Effects of Parent-Implemented Interventions on Outcomes of Children with Autism: A Meta-Analysis.

Children with autism spectrum disorder (ASD) have been shown to benefit from parent-implemented interventions (PIIs). This meta-analysis improved on prior reviews of PIIs by evaluating RCTs and multiple potential moderators, including indicators of research quality. Fifty-one effect sizes averaged moderately strong overall benefits of PIIs (g = 0.553), with studies having lower risk of research bias yielding lower estimates (g = 0.47). Parent and observer ratings yielded similar averaged estimates for positive behavior/social skills (g = 0.603), language/communication (g = 0.545), maladaptive behavior (g = 0.519), and to a lesser extent, adaptive behavior/life skills (g = 0.239). No other study, intervention, or participant characteristic moderated outcomes. PIIs with children with ASD tend to be effective across a variety of circumstances.

Stent retriever versus direct aspiration thrombectomy for acute large vessel occlusion: A meta-analysis including 17,556 patients, from MR CLEAN to present.

OBJECTIVE: Stent retriever (SR) and direct aspiration (DA) mechanical thrombectomy (MT) improve clinical outcomes for stroke secondary to large vessel occlusion. The purpose is to perform an updated meta-analysis comparing the two techniques. METHODS: PubMed database was searched for studies between January 1, 2015, and July 5th, 2021 with mechanical thrombectomy to treat acute ischemic stroke. RESULTS: We identified 136 studies including 17,556 patients, with 11,258 (64.1%) patients treated by SR or a combined approach and 6298 (35.9%) patients with DA. The DA group had less posterior cerebral artery strokes, was significantly older, and had lower National Institutes of Health Stroke Scale scores (p = .05,.02,.04) There was no difference between groups in percentage of middle cerebral artery or internal carotid artery occlusions or intravenous tissue plasminogen activator administered (p = .62,.19,.06). A regression model showed no difference between SR and DA in mortality, symptomatic intracranial hemorrhage, and disability (mRS > 2) at 90 days (p = .13,.75,.84). Successful reperfusion (mTICI 2b/3 rates) were higher in the DA group (DA 87.6% vs SR 82.3%, p < .01), but after accounting for covariates was not significant (p = .17). CONCLUSION: Our updated meta-analysis shows that DA has similar safety, reperfusion and 90-day clinical outcomes compared to SR. These results should serve to increase confidence in DA thrombectomy for acute ischemic stroke secondary to LVO.

Effects of psychosocial support interventions on survival in inpatient and outpatient healthcare settings: A meta-analysis of 106 randomized controlled trials.

BACKGROUND: Hospitals, clinics, and health organizations have provided psychosocial support interventions for medical patients to supplement curative care. Prior reviews of interventions augmenting psychosocial support in medical settings have reported mixed outcomes. This meta-analysis addresses the questions of how effective are psychosocial support interventions in improving patient survival and which potential moderating features are associated with greater effectiveness. METHODS AND FINDINGS: We evaluated randomized controlled trials (RCTs) of psychosocial support interventions in inpatient and outpatient healthcare settings reporting survival data, including studies reporting disease-related or all-cause mortality. Literature searches included studies reported January 1980 through October 2020 accessed from Embase, Medline, Cochrane Library, CINAHL, Alt HealthWatch, PsycINFO, Social Work Abstracts, and Google Scholar databases. At least 2 reviewers screened studies, extracted data, and assessed study quality, with at least 2 independent reviewers also extracting data and assessing study quality. Odds ratio (OR) and hazard ratio (HR) data were analyzed separately using random effects weighted models. Of 42,054 studies searched, 106 RCTs including 40,280 patients met inclusion criteria. Patient average age was 57.2 years, with 52% females and 48% males; 42% had cardiovascular disease (CVD), 36% had cancer, and 22% had other conditions. Across 87 RCTs reporting data for discrete time periods, the average was OR = 1.20 (95% CI = 1.09 to 1.31, p < 0.001), indicating a 20% increased likelihood of survival among patients receiving psychosocial support compared to control groups receiving standard medical care. Among those studies, psychosocial interventions explicitly promoting health behaviors yielded improved likelihood of survival, whereas interventions without that primary focus did not. Across 22 RCTs reporting survival time, the average was HR = 1.29 (95% CI = 1.12 to 1.49, p < 0.001), indicating a 29% increased probability of survival over time among intervention recipients compared to controls. Among those studies, meta-regressions identified 3 moderating variables: control group type, patient disease severity, and risk of research bias. Studies in which control groups received health information/classes in addition to treatment as usual (TAU) averaged weaker effects than those in which control groups received only TAU. Studies with patients having relatively greater disease severity tended to yield smaller gains in survival time relative to control groups. In one of 3 analyses, studies with higher risk of research bias tended to report better outcomes. The main limitation of the data is that interventions very rarely blinded personnel and participants to study arm, such that expectations for improvement were not controlled. CONCLUSIONS: In this meta-analysis, OR data indicated that psychosocial behavioral support interventions promoting patient motivation/coping to engage in health behaviors improved patient survival, but interventions focusing primarily on patients' social or emotional outcomes did not prolong life. HR data indicated that psychosocial interventions, predominantly focused on social or emotional outcomes, improved survival but yielded similar effects to health information/classes and were less effective among patients with apparently greater disease severity. Risk of research bias remains a plausible threat to data interpretation.

