Psychosocial Research Research Articles

Training of Nurse Interventionists to Optimize Intervention Fidelity in a Telehealth Pilot Study.

Interventionist training and on-going guidance by the research team are essential in psychosocial interventional research to ensure fidelity. Consistency in delivering an intervention requires recruiting interventionists with well-aligned clinical experience, developing a replicable training process, and reassessing ongoing intervention fidelity using an assessment tool of observable behaviors that are essential to the intervention. This paper describes one research team's experience of hiring and training nurse interventionists to deliver a theory-based, telehealth psychosocial intervention for a single-arm pilot study. The training methods used to foster the nurses' integration of theory into intervention delivery are discussed, along with approaches adopted to optimize and measure fidelity. The research team and interventionist trainees in this pilot study overcame learning challenges through establishing mutual trust and promoting effective communication throughout the training process. Fostering connections between cognitive and affective learning during the nurse interventionists' training was critical to establishing and maintaining intervention fidelity.

The opposite roles of injustice and cruelty in the internalization of a devaluation: The humiliation paradox revisited.

Cruelty and its link to injustice in contexts of humiliation have not received to date due attention from experimental psychosocial research. Aiming at filling this gap, this paper presents three studies with increasing degrees of experimental control (Ntotal = 1098) that show a dual opponent-process response to being targeted by potentially humiliating actions: while targets appraising more injustice internalize less the devaluation underlying the humiliation experience (thus partially dissolving the so-called "paradox of humiliation", Fernández etal., 2015, Personality and Social Psychology Bulletin, 41, 976), targets appraising more cruelty internalize more a devalued self-view and feel more humiliated. The fine balance between these two closely connected but distinct appraisals is key to understand the internal/subjective experience of targets: seeing themselves mainly as victims of injustice or cruelty will prevent or favour, respectively, their internalization of the devaluation and their feeling humiliated. This opposite pattern also impacts victims' reaction: Both appraisals relate to aggressive responses via anger but while appraising cruelty also paradoxically leads to powerless inertia, appraising injustice (including importantly the injustice of cruelty itself) leads to less powerlessness and more assertive agency. The theoretical and applied implications of approaching the victims of humiliation as victims of both an injustice and a cruelty are discussed.

Genes in context: path to more precise risk prediction in psychiatry?

This guest editorial describes the importance of converging genetics and psychosocial epidemiology research methods to understand the biopsychosocial etiology of psychiatric phenotypes.

Trends in psychosocial research on LGBTIQ+ populations in Latin America: Findings, challenges, and concerns

AbstractPsychosocial research on lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) populations from Latin America is relatively recent. Initially, research focused mainly on prejudice, using qualitative techniques. Studies on LGBTIQ+ populations, using more sophisticated psychosocial theories such as those of Herek or Meyer, began in the mid‐1990s. This study deals with surveys and scales based on non‐probabilistic samples, LGBTIQ+ populations being the first studied. In the early 2000s, queer and/or LGBTIQ+ theories were introduced, and research has been much more interdisciplinary. This paper describes the theoretical frameworks used in LGBTIQ+ research in Latin America and examines distinctions in the findings from Mexico, Colombia, Chile, Argentina, and Brazil. Future research must involve cross‐cultural studies, systematic or scoping reviews, and studies on non‐binary populations. Finally, the conditions for reimaging LGBTIQ+ research in Latin America are discussed.

"You Can't Let Go" - A Black Community Leader's Perspective on Engagement and Advocacy.

Lanre Tunji-Ajayi is president and CEO of the Sickle Cell Awareness Group of Ontario (SCAGO). This charitable organization focuses on ameliorating the lives of those living with sickle cell disease by providing evidence-based support to patients and supporting clinical and psychosocial research, health promotion and the development of best practice guidelines. Lanre's passion for this work is personal. Following the death of her brother Sunday Afolabi from preventable and treatable complications of sickle cell disease, Lanre immersed herself in advocacy for community health and quality patient care. In this oral history narrative, Lanre reflects on her decades-long journey advocating for those living with sickle cell disease - a disease which disproportionately affects Black people. Her reflections focus acutely on the challenges she has faced in raising awareness and visibility, including through formal public engagement policy processes. Lanre also speaks to the personal costs she has encountered engaging in this advocacy work and the subtle and institutionalized forms of anti-Black racism that have punctuated this already difficult effort to bring about change.

