Behavioral Health Outcomes Research Articles

A Chinese version of the Stroke Illness Perception Questionnaire-Revised: Reliability and validity assessment in stroke patients.

Illness perceptions are an important factor affecting the prognosis of stroke patients. Evaluating the illness perceptions of stroke patients is of great importance for predicting their health behaviour and rehabilitation outcomes. However, there is no specific tool for assessing illness perceptions in stroke patients in China. The objective of this study is to translate the Stroke Illness Perception Questionnaire-Revised (SIPQ-R) into Chinese and to psychometrically test the Chinese version of the scale in the population of Chinese stroke patients. This was a methodological study. We investigated 593 stroke patients in the neurology department of a hospital in China from March to September 2021. We translated the SIPQ-R and adapted it to the cultural context, after which we evaluated the reliability and validity of the Chinese version of SIPQ-R. Exploratory factor analysis identified eight common factors that accounted for 71.74% of the total variance, and the factor loadings ranged from 0.530 to 0.933. Confirmatory factor analysis confirmed the eight-factor structure (χ2/df =1.765, root mean square error of approximation =0.053, incremental fit index =0.906, comparative fit index =0.905 and Tucker-Lewis index =0.900). Internal consistency was confirmed by a Cronbach's alpha coefficient of 0.982. The test-retest reliability was 0.762. The results showed good content validity (the scale level content validity index was 0.940, and the item level content validity index values ranged from 0.860 to 0.960). There were no missing responses and floor or ceiling effects. The standard error of measurement and the smallest detectable change for the SIPQ-R were 45.49 and 126.10, respectively. The results of this study provide empirical evidence for the reliability and validity of the Chinese version of the SIPQ-R for stroke patients.

Sleep Problems and Health Outcomes Among Urban American Indian and Alaska Native Adolescents

Adolescent sleep problems are prevalent, particularly among racial and ethnic minority groups, and can increase morbidity. Despite the numerous strengths of their racial and ethnic group, urban American Indian and Alaska Native adolescents face significant health disparities but are rarely included in health research. Understanding how sleep problems are associated with health outcomes among American Indian and Alaska Native adolescents may elucidate novel targets for interventions to promote health equity. To assess whether baseline sleep problems are associated with changes in behavioral and cardiometabolic health outcomes among urban American Indian and Alaska Native adolescents 2 years later. American Indian and Alaska Native adolescents were recruited via flyers and community events for an observational cohort study in California. Baseline assessments were conducted among 142 adolescents from March 1, 2018, to March 31, 2020, and follow-ups were conducted among 114 adolescents from December 1, 2020, to June 30, 2022. Baseline actigraphy-assessed sleep duration and efficiency and self-reported sleep disturbances and social jet lag (absolute value of the difference in sleep midpoint on weekends vs weekdays; indicator of circadian misalignment). Main outcome measures included self-reported depression (measured using the Patient Health Questionnaire), anxiety (measured using the Generalized Anxiety Disorder 7-item scale), past year alcohol and cannabis use, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist circumference, and glycosylated hemoglobin (HbA1c). Analyses examined whether baseline sleep was associated with health outcomes at follow-up, controlling for age, sex, and baseline outcome measures. The baseline sample included 142 urban American Indian and Alaska Native adolescents (mean [SD] age, 14.0 [1.4] years; 84 girls [59%]), 80% of whom (n = 114; mean [SD] age, 14.1 [1.3] years; 71 girls [62%]) completed follow-ups. Linear or logistic regressions showed significant negative associations between shorter sleep duration and depression (β = -1.21 [95% CI, -2.19 to -0.24]), anxiety (β = -0.89 [95% CI, -1.76 to -0.03]), DBP (β = -2.03 [95% CI, -3.79 to -0.28]), and HbA1c level (β = -0.15 [95% CI, -0.26 to -0.04]) and likelihood of alcohol (odds ratio [OR], 0.57 [95% CI, 0.36-0.91]) and cannabis use (full week: OR, 0.59 [95% CI, 0.35-0.99]) at follow-up. Greater social jet lag was associated with significantly higher SBP (β = 0.06 [95% CI, 0.01-0.11]) at follow-up. This cohort study found significant associations between poor sleep and adverse changes in health outcomes. Findings highlight the importance of developing culturally responsive interventions that target sleep as a key modifiable risk factor to improve the health of American Indian and Alaska Native adolescents.

