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Callan S, Ulrich GR, Wooldridge JS, Roberts S, Ranby KW. The development and psychometric examination of the partner investment in health scale. Psychol Health 2024; 39:786-802. [PMID: 35993380 DOI: 10.1080/08870446.2022.2112581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Relationship partners' impacts on health are not fully captured by existing measures. A measure that applies to a prevention context and accounts for both partners' perspectives is needed. This work developed and assessed the psychometric properties of the novel Partner Investment in Health scale (PI-H). DESIGN A cross-sectional design assessed participants (N = 261) using an online survey. Exploratory factor analyses were used to determine the PI-H factor structure. MAIN OUTCOME MEASURES Items assessed the person's investment in their partner's health and their perception of their partner's investment in their health. RESULTS A 2 factor structure underlying 24 items on the PI-H scale was supported. Factors represented 1) the respondent's investment and 2) the respondent's perception of their partner's investment. The PI-H significantly correlated with related measures (e.g. relationship satisfaction, dyadic and communal coping; p < .05). CONCLUSION A full PI-H scale, two subscales, and a short version of the scale (8 items) are presented. Correlations demonstrated convergent validity and suggested the PI-H is distinct from existing constructs. Theoretical implications and applications are discussed.
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Affiliation(s)
| | | | - Jennalee S Wooldridge
- VA San Diego Healthcare System, United States
- Department of Psychiatry, University of California, San Diego, United States
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Tynan M, Virzi N, Wooldridge JS, Morse JL, Herbert MS. Examining the Association Between Objective Physical Activity and Momentary Pain: A Systematic Review of Studies Using Ambulatory Assessment. J Pain 2024; 25:862-874. [PMID: 37914094 DOI: 10.1016/j.jpain.2023.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/22/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023]
Abstract
Chronic pain (CP) is a debilitating and increasingly common health condition that adversely impacts function, including physical activity (PA). Research using ambulatory assessment (AA) methods (eg, ecological momentary assessment, actigraphy) offers promise for elucidating the relationship between momentary pain and objective PA in CP populations. This study aimed to systematically review articles assessing the association between momentary pain and PA in adults with CP as measured using AA and to make recommendations for the measurement and study of this relationship. Five databases were systematically searched, and 13 unique records (N = 768) met the inclusion criteria. CP conditions included mixed/nonspecific CP (k = 3), low back pain (k = 2), fibromyalgia (k = 1), unspecified arthritis (k = 1), and hip/knee osteoarthritis (k = 6). The average age of participants across studies was 55.29 years, and the majority identified as women (60.68%) and White (83.16%). All studies measured objective PA via actigraphy, and momentary pain with either a diary/log or ratings on an actigraph. Studies varied in the quantification of PA (ie, activity counts, step count, moderate-vigorous PA), statistical method (ie, correlation, regression, multilevel modeling), and inclusion of moderators (eg, pain acceptance). Studies reported mixed results for the pain-PA relationship. This heterogeneity suggests that no summarizing conclusions can be drawn about the pain-PA relationship without further investigation into its complex nuances. More within-person and exploratory examinations that maximize the richness of AA data are needed. A greater understanding of this relationship can inform psychotherapeutic and behavioral recommendations to improve CP outcomes. PERSPECTIVE: This article presents a systematic review of the literature on the association between momentary pain and PA in adults with CP as measured using AA methods. A better understanding of this nuanced relationship could help elucidate areas for timely intervention and may inform clinical recommendations to improve CP outcomes. PROSPERO REGISTRATION NUMBER: CRD42023389913.
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Affiliation(s)
- Mara Tynan
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Nicole Virzi
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California, San Diego, California
| | - Jessica L Morse
- VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California, San Diego, California
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California, San Diego, California; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California
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Morse JL, Wooldridge JS, Herbert MS, Afari N. The Impact of COVID-19 on Health Behavior Engagement and Psychological and Physical Health Among Active Duty Military Enrolled in a Weight Management Intervention: An Exploratory Study. Mil Med 2024:usae092. [PMID: 38518071 DOI: 10.1093/milmed/usae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic profoundly affected the health and well-being of people globally. Some studies suggest individuals with overweight or obesity may have been more adversely impacted by pandemic restrictions. Additionally, military personnel may have been more vulnerable to stress during the pandemic because of job demands (e.g., work in close quarters). Our research group was conducting a randomized clinical trial of a weight management intervention in active duty military personnel with overweight or obesity when the COVID-19 pandemic struck. Thus, we collected additional pandemic-related data from participants enrolled during the COVID-19 pandemic and conducted exploratory analyses to understand how the pandemic affected their stress levels and perceived abilities to engage in health behaviors like exercise and healthy eating. The aims of this exploratory study were to: (1) assess associations between pandemic-related stress and health behaviors with body fat percentage (BF%) and psychological and physical health, and (2) explore how pandemic-related stress and health behaviors affected BF% during and after the intervention. MATERIALS AND METHODS A total of 29 active duty Navy personnel (55% female, 69% White) were enrolled after the onset of pandemic restrictions and completed measures assessing pandemic-related stress and health behaviors as well as measures of general psychological and physical health before the intervention. BF% was collected at 5 timepoints, including baseline, during, and following the intervention. Bivariate correlations assessed associations at baseline. Linearmixed-effects longitudinal models explored how pandemic-related stress and health behaviors affected BF%. Post-hoc analyses evaluated the effects of pandemic factors on BF% at each timepoint. RESULTS Most participants perceived of the pandemic as increasing stress and detracting from their abilities to engage in health behaviors (i.e., exercise and healthy eating). Higher pandemic stress was significantly associated with reporting exercise and healthy eating as more difficult, worse overall health, and more anxiety and general stress. Reporting exercise as harder during the pandemic also was associated with more psychological distress at baseline. A linearmixed- effects model controlling for age, sex, and number of intervention sessions attended revealed endorsing "exercise as harder" was associated with higher BF%. Post-hoc regression analyses revealed rating "exercise as harder" significantly predicted higher BF% 3 months post-intervention (B = 0.65, P = .01), whereas pandemic stress was not significantly associated with higher BF% at 3 month (B =0.14, P = .08) or 6 month (B = 0.21, P = .09) follow-up. CONCLUSIONS As expected, most participants perceived of the pandemic as heightening stress and interfering with engagement in health behaviors. It is possible that pandemic-related stress may have exacerbated weight gain-promoting behaviors and/or interfered with achievement of desired weight management outcomes. Outside the context of the pandemic, it may be beneficial for healthcare providers to screen individuals for stress and perceptions of ease of engagement in health behaviors before enrollment in a weight management intervention. Further, tailoring interventions to mitigate stress and promote perceptions of ease in engaging in health behaviors may promote better weight management outcomes.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92161, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92161, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA 92161, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92161, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA 92161, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92161, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA 92161, USA
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Wooldridge JS, Soriano E, Filip TF, Moore RC, Eyler LT, Herbert MS. Compassion Dynamics in Medical Students: An Ecological Momentary Assessment Study. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10003-x. [PMID: 38402300 DOI: 10.1007/s10880-024-10003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/26/2024]
Abstract
Effective interventions to support compassionate patient- and self-care requires an understanding of how to best assess compassion. Micro-ecological momentary assessment (micro-EMA), a method in which participants provide brief responses in real-time within their own environments, can capture changes in compassion across time and contexts. This study examined a micro-EMA approach for measuring the temporal dynamics of compassion in medical students during the COVID-19 pandemic. Medical students (N = 47) completed demographic information and self-report questionnaires assessing empathy and compassion for self and others. Participants then completed six bursts of micro-EMA smartphone-delivered surveys. Each burst was 14 days, with 28 days between bursts. During each burst, participants received four daily micro-EMA surveys assessing compassion, stress, positive affect, and negative affect. Dynamic structural equation modeling was used to examine micro-EMA responses. The overall micro-EMA response rate was 83.75%. On average, daily compassion did not significantly change across the academic year. However, there was significant within-person variability in medical students' compassion trajectories over the training year (b = 0.027, p < .01). At concurrent timepoints, micro-EMA assessed compassion was associated with greater happiness (b = 0.142, p < .001) and lower stress (b = -0.052, p < .05) but was not associated with sadness. In lagged analyses, higher micro-EMA assessed compassion predicted higher next day happiness (b = 0.116, p < .01) and vice versa (b = 0.185, p < .01). Results suggest it is feasible to use micro-EMA to assess daily levels of compassion among medical students. Additionally, there is wide variability in day-to-day fluctuations in compassion levels among medical students, with some students showing substantial increases in daily compassion across the training year and others showing decreases. Positive affect as opposed to negative affect may have particularly strong associations with compassion. Further examination of antecedents and consequences of fluctuations in daily compassion could inform potent intervention targets.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Emily Soriano
- Scripps Whittier Diabetes Institute, San Diego, CA, USA
| | - Tess F Filip
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research, Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.