Fifty years of research on psychosocial working conditions and health: From promise to practice.

This paper presents an overview of 50 years of research on psychosocial working conditions and health with regards to conceptualization, interventions and policy. We reflect on the promise of past and current research on psychosocial working conditions and, in addition, discuss current progress in translating this research into workplace practice and improvements in people's working lives. We conducted a narrative review of meta-reviews and key publications on psychosocial working conditions and health. The review covers a historical overview of theories of the past 50 years, measurement of psychosocial working conditions, health effects, intervention research, and policy development on psychosocial working conditions. Psychosocial working conditions are conceptualized in different ways, with increasing complexity in the understanding developing over time. Exposures related to psychosocial working conditions are associated with a wide range of health outcomes, in particular cardiovascular disease and mental health conditions. In response to growing evidence on associations between psychosocial working conditions and health outcomes, intervention research has expanded rapidly, but for various reasons the evidence base is stronger and more extensive for individual- than organizational-level interventions. This individual/organizational imbalance is reflected in practice, and may partly explain why policy interventions have yet to show reductions in exposures to psychosocial work factors and associated adverse outcomes. Pressing needs for advancing the field include improvements in capturing exposure dynamics, developing objective measures of exposure, methodologic advancements to optimize causal inference in etiologic studies, and alternatives to randomized controlled trials for intervention evaluation.

Knowing Me, Knowing You: Changes in Parental Representations Among Established Adults Going Through Progressive Identity Development

AbstractDeveloping and revising one’s identity is a lifelong task, one that influences and is influenced by close relationships in the individual’s social context. For emerging adults, different approaches to identity formation have been associated with different ways of relating to their parents; however, little is known about how identity development and views on one’s parents interact beyond the emerging adult years. In the present study, we addressed this gap by examining changes in how established adults describe and relate to internal representations of their parents as they develop from identity foreclosure to identity achievement, an identity status transition that is considered progressive and has been related to shifts in parental representations in younger samples. From a longitudinal study using the Identity Status Interview (Marcia et al., Ego identity: A handbook for psychosocial research, Springer, 1993), we selected participants coded as foreclosed at age 29 and identity achieved at age 33 (N = 18). A case study approach was used to analyze individual changes in parental representations, and a thematic analysis was conducted to identify themes across cases. The findings show that progressive identity development in established adulthood may involve making more reflective comparisons between oneself and one’s parents, describing one’s parents more as whole persons, and relating to parental influence with greater independence and agency. The results highlight the continued importance of parents for adult identity development, and that progressive identity development in established adulthood may involve increased complexity in representations of both oneself and one’s parents.

Психометрия латентных характеристик: инструменты, проблемы обработки ранговой информации, решения

<p>The paper examines the problems of correctness and adequacy of the use of psychometric tools in psychosocial research and applications. The main attention is paid to the problem of correct processing of rank information, which is non-numeric information that does not allow the use of classical mathematical operations, starting with the addition operation. The approach of forming the results of processing expert, ranked information in the scale of relations based on the Analytic Hierarchy Process (AHP), which includes a measurement apparatus and decision-making algorithms, is presented. An example is given that simulates the situation of an expert council and demonstrates unacceptable contradictions that arise with the "numerical" approach to processing rank information. The algorithms of the AHP normative approach are presented, which allow obtaining numerical, personalized assessments of psychosocial characteristics. The basic concepts of the Rasch Measurement (RM) for comparing the capabilities of AHP and RM in psychosocial applications are described. Some critical remarks about the methods of psychometry are considered. It is shown that the origins of the criticisms are associated with a superficial understanding of the basic concepts of psychometric measurements and the scope of their applications, as well as with elementary errors when using the apparatus of psychometric instruments.</p>

The Mediation of Critical Themes of Motherhood Studies in Storytelling: The Case of The Girl Who Drank the Moon

By contemplating the emotional and intellectual link between the reader and the book, this article considers how a contemporary text might respond to current motherhood studies’ issues, and how these studies are mediated to be considered appropriate for an audience of young readers. A psychosocial research strategy is used, through a feminist theoretical framework, to analyze how the young adult novel The Girl Who Drank the Moon incorporates key ideas of motherhood studies through characters’ agency and the storytelling arch. Motherhood is represented as an institution, an individual identity and an emotional experience, and the novel offers the young reader a nuanced vision into an ongoing discussion. The potential of storytelling to mediate social justice concerns to the young reader is highlighted.