Cultural adaptations and therapist multicultural competence: Two meta-analytic reviews.

Mental health treatments can be more effective when they align with the culture of the client and when therapists demonstrate multicultural competence. We summarize relevant research findings in two meta-analyses. In the meta-analysis examining culturally adapted interventions, the average effect size across 99 studies was d = 0.50 (0.35 after accounting for publication bias). In the second meta-analysis on 15 studies of therapist cultural competence, the results differed by rating source: Client-rated measures of therapist cultural competence correlated strongly (r = 0.38) with treatment outcomes but therapists' self-rated competency did not (r = 0.06). We describe patient considerations and research limitations. We conclude with research supported therapeutic practices that help clients benefit from modifications to treatment related to culture.

Reliability generalization of the Multigroup Ethnic Identity Measure-Revised (MEIM-R).

[Correction Notice: An Erratum for this article was reported in Vol 63(5) of Journal of Counseling Psychology (see record 2016-33161-001). The name of author Erika Feinauer was misspelled as Erika Feinhauer. All versions of this article have been corrected.] Individuals' strength of ethnic identity has been linked with multiple positive indicators, including academic achievement and overall psychological well-being. The measure researchers use most often to assess ethnic identity, the Multigroup Ethnic Identity Measure (MEIM), underwent substantial revision in 2007. To inform scholars investigating ethnic identity, we performed a reliability generalization analysis on data from the revised version (MEIM-R) and compared it with data from the original MEIM. Random-effects weighted models evaluated internal consistency coefficients (Cronbach's alpha). Reliability coefficients for the MEIM-R averaged α = .88 across 37 samples, a statistically significant increase over the average of α = .84 for the MEIM across 75 studies. Reliability coefficients for the MEIM-R did not differ across study and participant characteristics such as sample gender and ethnic composition. However, consistently lower reliability coefficients averaging α = .81 were found among participants with low levels of education, suggesting that greater attention to data reliability is warranted when evaluating the ethnic identity of individuals such as middle-school students. Future research will be needed to ascertain whether data with other measures of aspects of personal identity (e.g., racial identity, gender identity) also differ as a function of participant level of education and associated cognitive or maturation processes. (PsycINFO Database Record

Collectivistic coping strategies for distress among Polynesian Americans.

Previous research has shown that psychological services designed to assist clients in coping with stressful or traumatic events are more effective when aligned with clients' cultural values, practices, and worldviews. However, limited research is available regarding the preferred coping strategies of Polynesian Americans. In examining collectivistic coping styles and their association with previous distress among 94 Polynesian Americans, we found that participants were highly likely to use family support and religion/spirituality to buffer the initial and residual effects of impairment attributable to distressing events, and private emotional outlets, such as psychotherapy, very infrequently. The use of private emotional outlets was associated with lower impairment from distress, although family support was much more predictive of lower impairment and positive psychological well-being. Mental health professionals can align their services with the cultural values of Polynesian Americans by accounting for collectivistic coping styles and family dynamics.

Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.

School experiences of early adolescent Latinos/as at risk for emotional and behavioral disorders.