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Morse JL, Wooldridge JS, Herbert MS, Tynan M, Dochat C, Afari N. Associations Among Stress, Internalized Weight Stigma, Emotional Eating, and Body Composition in Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program. Int J Behav Med 2024; 31:145-150. [PMID: 36729285 DOI: 10.1007/s12529-023-10157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obesity is a critical public health concern with particular relevance to US military personnel. Stress and internalized weight stigma ("stigma") may contribute to and maintain obesogenic processes and behaviors, including emotional eating. In this secondary cross-sectional analysis, we examined (1) associations among stress and stigma with emotional eating and body fat percentage (BF%), (2) whether stress explains the association between stigma and emotional eating, and (3) whether emotional eating explains associations between stress and stigma with BF%. METHOD Active-duty military service members (N = 178) completed BF% assessment and questionnaires assessing stress, stigma, and emotional eating. RESULTS Structural equation modeling path analyses showed that stress and stigma were both significantly associated with emotional eating (b = 0.35, p < 0.001 and b = 0.23, p < 0.001, respectively) and with BF% (b = 0.38, p < 0.001 and b = 0.29, p < 0.001, respectively) such that individuals who reported higher stress and stigma tended to report more emotional eating and had higher BF%. Stress partially explained the association between internalized weight stigma and emotional eating, and emotional eating partially explained the relationship between stress and BF% but did not significantly mediate the association between stigma and BF%. CONCLUSION Greater stress and internalized weight stigma were associated with more emotional eating and higher BF%; however, emotional eating only partially explained the association between stress and BF%. Results highlight the importance of interventions targeting stress management skills, but additional research is needed to identify mechanisms that explain the association between stigma and BF%.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Mara Tynan
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 9500 Gilman Drive, 0737, La Jolla, CA, 92093, USA
| | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 9500 Gilman Drive, 0737, La Jolla, CA, 92093, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.
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Khalifian CE, Titone M, Wooldridge JS, Knopp K, Seibert G, Monson C, Morland L. The role of veterans' PTSD symptoms in veteran couples' insomnia. Fam Process 2023; 62:1725-1739. [PMID: 36347178 DOI: 10.1111/famp.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Insomnia contributes to individual mental and physical health and relationship well-being. Veterans' PTSD symptoms are associated with their own insomnia. However, research has not explored whether and how veterans' PTSD symptoms are associated with their partners' insomnia. The present study examined the association between veterans' PTSD symptom severity and veterans' and partners' insomnia. Veterans (n = 192) and their partners (n = 192; total N = 384) completed baseline assessments in a PTSD treatment study for veterans with PTSD and their partners. Path analysis was used to examine the relation between veterans' PTSD symptom severity, as measured by the PTSD symptom checklist-5 (PCL-5) and veterans' and partners' insomnia, as measured by the Insomnia Severity Index (ISI). Veterans' full-scale PCL-5 was positively related to veterans' and partners' insomnia. For veterans, intrusion and arousal symptoms were positively related to their own insomnia severity, while veterans' negative alterations in cognition and mood were associated with partners' insomnia severity. In exploratory analyses, partners' depressive symptoms fully mediated the relation between veterans' negative cognitions and mood and partners' insomnia. PTSD symptoms impact both veterans' and partners' insomnia. However, different PTSD symptom clusters were related to insomnia for each partner, and the link for partners was explained by their own depression symptoms. PTSD, insomnia, and integrated treatments should consider strategies for including partners in treatment to address these interconnected problems.
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Affiliation(s)
- Chandra E Khalifian
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Madison Titone
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Jennalee S Wooldridge
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Kayla Knopp
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Gregory Seibert
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | | | - Leslie Morland
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- National Center for PTSD -Pacific Islands division, Honolulu, Hawaii, USA
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Wooldridge JS, Morse JL, Delgado J, Afari N. Daily Functioning of Veterans With Type 2 Diabetes: Protocol for an Ambulatory Assessment Study. JMIR Res Protoc 2023; 12:e53874. [PMID: 37983070 PMCID: PMC10696502 DOI: 10.2196/53874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Diabetes impacts nearly 25% of veterans. Many veterans do not engage in recommended physical activity and other diabetes self-management behaviors. Type 2 diabetes is generally asymptomatic; as such, the long-term consequences of inadequate self-management and benefits of consistent self-management are not salient in the short term. Furthermore, self-management behaviors typically take place outside of medical visits; however, self-management-related factors are only assessed during medical visits, likely missing large amounts of variability. Thus, ambulatory assessment methods such as ecological momentary assessment (EMA), accelerometry, and continuous glucose monitoring are needed to understand the dynamics of daily self-management and identify potential intervention targets. OBJECTIVE The overarching goal of this study is to understand daily, time-varying factors (comorbid affective symptoms and social context) that influence physical activity, diabetes self-management, glycemic management, daily functioning, and quality of life in participants' natural environments. METHODS We are recruiting veterans with type 2 diabetes (target N=100). Participants are required to complete a battery of baseline assessments related to mental health, psychosocial factors, and self-management behaviors. Participants then receive 5 momentary EMA surveys and 1 daily EMA survey per day, in which veterans report comorbid affective symptoms (mood, stress, and pain), social support, social interactions, physical activity, and other self-management behaviors. Momentary surveys are delivered randomly during daily preprogrammed intervals over a 14-day sampling period. Accelerometry and continuous glucose monitoring are also used to assess physical activity and blood glucose, respectively. The first 6 participants also completed interviews assessing their experience in the study and barriers to participation. These test participants informed modifications to the protocol for the remaining participants. RESULTS The project received funding in April of 2023. Enrollment began in March of 2023 and is planned to be completed in April 2025. Among the 6 test participants, the overall EMA response rate was 87% (range 74%-95%). The response rate for the EMA survey including daily items (67%, range 21%-93%) was lower than the earlier shorter EMA surveys (89%, range 81%-96%). The mean rate of valid accelerometer wear of at least 20 hours per day was 93% (SD 11%), and continuous glucose monitoring data were available for 91% (SD 17%) of days on average. Participants reported few barriers to completing EMA surveys but noted the random timing of questions made it difficult to plan around, and the end-of-day survey was long. Two participants reported survey items reminded or motivated them to engage in diabetes self-management behaviors. CONCLUSIONS Assessment tools developed from this study can inform clinical decision-making by considering barriers to self-management that occur in daily life. Clinical applications include tailored, adaptive technology-supported interventions to improve self-management that provide the right type and amount of support at the right time by adapting to an individual's changing internal and contextual state. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53874.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Jorge Delgado
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States
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Dickinson JK, Guzman SJ, Wooldridge JS. The Emotional Impact of Negative Language in People With Diabetes: A Descriptive Study Using a Semantic Differential Scale. Sci Diabetes Self Manag Care 2023; 49:193-205. [PMID: 37052352 DOI: 10.1177/26350106231168326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE Explore the emotional experience of people with diabetes as they encounter words and phrases that have been previously identified as problematic and evaluate potential differences in their emotional impact based on type of diabetes and demographic characteristics. METHODS A cross-sectional descriptive study employing an online survey of 107 adults with type 1 diabetes and 110 adults with type 2 diabetes. A semantic differential scale was used to examine feeling states associated with negative diabetes language. Descriptive statistics including means, standard deviations, and frequencies were calculated for all study variables. For each target word, frequencies of participants who endorsed a positive, neutral, or negative affective response on the sematic differential scale are reported. RESULTS People with diabetes reported feeling blamed, misunderstood, hopeless, judged, not motivated, and not trusting in response to "noncompliant," "unmotivated," "in denial," "preventable," "failed," "should," "uncontrolled," "what did you do wrong," and "you could end up blind or on dialysis." Participants who have type 1 diabetes and are female, White, more educated, and younger reported more negative feelings about the target words. CONCLUSION People with diabetes experience highly negative affective responses when they read and hear previously identified words and phrases considered to be judgmental and unhelpful.
