COVID-19 and mental health treatment in primary care: Impacts of a global pandemic on a psychopharmacological collaborative care management program.

OBJECTIVE: The COVID-19 pandemic has had a profound impact on individuals with mental health (MH) disorders and on the delivery of MH services. Studies examining treatment models which did not require substantial changes to the delivery of services during pandemic restrictions, such as collaborative care management (CoCM) programs are minimal. Therefore, a longitudinal retrospective cohort analysis was conducted to examine the impacts of the COVID-19 pandemic on a psychopharmacological CoCM program. METHOD: Data was collected on all U.S. Veterans enrolled in a CoCM program at a large VA during the first 10 months of the COVID-19 pandemic and compared to a one-year prior date matched control group. Treatment in the program pre-COVID vs. treatment during the pandemic was compared in relation to baseline symptomatology, improvements in MH symptoms, and program adherence. RESULTS: 462 Veterans were referred during the control dates, compared to 351 during the pandemic. Veterans enrolled during the first four months of each study arm, done to allow for a minimum of 6 months of follow up data, had no differences in baseline symptoms of depression or anxiety. Veterans receiving care during the pandemic had higher rates of program completion than pre-pandemic controls. COVID-era Veterans had higher rates of depression response than controls, and no differences were observed in depression remission, anxiety response, or anxiety remission. CONCLUSIONS: Psychopharmacological CoCM treatment models can successfully manage depression and anxiety with no observed decrease in the effectiveness of this intervention even during periods of unprecedented disruptions to the delivery of MH services.

The role of religious affiliation in Christian and unaffiliated bereaved emerging adults' use of religious coping.

Though research on bereavement has grown, few studies have focused on emerging adults. To add to the literature, the authors administered the RCOPE to a sample of bereaved college students (analyzed sample N = 748) and explored the relationship between self-reported religious affiliation and religious coping strategies used and endorsed as "most helpful." Results highlight the rich topography of bereavement previously unexamined in understudied populations (i.e., emerging adults, religiously unaffiliated). Specifically, the Christians/affiliated used "negative" religious coping strategies most often, yet identified "positive" strategies as "most helpful," whereas the unaffiliated instead used "positive" strategies most often and identified "negative" strategies as "most helpful."

Development of a Short-Form of the RCOPE for Use with Bereaved College Students.

Bereavement is being increasingly recognized as a key issue in college populations (Balk in Mortality 2:207-220, 1997; Balk et al. in Death Stud 34:459-468, 2010). However, there is currently a dearth of research on the impact that the loss of a loved one has on college students and the ways that college students cope during the grieving process. This lack of research, particularly among younger groups, is problematic as researchers have shown that emerging adults experience a surprisingly high number of losses and are an at-risk group for poor post-loss outcomes (Servaty-Seib and Taub 2010; Servaty-Seib and Hamilton 2006; Arnett in Am Psychol 55(5):469, 2000). Religion is a common way that individuals cope with bereavement (Frantz et al. in Pastor Psychol 44(3):151-163, 1996) and may also be commonly used by college students to manage everyday stress (Merrill et al. 2009). The RCOPE (Pargament et al. in J Clin Psychol 56(4):519-543, 2000; J Health Psychol 9:713-730, 2004) is a frequently used measure of religious coping that has recently been evaluated for use with a bereaved undergraduate population. Lord and Gramling (2014) examined the factor structure of the RCOPE and concluded that overlap between the positive and negative religious coping subscales when used with a bereaved undergraduate sample detracted from the predictive utility of the instrument. The researchers provided evidence for the use of a new 2-factor, 39-item version of the RCOPE with the bereaved college student population. The current study replicated Lord and Gramling (2014) with a large follow-up sample of bereaved undergraduates. Participants (N = 677) consisted of individuals who had lost a loved one within the past 2 years, had a mean age of 19.1, and were predominantly female (62%) underclassmen (84% freshman or sophomore status). A majority of participants (68%) were identified as Christian. Exploratory factor analyses closely mimicked the results of the previous study, and the number of items was further reduced in order to provide a briefer version of the scale for use in future research. Hierarchical regression models demonstrated discriminate, convergent, and predictive validity of the instrument.