Cancer predisposing syndromes in childhood and adolescence pose several challenges necessitating interdisciplinary care in dedicated programs.

Genetic disposition is a major etiologic factor in childhood cancer. More than 100 cancer predisposing syndromes (CPS) are known. Surveillance protocols seek to mitigate morbidity and mortality. To implement recommendations in patient care and to ascertain that the constant gain of knowledge forces its way into practice specific pediatric CPS programs were established. We retrospectively analyzed data on children, adolescents, and young adults referred to our pediatric CPS program between October 1, 2021, and March 31, 2023. Follow-up ended on December 31, 2023. We identified 67 patients (30 male, 36 female, 1 non-binary, median age 9.5 years). Thirty-five patients were referred for CPS surveillance, 32 for features suspicious of a CPS including café-au-lait macules (n = 10), overgrowth (n = 9), other specific symptoms (n = 4), cancer suspicious of a CPS (n = 6), and rare neoplasms (n = 3). CPS was confirmed by clinical criteria in 6 patients and genetic testing in 7 (of 13). In addition, 6 clinically unaffected at-risk relatives were identified carrying a cancer predisposing pathogenic variant. A total of 48 patients were eventually diagnosed with CPS, surveillance recommendations were on record for 45. Of those, 8 patients did not keep their appointments for various reasons. Surveillance revealed neoplasms (n = 2) and metachronous tumors (n = 4) by clinical (n = 2), radiological examination (n = 2), and endoscopy (n = 2). Psychosocial counselling was utilized by 16 (of 45; 35.6%) families. The diverse pediatric CPSs pose several challenges necessitating interdisciplinary care in specified CPS programs. To ultimately improve outcome including psychosocial well-being joint clinical and research efforts are necessary.

The feasibility and acceptability of collecting psychosocial outcome measures embedded within a precision medicine trial for childhood cancer.

Patient-reported outcomes measures (PROMs) are increasingly being collected within cancer clinical trials, yet limited literature on the feasibility and acceptability of doing so. We collected parent-proxy and adolescent (≥12 years old) PROMs through a longitudinal, psychosocial sub-study ('PRISM-Impact') embedded in a precision medicine trial for children with poor prognosis cancer ('PRISM'). We report on feasibility (response, participation, and attrition rates; follow-up and responding to elevated distress) and acceptability (parents' perceived benefit/burden of participation; and impact on decision to participate in PRISM) of PRISM-Impact. Over the reporting period, 462 families were eligible for PRISM-Impact. Family and adolescent response rates were 53% and 45%, respectively. Parents whose child had relapsed were more likely to participate in PRISM-Impact than parents whose child had not (p < 0.001). Parent and adolescent attrition rates were 30% and 56% respectively. We conducted 478 calls for intake and to follow-up on missing questionnaires, and 122 calls to respond to elevated distress. Parents reported wanting to participate in PRISM-Impact for altruistic reasons and because they valued psychosocial research. Parents reported little-to-no burden and some benefit from participating in PRISM-Impact, with little change in ratings overtime. Most parents felt that participating in PRISM-Impact did not impact their desire to participate in PRISM (72%), with some feeling more eager to participate (19%). PRISM-Impact response rates were comparable to other psycho-oncology studies, despite the poor prognosis population. Integration of PROMs within a paediatric oncology trial is acceptable to parents, and may provide a more comprehensive assessment of the impact of trial participation.

The Crucial Role of Psychosocial Research for Patients and Caregivers: A Narrative Review of Pediatric Psycho-Oncology Research in India

AbstractThe focus of pediatric cancer research in India has largely been medical and clinical, with little focus on psycho-oncological aspects. Receiving a cancer diagnosis can be life altering for both the patients as well as their families and points to a need for psycho-oncological research. The present narrative review examined original articles on pediatric psycho-oncology research conducted in India particularly in the past two decades. There is promising research in various domains such as survivorship and quality of life, patient needs and psychosocial concerns, communication between health care providers, patients, and caregivers, parent and caregiver needs including psychosocial support and information, as well as some intervention-based studies. With much of the research being conducted within clinical setups through surveys and retrospective data, psychosocial issues faced by patients and their families are discussed along with physical, logistical, and financial concerns, while forays into intervention-based research are still in primary phases but show potential in terms of outcomes and feasibility. There is need for more methodologically rigorous research rooted in strong theoretical foundations, culturally sound models, and with evidence-based examination of all stages and stakeholders involved in providing and receiving care in pediatric cancer.

