Intolerance of Uncertainty, Looming Cognitive Style, and Avoidant Coping as Predictors of Anxiety and Depression During COVID-19: a Longitudinal Study.

The COVID-19 pandemic has resulted in increased distress and uncertainty. Understanding the progression of mental health and factors underlying the perpetuation of distress during the pandemic is pivotal in informing interventions and public health messaging. This current study examined longitudinal effects of two cognitive vulnerabilities, looming cognitive style, and intolerance of uncertainty, as well as coping styles on anxiety and depression through online questionnaires at two time points in the pandemic, May 2020 (N = 1520) and August 2020 (N = 545). Depression, but not anxiety, significantly increased across time, which was moderated by coping style. Serial mediation modeling using path analysis demonstrated a significant pathway illustrating increased looming cognitive style in the beginning of the pandemic leads to increased intolerance of uncertainty, avoidant coping, and anxiety later in the pandemic. Results suggest a novel model in conceptualizing anxiety during the pandemic, namely highlighting looming cognitive style as an underlying cognitive vulnerability factor and antecedent of intolerance of uncertainty and illuminating the temporal directionality between looming cognitive style and intolerance of uncertainty. These findings provide important implications regarding intervention and public health messaging with modifiable behavioral and cognitive factors to improve mental health during a pandemic.

Correction to: Intolerance of Uncertainty, Looming Cognitive Style, and Avoidant Coping as Predictors of Anxiety and Depression During COVID-19: a Longitudinal Study.

[This corrects the article DOI: 10.1007/s41811-021-00123-9.].

Obstetrician-gynecologist and patient factors associated with intimate partner violence screening in a clinical setting.

Screening for intimate partner violence is recommended by the medical community. This study investigated obstetrician-gynecologists' intimate partner violence screening patterns and physician and patient factors associated with screening. Four hundred obstetricians-gynecologists completed the Physician Readiness to Manage Intimate Partner Violence Survey between December 2014 and July 2015. Their patients completed the Patient Safety and Satisfaction Survey. Hierarchical generalized linear modeling analyzed physician and patient variables related to the likelihood of being screened. Forty-four physicians responded. The viable patient response rate was 81.3 percent (n = 894) of patients from included physicians. Less than half (43.2 percent) of physicians reported screening during annual exams. There was a statistically significant difference for patient race/ethnicity (p < .03) and the number of previous doctor visits (p < .03) with not being screened. These patient-level variables accounted for approximately 68.3 percent of the variance screening odds. There was no significant difference (p < .10) between physicians' perceived preparation, knowledge, and attitudes for not being screened. The hierarchical generalized linear modeling analysis showed a trend for physicians with a high-perceived preparation for screening was related to initial visits. This study identified that obstetrician-gynecologists do not routinely screen for IPV and race/ethnicity and number of visits are factors in screening for intimate partner violence.

Implicit Association Task and Perception of Homosexuality: Differences between African American and Non-Hispanic Caucasian Homosexual Males.

This study investigated the relationship between sexual orientation and minority group membership in a sample of African American and non-Hispanic Caucasian (NHC) homosexual men. Participants competed measures of pathology, sexual orientation, and ethnic identity. They completed two IATs, one using homosexual symbols and the other ethnically diverse homosexual images. Results indicated that African American participants reported more ethnic and sexual orientation discriminatory experiences than NHC. It was also found that both groups exhibited a positive association toward gay symbols. Both groups also demonstrated a bias toward NHC homosexual images, although the bias was stronger for NHC participants. Moderation analyses indicated that as internalized homophobia increased, preference for gay NHC images decreased, and that high ethnically discriminatory experiences resulted in stronger associations between NHC images and "good" attributes. Overall, the results partially support the minority stress theory and highlight some important differences between African American and NHC homosexual men.

Perpetuating factors of social anxiety: a serial mediation model.

