Retaining Interest in Child and Adolescent Psychiatry Among General Residency Trainees.

OBJECTIVES: This study aimed to identify factors affecting current general psychiatry residents' interest in child and adolescent psychiatry (CAP) at Lehigh Valley Health Network (LVHN). Furthermore, it aimed to identify areas for improvement in clinical education to address the shortage of child psychiatrists at the institution at the time of this study. METHODS: An electronic anonymous pre-implementation survey was sent to all the current general psychiatry residents at LVHN. It assessed the most important factors for trainees in deciding their career paths into CAP, their comfort level with children and families, and overall CAP and related systems-based knowledge. Interventions based on the survey results were implemented in the LVHN psychiatry residency program. The residents then completed a post-intervention survey to assess the impact of these interventions on their perspectives toward CAP. RESULTS: CAP rotation experience and work with families were strong influencers for general psychiatry residents at LVHN in pursing CAP. Systems-based knowledge was particularly lacking compared to overall CAP knowledge. Educational interventions that were implemented at LVHN led to improvements in residents' sense of competence working with children and families with no net loss of interest in CAP. CONCLUSIONS: Educational modifications enhanced attitudes toward CAP among LVHN general psychiatry residents. Implementing such modifications at other residency programs may be likewise effective in retaining interest in CAP among their general psychiatry residents.

More direction but less freedom? How task rules affect intrinsic motivation.

Task rules restrict freedom by definition, but do they necessarily harm intrinsic motivation? We examine how task rules for an open-ended writing activity affect intrinsic motivation, or enjoyment, with one's sense of direction and psychological freedom as potential mechanisms. Results from three online experiments (Experiment 1, Experiments 3a and 3b; N = 1,176), conducted with both undergraduate student and adult (Amazon MTurk and Prolific) samples, suggest that task rules may indirectly increase enjoyment by enhancing direction (indirect effect: ß's range [0.09, 0.17], p's < .05), yet at the same time, indirectly decrease enjoyment by reducing freedom (indirect effect: ß's range [-0.31, -0.07], p's < .05). Results from a fourth online experiment (Experiment 2; student sample; N = 121) address a potential alternative explanation, finding that only the task rules, not mere examples, were sufficient to increase direction (rules present: d = 0.55, p = .04; examples: d = 0.25, p = .48) and reduce freedom (rules present: d = 0.78, p < .001; examples: d = 0.22, p = .31). Theoretical and empirical connections are made to self-determination theory and flow theory. Further research is needed to delineate situational and personal factors that may moderate these effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

I've been thinkin' bout you: socially distant relationship pursuit during COVID-19.

The COVID-19 pandemic has radically altered everyday interactions, potentially disrupting the process of romantic relationship formation. Prior research suggests that threats to the basic psychological need for relatedness, along with negative mental imagery, can lead to an obsessive preoccupation with a romantic interest. The present research examines how the relatedness-threatening nature of the pandemic may similarly facilitate problematic relationship behaviors. Two studies-a small-scale natural experiment with measurements before and during the pandemic (Study 1) and a daily diary study (Study 2)-investigated how relatedness frustration and negative fantasies predict presumptuous romantic intentions. In Study 1 these threats unexpectedly corresponded to reduced presumptuous romantic intentions, though no such main effect was present in Study 2. Replicating prior experimental work, in both studies, more negative fantasies about a romantic target predicted greater presumptuous romantic intentions. Study 2 also revealed that at the between-person level the combinatory effect of relatedness frustration and negative fantasies led to greater intentions. At the within-person level, this combinatory effect led unexpectedly to reduced intentions. Finally, there was substantial heterogeneity in the within-person effect of COVID-induced relatedness frustration: although frustration stoked intentions for some individuals, for others it reduced intentions. This work suggests that for many, the early social ramifications of COVID-19 reduced motivation to presumptuously pursue romantic relationships. Yet, certain individuals, particularly those with more negative fantasies, are more prone to pursue presumptuously amidst the pandemic.

Effectiveness of a Motivational Smoking Reduction Strategy Across Socioeconomic Status and Stress Levels.