Financial hardship, positive financial behaviour, and behavioural health outcomes among U.S. soldiers

LAY SUMMARY Financial hardship, such as difficulty paying for expenses or having to borrow money from family and friends to pay for needs, is of concern for several reasons, including how it affects mental and physical health. The authors wanted to provide more detailed information on which aspects of health it affects and were also curious about whether positive financial behaviors affected the health of military personnel. This study found that service members who reported more financial hardship also reported higher levels of depression, anxiety, posttraumatic stress disorder, insomnia, and physical aggression, poorer general health, and less sleep. However, positive financial behaviors had little effect on any of the health outcomes. Findings suggest that focusing on reducing financial hardship will be more effective in improving mental health than encouraging positive financial behaviors. This research has implications for the ongoing military efforts to improve financial literacy and reduce financial hardship.

Evaluation of a Ready4LifeProgram for US Refugee and Immigrant Youth

program on 4 outcome measures: (1) communication skills; (2) conflict resolution/conflict management, and problem-solving skills; (3) healthy relationship and marriage skills; and (4) progress towards greater economic stability. Methods. Refugee and immigrant youth (N = 341) were randomly assigned to either an intervention group or a comparison group. Intervention participants received a 16-hour relationship enhancement (RE) program developed for refugee populations. In addition to the RE program, intervention participants also received case management. Participants in the comparison group only received case management. All participants, intervention and control, completed self-report questionnaires prior to the beginning of the program. Intervention youth participated in the RE program. All participants completed a posttest questionnaire at the end of the program, and again 6 months after the end of the program. Results. Intervention participants made statistically significant improvements from pretest to 6-month follow-up (p < .05) compared to control participants for 3 of the 4 outcome variables. Conclusion. These results indicate the positive impact of an RE program on refugee and immigrant youth. Future researchers should consider including specific health programming as part of the intervention and also examine health behavior and other direct health outcomes.

Translational science approaches for food insecurity research

Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.

Greenspaces and Health: Scoping Review of studies in Europe.

Access to greenspaces and contact with nature can promote physical activity and have positive effects on physical and mental health. This scoping literature review aims to examine current evidence linking greenspaces and (a) behaviour change, (b) health outcomes and (c) co-benefits. This review was conducted in accordance with the PRISMA scoping review guidelines. Searches were conducted through PubMed and EMBASE databases for studies published between 2000 and March 2023 with a focus on Europe. 122 scientific articles and grey literature reports were identified. Access to greenspaces is positively associated with physical and mental health, and reduced risk of all-cause mortality and some non-communicable diseases. Greenspace quality is associated with increased physical activity and reduced risk of obesity. Nature-based therapies or green prescription are effective in improving mental health outcomes and overall health. Importantly, numerous co-benefits of greenspaces are identified. Increasing access to greenspaces for populations with particular attention to greenspace quality is important for co-benefits. Responsible governance and use of greenspaces are crucial to minimize public health risks and human disturbance of nature.

A Collective Action Formation to Address Mental, Emotional, and Behavioral Health in Schools: The District 87 Wellness Collaborative

The District 87 Wellness Collaborative is a multi-dimensional, interprofessional initiative in the Midwest region of the United States that was co-designed to facilitate collaboration, civic engagement, and partnerships among university scholar-practitioners, community agencies, and school administrators and personnel. The primary aims of the Wellness Collaborative are to develop, enhance, and extend school initiatives that address mental, emotional, and behavioral health outcomes of school-age children, their families, and the education workforce. The Wellness Collaborative is composed of disciplinary expertise in kinesiology, school counseling and psychology, social work, nursing, geography, and community health. Broader campus and community partners include specialists from civic and community engagement offices, extension services, and healthcare providers. This ecologically framed initiative supports strategic and system-level change within the district (system) and individual schools (sub-systems). It addresses complex school-level organizational factors (i.e., environment, norms, organizational culture, incentives, etc.) that influence wellness behaviors that affect school and physical education workforce professionals.