Comprehensive examination of support needs and mental well-being: a mixed-method study of the Austrian general population in times of crisis.

In the recent years, the Austrian general population has faced a confluence of multiple crises. This study investigates the support wishes and mental health parameters of the Austrian general population aiming to comprehending the unmet needs and providing guidance for future psychosocial interventions and research endeavors. 1,031 participants attended the online survey and one third (n = 332) wished for further support to improve mental well-being in April 2022. A total of 280 participants accompanied their support wish with written accounts. Participants' mental health status was evaluated using the PHQ-9 (depression), GAD-7 (anxiety), ISI (insomnia), PSS-10 (perceived stress), CAGE (alcohol abuse), WHO-5 (well-being), and the SCOFF (eating disorder) questionnaires. Data analysis employed a mixed-methods approach. The preeminent support wish identified was the need for professional mental support (29.3%), followed by communication (21.6%), other professional support except mental and medical support (13.9%). In line with these findings, participants expressing a support wish experienced increased mental health distress across all assessed parameters. The findings indicate the presence of a vulnerable population within the Austrian general population, which may benefit from targeted support interventions. Consequently, this study contributes to the identification of unmet support needs among the Austrian populace during times of crisis, facilitating the development and enhancement of precisely tailored intervention strategies.

Psychosocial Experiences of Spanish-Speaking Parents of Children With Craniofacial Microsomia.

Craniofacial microsomia (CFM) and microtia psychosocial research in the US is primarily with English-speaking participants. Given that 19% of the US is Latino, and there is a higher prevalence of CFM in Latino populations, this study aims to describe psychosocial experiences related to CFM among Spanish-speaking Latino caregivers to better inform health care. Narrative interviews (mean 73±17min) were completed in Spanish with parents of children with CFM aged 3 to 17 (mean age 10.8±4.8years). Transcripts were analyzed using quantitative linguistic analyses and reflexive thematic analysis. Participants (N=12) were mostly mothers (83%) who had immigrated to the US and had low socioeconomic status. Based upon analysis of grouped word counts, participants spent approximately half of their narratives discussing the first two years of their child's life. Themes selected based on US Latino sociodemographics and cultural values included the Impact of Language, Healthcare Challenges, Supportive Healthcare Experiences, Caregiver Coping with CFM, Family Roles, and Addressing Social Implications of CFM. Results highlighted that the first years of care are of critical importance to parents and suggest this is an optimal time to focus on education and support services for families. Additional treatment suggestions include providing interpretation and informational materials in Spanish, addressing care barriers, supporting familial and child coping, accounting for the role of extended family, and helping address social concerns. Ongoing research with Latino families can further assist in guiding culturally sensitive CFM health care.

Experimenting with arts-based methods and affective provocations to understand complex lived experience of a diagnosis of borderline personality disorder

This article draws on arts-based psycho-social research to explore embodied and visceral knowing and feeling in the context of people living with a diagnosis of borderline personality disorder (BPD). It presents a discussion of creative artworks solicited through a nation-wide online survey conducted in Australia in 2021 that generated intimate and affective understanding about living with a diagnosis of BPD. To investigate what lived experiences of distress associated with a BPD diagnosis communicate through sensation, emotion, image and affective capacity, the authors put to work Blackman's (2015) concept of “productive possibilities of negative states of being” and the broader theoretical framework of new materialism. This approach allows a more transformative feeling-with that exceeds the normative affective repertoires and scripts associated with a diagnosis of BPD. The authors recognise the often unspoken and invisible affects of complex mental distress and trauma, and purposefully open the space for affective and symbolic aspects of creative artworks to communicate what is less known or has less presence in dominant biomedical frameworks about living with a BPD diagnosis. The article foregrounds the lived and living experience of participants to generate experiential rather than clinical understandings of the diagnosis.

