, smoking status, or high-risk alcohol consumption were associated with sleep difficulty or low sleep quantity, defined by the American Academy of Sleep Medicine as less than 7 h of sleep per night on average.ResultsResults from the multivariate logistic regressions found that sleep difficulty was associated with psoriatic arthritis (OR 2.15, 95% CI [1.79-2.58]), female gender (2.03 [1.67-2.46]), obese body mass index (BMI ≥ 30) (1.25 [1.00-1.56]), sleep apnea (1.41 [1.07-1.86]), psoriasis severity of moderate (1.59 [1.30-1.94]) or severe (2.40 [1.87-3.08]), and smoking (1.60 [1.26-2.02]). Low sleep quantity was associated with obese BMI (1.62 [1.29-2.03]), sleep apnea (1.30 [1.01-1.68]), psoriasis severity of moderate (1.41 [1.16-1.72]) or severe (1.40 [1.11-1.76]), and smoking (1.62 [1.31-2.00]). Sleep difficulty and low sleep quantity were not associated with age, alcohol consumption, or timing of worst itch.ConclusionThese results are potentially meaningful in several aspects. We identify an important distinction between sleep difficulty and sleep quantity in psoriatic disease, whereby having psoriatic arthritis and being female are each associated with sleep difficulty despite no association with low sleep quantity. Furthermore, there is conflicting evidence from prior studies as to whether psoriasis severity is associated with sleep difficulty, but this well-powered, large study revealed a strong, graded relationship between psoriasis severity and both sleep difficulty and low sleep quantity. Overall, our results show that both sleep difficulty and low sleep quantity were associated with multiple factors in this analysis of a large psoriatic cohort. These findings suggest that dermatologists may gather clinically useful information by screening psoriatic patients for trouble sleeping and low sleep quantity to identify potential comorbidities and to more effectively guide disease management

Assessing the within-person variability of internal and external sexual consent

Sexual consent is often conceptualized as an internal willingness to engage in sexual activity, which can be communicated externally to a sexual partner. Internal sexual consent comprises feelings of physical response, safety/comfort, arousal, agreement/want, and readiness; external sexual consent includes communication cues that may be explicit or implicit and verbal or nonverbal. Most previous research on sexual consent has focused on between-person differences; little attention has been devoted to examining the within-person variation of sexual consent across time. We conducted a 28-day experience sampling methodology (ESM) study with a sample of adults (N = 113) to assess fluctuations in internal and external sexual consent across a given person’s sexual events. We found that more than 50% and up to 80% of the variance in sexual consent scores could be accounted for by within-person variability. The type of sexual behavior participants engaged in during a sexual event predicted their internal and external consent. Further, internal consent feelings predicted external consent communication. Overall, our findings provided initial evidence regarding the extent that situational contexts are relevant for sexual consent. ESM study designs may be used to further investigate the potential contextual, intrapersonal, and interpersonal factors associated with internal and external sexual consent

Developing valid and feasible measures of sexual consent for experience sampling methodology

Preliminary evidence indicates that people’s sexual consent (i.e., their willingness to engage in sexual activity and communication of that willingness) varies across time and context. Study designs that assess sexual consent at multiple time points (e.g., experience sampling methodology [ESM]) are needed to better understand the within-person variability of sexual consent. However, extant validated measures of sexual consent are not appropriate for ESM studies, which require shorter assessments due to the increased burden this methodology has on participants. As such, the goal of the present study was to develop ESM measures of sexual consent based on items that have previously been validated for use in cross-sectional surveys. We selected items that balanced face validity as evidenced by cognitive interviews (n = 10) and content validity as evidenced by experts’ ratings (n = 6). To assess the construct validity and feasibility of these items, we administered the selected ESM measures of sexual consent in a seven-day pilot study (n = 12). The results suggested that the ESM measures developed in the present study were a valid and feasible assessment of people’s experience-specific internal consent feelings and external consent communication. We conclude with recommendations for sex researchers interested in ESM