Feasibility and preliminary efficacy of a public mobile app to reduce symptoms of postdisaster distress in adolescent wildfire survivors: Sonoma rises.

In October 2017, Northern California experienced devastating and historic wildfires leaving the community in need of support to foster emotional resilience during the recovery process. Adolescents represent a particularly vulnerable population in the wake of disaster, and digital mental health interventions may hold promise for reaching teens at scale. The present study examined the feasibility and efficacy of a mobile mental health app for disaster, Sonoma Rises. A multiple-baseline single-case experimental design (SCED) utilizing a research-enabled version of the app was employed with seven adolescents who experienced significant damage to their homes and schools in the wildfires. Participants completed daily mood ratings, weekly measures of posttraumatic stress symptoms, internalizing and externalizing symptoms, psychosocial functioning, and then pre-post-measures of anxiety, depression, wellbeing, sleep, academic engagement, and perceived social support as well as quantitative and qualitative measures of intervention satisfaction and feasibility. Sonoma Rises was found to be feasible in terms of engagement, satisfaction, and likelihood of recommending to a friend. During the study, another wildfire occurred and all participants underwent a prolonged mandated evacuation and were subject to a series of extended power outages. Uptake of the publicly available version of the Sonoma Rises app among the general population was modest but engagement among users was sustained. Lessons learned are offered to contribute to the science and practice of building, disseminating, and implementing digital tools to conduct more equitable disaster mental health outreach and research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes.

It is critical that health service evaluation frameworks include Aboriginal people and their cultural worldviews from design to implementation. During a large participatory action research study, Elders, service leaders and Aboriginal and non-Aboriginal researchers co-designed evaluation tools to test the efficacy of a previously co-designed engagement framework. Through a series of co-design workshops, tools were built using innovative collaborative processes that foregrounded Aboriginal worldviews. The workshops resulted in the development of a three-way survey that records the service experiences related to cultural safety from the perspective of Aboriginal clients, their carer/s, and the service staff with whom they work. The surveys centralise the role of relationships in client-service interactions, which strongly reflect their design from an Aboriginal worldview. This paper provides new insights into the reciprocal benefits of engaging community Elders and service leaders to work together to develop new and more meaningful ways of servicing Aboriginal families. Foregrounding relationships in service evaluations reinstates the value of human connection and people-centred engagement in service delivery which are central to rebuilding historically fractured relationships between mainstream services and Aboriginal communities. This benefits not only Aboriginal communities, but also other marginalised populations expanding the remit of mainstream services to be accessed by many.

Contraception counseling for women with premenstrual dysphoric disorder (PMDD): current perspectives.

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) affecting up to 7% of reproductive age women. Women with PMDD are of reproductive age; therefore, contraception and treatment of PMDD are important considerations. The disorder as described in the DSM-V is characterized by moderate to severe psychological, behavioral and physical symptoms beginning up to two weeks prior to menses, resolving soon after the onset of menstruation and significantly interfering with daily functioning. PMDD develops in predisposed individuals after they are exposed to progesterone at the time of ovulation. It has been hypothesized that PMDD is in part attributable to luteal phase abnormalities in serotonergic activity and to altered configuration of ℽ-aminobutyric acid subunit A (GABAA) receptors in the brain triggered by the exposure to the neuroactive steroid progesterone metabolite, allopregnanolone (Allo). A large body of evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can be effective in the treatment of PMDD. Combined hormonal contraceptive (CHC) pills, specifically the 20 mcg ethinyl estradiol/3mg drospirenone in a 24/4 extended cycle regimen has been shown to significantly improve the emotional and physical symptoms of PMDD. Other combined monophasic, extended cycle hormonal contraceptive pills with less androgenic progestins may also be helpful, although not well studied. Copper intrauterine devices (IUDs) are recommended for those not seeking hormonal contraceptives. Progestin-only methods including the progestin-only pill (POP), levonorgestrel (LNG) IUD, etonorgestrel implant or depot medroxyprogesterone acetate (DMPA) have the potential to negatively affect mood symptoms for women with or without baseline mood disorders, including PMDD. Careful counseling and close follow-up is recommended for patients with PMDD seeking these contraceptive methods.