High Healthcare Utilization at the Onset of Medically Unexplained Symptoms

Objective: Patients with medically unexplained syndromes (MUS) often do not receive appropriate healthcare. A critical time for effective healthcare is the inception of MUS. The current study examined data from a prospective longitudinal study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans to understand the relationship of increasing physical symptom burden to healthcare utilization. Methods: Data was examined from a prospective study of OEF/OIF veterans assessed before and one year after deployment (n=335). Physical symptom burden was measured with the Patient Health Questionnaire (PHQ-15). Analyses were conducted with polynomial regression and response surface analysis (RSA). Results: Increases in physical symptom burden predicted greater healthcare utilization one year after deployment: primary care practitioner (slope = -0.26, F=4.07, p=0.04), specialist (slope = -.43, t=8.67, p=0.003), allied health therapy (e.g., physical therapy) (slope = -.41, t=5.71, p=0.02) and mental health (slope = -.32, F=4.04, p=0.05). There were no significant difference in utilization between those with consistently high levels and those with increases in physical symptom burden. Conclusion: This is the first prospective study to examine, and show, a relationship between onset of clinically significant physical symptoms and greater healthcare utilization. Our data suggest that patients with increasing physical symptom burden have the same level of healthcare as patients with chronic physical symptom burden. Needed next steps are to better understand the quality of care at inception and determine how to intervene so that recommended approaches to care are provided from the onset

Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

Background: The mutual maintenance model proposes that post-traumatic stress disorder (PTSD) symptoms and chronic physical symptoms have a bi-directional temporal relationship. Despite widespread support for this model, there are relatively few empirical tests of the model and these have primarily examined patients with a traumatic physical injury. Objective: To extend the assessment of this model, we examined the temporal relationship between PTSD and physical symptoms for military personnel deployed to combat (i.e., facing the risk of death) who were not evacuated for traumatic injury. Methods: The current study used a prospective, longitudinal design to understand the cross-lagged relationships between PTSD and physical symptoms before, immediately after, 3 months after, and 1 year after combat deployment. Results: The cross-lagged results showed physical symptoms at every time point were consistently related to greater PTSD symptoms at the subsequent time point. PTSD symptoms were related to subsequent physical symptoms, but only at one time-point with immediate post-deployment PTSD symptoms related to physical symptoms at three months after deployment. Conclusion: The findings extend prior work by providing evidence that PTSD and physical symptoms may be mutually maintaining even when there is not a severe traumatic physical injury

Using the common-sense model to understand health outcomes for medically unexplained symptoms: a meta-analysis

Consistent with the common-sense model of self-regulation, illness representations are considered the key to improving health outcomes for medically unexplained symptoms and illnesses (MUS). Which illness representations are related to outcomes and how they are related is not well understood. In response, we conducted a meta-analysis of the relationship between illness representations, self-management/coping, and health outcomes (perceived disease state, psychological distress, and quality of life) for patients with MUS. We reviewed 23 studies and found that threat-related illness representations and emotional representations were related to worse health outcomes and more negative coping (moderate to large effect). Generally, increases in negative coping mediated (with a moderate to large effect) the relationship of threat/emotional illness representations and health outcomes. Protective illness representations were related to better health outcomes, less use of negative coping and greater use of positive coping (small to moderate effect). The relationship of protective illness representations to better health outcomes was mediated by decreases in negative coping (moderate to large effect) and increases in positive coping (moderate effect). Perceiving a psychological cause to the MUS was related to more negative health outcomes (moderate to large effect) and more negative emotional coping (small effect). The relationship of perceiving a psychological cause and more negative health outcomes was mediated by increases in negative emotional coping. Improving our understanding of how illness representations impact health outcomes can inform efforts to improve treatments for MUS. Our results suggest behavioural treatments should focus on reducing threat-related illness representations and negative coping

