Methodological considerations for collecting and analyzing data on multiply marginalized psychology trainees with disabilities.

OBJECTIVE/PURPOSE: Historically, psychology trainees from marginalized communities have been underrepresented both as researchers and as participants in research on trainee experiences and outcomes. The current research can be used to develop evidence-based strategies to understand and improve the recruitment, retention, advancement, and overall training experiences of trainees with marginalized identities. METHOD: We review the existing literature on the experiences of psychology trainees, particularly that focused on trainees from marginalized backgrounds. RESULTS: Quantitative, qualitative, and archival data collection and analysis methods each carry their own benefits and limitations, which must be considered and addressed intentionally to optimize the impact of research findings for multiply marginalized individuals. Mixed methods approaches are also discussed. Matching each limitation with a research design strategy is recommended, including the use of sample weights from population archival data to contextualize sample results, incorporating flexibility for reasonable accommodations for intensive qualitative studies, and other strategies. CONCLUSIONS/IMPLICATIONS: We provide guidance on selecting a methodology based on specific research and dissemination goals within this area and discuss implications and recommendations for both rehabilitation psychology specifically and the field more broadly. Training programs, governing bodies, faculty, researchers, and other invested parties have shared accountability to deliver diverse, equitable, and inclusive education and training experiences, and conducting high-quality research on the experiences of multiply marginalized trainees, including those with disabilities, is a key component of that process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychology consultation patterns in a medical intensive care unit: A brief report.

PURPOSE/OBJECTIVE: Intensive care unit (ICU) survivors frequently experience long-lasting mental health, cognitive, and physiologic challenges. Psychologists have a role in providing interventions to reduce patient distress during critical illness and improve outcomes. There is limited data regarding psychology consultations in the ICU. This brief report characterizes psychology consultations in a medical intensive care unit (MICU) in an academic medical center. METHOD: Psychology consultations were prospectively tracked, with patient-related data retrospectively collected and analyzed. RESULTS: A total of 79 consecutive psychology consultations occurred at mean of 8 ± 6 days after MICU admission. Reasons for consultation were patient emotional distress (56%), rehabilitation therapy engagement (24%), family engagement (13%), cognitive disturbance (4%), and pain (4%). Patient characteristics were: mean age 56 ± 15 years, 54% women, 53% White, and 34% with psychiatric comorbidity at MICU admission. Patients referred for consultation had a longer MICU length of stay than the total MICU population (12 ± 9 days vs. 4 ± 6 days, p < .01). For consultations for emotional distress compared with limited rehabilitation therapy engagement, patient demographic characteristics were similar, with the exception of women (vs. men) being more commonly consulted for emotional distress (64 vs. 26%, p = .01). CONCLUSIONS: Patients with a longer MICU stay more commonly had a rehabilitation psychology consultation request, typically to provide support for emotional distress or engagement in rehabilitation therapy. Future research should evaluate the effectiveness of psychology interventions in the ICU. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness.

Black consumers with serious mental illness (SMI) face significant challenges in obtaining quality mental health care and are at risk for experiencing significant disparities in mental health care outcomes, including recovery from mental illness. Patient-provider interactions may partly contribute to this disparity. The purpose of the current study was to understand the effects of race, psychosis, and therapeutic alliance on mental health recovery orientation among Veterans with SMI. Participants were Veterans who had an SMI being treated at two Veteran Affairs outpatient mental health clinics by a psychiatrist or nurse practitioner. Participants completed the Behavior and Symptom Identification Scale (BASIS-24), Mental Health Recovery Measure, and patient-report Scale to Assess the Therapeutic Relationship (STAR-P) which includes three subscales: positive collaboration, positive clinician input, and non-supportive clinician input. Regression analyses were used to determine interactive effects of race, psychosis severity, and therapeutic alliance variables. The sample was 226 Veterans (50% black, 50% white). Black participants were slightly older (p < .05), had higher baseline psychosis (p < .05), higher mental health recovery (p < .05), and perceived less non-supportive clinician input (p < .01) than white participants. Regression analyses indicated a significant three-way interaction among race, psychosis, and positive collaboration (p < .01). Greater positive collaboration attenuated the negative effect of higher levels of psychosis on mental health recovery orientation for black participants. Conversely, for white participants, positive collaboration had little effect on the negative relationship between psychosis severity and mental health recovery orientation. Increased levels of psychosis may inhibit patients' perceptions of their ability to recover from SMI. However, for black participants, positive collaboration with mental health providers may moderate the effects of psychotic symptomatology.

Psychology in patient-centered medical homes: Reducing health disparities and promoting health equity.

With persisting health disparities contributing to a disproportionate impact on the health and well-being of socially disenfranchised and medically underserved populations, the emerging patient-centered medical home (PCMH) model offers promise in bridging the health disparities divide. Because behavioral health care is an important component of the PCMH, psychologists have significant opportunity to contribute to the development and implementation of PCMH services in settings that primarily serve medically underserved communities. In this article, after briefly defining the PCMH model and its role in clinical settings for medically underserved populations for whom health disparities are present, roles of psychologists as interprofessional collaborators on PCMH medical care teams are explored. Next, the constellation of competencies that position psychologists as behavioral health specialists to contribute to PCMH care teams for medically underserved groups are characterized. The article concludes with reflections on the prospects for psychologists to make tangible contributions as health care team members toward reducing health disparities and promoting health equity in patients served in the PCMH. (PsycINFO Database Record

Meeting evolving workforce needs: Preparing psychologists for leadership in the patient-centered medical home.