Smoking consequences are seen disproportionately among low-SES smokers. We examine the self-regulatory strategy of mental contrasting with implementation intentions (MCII) as a smoking reduction tool and whether its effectiveness depends on subjective-SES. This pre-registered online experiment comprised a pre-screening, baseline survey, and follow-up. Participants reported past-week smoking, subjective-SES, perceived stress, and were randomized to an active control (n = 161) or MCII condition (n = 164). Data were collected via MTurk, during the U.S.' initial wave of COVID-19. Participants were moderate-to-heavy smokers open to reducing or quitting. The primary outcome was self-reported smoking reduction, computed as the difference between recent smoking at baseline and follow-up. The secondary outcome was cessation, operationalized as self-reported 7-day point-prevalence abstinence at follow-up. Among those low-but not high-in subjective-SES, MCII (vs. control) improved smoking reduction by an average of 1.09 fewer cigarettes smoked per day, though this effect was not conclusive (p = 0.11). Similarly, quitting was descriptively more likely for those in the MCII than control condition, but the effect was non-significant (p = 0.11). Per an exploratory analysis, we observed that stress significantly moderated the condition effect (p = 0.01), such that MCII (vs. control) facilitated reduction among those experiencing high (p = 0.03), but not low stress (p = 0.15). Consistent with prior findings that MCII works best in vulnerable populations, MCII may be more effective for smoking reduction among high-stress than low-stress individuals. These findings contribute to growing research on income-related health disparities and smoking behavior change tools.

An online randomised controlled trial of mental contrasting with implementation intentions as a smoking behaviour change intervention.

Objective: We assessed the effectiveness of mental contrasting with implementation intentions (MCII), an established self-regulatory strategy, as a brief online smoking behaviour change intervention. We expected that MCII would enhance smoking reduction among the highly cigarette dependent because MCII is most effective for challenging pursuits. Design: Participants interested in reducing or quitting smoking were recruited online via Amazon Mechanical Turk. At Time 1, we assessed cigarette dependence using the Cigarette Dependence Scale (CDS-5), then administered one of two brief self-help interventions: MCII (n = 172) or a government-promoted control strategy (n = 174). Participants were invited to complete an online follow-up survey 4 weeks later (Time 2). Main Outcome Measure: At Time 1 and Time 2, we measured recent cigarette smoking with a retrospective, self-report questionnaire. We used these reports to compute smoking reduction scores, with an intent-to-treat approach. Results: MCII increased smoking reduction compared to the control strategy at high, but not low, levels of cigarette dependence. Conclusion: We found preliminary evidence consistent with MCII, delivered as a brief online intervention, as an effective smoking reduction strategy for highly dependent cigarette smokers. Further research is needed on MCII as a smoking behaviour change intervention.

Major Physical Health Conditions and Risk of Suicide.

INTRODUCTION: Most individuals make healthcare visits before suicide, but many do not have a diagnosed mental health condition. This study seeks to investigate suicide risk among patients with a range of physical health conditions in a U.S. general population sample and whether risk persists after adjustment for mental health and substance use diagnoses. METHODS: This study included 2,674 individuals who died by suicide between 2000 and 2013 along with 267,400 controls matched on year and location in a case-control study conducted in 2016 across eight Mental Health Research Network healthcare systems. A total of 19 physical health conditions were identified using diagnostic codes within the healthcare systems' Virtual Data Warehouse, including electronic health record and insurance claims data, during the year before index date. RESULTS: Seventeen physical health conditions were associated with increased suicide risk after adjustment for age and sex (p<0.001); nine associations persisted after additional adjustment for mental health and substance use diagnoses. Three conditions had a more than twofold increased suicide risk: traumatic brain injury (AOR=8.80, p<0.001); sleep disorders; and HIV/AIDS. Multimorbidity was present in 38% of cases versus 15.5% of controls, and represented nearly a twofold increased risk for suicide. CONCLUSIONS: Although several individual conditions, for example, traumatic brain injury, were associated with high risk of suicide, nearly all physical health conditions increased suicide risk, even after adjustment for potential confounders. In addition, having multiple physical health conditions increased suicide risk substantially. These data support suicide prevention based on the overall burden of physical health.