High healthcare utilization near the onset of medically unexplained symptoms

Objective: Patients with medically unexplained syndromes (MUS) often do not receive appropriate healthcare. A critical time for effective healthcare is the inception of MUS. The current study examined data from a prospective longitudinal study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) soldiers to understand the relationship of increasing physical symptom burden to healthcare utilization. Methods: Data was examined from a prospective study of OEF/OIF soldiers assessed before and one year after deployment (n = 336). Physical symptom burden was measured with the Patient Health Questionnaire (PHQ-15). Analyses were conducted with polynomial regression and response surface analysis (RSA). Results: Increases in physical symptom burden predicted greater healthcare utilization one year after deployment: primary care practitioner (slope = − 0.26, F = 4.07, p = 0.04), specialist (slope = − 0.43, F = 8.67, p = 0.003), allied health therapy (e.g., physical therapy) (slope = − 0.41, F = 5.71, p = 0.02) and mental health (slope = − 0.32, F = 4.04, p = 0.05). There were no significant difference in utilization between those with consistently high levels and those with increases in physical symptom burden. Conclusion: This is the first prospective study to examine, and show, a relationship between onset of clinically significant physical symptoms and greater healthcare utilization. Our data suggest that patients with increasing physical symptom burden have the same level of healthcare as patients with chronic physical symptom burden. Needed next steps are to better understand the quality of care at inception and determine how to intervene so that recommended approaches to care are provided from the onset

Combined Forward-Backward Asymmetry Measurements in Top-Antitop Quark Production at the Tevatron

The CDF and D0 experiments at the Fermilab Tevatron have measured the asymmetry between yields of forward- and backward-produced top and antitop quarks based on their rapidity difference and the asymmetry between their decay leptons. These measurements use the full data sets collected in proton-antiproton collisions at a center-of-mass energy of $\sqrt s =1.96$ TeV. We report the results of combinations of the inclusive asymmetries and their differential dependencies on relevant kinematic quantities. The combined inclusive asymmetry is $A_{\mathrm{FB}}^{t\bar{t}} = 0.128 \pm 0.025$. The combined inclusive and differential asymmetries are consistent with recent standard model predictions

Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

Background: The mutual maintenance model proposes that post-traumatic stress disorder (PTSD) symptoms and chronic physical symptoms have a bi-directional temporal relationship. Despite widespread support for this model, there are relatively few empirical tests of the model and these have primarily examined patients with a traumatic physical injury. Objective: To extend the assessment of this model, we examined the temporal relationship between PTSD and physical symptoms for military personnel deployed to combat (i.e., facing the risk of death) who were not evacuated for traumatic injury. Methods: The current study used a prospective, longitudinal design to understand the cross-lagged relationships between PTSD and physical symptoms before, immediately after, 3 months after, and 1 year after combat deployment. Results: The cross-lagged results showed physical symptoms at every time point were consistently related to greater PTSD symptoms at the subsequent time point. PTSD symptoms were related to subsequent physical symptoms, but only at one time-point with immediate post-deployment PTSD symptoms related to physical symptoms at three months after deployment. Conclusion: The findings extend prior work by providing evidence that PTSD and physical symptoms may be mutually maintaining even when there is not a severe traumatic physical injury.This article is published as McAndrew, Lisa M., Shou-En Lu, L. Alison Phillips, Kieran Maestro, and Karen S. Quigley. "Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment." European Journal of Psychotraumatology 10, no. 1 (2019): 1608717. DOI: 10.1080/20008198.2019.1608717.</p

Using the common-sense model to understand health outcomes for medically unexplained symptoms: a meta-analysis

Consistent with the common-sense model of self-regulation, illness representations are considered the key to improving health outcomes for medically unexplained symptoms and illnesses (MUS). Which illness representations are related to outcomes and how they are related is not well understood. In response, we conducted a meta-analysis of the relationship between illness representations, self-management/coping, and health outcomes (perceived disease state, psychological distress, and quality of life) for patients with MUS. We reviewed 23 studies and found that threat-related illness representations and emotional representations were related to worse health outcomes and more negative coping (moderate to large effect). Generally, increases in negative coping mediated (with a moderate to large effect) the relationship of threat/emotional illness representations and health outcomes. Protective illness representations were related to better health outcomes, less use of negative coping and greater use of positive coping (small to moderate effect). The relationship of protective illness representations to better health outcomes was mediated by decreases in negative coping (moderate to large effect) and increases in positive coping (moderate effect). Perceiving a psychological cause to the MUS was related to more negative health outcomes (moderate to large effect) and more negative emotional coping (small effect). The relationship of perceiving a psychological cause and more negative health outcomes was mediated by increases in negative emotional coping. Improving our understanding of how illness representations impact health outcomes can inform efforts to improve treatments for MUS. Our results suggest behavioural treatments should focus on reducing threat-related illness representations and negative coping.This article is published as McAndrew, Lisa M., Marcus Crede, Kieran Maestro, Sarah Slotkin, Justin Kimber, and L. Alison Phillips. "Using the common-sense model to understand health outcomes for medically unexplained symptoms: a meta-analysis." Health Psychology Review 13, no. 4 (2019): 427-446. DOI: 10.1080/17437199.2018.1521730.</p