DNA methylation as a possible mechanism linking childhood adversity and health: results from a 2-sample mendelian randomization study.

Childhood adversity is an important risk factor for adverse health across the life course. Epigenetic modifications, such as DNA methylation (DNAm), are a hypothesized mechanism linking adversity to disease susceptibility. Yet, few studies have determined whether adversity-related DNAm alterations are causally related to future health outcomes or if their developmental timing plays a role in these relationships. Here, we used 2-sample mendelian randomization to obtain stronger causal inferences about the association between adversity-associated DNAm loci across development (ie, birth, childhood, adolescence, and young adulthood) and 24 mental, physical, and behavioral health outcomes. We identified particularly strong associations between adversity-associated DNAm and attention-deficit/hyperactivity disorder, depression, obsessive-compulsive disorder, suicide attempts, asthma, coronary artery disease, and chronic kidney disease. More of these associations were identified for birth and childhood DNAm, whereas adolescent and young adulthood DNAm were more closely linked to mental health. Childhood DNAm loci also had primarily risk-suppressing relationships with health outcomes, suggesting that DNAm might reflect compensatory or buffering mechanisms against childhood adversity rather than acting solely as an indicator of disease risk. Together, our results suggest adversity-related DNAm alterations are linked to both physical and mental health outcomes, with particularly strong impacts of DNAm differences emerging earlier in development.

Towards personalized precision functional mapping in infancy

Abstract The precise network topology of functional brain systems is highly specific to individuals and undergoes dramatic changes during critical periods of development. Large amounts of high-quality resting state data are required to investigate these individual differences, but are difficult to obtain in early infancy. Using the template matching method, we generated a set of infant network templates to use as priors for individualized functional resting-state network mapping in two independent neonatal datasets with extended acquisition of resting-state functional MRI (fMRI) data. We show that template matching detects all major adult resting-state networks in individual infants and that the topology of these resting-state network maps is individual-specific. Interestingly, there was no plateau in within-subject network map similarity with up to 25 minutes of resting-state data, suggesting that the amount and/or quality of infant data required to achieve stable or high-precision network maps is higher than adults. These findings are a critical step towards personalized precision functional brain mapping in infants, which opens new avenues for clinical applicability of resting-state fMRI and potential for robust prediction of how early functional connectivity patterns relate to subsequent behavioral phenotypes and health outcomes.

FarmResponse: Promoting Agricultural Competency to Improve Behavioral Health Outcomes in Rural Communities

FarmResponse: Promoting Agricultural Competency to Improve Behavioral Health Outcomes in Rural Communities

Ethnic Identity Protects and Internalized Racism Harms Health and Coping in Asian Americans Following COVID-19 Discrimination: A Mixed-Methods Study.

Mechanisms underlying the link between COVID-19 anti-Asian racial discrimination and psychological health are underexplored. This mixed-methods study examined the moderating effects of ethnic identity and internalized racism on the relationship between COVID discrimination and behavioral health outcomes among Asian Americans. We hypothesized that individuals with lower ethnic identity and higher internalized racism levels would demonstrate more adverse outcomes, including worsened psychological trauma and identity-avoidant behaviors, post-discrimination. Asian American participants (N = 215) responded to a Qualtrics survey, including qualitative and quantitative questions on COVID-related racism experiences, ethnic identity, internalized racism, trauma, and other subsequent effects. For qualitative analysis, participants were sorted into four subgroups defined by low- and/or high-ethnic identity and internalized racism scores, and we explored themes in participant reports of identity-related coping effects after racism. We additionally used hierarchical multiple regression analyses to quantitatively assess the moderating impact of ethnic identity and internalized racism on the relationship between COVID discrimination and trauma. Analyses revealed no moderating effects from the two identity variables. However, qualitative analyses identified themes of identity-promoting and identity-avoidant behavioral responses, and moderation analyses revealed that ethnic identity had a main effect on mitigating racial trauma, while internalized racism exacerbated both racial trauma and PTSD levels. This study identified ethnic identity and internalized racism as underlying causes to behavioral health outcomes for Asian Americans. Results offer mental health providers serving Asian clients insight into identity-related influences to help optimize culturally appropriate interventions and support initiatives of identity promotion to foster community engagement for this population.