Patterns of religious coping among bereaved college students.

Contemporary research has suggested that bereavement is a paramount issue in college populations, a group which has historically been underrepresented in grief research (Balk. in Death studies 25:67-84, 2001; Balk et al. in Death Studies 34:459-468, 2010). Indeed, there has been a call to generate new research on grief with specific populations and age groups (Center for the Advancement of Health. in Death Studies 28:568-575, 2004). Religion is often described as a primary way that individuals cope with bereavement in particular (Frantz et al. in Pastor Psychol 44(3):151-163, 1996) and has been shown to effect college student reactions to stress in general (Merrill et al. in Mental Health, Religion & Culture 12(5):501-511, 2009). The RCOPE (Pargament et al. in J Clin Psychol 56(4):519-543, 2000, J Health Psychol 9:713-730, 2004) is a frequently used measure of religious coping, but has not been evaluated with a bereaved undergraduate population. Given that emerging adulthood is a critical developmental phase of religious identity (Fowler. in New Directions for Child Development 3(52):27-45, 1991), the current study examined the factor structure of the RCOPE within a sample of bereaved college students. An exploratory factor analysis was performed, which approximated the factor structure proposed by Pargament et al. (J Clin Psychol 56(4):519-543, 2000). However, a high correlation between the positive and negative religious coping subscales (r = 0.71) detracted from the predictive utility of Pargament et al.'s (2000) two overarching subscales. Therefore, an exploratory factor analysis with an orthogonal rotation was used to identify two uncorrelated subscales (adaptive religious coping and maladaptive religious coping). This new two-factor, 39-item version of the RCOPE was found to demonstrate good internal consistency (α > 0.8) as well as convergent and discriminant validity. The interaction between religious coping strategies and core beliefs about the predictability of the world is explored, and directions for future research and clinical practice are suggested.

The significant other history: an interpersonal-emotional history procedure used with the early-onset chronically depressed patient.

An interpersonal-emotional history procedure, the Significant Other History, is administered to the early-onset chronically depressed patient during the second therapy session in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Patients are asked to name up to six significant others and answer two questions: (1) What was it like growing up with or being around this person? (2) What is the emotional "stamp" you take from this relationship that informs who you are today? An interpersonal-emotional theme reflecting the early learning history of the patient is derived from these "stamps" or causal theory conclusions. One transference hypothesis (TH) is derived from the Significant Other History (SOH) and is formulated in one sentence, such as "If I do this, then the therapist will likely do that" (e.g., "If I make a mistake around Dr. E, then Dr. E will label me 'stupid' or 'incompetent"). The transference hypothesis highlights the interpersonal content that most likely informs the patient's expectancy of the therapist's reactions toward him or her. Throughout the therapy process, the therapist will proactively employ the transference hypothesis in a technique known as the Interpersonal Discrimination Exercise to help patients cognitively and emotionally discriminate the practitioner from hurtful significant others. The goal here is to increase the patient's felt safety within the therapeutic dyad and eventually to generalize the felt safety to the patient's other relationships.

A method for conducting intensive psychological studies with early-onset chronically depressed patients.

An intensive empirical methodology is introduced to evaluate the efficacy of Cognitive Behavioral Analysis System of Psychotherapy (CBASP) treatment for outpatients with early onset chronic depression. The patient with chronic illness presents a unique measurement challenge to psychotherapists. One of the most prominent reasons is the refractory nature of the disorder. In order to measure the change process, the authors have found it helpful to use an acquisition-learning methodology to answer three questions: (1) What are we trying to teach the patient? (2) How much has the patient learned throughout the course of therapy? And, (3) how does the extent of patient learning impact the change indices at the end of treatment and during the follow-up period? Answering questions 2 and 3 allows us to superimpose the change process variables over the performance learning variables on a graph. These combined variables also allow us to test the hypothesis: By learning what psychotherapy teaches, the chronic psychological disorder may be resolved.