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Affiliation(s)
- Jane K Dickinson
- Department of Health & Behavior Studies, Teachers College Columbia University, Steamboat Springs, Colorado
| | | | - Jennalee S Wooldridge
- Mental Health Service, VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California San Diego, California
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Ranby KW, Roberts S, Wooldridge JS, Ulrich GR. Differences between complete and incomplete couples in physical health research: Implications for methods and generalizability. Soc Sci Med 2023; 327:115965. [PMID: 37210982 DOI: 10.1016/j.socscimed.2023.115965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
RATIONALE Couples-based interventions to facilitate health behavior change and improve disease outcomes are gaining attention from researchers. Dyadic research, however, poses unique methodological challenges that have raised questions about research samples and the generalizability of findings. OBJECTIVE The current study examined whether couples in which both partners participated (i.e., complete couples) in a couples' health research study systematically differed from those in which only one partner participated (i.e., incomplete couples). METHODS Between January 2014 and November 2015, an online survey was advertised on Facebook to people who were both engaged to be married and living in the Denver, Colorado metropolitan area. When the first member of a couple completed the survey (initially recruited participant), they provided their partner's email address, which prompted the research staff to invite the second partner to complete the same online survey. Constructs assessed included demographics, health behaviors, general health status, and relationship quality. Participants answered questions about themself and their partner. Approximately one-third of the partners of initially recruited participants also participated. Data from initial participants in complete couples (N = 265) were compared to data from initial participants in incomplete couples (N = 509). RESULTS Chi-square tests and independent samples t-tests indicated participants in incomplete couples had significantly lower relationship quality, worse health behaviors, and poorer health status compared to those in complete couples. Reports on partner health behaviors also differed in the same direction between the two groups. Participants in complete couples were more likely to be White, less likely to have children, and had more education than in incomplete couples. CONCLUSIONS Findings suggest that studies requiring both members of a couple may recruit samples that are less diverse with fewer health concerns than research that only requires individual participation if their partner refused participation. Implications and recommendations for future couples-based health research are discussed.
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Affiliation(s)
- Krista W Ranby
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, USA.
| | - Sydneyjane Roberts
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, USA.
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System & University of California San Diego School of Medicine, Department of Psychiatry, 9500 Gilman Dr.La Jolla, CA, 92093, USA.
| | - Gillian R Ulrich
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO, 80217-3364, USA.
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Morse JL, Wooldridge JS, Afari N, Angkaw AC, Schnurr PP, Lang AJ, Capone C, Norman SB. Associations among meaning in life, coping, and distress in trauma-exposed U.S. military veterans. Psychol Serv 2023:2023-49912-001. [PMID: 36848054 PMCID: PMC10460455 DOI: 10.1037/ser0000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Experiencing meaning in life may be particularly relevant following traumatic experiences as individuals who report meaning post trauma report less psychological distress. Engaging in avoidant coping, however, may be a sign of underlying psychological distress in the aftermath of traumatic experiences. We sought to examine associations among meaning in life, avoidant coping, and psychological distress in a sample of trauma-exposed veterans. Secondary cross-sectional analyses were conducted on data from veterans exposed to a traumatic event(s) who experienced clinically meaningful guilt (N = 145). Questionnaires on meaning in life, avoidant coping, and psychological distress were administered, and structural equation modeling was used to test direct effects. Path analysis revealed that greater meaning was associated with lower depression, anxiety, and posttraumatic stress symptomatology, while higher avoidant coping was associated with greater depression, anxiety, posttraumatic stress, and somatization symptomatology. Participants who report more meaning in life and report lower avoidant coping post trauma may experience less psychological distress. If replicated longitudinally, results could suggest cultivating meaning in life and reducing avoidant coping may decrease psychological distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Wooldridge JS, Tynan M, Rossi FS, Gasperi M, McLean CL, Bosch J, Trivedi RB, Herbert MS, Afari N. Patterns of adverse childhood experiences and cardiovascular risk factors in U.S. adults. Stress Health 2023; 39:48-58. [PMID: 35618265 PMCID: PMC9699903 DOI: 10.1002/smi.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023]
Abstract
Adverse Childhood Experiences (ACEs) are associated with poor health yet, we know little about how distinct patterns of ACE types are associated with cardiovascular (cardiovascular (CVD)) risk factors. The current study 1) examined associations of latent ACE classes with modifiable CVD risk factors including high cholesterol, smoking, diabetes, hypertension, high triglycerides, physical inactivity, overweight/obesity, and lifetime depression; and 2) examined the impact of socioeconomic status-related (SES) factors on these relationships. Using a cross-sectional analysis of the National Epidemiologic Survey of Alcohol and Related Conditions-III (n = 36,309) data, four latent classes of ACEs were previously identified: 1) low adversity, 2) primarily household dysfunction, 3) primarily maltreatment, and 4) multiple adversity types. We examined the association of these classes with CVD risk factors in adulthood and subsequently, the same model accounting for SES-related factors. Tobacco smoking, overweight/obesity, and lifetime depression were each associated with higher odds of being in classes 2, 3, and 4 than class 1, respectively. These relationships held after adjusting for SES-related factors. Class 4 was associated with the most CVD risk factors, including high triglycerides and high cholesterol after controlling for SES-related factors. The consistent associations between tobacco smoking, overweight/obesity, and lifetime depression with each adverse ACE profile, even after controlling for SES, suggest behavioural CVD prevention programs should target these CVD risk factors simultaneously.