Genital Surgery Outcomes Using an Individualized Algorithm for Hormone Management in Transfeminine Individuals.

Transgender and gender diverse (TGD) individuals have greater access to genital surgery (GS) with improved insurance coverage and access to trained surgeons and interdisciplinary gender-affirming providers. To determine perioperative medical and behavioral health outcomes in transfeminine (TF) individuals undergoing GS, with use of a specific gender-affirming hormone therapy (GAHT) algorithm based on individualized risk factor assessment. In this retrospective observational cohort study, we collected preoperative and postoperative data from 183 TF individuals at a single tertiary referral center from 2017 to 2022, grouping patients by those who continued estradiol (Group 1) vs those who had temporarily discontinued estradiol for 2 to 6 weeks preoperatively (Group 2). Data included clinical and biochemical assessment, GAHT regimens, validated behavioral health measures, and postoperative complications. Main outcomes included venous thromboembolism (VTE) incidence, non-VTE postoperative complication incidence, and change in behavioral health assessments. The majority of individuals continued estradiol perioperatively (Group 1; 138 [75.4%]). Individuals who temporarily held estradiol preoperatively (Group 2; 45 [24.6%]) were statistically older (P < .01), had higher incidence of cardiometabolic comorbidities (P < .01), and higher Caprini scores (P < .01). Group 1 was statistically more likely to use oral estradiol (P < .01). One episode (0.05%) of VTE occurred (Group 1). There was no significant difference in postoperative complications or behavioral health measures between groups. An individualized algorithm for preoperative hormone management for TF GS resulted in perioperative continuation of GAHT for the majority of individuals without significantly increasing the risk for postoperative surgical complications, while maintaining stable behavioral health measures perioperatively.

Perceived Physical Health and Cognitive Behavioral Therapy vs Supportive Psychotherapy Outcomes in Adults With Late-Life Depression

Physical diseases co-occur with late-life depression (LLD). The influence of physical diseases and the subjective perception of physical health (PPH) on treatment outcome in LLD, however, is not well understood. To assess the association of physical diseases and PPH with the outcomes of 2 different types of psychotherapy in LLD. This post hoc secondary analysis of a multicenter, observer-blinded, controlled, parallel-group randomized clinical trial assessed participants 60 years or older with moderate to severe depression recruited at 7 psychiatric-psychotherapeutic outpatient trial sites in Germany from October 1, 2018, to November 11, 2020. Data analysis was performed from April 1 to October 31, 2023. Patients received LLD-specific cognitive behavioral therapy (LLD-CBT) or supportive unspecific intervention (SUI). Depression severity, response, and remission were measured during treatment and at 6-month follow-up by the change in the 30-item Geriatric Depression Scale (GDS) score. Physical health and PPH were assessed by the number of physical diseases, Charlson Comorbidity Index (CCI), and the World Health Organization Quality of Life Brief Version physical health subscale. A total of 251 patients were randomized to LLD-CBT (n = 126) or SUI (n = 125), of whom 229 (mean [SD] age, 70.2 [7.1] years; 151 [66%] female) were included in the intention-to-treat analysis. Patients with low and moderate PPH at baseline had significantly less reduction in the GDS score across both treatment groups than patients with high PPH (estimated marginal mean difference [EMMD], 2.67; 95% CI, 0.37-4.97; P = .02 for low PPH and EMMD, 1.82; 95% CI, 0.22-3.42; P = .03 for moderate vs high PPH). Higher PPH at baseline was associated with higher likelihood of response (odds ratio [OR], 1.04; 95% CI, 1.00-1.06; P = .009) and remission at the end of treatment (OR, 1.04; 95% CI, 1.02-1.08; P = .002) and response (OR, 1.05; 95% CI, 1.02-1.08; P < .001) and remission at follow-up (OR, 1.06; 95% CI, 1.03-1.10; P < .001) across both treatment groups. However, a significant interaction of PPH with treatment group was observed with low PPH at baseline being associated with significantly larger reduction in GDS scores in SUI compared with LLD-CBT at the end of treatment (EMMD, -6.48; 95% CI, -11.31 to -1.64; P = .009) and follow-up (EMMD, -6.49; 95% CI, -11.51 to -1.47; P = .01). In contrast, patients with high PPH at baseline had a significantly greater reduction in GDS scores in LLD-CBT compared with SUI at all time points (week 5: EMMD, -4.08; 95% CI, -6.49 to -1.67; P = .001; end-of-treatment: EMMD, -3.67; 95% CI, -6.72 to -0.61; P = .02; and follow-up: EMMD, -3.57; 95% CI, -6.63 to -0.51; P = .02). The number of physical diseases or CCI at baseline did not have an effect on the change in GDS score, response, or remission, neither across both groups nor within either group. In this secondary analysis of a randomized clinical trial, subjective PPH was associated with treatment outcome, response, and remission in psychotherapy of LLD. Patients with LLD responded differently to LLD-CBT and SUI, depending on their baseline PPH score. Treatment approaches for patients with LLD should address PPH in personalized interventions. ClinicalTrials.gov Identifier: NCT03735576; Deutsches Register Klinischer Studien Identifier: DRKS00013769.