Previous research has shown that Latino/a middle school students exhibiting emotional or behavioral disturbance are at risk for undesirable academic outcomes. The purpose of this study was to understand the perceptions and experiences of at-risk Latino/a students to identify ways to improve interventions targeted to promote their academic retention and success. Participants included 11 Latino/a students between the ages of 11 and 13 years, 8 males and 3 females, who were screened as being at risk for behavior disorders using the Systematic Screening for Behavior Disorders (SSBD). These students shared their perceptions and experiences of schooling during in-depth qualitative interviews. Interpretative phenomenological analysis (IPA) was used to understand how these students made sense of their school experiences. Students' descriptions tended to be contextualized within relationships with peers, teachers, and family members. Many students shared experiences of being the target of overt racism and microaggressions from peers. Students believed they were more likely to be successful in school when teachers displayed flexibility with deadlines, provided extra help, and communicated a sense of warmth and caring. The data from this study suggested that school psychologists can benefit from attending to at-risk students' perceptions, which, in the context of this study, would require facilitating an inclusive school climate, fostering effective teacher and student relationships, and facilitating parent-teacher relationships during the difficult transition from elementary to middle school.

Hispanic mortality paradox: a systematic review and meta-analysis of the longitudinal literature.

To investigate the possibility of a Hispanic mortality advantage, we conducted a systematic review and meta-analysis of the published longitudinal literature reporting Hispanic individuals' mortality from any cause compared with any other race/ethnicity. We searched MEDLINE, PubMed, EMBASE, HealthSTAR, and PsycINFO for published literature from January 1990 to July 2010. Across 58 studies (4 615 747 participants), Hispanic populations had a 17.5% lower risk of mortality compared with other racial groups (odds ratio = 0.825; P < .001; 95% confidence interval = 0.75, 0.91). The difference in mortality risk was greater among older populations and varied by preexisting health conditions, with effects apparent for initially healthy samples and those with cardiovascular diseases. The results also differed by racial group: Hispanics had lower overall risk of mortality than did non-Hispanic Whites and non-Hispanic Blacks, but overall higher risk of mortality than did Asian Americans. These findings provided strong evidence of a Hispanic mortality advantage, with implications for conceptualizing and addressing racial/ethnic health disparities.

Positive parenting of children with developmental disabilities: a meta-analysis.

Although a large body of literature exists supporting the relationship between positive parenting and child outcomes for typically developing children, there are reasons to analyze separately the relevant literature specific to children with developmental disabilities. However, that literature has not been synthesized in any systematic review. This study examined the association between positive parenting attributes and outcomes of young children with developmental disabilities through meta-analytic aggregation of effect sizes across 14 studies including 576 participants. The random effects weighted average effect size was r=.22 (SE=.06, p<.001), indicative of a moderate association between positive parenting attributes and child outcomes. Publication bias did not appear to be a substantial threat to the results. There was a trend for studies with more mature parents to have effect sizes of higher magnitude than studies with young parents. The results provide support for efforts to evaluate and promote effective parenting skills when providing services for young children with disabilities.

Racial/ethnic matching of clients and therapists in mental health services: a meta-analytic review of preferences, perceptions, and outcomes.

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes.

Ethnic identity and personal well-being of people of color: a meta-analysis.

This article summarizes research examining the relationship between the constructs of ethnic identity and personal well-being among people of color in North America. Data from 184 studies analyzed with random effects models yielded an omnibus effect size of r = .17, suggesting a modest relationship between the 2 constructs. The relationship was somewhat stronger among adolescents and young adults than among adults over age 40. No differences were observed across participant race, gender, or socioeconomic status, which findings support the general relevance of ethnic identity across people of color. Studies correlating ethnic identity with self-esteem and positive well-being yielded average effect sizes twice as large as those from studies correlating ethnic identity with personal distress or mental health symptoms. Ethnic identity was thus more strongly related to positive well-being than to compromised well-being. Overall, the corpus of research reviewed consisted of correlational designs; limited scholarship has addressed causal mechanisms, mediating factors, or psychological functions of ethnic identity across different social contexts.

Culture.

This article summarizes the definitions, means, and research of adapting psychotherapy to clients' cultural backgrounds. We begin by reviewing the prevailing definitions of cultural adaptation and providing a clinical example. We present an original meta-analysis of 65 experimental and quasi-experimental studies involving 8,620 participants. The omnibus effect size of d = .46 indicates that treatments specifically adapted for clients of color were moderately more effective with that clientele than traditional treatments. The most effective treatments tended to be those with greater numbers of cultural adaptations. Mental health services targeted to a specific cultural group were several times more effective than those provided to clients from a variety of cultural backgrounds. We recommend a series of research-supported therapeutic practices that account for clients' culture, with culture-specific treatments being more effective than generally culture-sensitive treatments.