BACKGROUND: There is evidence that individuals with high levels of social anxiety utilize more safety behaviours and experience more post-event processing than those with lower levels of social anxiety. There are also data to suggest that the relationship between safety behaviour use and social anxiety symptoms is mediated by perceived control of one's anxiety. Furthermore, it has been suggested that post-event processing influences anticipatory anxiety for a future social situation. AIM: A direct link between the perpetuating factors of social anxiety described above has not been established in the literature. The aim of the current study was to test a model examining the relationship between these constructs. METHOD: Participants first completed a battery of questionnaires. They then participated in an impromptu, 3-minute speech and were informed they would be videotaped. Following the speech, participants completed measures of anxiety and were instructed to return the following week. During the second session, they were informed they would deliver an additional speech and provided ratings of their anxiety in anticipation of delivering the second speech. RESULTS: The results of a serial mediation support that greater levels of social anxiety lead to less perceived control over one's anxiety, leading to increased safety behaviour use. The increase in safety behaviours led to an increase of post-event processing which resulted in greater anticipatory anxiety for a future speech task. CONCLUSIONS: This study provides novel evidence for the importance of perceived control in the genesis of social anxiety, which has implications for treatment.

Management of the Jehovah's Witness in Obstetrics and Gynecology: A Comprehensive Medical, Ethical, and Legal Approach.

IMPORTANCE: Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah's Witness patients in obstetrics and gynecology, most of them are case reports, and a comprehensive review about these patients including ethicolegal perspective is lacking. OBJECTIVE: This review outlines the medical, ethical, and legal implications of management of Jehovah's Witness patients in obstetrical and gynecological settings. EVIDENCE ACQUISITION: A search of published literature using PubMed, Ovid Medline, EMBASE, and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion, and ethical/legal considerations in Jehovah's Witness patients. RESULTS: Early diagnosis of anemia and immediate initiation of therapy are essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as antihepcidin antibodies and hemoglobin-based oxygen carriers. Options to decrease blood loss include antifibrinolytics, desmopressin, recombinant factor VII, and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches. CONCLUSION AND RELEVANCE: All obstetricians and gynecologists should be familiar with alternatives and "less invasive" options for patients who refuse blood transfusions.

Ethnic Identity and Implicit Anti-fat Bias: Similarities and Differences between African American and Caucasian Women.

Research using self-report or explicit measures of body image suggests African American women have a more accepting view of larger figures than non-Hispanic White (NHW) women. However, increasing research indicates that explicit views may vary from those held at a deeper, implicit level. Our study examined whether African American women held an implicit negative bias toward overweight/fat individuals, despite a greater explicit acceptance of larger body size. Additionally, ethnic identity was measured to assess if strength of identity related to bias. Anti-fat bias was compared within and between ethnic groups using an Implicit Association Test (IAT), which measures the strength of automatic associations between two concepts. This online IAT measured spontaneous thoughts about figures of various body weights (underweight, overweight, obese) and positive and negative terms (eg, attractive and unattractive or healthy and unhealthy). A pervasive anti-fat bias was found in African American as well as NHW women. For both groups, this bias was related to ethnic identity when thinking about figure size and health. Specifically, African American women with lower ethnic identity were more negatively biased and NHW women with higher ethnic identity were more negatively biased. Findings from this study indicate that implicitly there are few differences in the way these two ethnicities classify heavy figures, and therefore African Americans may not be immune to weight stigma. Given the prevalence of obesity and the lack of research on weight stigma among African American women, there is need to address this issue and its impact on well-being.

Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Patterns.

BACKGROUND: African American and Hispanic women are disproportionately affected by cardiovascular disease (CVD) and its many risk factors. Obstetrician-gynecologists (OB/GYNs) play an integral role in well-woman care and have a unique opportunity to provide CVD counseling and screening to these at-risk and underserved groups. OBJECTIVE: To assess whether OB/GYN race/ethnicity and OB/GYN practices with increasing minority patient populations predicted differences in OB/GYNs' knowledge, attitudes, and practice patterns relevant to racial/ethnic disparities in CVD. This study also sought to determine provider and patient-related barriers to CVD care. METHOD: A questionnaire on CVD was mailed to 273 members of The American College of Obstetricians and Gynecologists in March-July 2013. RESULTS: African American and Hispanic OB/GYNs and OB/GYN practices with increasing minority patient populations were more knowledgeable of CVD disparities. These OB/GYNs reported greater concern for minority women's CVD risk relative to White OB/GYNs. Overall, OB/GYNs appear less knowledgeable and concerned with Hispanics' increased CVD risk relative to African Americans'. The most commonly reported provider and patient-related barriers to CVD care were time constraints, patient nonadherence to treatment recommendations, and inadequate training. CONCLUSION: It is likely that minority OB/GYNs and those with practices with increasing minority patient populations have greater exposure to women at risk for CVD. Dissemination of educational information regarding Hispanic women's CVD risk profile may improve OB/GYN knowledge, counseling, and screening. Increased training in CVD and multicultural competency during medical school and residency should help OB/GYNs overcome what they report as primary barriers to CVD care.