Behavioral health integration in the patient-centered medical home (PCMH) offers opportunities for psychologists to play leadership roles. Widespread practice transition to PCMH models of care are expected to substantially impact the psychology workforce. Conservative estimates suggest that approximately 90% of the 93,000 clinically trained psychologists would be required to meet projected need in these settings. This has implications for how health service psychologists are trained. In addition to relevant clinical competencies, they must be versed in system/program development, administration, evaluation, quality improvement, and interprofessional collaboration. Herein, the need to introduce psychologists to the many potential roles in the PCMH is underscored. Inherent to effective work in the PCMH is the synthesis of professional competences in addition to those traditionally included in psychology training. We offer a competency-based PCMH training framework adapted from levels of intensity in the Education and Training Guidelines: A taxonomy for education and training in professional psychology health service specialties (American Psychological Association, 2012). Practical examples of training activities, taking into account available programmatic resources, also are presented. (PsycINFO Database Record

Examining the Influence of Measures of Adiposity on Cognitive Function in Middle Age and Older African Americans.

The objectives of the study were to examine whether measures of total obesity (body mass index [BMI]) and central obesity (waist circumference [WC] and waist-to-hip ratio [WHR]) are associated with cognitive function in African Americans, and whether sex moderates these associations. A sample of 194 African Americans, with a mean age of 58.97 years, completed a battery of cognitive tests and a self-reported health questionnaire. Height, weight, waist and hip circumference, and blood pressure were assessed. Linear regression analyses were run. Results suggested lower performance on measures of verbal fluency and complex attention/cognitive flexibility was accounted for by higher levels of central adiposity. Among men, higher WHR was more strongly related to complex attention/cognitive flexibility performance, but for women, WC was a salient predictor. Higher BMI was associated with poorer verbal memory performance among men, but poorer nonverbal memory performance among women. Findings suggest a need for healthy lifestyle interventions for African Americans to maintain healthy weight and cognitive function.

Executive function and negative eating behaviors in severely obese African Americans.

OBJECTIVE: African Americans are disparately impacted by severe obesity. Low socioeconomic status and psychosocial risk factors help to explain this disparity; however, few studies have examined the role of negative eating behaviors or the influence of executive function on negative eating behaviors in this population. The objective was to examine the association between executive function (ie, inhibition and set shifting) and negative eating behaviors in severely obese African Americans. PARTICIPANTS: Forty-seven African Americans who met criteria for severe obesity participated. DESIGN AND SETTING: Data were analyzed from a cross-sectional study entitled Stress and Psychoneuroimmunological Factors in Renal Health and Disease. The mean age of participants was 45.7 years (SD = 10.8) and the mean educational attainment was 13 years (SD = 2.1). MAIN OUTCOME MEASURES: Participants completed the Wisconsin Card Sorting Task, the Stroop Color-Word Test, and the Eating Behavior Patterns Questionnaire. RESULTS: Correlation results suggested poorer inhibition was associated with greater self-reported emotional eating and snacking on sweets. Subsequent hierarchical regression analyses confirmed the inverse relations between inhibition, emotional eating, and snacking on sweets, after controlling for age, sex, years of education, and depression. CONCLUSIONS: Reduced inhibition may be an important risk factor for negative eating behaviors and subsequent obesity in this population. Interventions aimed at increasing inhibition and self-regulation in this at-risk group are warranted.

Dispositional depression and hostility are associated with inflammatory markers of cardiovascular disease in African Americans.

Prior research has demonstrated that state depressive symptoms and hostility can modulate inflammatory immune responses and directly contribute to cardiovascular disease (CVD) onset and development. Previous studies have not considered the contribution of dispositional depressive symptoms to the inflammatory process. They have also largely excluded African Americans, despite their disproportionate risk for CVD. The first aim of the study was to examine the impact of state and dispositional depression and hostility on CVD-associated inflammatory biomarkers interleukin-6 (IL-6) and C-reactive protein (CRP) in an African American sample. The second aim was to examine synergistic influences of hostility and state and dispositional depression on IL-6 and CRP. The final aim was to examine whether the relations between state and dispositional depression, hostility, IL-6, and CRP varied as a function of gender and education. Anthropometric measures, blood serum samples, and psychosocial data were collected from 198 African Americans from the Washington, DC metropolitan area. Hierarchical and stepwise regression analyses indicated that (1) increased levels of hostility were associated with increased levels of CRP; (2) hostility and IL-6 were more strongly associated among participants with lower educational attainment; and (3) dispositional depression and CRP were more strongly associated among participants with greater hostility and lower educational attainment. Findings suggest that enduring personality dispositions, such as dispositional depression and hostility, are critical to a thorough assessment of cardiovascular profiles in African Americans. Future studies should investigate causal pathways that link depressive and hostile personality styles to inflammatory activity for African American men and women.

Psychometric properties of the Cook Medley hostility scale and its association with inflammatory markers in African Americans.

Dispositional hostility as measured by the Cook Medley Hostility (Ho) Scale has been associated with inflammation and cardiovascular disease (CVD) risk. There is evidence that suggests that factors of hostility are more useful in predicting poor cardiovascular health outcomes than a single hostility construct. The purpose of this study was to investigate the latent factors of hostility and their association with inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) in an African-American community sample. This racial/ethnic group has been largely excluded from this line of research despite their disproportionate burden of CVD and its risk factors. Blood samples for plasma IL-6 and CRP were collected on the same day the Ho Scale was administered. Plasma IL-6 and CRP levels were determined using enzymatic-linked immunosorbent assay. Confirmatory factor analysis revealed three latent main factors of hostility: Neuroticism, Manichaeism and Moral Primitiveness, and seven intermediary subfactors. Of the subfactors, hostile affect was significantly associated with greater CRP levels and predatory self interest was significantly associated with greater IL-6 levels. Findings suggest that African Americans have a unique pattern of hostility and two latent subfactors are associated with a marker of CVD. Based on the findings, future studies should aim to further delineate how hostility influences health outcomes in African Americans.