High healthcare utilization near the onset of medically unexplained symptoms

Objective: Patients with medically unexplained syndromes (MUS) often do not receive appropriate healthcare. A critical time for effective healthcare is the inception of MUS. The current study examined data from a prospective longitudinal study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) soldiers to understand the relationship of increasing physical symptom burden to healthcare utilization. Methods: Data was examined from a prospective study of OEF/OIF soldiers assessed before and one year after deployment (n = 336). Physical symptom burden was measured with the Patient Health Questionnaire (PHQ-15). Analyses were conducted with polynomial regression and response surface analysis (RSA). Results: Increases in physical symptom burden predicted greater healthcare utilization one year after deployment: primary care practitioner (slope = − 0.26, F = 4.07, p = 0.04), specialist (slope = − 0.43, F = 8.67, p = 0.003), allied health therapy (e.g., physical therapy) (slope = − 0.41, F = 5.71, p = 0.02) and mental health (slope = − 0.32, F = 4.04, p = 0.05). There were no significant difference in utilization between those with consistently high levels and those with increases in physical symptom burden. Conclusion: This is the first prospective study to examine, and show, a relationship between onset of clinically significant physical symptoms and greater healthcare utilization. Our data suggest that patients with increasing physical symptom burden have the same level of healthcare as patients with chronic physical symptom burden. Needed next steps are to better understand the quality of care at inception and determine how to intervene so that recommended approaches to care are provided from the onset.This article is published as McAndrew, Lisa M., L. Alison Phillips, Drew A. Helmer, Kieran Maestro, Charles C. Engel, Lauren M. Greenberg, Nicole Anastasides, and Karen S. Quigley. "High healthcare utilization near the onset of medically unexplained symptoms." Journal of Psychosomatic Research 98 (2017): 98-105. DOI: 10.1016/j.jpsychores.2017.05.001.</p

Cultural Incongruity Predicts Adjustment to College for Student Veterans

Little is known about what predicts student service members’ and veterans’ (SSM/V) adjustment to college. In qualitative research, SSM/V report feeling they do not belong and are misunderstood by college communities, a phenomenon that counseling psychologists call cultural incongruity. The goal of the current study was to quantitatively examine the relationship between cultural incongruity and adjustment to college. We surveyed 814 SSM/V about their adjustment to college using the Student Adaptation to College Questionnaire. Cultural incongruity was operationalized in two ways: feelings of not belonging were measured via direct report and the association with adjustment to college assessed with regression. Feelings of being misunderstood about academic barriers were assessed by comparing SSM/V’s perceptions of academic barriers and SSM/V’s perceptions of how others view the SSM/V’s academic barriers and the association with adjustment was assessed using polynomial regression and response surface analysis. Cultural incongruity predicted adjustment to college. After controlling for other known predictors, feelings of not belonging accounted for 18% of the variance in adjustment to college. Polynomial regression showed that feeling understood about academic barriers protected against the negative impact of the barrier on adjustment to college. Cultural incongruity predicts adjustment to college for SSM/V. Helping SSM/V feel their unique barriers to college adjustment are understood may blunt the impact of these barriers.This article is published as McAndrew, Lisa M., Sarah Slotkin, Justin Kimber, Kieran Maestro, L. Alison Phillips, Jessica L. Martin, Marcus Credé, and Austin Eklund. "Cultural incongruity predicts adjustment to college for student veterans." Journal of Counseling Psychology 66, no. 6 (2019): 678. DOI: 10.1037/cou0000363.</p