Ethnic differences in the effects of media on body image: the effects of priming with ethnically different or similar models.

UNLABELLED: Media exposure has been positively correlated with body dissatisfaction. While body image concerns are common, being African American has been found to be a protective factor in the development of body dissatisfaction. METHOD: Participants either viewed ten advertisements showing 1) ethnically-similar thin models; 2) ethnically-different thin models; 3) ethnically-similar plus-sized models; and 4) ethnically-diverse plus-sized models. Following exposure, body image was measured. RESULTS: African American women had less body dissatisfaction than Caucasian women. Ethnically-similar thin-model conditions did not elicit greater body dissatisfaction scores than ethnically-different thin or plus-sized models nor did the ethnicity of the model impact ratings of body dissatisfaction for women of either race. There were no differences among the African American women exposed to plus-sized versus thin models. Among Caucasian women exposure to plus-sized models resulted in greater body dissatisfaction than exposure to thin models. DISCUSSION: Results support existing literature that African American women experience less body dissatisfaction than Caucasian women even following exposure to an ethnically-similar thin model. Additionally, women exposed to plus-sized model conditions experienced greater body dissatisfaction than those shown thin models.

Psychometric properties of the social phobia and social interaction anxiety scales: evidence of construct equivalence in an African American sample.

This study evaluated the psychometric properties of the Social Phobia Scale and Social Interaction Anxiety scale in a community sample of African Americans. We conducted a confirmatory factor analysis of the combined scales comparing the data to 2- and 3-factor solutions commonly reported in the literature. The results indicated that neither solution produce an adequate fit to the data in this study. We then proceeded to conduct an exploratory factor analysis within a confirmatory framework of both scales. While we were able to extract a 2-factor solution from the data, the item composition of the factors was somewhat different for African Americans than what is typically reported in non-Hispanic White samples. While we conclude that use of the two social anxiety scales is warranted, we make recommendations regarding the interpretation of both scales with African Americans.

Adapting interpersonal psychotherapy for the prevention of excessive weight gain in rural African American girls.

OBJECTIVE: To obtain focus group data regarding the perspectives of rural African American (AA) girls, parents/guardians, and community leaders on obesity, loss of control (LOC) eating, relationships, and interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG). METHODS: 7 focus groups (N = 50 participants) were moderated and the transcripts analyzed by Westat researchers using widely accepted methods of qualitative and thematic analysis. A session was held with experts in health disparities to elucidate themes. RESULTS: Participants understood LOC eating; however, they had culturally specific perceptions including usage of alternative terms. Relationships were highly valued, specifically those between mothers and daughters. IPT-WG program components generally resonated with participants, although modifications were recommended to respect parental roles. Experts interpreted focus group themes and discussed potential barriers and solutions to recruitment and participation. CONCLUSION: Findings suggest that adapting IPT-WG may be acceptable to rural AA families. This research is the first step in developing a sustainable excessive weight gain and binge eating disorder prevention program for rural AA adolescents.

An experimental analysis of disgust sensitivity and fear of contagion in Spider and Blood Injection Injury Phobia.

Disgust sensitivity and concern with contamination have been frequently associated with Spider and Blood-Injection-Injury (BII) Phobias. This study assessed the domain specificity of disgust sensitivity and concern with contamination in 29 Non-Phobic Controls, 25 clinical Spider Phobics, 26 clinical BII Phobics, and 27 persons who met clinical criteria for Spider Phobia and BII Phobia. On self-report measures we found evidence of domain specificity of disgust sensitivity for the Spider and BII Phobia groups. Furthermore, we found that persons with both phobias may be more disgust sensitive than persons with a single phobia. Interestingly, the animal reminder disgust stimulus used in this research was more sensitive to detecting domain specific differences in disgust sensitivity between Phobic groups than was the core disgust stimulus, emphasizing the importance of developing standardized behavioral measures of disgust sensitivity in future research. Lastly, findings from this research suggest that concern with contamination may be more influential in phobic avoidance for persons with Spider Phobia than for persons with BII Phobia. Treatment implications for these findings are discussed.