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Affiliation(s)
- Jennalee S. Wooldridge
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
- VA Center of Excellence for Stress and Mental Health
| | - Mara Tynan
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Fernanda S. Rossi
- VA Palo Alto Health Care System, Center for Innovation to Implementation
- Stanford University Department of Psychiatry and Behavioral Sciences
| | - Marianna Gasperi
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
- VA Center of Excellence for Stress and Mental Health
| | - Caitlin L. McLean
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
| | - Jeane Bosch
- National Center for PTSD, Dissemination & Training Division
| | - Ranak B. Trivedi
- VA Palo Alto Health Care System, Center for Innovation to Implementation
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Public Mental Health and Population Sciences
| | - Matthew S. Herbert
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
- VA Center of Excellence for Stress and Mental Health
| | - Niloofar Afari
- VA San Diego Healthcare System
- University of California San Diego, Department of Psychiatry
- VA Center of Excellence for Stress and Mental Health
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12
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Morse JL, Dochat C, Wooldridge JS, Herbert MS, Materna K, Blanco BH, Hernandez J, Afari N. Baseline Characteristics and Their Associations with Body Composition of Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program. Mil Med 2022:usac242. [PMID: 35960850 DOI: 10.1093/milmed/usac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/20/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Increasing rates of overweight and obesity among military service members (SMs) necessitate the implementation of weight management interventions. Evidence for the effectiveness of military weight management interventions is mixed. Effectiveness may be impacted by individual sociodemographic, psychiatric, psychological, and behavioral factors. Baseline data from SMs who were overweight/obese or at risk of failing body composition or physical fitness tests and enrolling in a weight management randomized controlled trial were used to examine (1) individual characteristics of this sample as a whole and by gender and (2) relationships between those characteristics and body composition metrics that are targeted by military weight management interventions. Understanding these relationships may inform intervention approaches. MATERIALS AND METHODS Active duty SMs (N = 178) who enrolled in a randomized clinical trial of the Navy's weight management program "ShipShape" at a large military hospital provided data at their baseline visit. Because of gender differences in average body fat percentage (BF%) and underrepresentation of women SMs in research, independent samples t-tests and chi-square analyses were used to examine differences between male and female SMs across study variables. Multiple regression analyses were used to examine relationships of sociodemographic, psychiatric, psychological, and behavioral variables with body composition metrics, including weight, body mass index (BMI), BF%, and waist circumference (WC). RESULTS Participants (61% female; Mage = 29.66 ± 6.92 years; 59.60% White) had an average BMI in the "obese" range (MBMI = 33.1 ± 3.9 kg/m2). Female participants had significantly higher BF% and significantly lower weight and WC than male participants. Compared to male participants, females reported significantly higher rates of pain and headache diagnoses, lifetime diagnosis of an anxiety disorder, lifetime treatment for a mental health concern, lifetime experiences of sexual trauma/harassment and military sexual trauma, and higher current anxiety and post-traumatic stress disorder symptoms. Across all SMs, body composition metrics were significantly associated with several demographic variables, including gender, age, marital status, Asian race, and Black race. Higher weight-related stigma was significantly associated with higher weight, BMI, BF%, and WC. Additionally, more emotional eating was significantly associated with higher BF%, and higher weight-loss confidence was significantly associated with higher BMI. Sociodemographic, psychiatric, psychological, and behavioral variables predicted the greatest variance in BF% compared to other body composition metrics evaluated. CONCLUSIONS Participants in this study were more likely to be female, relatively young members of the Navy with overweight/obesity, who endorsed pain-related medical conditions, probable mental health conditions, and traumatic experiences at relatively high rates. Despite high endorsement of anxiety, depression, and post-traumatic stress disorder symptoms in this group, only weight-related stigma consistently emerged as significantly associated with body composition metrics. Regression results varied by body composition metric, with the most variance explained in BF%, suggesting that BF% may relate most strongly to sociodemographic, psychiatric, psychological, and behavioral variables associated with weight management. These results highlight the need for weight management programs that address weight-related stigma and mental health concerns of SMs to maximize the effectiveness of intervention efforts.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92093, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Karla Materna
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Brian H Blanco
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
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13
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Wooldridge JS, Rossi FS, Anderson C, Yarish NM, Pukhraj A, Trivedi RB. Systematic Review of Dyadic Interventions for Ambulatory Care Sensitive Conditions: Current Evidence and Key Gaps. Clin Gerontol 2022:1-29. [PMID: 35713392 DOI: 10.1080/07317115.2022.2086089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Identify non-pharmacological interventions to support patient/caregiver dyads with ACSCs; review the effects of dyadic interventions on health services outcomes; and review the effectiveness of dyadic interventions on patient and caregiver biopsychosocial outcomes. METHODS A systematic review of randomized controlled trials (RCTs). RESULTS Twenty-six manuscripts representing 20 unique RCTs (Mean N = 154 patients, 140 caregivers) were eligible. Eleven RCTs examined caregiving in patients with HF, seven with T2DM, one with COPD, and one with mixed ACSCs. Dyadic interventions for ACSCs were diverse in terms of length and content, with most including an educational component. Only 4/26 included studies had a low risk of bias. Interventions were most successful at improving quality of life, clinical health outcomes, health behaviors, and health services outcomes, with fewer improvements in patient mental health outcomes, psychosocial outcomes, relationship outcomes, and caregiver outcomes in general. The largest effect sizes were reported from trials focused on T2DM. CONCLUSIONS High-quality research with consistent measuring instruments is needed to understand which interventions are associated with improved patient and caregiver outcomes. CLINICAL IMPLICATIONS There may be clinically relevant benefits to including caregivers in interventions for patients with ACSCs, and clinicians should consider this when devising treatment plans.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Health Care System
- Department of Psychiatry, University of California, San Diego, United States
| | - Fernanda S Rossi
- VA Palo Alto Healthcare System
- Department of Psychiatry Stanford University Stanford, California, United States
| | | | - Natalie M Yarish
- VA San Diego Health Care System
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, United States
| | - Ambri Pukhraj
- VA Palo Alto Healthcare System
- Department of Psychiatry Stanford University Stanford, California, United States
| | - Ranak B Trivedi
- VA Palo Alto Healthcare System
- Department of Psychiatry Stanford University Stanford, California, United States
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14
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Afari N, Yarish NM, Wooldridge JS, Materna K, Hernandez J, Blanco BH, Camodeca AL, Peters JJ, Herbert MS. Transition from an In-Person to Virtual Randomized Controlled Trial for Weight and Fitness Concerns in Active-Duty Service Members: Lessons Learned (Preprint). J Med Internet Res 2022; 24:e37797. [PMID: 36201851 PMCID: PMC9693705 DOI: 10.2196/37797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/21/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This paper describes and discusses the transition of and modifications to a weight management randomized controlled trial among active-duty military personnel from an in-person to a virtual format as a result of the COVID-19 pandemic. The original pragmatic cohort-randomized controlled trial was designed to compare the effectiveness of an 8-week group weight management program, ShipShape, to a version of ShipShape enhanced with acceptance and commitment therapy. OBJECTIVE The objective of our study was to assess potential differences between in-person and virtual participation in participants' demographics, motivation, confidence, credibility, expectations, and satisfaction with the interventions; we also examined the pragmatics of the technology and participants' experiences in virtual-format intervention groups. METHODS A total of 178 active-duty personnel who had failed or were at risk of failing their physical fitness assessment or were overweight or obese were enrolled in the study. In-person (n=149) and virtual (n=29) participants reported demographics, motivation, confidence, credibility, expectations, and satisfaction. Interventionists recorded attendance and participation in the group sessions. Independent-sample 2-tailed t tests and chi-square tests were used to compare the characteristics of the in-person and virtual participants. Pragmatics of the technology and participants' experiences in the virtual format were assessed through surveys and open-ended questions. RESULTS Participants were 29.7 (SD 6.9) years old on average, 61.8% (110/178) female, and 59.6% (106/178) White and had an average BMI of 33.1 (SD 3.9) kg/m2. Participants were highly motivated to participate and confident in their ability to complete a weight management program. A total of 82.6% (147/178) of all participants attended 5 of the 8 sessions, and participation was rated as "excellent" by interventionists in both formats. The interventions were found to be credible and to have adequate expectations for effectiveness and high satisfaction in both formats. There were no differences between in-person and virtual participants in any of these metrics, other than interventionist-rated participation, for which virtual participants had significantly higher ratings (P<.001). Technical satisfaction with the virtual sessions was rated as "good" to "very good," and participants were satisfied with the content of the virtual sessions. A word cloud of responses identified "mindfulness," "helpful," "different," "food," "binder," and "class" as concepts the virtual participants found most useful about the program. CONCLUSIONS Modifications made in response to the COVID-19 pandemic were successful, given the recruitment of active-duty personnel with similar demographic characteristics, attendance levels, and indicators of credibility, expectancy, and satisfaction in the virtual format and the in-person format. This successful transition provides support for the use of virtual or digital weight management interventions to increase accessibility and reach among highly mobile active-duty personnel. TRIAL REGISTRATION ClinicalTrials.gov NCT03029507; https://clinicaltrials.gov/ct2/show/NCT03029507.
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Affiliation(s)
- Niloofar Afari
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA, United States
| | - Natalie M Yarish
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Jennalee S Wooldridge
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Karla Materna
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Jeffrey Hernandez
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Brian H Blanco
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Angela L Camodeca
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Joshua J Peters
- Navy Medicine Readiness and Training Command, San Diego, CA, United States
| | - Matthew S Herbert
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA, United States
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15
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Wooldridge JS, Soriano EC, Harris DE, Afari N. Feasibility and Acceptability of Ecological Momentary Assessment of Psychosocial Factors and Self-Management Behaviors Among Veterans With Type 2 Diabetes. Diabetes Spectr 2022; 35:76-85. [PMID: 35308149 PMCID: PMC8914587 DOI: 10.2337/ds21-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Comorbid symptoms such as post-traumatic stress and pain are common barriers to optimal self-management among veterans with type 2 diabetes. Additionally, self-management behaviors occur in the context of veterans' daily routines and social environments. This study evaluated the feasibility and acceptability of ecological momentary assessment (EMA) among veterans with type 2 diabetes. Ten veterans with type 2 diabetes were asked to respond to random EMA surveys during preprogrammed intervals five times per day for 14 days. EMA surveys were delivered via a mobile application and assessed momentary physical location, activities, social interactions, mood, stress, and pain. The last survey of each day included additional items about daily post-traumatic stress symptoms, diabetes distress, social support, physical activity, self-management behaviors, and functioning. Participants completed interviews assessing their experience in the study and barriers to responding and indicated their likelihood of participating in similar studies. The mean survey response rate was 96%, providing 675 observations. The majority of participants completed the five momentary surveys in <1 minute and the daily EMA surveys in <5 minutes. Results revealed substantial individual day-to-day variability across symptoms and self-management behaviors that is not captured by aggregated means across all participants. Participants generally reported enjoying responding to surveys and experiencing few barriers. Nine of 10 participants reported being "extremely likely" to participate in a similar study. These pilot data suggest that intensive EMA designs are feasible and acceptable for veterans with type 2 diabetes and can inform the design of future larger studies.