From Style to Wellness: How Fashion Influencers Are Affecting Healthy Behaviors in Saudi Arabia.

Background Social media influencers, particularly those in the fashion domain, have become prominent sources of health-related information, influencing the health behaviors of their followers, especially within the unique socio-cultural context of Saudi Arabia. This study aims to examine the relationship between following fashion influencers on social media and the adoption of healthy behaviors among Saudi residents. Methods A descriptive cross-sectional study with an analytic component was conducted from August 25, 2023, to December 15, 2023, among Saudi residents aged 18 years and older who actively follow fashion influencers. Data were collected via a structured, validated questionnaire distributed through various social media platforms. Data analysis was performed byemploying descriptive statistics, Pearson's chi-square test, and logistic regression analyses to identify predictors of negative health behavior outcomes. Results The study included 466 participants, revealing that despite insignificant differences in age and gender, postgraduate education was associated with negative outcomes (p = 0.016). Notably, 8.7% of individuals with negative outcomes held postgraduate degrees, compared to 2.9% in the non-negative group. Participants with negative outcomes more frequently followed influencers offering health tips (p = 0.01) and advocating a healthy lifestyle (p < 0.001). Logistic regression identified individuals who followed influencers with fewer than 10K followers had significantly higher odds of negative outcomes (OR = 3.6, 95% CI: 1.4-8.9, p = 0.006). Conclusion Following fashion influencers on social media can influence health behaviors among Saudis, with both positive and negative outcomes. Critical evaluation of influencer content is crucial to avoid potential adverse effects. Further research is also needed to explore the dynamics of influencer impact on health outcomes and to develop strategies for effective health communication in the digital age.

Neurobiological and Behavioral Underpinnings of Perinatal Mood and Anxiety Disorders (PMADs): A Selective Narrative Review.

Perinatal mood and anxiety disorders (PMADs) profoundly impact maternal and infant health, affecting women worldwide during pregnancy and postpartum. This review synthesizes current research on the neurobiological effects of PMADs, particularly their influence on brain structure, function, and corresponding cognitive, behavioral, and mental health outcomes in mothers. A literature search across PubMed, PsycINFO, and Google Scholar yielded studies utilizing neuroimaging (MRI, fMRI) and cognitive assessments to explore brain changes in PMADs. The key findings indicate significant neurobiological alterations in PMADs, such as glutamatergic dysfunction, neuronal damage, and altered neural connectivity, particularly in postpartum depression (PPD). Functional MRI studies reveal distinct patterns of brain function alteration, including amygdala non-responsivity in PPD, differing from traditional major depressive disorder (MDD). These neurobiological changes are connected with cognitive impairments and behavioral modifications, impacting maternal caregiving. Understanding these alterations is fundamental for developing effective treatments. The findings emphasize the importance of focusing on maternal mental health, advocating for early detection, and personalized treatment strategies to improve maternal and child outcomes.