Treating ethnic minority adults with anxiety disorders: current status and future recommendations.

The past three decades have witnessed an increase in the number of empirical investigations examining the phenomenology of anxiety and related conditions. There has also been an increase in efforts to understand differences that may exist between ethnic groups in the expression of the anxiety disorders. In addition, there is now substantial evidence that a variety of treatment approaches (most notably behavioral and cognitive behavioral) are efficacious in remediating anxiety. However, there continues to be comparatively few treatment outcome studies investigating the efficacy of anxiety treatments among minority populations. In this paper, we review the extant treatment outcome research for African American, Hispanic/Latino[a] American, Asian American, and Native Americans suffering with one of the anxiety disorders. We discuss some of the specific problems with the research in this area, and then provide specific recommendations for conducting treatment outcome research with minority populations in the future.

Assessing the Stages of Change Among African American Women in a Weight Management Program.

The objective of this study was to assess the relationship between stage of change (SOC) and behavioral outcomes among African American women entering obesity treatment in two settings. Fifty-five overweight/obese (body mass index = 26.50-48.13), but otherwise healthy African American women, 23 to 56 years old, attended a 13-week weight loss-treatment program that took place at churches (n = 36) or a university (n = 19). Participants were weighed, completed SOC measures, and had a physical fitness test at pre- and posttreatment. Pretreatment measures of SOC placed 47% of the participants as actors, 31% as contemplators, and 22% as maintainers. Of the 45 women who reported posttreatment SOC, 7% regressed, 44% did not change, and 31% progressed in SOC. Pretreatment SOC predicted posttreatment weight loss in the church setting but not in the university setting. At churches, contemplators lost more weight than actors and maintainers. The church may be a more conducive setting for weight change behaviors for African American women who are categorized as contemplators in the SOC model.

Trust, power, and vulnerability: a discourse on helping in nursing.

This article uses philosophical inquiry to present the relationship between the helping role in nursing and the concept of trust essential to it. It characterizes helping as the moral center of the nurse-patient relationship and discusses how patients' expectations of help and caring create obligations of trustworthiness on the part of the nurse. It uses literature from various disciplines to examine different theoretical accounts of trust, each presenting important features of trust relationships that apply to health care professionals, patients, and families. Exploring the concept of trust, and the key leverage points that elicit it, develops a thesis that nurses can improve their understanding of the principal attributes and the conditions that foster or impede trust. The article concludes that trust is the core moral ingredient of helping relationships. Trust as a moral value is even more basic than duties of beneficence, respect, veracity, and autonomy. Trust is the confident expectation that others can be relied upon to act with good will and to secure what is best for the person seeking help.

Predicting anxious response to a social challenge and hyperventilation: comparison of the ASI and ASI-3.

This study compared the predictive ability of the original ASI to the ASI-3 and measures of trait and social anxiety in two challenge conditions; hyperventilation or a social challenge. During hyperventilation, the ASI-3 social concerns subscale was a better predictor than the subscales of the original ASI and measures of general trait and social anxiety. During the social manipulation, results indicated the ASI-3 social concerns subscale and the social anxiety measure were significant predictors of anxious response. Results provide evidence that the ASI-3 is an improvement over the original ASI and is a sound overall measure of response to challenge procedures.

United States obstetrician-gynecologists' accuracy in the simulation of diagnosing anxiety disorders and depression during pregnancy.

The objective of this study was to examine obstetrician-gynecologists' diagnostic accuracy for mental health issues during pregnancy through utilization of clinical vignettes describing depressive and anxiety symptoms, as well as to explore factors associated with increased diagnostic accuracy and related practice patterns. Questionnaires were mailed to 1193 American College of Obstetricians and Gynecologists Fellows and Junior Fellows. The response rate was 44% after three mailings. Depression was correctly identified by over 90% of respondents, whereas significantly fewer correctly diagnosed panic disorder (55%) and generalized anxiety disorder (32%). Confidence ratings significantly predicted diagnostic accuracy in some cases. Approximately half of respondents reported referring anxiety disordered patients to a mental health professional. There may be an education gap in ob-gyns' diagnostic knowledge of anxiety disorders, which may addressed by increasing physician confidence in diagnosis through increased training.