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Affiliation(s)
- Jennalee S. Wooldridge
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Center of Excellence for Stress and Mental Health, San Diego, CA
- Corresponding author: Jennalee S. Wooldridge,
| | - Emily C. Soriano
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE
| | | | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Center of Excellence for Stress and Mental Health, San Diego, CA
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16
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Tynan M, Wooldridge JS, Rossi F, McLean CL, Gasperi M, Bosch J, Timko C, Herbert M, Afari N. Latent Class Patterns of Adverse Childhood Experiences and Their Relationship to Veteran Status and Sex in the National Epidemiologic Survey of Alcohol and Related Conditions Wave III. Mil Med 2022; 187:304-312. [PMID: 34977940 DOI: 10.1093/milmed/usab536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are associated with poor psychosocial and health outcomes in adulthood. Veterans and females experience ACEs disproportionately. A greater understanding of this disparity may be achieved by examining the relationship between distinct ACE patterns and these demographic characteristics. Therefore, this study examined distinct ACE patterns and their association with Veteran status, sex, and other demographics in a nationally representative sample of U.S. adults to inform interventions tailored to ACE patterns experienced by specific groups. MATERIALS AND METHODS Latent class analysis (LCA) was conducted with data from the National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative structured diagnostic interview conducted from 2012-2013. The target population was the noninstitutionalized adult population living in the USA. The analytic sample was 36,190 (mean age 46.5 years; 48.1% male). Of these participants, 3,111 were Veterans. Data were analyzed between September 2020 and January 2021. RESULTS Latent class analysis revealed a four-class solution: (1) "Low adversity" (75.3%); (2) "Primarily household dysfunction" (9.0%); (3) "Primarily maltreatment" (10.7%); and (4) "Multiple adversity types" (5.1%). Compared to "Low adversity," members in the other classes were more likely to be Veterans (odds ratio (OR)C2vC1 = 1.33, ORC3vC1 = 1.55, ORC4vC1 = 1.98) and female (ORC2vC1 = 1.58, ORC3vC1 = 1.22, ORC4vC1 = 1.65). While lower education and income were also related to higher adversity class membership, Veteran status and sex were the strongest predictors, even when controlling for education and income. CONCLUSIONS Distinct and meaningful patterns of ACEs identified in this study highlight the need for routine ACE screenings in Veterans and females. As in the current study, operationalizing and clustering ACEs can inform screening measures and trauma-informed interventions in line with personalized medicine. Future work can test if classes are differentially associated with health outcomes.
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Affiliation(s)
- Mara Tynan
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92120, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.,VA San Diego Center of Excellent for Stress and Mental Health, San Diego, CA 92161, USA
| | - Fernanda Rossi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Caitlin L McLean
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Marianna Gasperi
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.,VA San Diego Center of Excellent for Stress and Mental Health, San Diego, CA 92161, USA
| | - Jeane Bosch
- National Center for PTSD, Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.,VA San Diego Center of Excellent for Stress and Mental Health, San Diego, CA 92161, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.,VA San Diego Center of Excellent for Stress and Mental Health, San Diego, CA 92161, USA
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17
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Herbert MS, Dochat C, Wooldridge JS, Materna K, Blanco BH, Tynan M, Lee MW, Gasperi M, Camodeca A, Harris D, Afari N. Technology-supported Acceptance and Commitment Therapy for chronic health conditions: A systematic review and meta-analysis. Behav Res Ther 2022; 148:103995. [PMID: 34800873 PMCID: PMC8712459 DOI: 10.1016/j.brat.2021.103995] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 01/03/2023]
Abstract
Chronic health conditions (CHCs) are common and associated with functional limitations. Acceptance and commitment therapy (ACT) shows promise in improving functioning, quality of life, and distress across several CHCs. The purpose of this study was to conduct a systematic review of technology-supported ACT for CHCs and perform a meta-analysis on functioning and ACT process outcomes. Multiple databases were systematically searched for randomized controlled trials. A total of 20 unique studies with 2,430 randomized participants were included. CHCs addressed in these studies were chronic pain (k = 9), obesity/overweight (k = 4), cancer (k = 3), hearing loss (k = 1), HIV (k = 1), multiple sclerosis (k = 1), and tinnitus (k = 1). Internet and telephone were the most used technology platforms. All studies included therapist contact with considerable heterogeneity between studies. Random effects meta-analyses found medium effect sizes showing technology-supported ACT outperformed comparator groups on measures of function at post-treatment (Hedges' g = -0.49; p = 0.002) and follow-up (Hedges' g = -0.52; p = 0.02), as well as ACT process outcomes at post-treatment (Hedges' g = 0.48; p < 0.001) and follow-up (Hedges' g = 0.44; p < 0.001). Technology-supported ACT shows promise for improving function and ACT process outcomes across a range of CHCs. Recommendations are provided to optimize technology-supported ACT for CHCs. PROSPERO registration number: CRD42020200230.
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Affiliation(s)
- Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
| | - Cara Dochat
- VA San Diego Healthcare System, San Diego, CA, USA; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | | | | | - Mara Tynan
- VA San Diego Healthcare System, San Diego, CA, USA; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Marianna Gasperi
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | | | - Devon Harris
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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18
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Herbert MS, Wooldridge JS, Paolillo EW, Depp CA, Moore RC. Social Contact Frequency and Pain among Older Adults with HIV: An Ecological Momentary Assessment Study. Ann Behav Med 2021; 56:168-175. [PMID: 34057465 DOI: 10.1093/abm/kaab037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social relationships are important for pain management among individuals with HIV, but the impact of daily social contact on pain responses in real-time, real-world settings has never been specifically examined. PURPOSE The purpose of the present study was to examine the relationship between social contact frequency and pain, and the role of negative and positive affect in this relationship among older adults with HIV using ecological momentary assessment (EMA). METHODS A total of 66 (Mage = 59.3, SD = 6.3, range: 50-74) older adults with HIV completed EMA surveys that included social contact frequency, pain level, and negative and positive affect four times per day for 2 weeks. Mixed-effects regression models were used to examine concurrent and lagged associations between social contact frequency, pain, and negative and positive affect. RESULTS Greater recent social contact frequency was associated with less severe current pain (unstandardized B = -0.04, 95% CI: -0.08, -0.01, p = .014), while greater current pain was associated with lower subsequent social contact frequency (unstandardized B = -0.07, 95% CI: -0.11, -0.03, p < .001). Further, higher current negative affect was related to greater current pain, and this relationship was dampened by increased recent social contact frequency (unstandardized B = -0.17, 95% CI: -0.26, -0.08, p < .001). Neither negative nor positive affect was significantly associated with the relationship between current pain and subsequent social contact frequency. CONCLUSIONS Social contact frequency and pain are bidirectionally and inversely associated among older adults with HIV. Further, recent social contact influences current pain by attenuating negative affect. Together, these results highlight the need to address social engagement in interventions for pain among older adults with HIV.