Combustible cigarette smokers versus e-cigarette dual users among Latinx individuals: Differences in alcohol and drug use severity.

The Latinx population in the United States (U.S.) experiences significant tobacco and other substance use-related health disparities. Yet, little is known about the couse of combustible cigarettes and e-cigarettes (dual use) in relation to substance use behavior among Latinx smokers. The present investigation compared English-speaking Latinx adults living in the United States who exclusively smoke combustible cigarettes versus dual users in terms of alcohol use and other drug use problem severity. Participants were 297 Hispanic/Latinx daily cigarette smokers (36.4% female, Mage = 35.9 years, SD = 8.87) recruited nationally across the United States using Qualtrics Panels to complete self-report measures of behavioral health outcomes. Five analysis of covariance models were conducted to evaluate differences in overall alcohol consumption, dependence, related problems, hazardous drinking, and drug use problem severity between exclusive combustible cigarette smokers (N = 205) and dual users (N = 92). Results indicated that dual users evinced greater levels of alcohol consumption, dependence, alcohol-related problems, and hazardous drinking compared to exclusive combustible cigarette smokers (ps < .001). Dual users also reported greater levels of drug use problems relative to exclusive combustible cigarette smokers (p < .001). The current findings are among the first to document that dual cigarette and e-cigarette use status (compared to exclusive combustible cigarette smoking) may serve as a clinically relevant risk indicator for a range of deleterious substance use problems among Latinx individuals. Future research is needed to corroborate these findings and examine dual-use status as a longitudinal predictor of alcohol and other substance-related problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing Structural Racism Measures on Health Outcomes of Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review.

Limited literature exists on structural racism measures on health outcomes for Asian Americans, Native Hawaiians, and Pacific Islanders (AAs and NH/PIs). AAs and NH/PIs make up approximately 6.2% of the U.S. population and consist of diverse ethnic subgroups with distinct languages, cultures, religions, socioeconomic statuses, and historical backgrounds. The lack of disaggregated data collection and contextualized measures hinders our understanding of how structural racism affects health outcomes in these populations. We conducted a scoping review to assess the extent to which measures of structural racism are used in research with AAs and NH/PIs. Databases, including CINAHL, EBSCO, PsychINFO, PubMed, Scopus, and Social Science Citation Index, were searched for peer-reviewed articles on the measures of and empirical impacts of structural racism on AA and NH/PI health. We identified 23 full-text articles from a pool of 11,660 screened articles. Four articles were included in the final analysis. Among the selected studies, two studies identified an association between racial segregation and mental and behavioral health outcomes within AAs and NH/PIs. The other two studies found redlining on chronic health outcomes in these communities. These studies uncovered associations between government systems and policies and AA and NH/PI health outcomes. Existing measures may not adequately capture the complex relationships between structural racism and health outcomes in AAs and NH/PIs. Future research should contextualize and operationalize the multifaceted manifestations of structural racism unique to AAs and NH/PIs to achieve health equity.