Considering Parents of Malignant ill Children in COVID-19 Health Crisis

Aim: Parents of children suffering from malignant diseases indubitably represent a very dainty population, underrepresented in psychosocial research. It is common for these parents to move to the hospital wards in order to support their children, which causes an unnatural cut in their lifeline, in addition to coping with terrifying diagnosis. Coping with a child’s malignant disease includes a continuous feeling of fear and concern, and change in the overall family dynamics, but also the cessation of daily life activities, even outside the context of a global pandemic, some pre-COVID research had shown. COVID-19 brought some additional challenges. In order to protect children’s fragile physical state, parents were obliged to adapt to new rules and distance from the others even more. At the same time, their fears and worries grew only bigger and coping mechanisms were seriously limited. Subjects and Methods: In this paper we investigate parental experiences and needs during COVID-19 crisis. Semi-structured in-depth interviews were conducted with ten mothers with experience of children’s in-patient treatment before and during pandemics. Results: According to main findings, theoretical model of parental adjustment and wellbeing in health crisis is proposed. Conclusion: Results imply the necessity to consider parental psychological wellbeing in order to support them and their children, especially when additional stressful and/or traumatic experiences emerge, and treat them as especially vulnerable group in research and practice.

Evaluation of the effectiveness of psychosocial rehabilitation: an innovative approach based on the analytic hierarchy process

IntroductionIn psychosocial rehabilitation (PSR), rank scales are widely used to assess the severity of functional disorders in patients. The main problem of evaluating the effectiveness of PSR is related to the methods of processing data obtained using psychometric scales used to evaluate the effectiveness of interventions within PSR. The proof of the non-numerical nature of ranks was obtained by J. Pfanzagl (1968). Incorrect processing of rank information obtained in the framework of psychosocial research leads to contradictions in the assessment of the patient’s condition. Consequently, rank processing does not allow classical mathematical operations (summation, average), which makes it impossible to correctly estimate the effectiveness of PSR numerically.ObjectivesDevelopment of algorithms for numerical evaluation of PSR efficiency based on rank information processing using the analytic hierarchy process (AHP) [1].MethodsClinical, psychometric, AHP algorithmsResultsThe analysis of the problems of assessing the patient’s conditions on the basis of categorical and psychometric (rank) scales and subscales shows that these problems can be presented in the form of appropriate hierarchies, the structure of which must be taken into account when processing the initial information.According to the results of the analysis of the data of preliminary studies, the main areas of impaired functioning of patients affecting the evaluation of the effectiveness of PSR have been identified. Rank estimates of changes in the relevant areas of the patient’s dysfunction after the PSR program compared to the initial level are the basis for the conclusion about the effectiveness of the PSR components. Algorithms of the AHP normative approach were used to translate rank information into numerical information [2]. The weight of the areas of the patient’s functioning disorders was used in the formation of integral estimates of the effectiveness of PSR.The fundamental difference between AHP-based assessments and rank assessments is due to the fact that numerical estimates of the weight of the criteria and the corresponding changes in the patient’s condition are obtained, which depend on the qualifications of specialists, the characteristics of the scales used to measure violations in the relevant areas and the procedures of the PSR.ConclusionsObtaining the results of processing rank information in a numerical scale allows to obtain the correct integration of the patient’s personal characteristics when considering PSR procedures and to obtain correct prognostic models of the patient’s condition. 1. Saaty T. European Journal of Operational Research.1990; 48(1):9-26. https://doi.org/10.1016/0377-2217(90)90057-I 2. Mitikhin V.G., Solokhina T.A. et al. Psychiatry, 2022; 20(2): 51-59. DOI: 10.30629/2618-6667-2022-20-2-51-59Disclosure of InterestNone Declared

Personalized assessment of the effectiveness of psychosocial rehabilitation: an innovative approach based on the process of analytical hierarchy