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Affiliation(s)
- Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Emily W Paolillo
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Colin A Depp
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Wooldridge JS, Herbert MS, Dochat C, Afari N. Understanding relationships between posttraumatic stress disorder symptoms, binge-eating symptoms, and obesity-related quality of life: the role of experiential avoidance. Eat Disord 2021; 29:260-275. [PMID: 33459212 PMCID: PMC8285449 DOI: 10.1080/10640266.2020.1868062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity, binge-eating symptoms, and PTSD symptoms commonly co-occur. Avoidance, a key feature of PTSD and proposed mechanism of binge-eating, is one potential mechanism for explaining this clinical overlap. The purpose of the current study was to: 1) examine the associations between PTSD symptoms (PTSD Checklist-Civilian; PCL-C) and measures of bingeeating symptoms (Binge Eating Scale; BES) and obesity-related quality of life (Obesity Related Well-Being Questionnaire-97; ORWELL-97) in a sample of veterans with overweight or obesity (N = 89), and 2) determine whether experiential avoidance (The Acceptance and Action Questionnaire-II; AAQ-II) explains the relationship between PTSD symptoms and binge-eating symptoms, and PTSD symptoms and obesity-related quality of life, respectively. Scores on the PCL-C, BES, ORWELL-97, and AAQ-II were all significantly correlated. Linear regression analyses indicated that higher PCL-C scores were related to higher scores on the BES and ORWELL-97 after controlling for potentially confounding factors (BMI and race). Effect sizes were in the medium-large range. Further, AAQ-II mediated the relationship between PCL-C and ORWELL-97, but did not mediate the relationship between PCL-C and BES. These findings suggest that experiential avoidance should be considered in interventions addressing co-occurring PTSD, binge-eating, and poor obesity-related well-being. Longitudinal research is needed to better understand directionality of these relationships and changes over time.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, California, San Diego, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
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Afari N, Gasperi M, Dochat C, Wooldridge JS, Herbert MS, Schur EA, Buchwald DS. Genetic and environmental influences on posttraumatic stress disorder symptoms and disinhibited eating behaviors. Eat Disord 2021; 29:226-244. [PMID: 33404377 PMCID: PMC8257777 DOI: 10.1080/10640266.2020.1864587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Posttraumatic stress disorder (PTSD) and eating disorders (ED) frequently co-occur, but the mechanisms underlying this association remain unclear. EDs are characterized by features of maladaptive eating behaviors including disinhibited eating and cognitive dietary restraint. Identifying the genetic overlap between PTSD symptoms and maladaptive eating behaviors may elucidate biological mechanisms and potential treatment targets. A community sample of 400 same-sex twins (102 monozygotic and 98 dizygotic pairs) completed the PTSD Checklist-Civilian (PCL-C) for PTSD symptoms and the Three-Factor Eating Questionnaire-Reduced (TFEQ-R18) for eating behaviors (uncontrolled eating, emotional eating, and cognitive dietary restraint). We used biometric modeling to examine the genetic and environmental relationships between PCL-C and TFEQ-R18 total and subscales scores. Heritability was estimated at 48% for PTSD symptoms and 45% for eating behavior overall. Bivariate models revealed a significant genetic correlation between PTSD symptoms and eating behavior overall (rg =.34; CI:.07,.58) and Uncontrolled Eating (rg =.53; CI:.24,.84), and a significant environmental correlation between PTSD symptoms and Emotional Eating (re =.30; CI:.12,.45). These findings suggest the influence of common etiology. Future research and clinical efforts should focus on developing integrated treatments.
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Affiliation(s)
- Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Marianna Gasperi
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Cara Dochat
- Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Jennalee S Wooldridge
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Matthew S Herbert
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Ellen A Schur
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dedra S Buchwald
- Elson S Floyd College of Medicine, Washington State University, Spokane, Washington, USA
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Dochat C, Wooldridge JS, Herbert MS, Lee MW, Afari N. Single-Session Acceptance and Commitment Therapy (ACT) Interventions for Patients with Chronic Health Conditions: A Systematic Review and Meta-Analysis. J Contextual Behav Sci 2021; 20:52-69. [PMID: 33868913 PMCID: PMC8045767 DOI: 10.1016/j.jcbs.2021.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
RATIONALE Chronic health conditions (CHCs) are costly and difficult to manage. Patients often struggle with behavioral adherence to complex treatment regimens and experience psychiatric distress. Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral approach that aims to improve functioning and quality of life (QoL), which are important treatment outcomes for this population. Preliminary efficacy of multi-session ACT in patients with CHCs has been demonstrated, and single-session ACT interventions have since been developed to increase feasibility, acceptability, and accessibility. The purpose of this systematic review and meta-analysis was to describe the literature on single-session ACT intervention studies in CHC populations with regards to (1) study design and methodology, (2) patient characteristics and conditions targeted, and (3) efficacy for outcomes across various domains, using narrative and quantitative methods. METHODS PsycINFO, PubMed, and Web of Science were systematically searched in August 2020. Studies of single-session ACT interventions in adult patients with CHCs that reported quantitative outcomes in any of the following domains were included: (a) functioning and related domains (e.g., disability, QoL, well-being); (b) mental health; (c) physical health; (d) ACT processes. Both controlled and uncontrolled studies were included. Study quality was assessed using the Psychotherapy Outcome Study Methodology Rating Scale (POMRF). Between-group random effects meta-analysis was conducted on general functioning outcomes. RESULTS Fourteen manuscripts reporting outcomes from 13 studies (N = 793) met inclusion criteria. Ten studies were identified by their authors as pilot or feasibility trials. Eight studies used comparison or control groups. Twelve studies delivered the ACT content in workshop format. Studies recruited for a variety of conditions. Narrative review found that between- and within-group effect sizes showed generally positive results favoring single-session ACT overall (69%), especially for measures of functioning and related domains (88%), mental health (67%), and ACT processes (73%). Meta-analysis found that ACT did not significantly outperform comparison groups on measures of general functioning (Hedges' g: -0.51, 95% confidence interval: [-1.19, 0.16]; I 2 = 86%; K = 5) despite a medium-sized pooled effect. DISCUSSION Use of single-session ACT interventions in CHC populations is an emergent field. There is preliminary evidence for the acceptability, feasibility, and efficacy of these interventions, which provides support for further testing in fully-powered RCTs. Additional RCTs will enable larger meta-analyses and stronger conclusions about efficacy. Recommendations for future trials are provided.
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Affiliation(s)
- Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Jennalee S. Wooldridge
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health
| | - Matthew S. Herbert
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health
| | | | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- VA Center of Excellence for Stress and Mental Health
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Wooldridge JS, Bosch J, Crawford JN, Morland L, Afari N. Relationships among adverse childhood experiences, posttraumatic stress disorder symptom clusters, and health in women veterans. Stress Health 2020; 36:596-605. [PMID: 32369234 DOI: 10.1002/smi.2953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 11/08/2022]
Abstract
Adverse childhood experiences (ACEs) increase risk for negative health outcomes. The goal of this study was to examine the relationships among cumulative ACEs, ACEs type, posttraumatic stress disorder (PTSD) symptoms, PTSD symptom clusters, and physical health symptoms in a sample of women veterans (N = 76). Bivariate correlations were used to determine which ACE domains were associated with PTSD and physical health symptoms. Follow-up linear regressions indicated cumulative ACEs were significantly associated with total PTSD symptoms. Cumulative ACEs were also significantly associated with the avoidance and hyperarousal symptom clusters, but not the re-experiencing symptom cluster. Total PTSD symptoms were significantly related to physical health symptoms. Of the three symptom clusters, only hyperarousal was significantly associated with physical health symptoms. Cross-sectional mediation analyses indicated the total and direct effects of ACEs on physical health were not significant. However, the indirect effect through PTSD was significant (b = 0.46, [95% CI: 0.02, 0.91]), as well as through the avoidance (b = 0.47, [95% CI: 0.06, 0.90]), and hyperarousal symptom clusters (b = 0.56, [95% CI: 0.11, 1.04]). This study highlights the potential impact of ACEs on PTSD symptoms and physical health and suggests that hyperarousal symptoms of PTSD, may play a potential role in the development of physical health problems.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Jeane Bosch
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Jennifer N Crawford
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
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23
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Dochat C, Afari N, Wooldridge JS, Herbert MS, Gasperi M, Lillis J. Confirmatory Factor Analysis of the Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States Sample of Adults with Overweight and Obesity. J Contextual Behav Sci 2020; 15:189-196. [PMID: 32257780 PMCID: PMC7108794 DOI: 10.1016/j.jcbs.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the psychometric properties of the English language version of the 10-item Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States (U.S.) sample of women and men with overweight/obesity (OW/OB). METHOD Adults with OW/OB seeking weight loss (N = 283; 59% women) completed the AAQW-R and other weight-related and psychosocial measures. Confirmatory factor analysis was used to examine single-factor, three-factor, and second-order factor structures of the AAQW-R, which were previously examined in a sample of Portuguese women. A chi-square difference test was used to compare the fit of a single-factor structure with three-factor and second-order factor structures. Internal reliability and convergent validity were examined for the total and three-factor subscale scores. RESULTS The single-factor structure evidenced poor fit to the data whereas the three-factor structure evidenced acceptable fit. The second-order structure was assessed qualitatively due to limitations to statistical model specification. The internal reliability of the AAQW-R total score and each of the three subscales were in the good and acceptable ranges, respectively. Total and subscale scores demonstrated good convergent validity. DISCUSSION Findings suggest that the English language version of the AAQW-R can be used to assess weight-related experiential avoidance in U.S. adult samples with OW/OB as a three-factor construct (food as control, weight as a barrier to living, weight stigma), with or without a total score. Additional research should confirm measurement invariance among various sociodemographic groups.