Shared Decision-Making in Cardiovascular Risk Factor Management

The effect of shared decision-making (SDM) and the extent of its use in interventions to improve cardiovascular risk remain unclear. To assess the extent to which SDM is used in interventions aimed to enhance the management of cardiovascular risk factors and to explore the association of SDM with decisional outcomes, cardiovascular risk factors, and health behaviors. For this systematic review and meta-analysis, a literature search was conducted in the Medline, CINAHL, Embase, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov databases for articles published from inception to June 24, 2022, without language restrictions. Randomized clinical trials (RCTs) comparing SDM-based interventions with standard of care for cardiovascular risk factor management were included. The systematic search resulted in 9365 references. Duplicates were removed, and 2 independent reviewers screened the trials (title, abstract, and full text) and extracted data. Data were pooled using a random-effects model. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Decisional outcomes, cardiovascular risk factor outcomes, and health behavioral outcomes. This review included 57 RCTs with 88 578 patients and 1341 clinicians. A total of 59 articles were included, as 2 RCTs were reported twice. Nearly half of the studies (29 [49.2%]) tested interventions that targeted both patients and clinicians, and an equal number (29 [49.2%]) exclusively focused on patients. More than half (32 [54.2%]) focused on diabetes management, and one-quarter focused on multiple cardiovascular risk factors (14 [23.7%]). Most studies (35 [59.3%]) assessed cardiovascular risk factors and health behaviors as well as decisional outcomes. The quality of studies reviewed was low to fair. The SDM intervention was associated with a decrease of 4.21 points (95% CI, -8.21 to -0.21) in Decisional Conflict Scale scores (9 trials; I2 = 85.6%) and a decrease of 0.20% (95% CI, -0.39% to -0.01%) in hemoglobin A1c (HbA1c) levels (18 trials; I2 = 84.2%). In this systematic review and meta-analysis of the current state of research on SDM interventions for cardiovascular risk management, there was a slight reduction in decisional conflict and an improvement in HbA1c levels with substantial heterogeneity. High-quality studies are needed to inform the use of SDM to improve cardiovascular risk management.

Children of trauma survivors: Influences of parental posttraumatic stress and child-perceived parenting

BackgroundResearch has established a negative association between parental posttraumatic stress symptoms (PTSS), including subthreshold symptoms, and child physical and behavioral health outcomes. Such intergenerational transmission of risk has multiple possible mechanisms, including lack of positive parenting, increased negative parenting, shared environmental and contextual risks, and potential biological components such as shared genetics or even transmission of epigenetic risk. MethodThis study examined 93 parent-child dyads (n = 171 participants total) from a mixed Urban-Suburban US metropolitan area to investigate the relations between parental PTSS and child-perceived parenting and child PTSS. We sought to examine interactions between parental PTSS and parenting on child PTSS. ResultsWe found an association between parent and child PTSS, consistent with prior literature showing increased risk for children of trauma survivors. Interestingly, we found effects of positive parenting on diminished child PTSS symptoms only in parents without PTSS, whereas the effect of positive parenting on buffering child symptoms was absent in parents with PTSS.Limitations.The present findings are tempered by the use of self-report data to assess parent and child PTSS, which is not as reliable as clinician assessment of symptoms. Further, the use of survey data limits what is known about the extent of trauma exposure in parents and children, and different measures were used to assess PTSS in parents and kids, which limits comparability of these reported symptoms. DiscussionLimitations notwithstanding, findings suggest joint attention paid to parenting practices and to a parent's recovery, even from subthreshold symptoms of PTSS, as two different but important ways to support trauma survivor parents in their efforts to most optimally parent and protect their children from intergenerational risk.

Smartphone and Wearable Device-Based Digital Phenotyping to Understand Substance use and its Syndemics.

Digital phenotyping is a process that allows researchers to leverage smartphone and wearable data to explore how technology use relates to behavioral health outcomes. In this Research Concepts article, we provide background on prior research that has employed digital phenotyping; the fundamentals of how digital phenotyping works, using examples from participant data; the application of digital phenotyping in the context of substance use and its syndemics; and the ethical, legal and social implications of digital phenotyping. We discuss applications for digital phenotyping in medical toxicology, as well as potential uses for digital phenotyping in future research. We also highlight the importance of obtaining ground truth annotation in order to identify and establish digital phenotypes of key behaviors of interest. Finally, there are many potential roles for medical toxicologists to leverage digital phenotyping both in research and in the future as a clinical tool to better understand the contextual features associated with drug poisoning and overdose. This article demonstrates how medical toxicologists and researchers can progress through phases of a research trajectory using digital phenotyping to better understand behavior and its association with smartphone usage.