IntroductionIn psychosocial rehabilitation (PSR), rank scales are widely used to assess the severity of functional disorders in patients. The main problem of evaluating the effectiveness of PSR is related to the methods of processing data obtained using psychometric scales used to evaluate the effectiveness of interventions within PSR. J. Pfanzagl (1968) obtained the proof of the non-numerical nature of ranks. Incorrect processing of rank information obtained in the framework of psychosocial research leads to contradictions in the assessment of the patient’s condition. Consequently, rank processing does not allow classical mathematical operations (summation, average), which makes it impossible to correctly estimate the effectiveness of PSR numerically.ObjectivesDevelopment of algorithms for numerical evaluation of PSR efficiency based on rank information processing using the analytic hierarchy process (AHP) [1].MethodsClinical, psychometric, AHP algorithms.ResultsThe analysis of the problems of assessing the patient’s conditions on the basis of categorical and psychometric (rank) scales and subscales shows that these problems can be presented in the form of appropriate hierarchies [2], the structure of which must be taken into account when processing the initial information.According to the results of the analysis of the data of preliminary studies, the main areas of impaired functioning of patients affecting the evaluation of the effectiveness of PSR have been identified. Rank estimates of changes in the relevant areas of the patient’s dysfunction after the PSR program compared to the initial level are the basis for the conclusion about the effectiveness of the PSR components. Algorithms of the AHP normative approach were used to translate rank information into numerical information [2]. The weight of the areas of the patient’s functioning disorders was used in the formation of integral estimates of the effectiveness of PSR.The fundamental difference between AHP-based assessments and rank assessments is due to the fact that numerical estimates of the weight of the criteria and the corresponding changes in the patient’s condition are obtained, which depend on the qualifications of specialists, the characteristics of the scales used to measure violations in the relevant areas and the procedures of the PSR.ConclusionsObtaining the results of processing rank information in a numerical scale allows to obtain the correct integration of the patient’s personal characteristics when considering PSR procedures and to obtain correct models of the patient’s state. 1. Saaty T. European Journal of Operational Research.1990; 48(1):9-26. https://doi.org/10.1016/0377-2217(90)90057-I 2. Mitikhin V.G., Solokhina T.A. et al. Psychiatry, 2022; 20(2): 51-59. DOI: 10.30629/2618-6667-2022-20-2-51-59Disclosure of InterestNone Declared

In search of a prerequisite for infant participation in pregnancy: a depth-hermeneutical interpretation of conversations between coming mothers and midwives

Based on the fact that the United Nations Convention on the Rights of the Child (UNCRC) gives the right to participate and be heard in situations that affect their lives to all children, even pre-verbal infants, we have looked for the infant voice in parental narratives about their child. Conversations between 16 mothers and a professional at two stages were videotaped and transcribed. The first conversation between mother and midwife took place in pregnancy and, the second, between mother and health nurse, was completed when the child was about six months old. We wanted to invent a method that could find the voice of pre-verbal children, even before birth, a method capable of registering the child’s impact on us and decoding this influence into common language and practical action. Based on infant research on intersubjectivity and qualitative methodology from psychosocial research, we developed a procedure of depth-hermeneutical interpretation of the parental narratives. In this article we describe the results from the interpretation of the narratives made in pregnancy. Through the procedure of Scenic-Narrative Microanalysis, a very suitable method of depth-hermeneutic group interpretation, we identified three different areas of conflict or tension in the data material: container versus oneness; openness versus narrowness; and control versus curiosity. A description of the epistemological foundations and the research procedures from data collection to interpretation will be given. The results from the second round of interpretation will be analysed and compared with the results from the pregnancy narratives, and published in a future article.

Abstract WP90: Participants With Complex Impairment Profiles Are Systematically Excluded From Stroke Psychosocial Support Research: A Scoping Review

Introduction: Disability after stroke often requires mental health treatment, but contradictorily, also restricts access to it. People with cognitive, motor, language, and perceptual impairments have been excluded from research on psychosocial supports like psychotherapy, support groups, and meaningful life activities. This exclusion adds to the inequitable distribution of benefits, including fewer treatment options and less knowledgeable providers. Very little is known about who is excluded from stroke psychosocial support research, why they are excluded, and how exclusion occurs. Methods: Exclusionary practices were investigated using a Johanna Briggs Institute-method scoping review. Independent reviewers screened searches of CINAHL, Embase, MEDLINE, and PsychInfo, resulting in 101 included studies. Content analysis was used to analyze studies following an a priori coding framework, which included: Design, inclusion/exclusion criteria, stroke impairment, psychiatric comorbidity, and psychosocial support type. Results: Samples were commonly limited to mild cognitive impairment, with other subpopulations under-represented. Moderate-to-severe cognitive and language impairments were systematically excluded from psychotherapy studies. In contrast, support group and meaningful life activity studies more often included a range of impairments, but also more often excluded psychiatric comorbidity. Studies with rigorous designs rarely included complex impairment profiles. Reasons for exclusion were seldom provided, and participant characteristics were routinely underreported. Conclusion: By including only people with mild and uncomplicated impairment profiles, the field risks neglecting the complex realities of others who arguably have even greater need for support. This scoping review offers recommendations for stroke research and practice, including: The inclusion of a range of stroke impairments in research samples, adapting procedures using compensatory strategies to facilitate inclusion, and greater cross-pollination between mental health and rehabilitation disciplines. This review serves as a call to action to make psychosocial supports equitable and accessible for all people, regardless of ability.