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Affiliation(s)
- Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Jennalee S. Wooldridge
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Matthew S. Herbert
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Marianna Gasperi
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
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Wooldridge JS, Herbert MS, Hernandez J, Dochat C, Godfrey KM, Gasperi M, Afari N. Improvement in 6-min Walk Test Distance Following Treatment for Behavioral Weight Loss and Disinhibited Eating: an Exploratory Secondary Analysis. Int J Behav Med 2019; 26:443-448. [PMID: 31236874 DOI: 10.1007/s12529-019-09796-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Poor functional exercise capacity is common among those with obesity; however, objective measures of exercise capacity are rarely examined in behavioral treatments targeting obese individuals. We examined whether a 4-week acceptance and commitment therapy (ACT) intervention for disinhibited eating or a behavioral weight loss (BWL) intervention improved exercise capacity and explored demographic and disinhibited eating variables related to exercise capacity. METHODS Veterans (n = 61), randomized to receive ACT or BWL, completed an assessment of exercise capacity via the 6-min walk test (6MWT) at baseline and 6-month follow-up. Measures of disinhibited eating patterns and body mass index (BMI), at baseline and post-treatment, were also collected. Change in 6MWT distance and treatment group differences were examined using mixed ANOVAs. Characteristics related to baseline 6MWT and predictors of improvement in 6MWT at 6 months were examined with hierarchical multiple regression. RESULTS There were overall significant improvements on the 6MWT from baseline to 6-month follow-up (F(1,59) = 11.14, p = .001, ηp2 = .159) but no differences between the ACT and BWL groups. Baseline BMI (β = - .33, p = .005) was the only variable related to baseline 6MWT. Improvements on the 6MWT were related to younger age (β = - .41, p = 0.001), female gender (β = .36, p = .001), and treatment-related increases in dietary restraint behaviors (β = .42, p = .001). CONCLUSIONS Functional exercise capacity improved among participants completing behavioral interventions for weight and disinhibited eating. Improvements in dietary behavior regulatory skills may have generalized to improved regulation in other behavioral domains associated with exercise capacity.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | | | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Kathryn M Godfrey
- Center for Weight, Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Marianna Gasperi
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA. .,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA. .,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.
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25
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Wooldridge JS, Gray C, Pukhraj A, Geller J, Trivedi RB. Understanding communal coping among patients and informal caregivers with heart failure: A mixed methods secondary analysis of patient-caregiver dyads. Heart Lung 2019; 48:486-495. [PMID: 31171368 DOI: 10.1016/j.hrtlng.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dyads that view illnesses as shared stressors ("shared appraisal"), and collaboratively respond to it, have better outcomes. This process, known as communal coping, has received little attention in heart failure (HF). OBJECTIVES To examine communal coping among patient-caregiver dyads managing HF. METHODS We conducted semi-structured interviews with 34 dyads. Shared appraisal was measured using we-ratio, as calculated with Linguistic Inquiry Word Count. We-ratio was divided into "high" and "low" for patients and caregivers, and concordance was examined. Thematic analyses were used to explore collaboration. RESULTS Caregivers had higher we-ratios than patients (p=.005); 29.6% and 33.3% dyads were concordant on high and low "we-ratio," respectively. In thematic analyses, we found that 1) dyads collaborated around diet, appointments, and medications, but less around physical activity; 2) dyads collaborated across all illnesses, not just HF; and 3) dyads concordant on high we-ratio reported stronger collaborations. CONCLUSIONS Communal coping varied by shared appraisal and collaboration. Understanding this variability may help develop tailored self-management interventions.
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Affiliation(s)
- Jennalee S Wooldridge
- Veteran Affairs Palo Alto Health Care System, Menlo Park Division, 795 Willow Rd, Menlo Park, CA 94025, United States.
| | - Caroline Gray
- Veteran Affairs Palo Alto Health Care System, Menlo Park Division, 795 Willow Rd, Menlo Park, CA 94025, United States
| | - Ambri Pukhraj
- Veteran Affairs Palo Alto Health Care System, Menlo Park Division, 795 Willow Rd, Menlo Park, CA 94025, United States
| | - Jessica Geller
- Denver-Seattle Center of Innovation, Department of Veterans Affairs, Aurora, CO, United States
| | - Ranak B Trivedi
- Veteran Affairs Palo Alto Health Care System, Menlo Park Division, 795 Willow Rd, Menlo Park, CA 94025, United States; Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
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O'Donnell HK, Berget C, Wooldridge JS, Driscoll KA. Graduated exposure to treat fear of hypoglycemia in a young adult with type 1 diabetes: A case study. Pediatr Diabetes 2019; 20:113-118. [PMID: 30370639 DOI: 10.1111/pedi.12791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022] Open
Abstract
Hypoglycemia is a common and dangerous complication of type 1 diabetes (T1D). Although some worry about hypoglycemia is adaptive, some individuals develop severe and impairing anxiety symptoms about hypoglycemic episodes. This presentation, known as severe fear of hypoglycemia (FOH), is similar to a specific phobia, and becomes problematic when it interferes with one's quality of life or T1D management. Although FOH is common, there have not yet been any treatment studies to address severe and impairing levels of FOH in the T1D population. The purpose of the following case report is to: (a) describe the presentation of a severe case of FOH in a young adult with T1D; (b) demonstrate the effectiveness of graduated exposure therapy for treatment of severe FOH; and (c) provide implications for clinical practice. A previously developed conceptual model for FOH management guided treatment. Treatment using graduated exposure therapy for FOH resulted in reduced worry about low blood glucose (BG) and significant reduction in behaviors to maintain high BG levels. Assessment of FOH and the risk and benefits of using a continuous glucose monitor among individuals with T1D and their families are discussed.
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Affiliation(s)
- Holly K O'Donnell
- Department of Psychology, University of Colorado Denver, Denver, Colorado
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado
| | | | - Kimberly A Driscoll
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado
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Abstract
Individuals with type 2 diabetes must engage in daily self-management behaviors to prevent complications. Given that management may be shared with a person's romantic partner, we examined both patients' and their partners' perceptions of relationship characteristics that were hypothesized to affect patients' self-efficacy for diabetes management. Adults with type 2 diabetes and their partners (n = 52 couples, 104 individuals) completed measures of three aspects of relationships that are theorized to affect self-efficacy: partner investment, partner support, and relationship satisfaction. Patients reported their self-efficacy for diabetes management and weekly frequency of diabetes self-management behaviors. A common fate modeling approach in which constructs were modeled as agreement between partner reports showed that relationship factors (investment, support, and satisfaction) significantly predicted patient self-efficacy (R 2 = 0.49), which in turn predicted patient self-management behaviors. This model fit the data well [χ2 (41) = 48.60, P = 0.19; comparative fit index (CFI) = 0.96; root mean square error of approximation = 0.06; and standardized root mean square residual = 0.07]. Interventions designed to support patients in their self-efficacy for self-management behavior may be improved through consideration of patients' romantic relationships.