Social relationships and mortality risk: a meta-analytic review.

BACKGROUND: The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality. OBJECTIVES: This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk. DATA EXTRACTION: Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships. RESULTS: Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44). CONCLUSIONS: The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.

Spiritual interventions in psychotherapy: evaluations by highly religious clients.

Spiritual and religious interventions in psychotherapy have increasingly received research attention, particularly with highly religious clients. This study examined client opinions about and experiences with religious interventions in psychotherapy. A sample of 152 clients at a counseling center of a university sponsored by the Church of Jesus Christ of Latter-Day Saints (LDS) completed a survey with ratings of specific religious interventions concerning appropriateness, helpfulness, and prevalence. Out-of-session religious interventions were considered more appropriate by clients than in-session religious interventions, but in-session interventions were rated as more helpful. Specific interventions considered both appropriate and helpful by the LDS participants included referencing scriptural passages, teaching spiritual concepts, encouraging forgiveness, involving religious community resources, and conducting assessments of client spirituality. Some religious interventions were perceived as inappropriate or not helpful, and clients provided explanations for why religious interventions can be either effective or ineffective in psychotherapy.

Preliminary examination of international students' adjustment and loneliness related to electronic communications.

Electronic communication, e.g., e-mail, internet, may facilitate international students' adjustment through contacts maintained in their native country. In the present study, the scores of 45 international students on a measure of adjustment and the Revised UCLA Loneliness Scale were significantly associated with their electronic communications involving their native country, but not with general internet or e-mail use. International students' scores on the Multigroup Ethnic Identity Measure were positively correlated with amount of contact with people in their native country but not with scores on measures of adjustment or loneliness.

Acculturation to Western society as a risk factor for high blood pressure: a meta-analytic review.

OBJECTIVE: A number of studies have documented that acculturation to western society is related to an increase in blood pressure (BP). Although there is evidence that higher socioeconomic status appears related to better cardiovascular health, increasing acculturation to western society appears related to worse cardiovascular health. The purpose of this meta-analysis was to investigate the association between acculturation and BP. METHODS: Literature searches yielded 125 relevant research manuscripts, which were coded by teams of two independent raters. This study was conducted in 2003 and 2004, and research databases such as MEDLINE and PsychINFO were searched through 2004. Measures of association (effect sizes) were extracted for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. Random effects models were used to analyze the resulting data. RESULTS: The overall effect sizes associated with acculturation were 0.28 for SBP and 0.30 for DBP, with increasing acculturation to western society related to higher BP. More acculturated individuals had an average of 4 mm Hg higher BP than less acculturated individuals, which is similar to the effect sizes of known risk factors for high BP such as diet and physical activity. The effects of acculturation on BP appear to be universal, with similar effect sizes found across all regions of the world. Change in BP due to acculturation was not related to body mass index (BMI) or cholesterol but was related to length of residence in the new culture, with the largest effect sizes seen on initial entry and then decreasing rapidly within the first few years. Sudden cultural changes, such as migration from rural to urban settings, resulted in the largest effect sizes, which finding supports the hypothesis that the stress of cultural change is important role in the acculturation effect. CONCLUSIONS: Acculturation to western society is associated with higher BP, and the distress associated with cultural change appears to be more influential than changes in diet or physical activity. Future studies would benefit from investigating how cultural change affects health and examining whether some non-Western cultural values and practices are health protective.

Culturally adapted mental health intervention: A meta-analytic review.

There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events.

The association between religiousness and depressive symptoms was examined with meta-analytic methods across 147 independent investigations (N = 98,975). Across all studies, the correlation between religiousness and depressive symptoms was -.096, indicating that greater religiousness is mildly associated with fewer symptoms. The results were not moderated by gender, age, or ethnicity, but the religiousness-depression association was stronger in studies involving people who were undergoing stress due to recent life events. The results were also moderated by the type of measure of religiousness used in the study, with extrinsic religious orientation and negative religious coping (e.g., avoiding difficulties through religious activities, blaming God for difficulties) associated with higher levels of depressive symptoms, the opposite direction of the overall findings.