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Affiliation(s)
| | - Krista W Ranby
- Department of Psychology, University of Colorado, Denver, CO
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28
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Abstract
PURPOSE To examine the effects of an employer-based monetary incentive program on membership termination and usage at a fitness center. DESIGN Retrospective nested case-control study examining the relationship between participation in an incentive program, visits to the fitness center, and membership termination at 1 year. SETTING University-based fitness center. PARTICIPANTS Members (N = 1122) of a university-based fitness center. INTERVENTION Members were offered either a US$25 incentive for each month they visited the fitness center at least 10 times or no incentive. MEASURES Data were extracted from the membership database and included membership termination at 1 year (yes, no), length of membership (days), participation in the incentive program (yes, no), and visits to the fitness center per month. ANALYSIS Cox proportional hazards model. RESULTS Members in the incentive program visited the fitness center on average more times per month (5.3 vs 4.3; P < .0001) but were significantly more likely to terminate memberships at 1 year compared to members who did not receive the incentive (38% vs 31%; P = .013). After controlling for relevant covariates, members who received the incentive had a 24% greater hazard of terminating their memberships compared to members who did not receive the incentive (hazard ratio [HR] = 1.24; P = .041). After controlling for the number of visits per month, the incentive program was no longer significantly related to membership termination (HR = 1.21; P = .07). CONCLUSION Being in a monetary incentive program to attend a fitness center may be initially associated with a greater fitness center utilization but may not be associated with a reduced risk of membership termination.
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Affiliation(s)
- Stephanie A Hooker
- 1 Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | | | - Kaile M Ross
- 1 Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Kevin S Masters
- 1 Department of Psychology, University of Colorado Denver, Denver, CO, USA
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Ross KM, Ranby KW, Wooldridge JS, Robertson C, Lipkus IM. Effects of physical and mental health on relationship satisfaction: a dyadic, longitudinal examination of couples facing prostate cancer. Psychooncology 2015; 25:898-904. [DOI: 10.1002/pon.3931] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 06/05/2015] [Accepted: 07/15/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Kaile M. Ross
- Department of Psychology; University of Colorado Denver; USA
| | - Krista W. Ranby
- Department of Psychology; University of Colorado Denver; USA
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Van Liew C, Wooldridge JS, Kothari DJ, Cronan TA. Ethnic Differences in Perceptions of Alzheimer’s Disease. CALIF J HEALTH PROMOT 2014. [DOI: 10.32398/cjhp.v12i1.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose: To examine ethnic differences in ratings of 1) condition severity, 2) need for medical assistance, and 3) likelihood of hiring a Healthcare Advocate (HCA) for an ill, elderly parent as a function of 1) parent’s cognitive state (Alzheimer’s disease [AD] or cognitively healthy), 2) parent’s physical malady (hip fracture or heart attack), and 3) distance (near or far from the parent), with an emphasis on the interaction between ethnicity and cognitive state. Method: Nine-hundred-seventy-four individuals who identified as White, Black, Hispanic, or Asian/Pacific Islander read a hypothetical vignette about an older man. The man’s physical malady (heart attack or hip fracture), cognitive state (AD or no AD), and physical distance from a close family member were manipulated in the vignette. Participants rated the severity of the medical condition and their likelihood of hiring an HCA. Results: Black and Asian/Pacific Islander participants did not differ from White participants on any outcomes. Unlike White participants, Hispanic participants did not rate the older man’s condition as more severe and were not more likely to seek assistance when he had AD than when he was cognitively healthy. Conclusion: Ethnic differences in perceptions of AD may be less extensive than previously thought. The medical severity of AD did not appear to be recognized among the Hispanic participants in our sample, suggesting that culturallysensitive AD education may be particularly important in this subgroup.
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Santoro MS, Van Liew C, Cronan TA, Franks HM, Adams RN, Roesch SC, Wooldridge JS, Tomita M. Physical function and quality of well-being in fibromyalgia: the applicability of the goodness-of-fit hypothesis. Health Psychol Behav Med 2014; 2:496-508. [PMID: 25750797 PMCID: PMC4346089 DOI: 10.1080/21642850.2014.905205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/11/2014] [Indexed: 11/05/2022] Open
Abstract
Objective: The goodness-of-fit hypothesis suggests that the effectiveness of a coping strategy depends on the match between type of strategy (problem-focused, emotion-focused) and the level of perceived control. This hypothesis was examined as a predictor of physical functioning and quality of well-being (QWB) in a large sample of women with fibromyalgia. Methods: Participants were 478 women with diagnosed fibromyalgia (Mage = 54.31, SD = 11.2), who were part of a larger intervention in which no intervention effects were found. Hierarchical, mixed selection regressions were performed to determine whether the relationship between coping and control-predicted physical functioning and QWB. Results: Participants who reported having lower levels of perceived control over their fibromyalgia syndrome and who engaged in more self-controlling coping (emotion-focused strategy) experienced greater QWB and physical functioning than those who used less self-controlling coping. Various main effects for coping and perceived control were also found. Level of physical functioning was also related to escape-avoidance, distancing, and perceived control. The level of QWB was related to social-support seeking, accepting responsibility, distancing, problem-solving, and perceived control. Conclusions: This study provides a greater understanding of the relationships among coping, perceived control, physical functioning, and well-being for women with fibromyalgia. Implications and directions for future research are discussed.
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Affiliation(s)
- Maya S Santoro
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology , 5500 Campanile Drive, San Diego , CA , USA , 92120
| | - Charles Van Liew
- Department of Psychology, San Diego State University , San Diego , CA , USA
| | - Terry A Cronan
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology , 5500 Campanile Drive, San Diego , CA , USA , 92120 ; Department of Psychology, San Diego State University , San Diego , CA , USA
| | - Heather M Franks
- Department of Psychology, San Diego State University , San Diego , CA , USA
| | - Rebecca N Adams
- Department of Psychology, San Diego State University , San Diego , CA , USA
| | - Scott C Roesch
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology , 5500 Campanile Drive, San Diego , CA , USA , 92120 ; Department of Psychology, San Diego State University , San Diego , CA , USA
| | | | - Mitsuo Tomita
- Kaiser Permanente of Southern California , San Diego , CA , USA
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Sarkin AJ, Tally SR, Wooldridge JS, Choi K, Shieh M, Kaplan RM. Gender differences in adapting driving behavior to accommodate visual health limitations. J Community Health 2013; 38:1175-81. [PMID: 23852327 DOI: 10.1007/s10900-013-9730-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study investigated whether men and women are equally likely to adapt their driving behaviors in response to visual limitations. Participants were 376 (222 women and 154 men) pre-surgical cataract patients from the Shiley Eye Center in La Jolla, California. All participants completed the National Eye Institute Visual Functioning Questionnaire, which assesses self-reported visual symptoms, functional limitations, and behaviors including driving during the day, at night, or in difficult conditions. Visual acuity was assessed using the log of the minimal angle of resolution (LogMAR) scale. There were no significant differences in LogMAR visual acuity between men and women who reported either that they stopped driving at night because of visual impairment or reported having no difficulty driving at night. Of participants who reported having difficulty driving at night, mean weighted LogMAR scores indicated significantly better visual acuity for women than men. There were no significant differences in LogMAR visual acuity between women and men in any of the difficult driving condition categories. Significantly more women than men reported that they stopped driving in difficult conditions because of eyesight, despite the lack of gender differences in visual acuity for this sample. We found no evidence that cataract disease had different effects on the visual acuity of older adult men and women. However, there was a significant difference between genders in self-reported driving behavior. It is possible that some women are more cautious or have less need to drive. However, failing to adapt driving behaviors to accommodate visual limitations may represent a potential behavioral public health risk for men.
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Affiliation(s)
- Andrew J Sarkin
- Health Services Research Center, University of California, San Diego, 9500 Gilman Drive #0994, La Jolla, San Diego, CA, 92093-0994, USA,
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Wooldridge JS, Vasserman-Stokes EA, Cronan TA, Sadler MS. Hiring a pediatric health care advocate for advisory and support services. Fam Community Health 2013; 36:125-134. [PMID: 23455683 DOI: 10.1097/fch.0b013e31828212de] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this study, factors that influence a person's likelihood of hiring a pediatric health care advocate (HCA) for support and/or advisory services were examined. Participants were asked to read vignettes in which a child's symptom severity, probability of mortality, and age were manipulated. A significantly higher likelihood of hiring an HCA for advisory services than for support services was found. A significant interaction between level of mortality and type of service indicated that when mortality was depicted as high, participants reported a greater likelihood of hiring an HCA for support services than for advisory services.
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