Search Results (34)

Hispanic youth have one of the highest rates of unmet physical and mental health needs. This study aims to examine how child and adolescent healthcare access creates pathways to behavioral/mental health among a national sample of 1711 U.S. Hispanic youth. Using psychometric network analysis, unique pathways in which child healthcare access (i.e., transportation and health service-related factors) and behavioral/mental health were identified. Findings indicate relationships among depression, anxiety, school settings, and friendships. These associations offer a starting point for interventionists and policymakers to ensure that interventions are not targeted individually but from an ecological systems framework. This study may raise awareness of Hispanic youth’s barriers and better equip scientists to plan and implement approaches to address identified barriers. Full article

Background: Traumatic injuries often lead to long-lasting impairments and complex rehabilitation needs. Trauma patients report lower health-related quality of life (HRQoL) and increased needs for healthcare and social support. This study aimed to describe HRQoL trajectories in a Norwegian cohort with moderate-to-severe trauma over 12 months and assess the relationship between unmet needs and HRQoL. Methods: A multicenter prospective cohort study with follow-up at six and twelve months post-injury included adults aged 18+ with a New Injury Severity Score (NISS) > 9 and a minimum hospital stay of two days. HRQoL was assessed using the EQ-5D-5L. Needs and unmet needs were evaluated using the Needs and Provision Complexity Scale. Hierarchical linear modeling (HLM) examined predictors of HRQoL trajectories. Results: Of 538 participants, 83% were followed up at six and/or twelve months. Mean age was 52 years, falls were the most common cause of injury (44%), and 76% had a severe injury (NISS > 15). HRQoL remained stable, except for improvements in usual activities and anxiety-depression domains. HLM showed that older age (b = −2.698), longer hospital stay (b = −4.108), and unmet healthcare (b = −1.094) and social support needs (b = −3.132) were associated with worse HRQoL over time. Unmet personal care needs were linked to improved HRQoL (b = 2.654). The only significant predictor*time interaction was between unmet healthcare needs and overall HRQoL. Conclusions: HRQoL largely remained stable, with improvements in some domains. Unmet healthcare needs predicted a decline in HRQoL, highlighting the importance of timely support and targeted interventions from health professionals. Full article

Purpose: This study explored the potential long-term effects of academic-related variables, including academic satisfaction, college degree attainment, unmet academic accommodation needs, and demographic characteristics on the job and career satisfaction of adults with disabilities using modern machine learning techniques. Method: Participants (n = 409) completed an online survey assessing these constructs. All had a disability or chronic health condition, had attended school in the U.S. throughout their K-12 education, and were between 19 and 86 years of age. Results: The random forest models had 68.6% accuracy in correctly identifying job satisfaction and 72.5% accuracy in correctly identifying career satisfaction. When using mean decrease in impurity (MDI) and permutation importance to identify statistical predictors, academic satisfaction was the most important predictor of job satisfaction in both MDI and permutation importance, while unmet academic accommodations was the fourth highest predictor for MDI behind academic satisfaction, disability level, and age, but ahead of other demographic variables and college degree status, and the second highest predictor of job satisfaction in permutation importance. For career satisfaction, academic satisfaction accounted for the highest MDI, while unmet academic accommodations ranked fourth. For permutation importance, academic satisfaction ranked first, and unmet academic accommodations ranked fifth behind academic satisfaction, age, college degree status, and disability level. Discussion: Meeting the academic accommodation needs of disabled students is linked with lasting vocational success. This study underscores the associations between unmet academic accommodation needs and future job and career satisfaction, illuminated using novel machine learning techniques. To our knowledge, this is the first investigation of the potential long-term associations between unfulfilled accommodation needs and future job and career satisfaction. Full article

Purpose/Objective: Children with disabilities are at a greater risk of being bullied and experience mental health and academic problems that may persist in adulthood. This study examined the association of childhood bullying experiences with current mental health (anxiety and depression) among adults with disabilities, and whether academic satisfaction mediated the relationship between childhood bullying and adult mental health outcomes. Research Method/Design: A sample of 409 adult participants with disabilities who had had their disabilities while attending school, and currently, completed an online survey assessing bullying experiences (California Bullying Victimization Scale-Retrospective), academic satisfaction (Academic Satisfaction Scale), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7). Bivariate correlations and two mediation analyses were conducted to identify the direct and indirect effects of school bullying experiences on current mental health outcomes, via academic satisfaction. Results: Participants reported a moderate amount of childhood bullying and relatively high levels of depression and anxiety symptomology (with averages close to or exceeding clinical cutoffs of 10). Bivariate correlations among the four variables were all significantly moderately or strongly correlated. Bullying and academic satisfaction had direct associations with depression and anxiety. Academic satisfaction partially mediated the relationships between bullying and both mental health outcomes. Conclusions/Implications: Bullying prevention interventions and programs, especially geared toward preventing bullying in students with disabilities, are critical to stop the likely long-term impacts of bullying on mental health outcomes in disabled communities. Full article

Background: The Coronavirus disease (COVID-19) pandemic profoundly impacted education, causing uncertainty and constant changes for teachers, including new teaching modalities, increased workloads, and limited rest periods. Global studies have reported mental health issues such as anxiety and depression among educators during and after the pandemic, primarily in Asia, Europe, and North America. However, these existing studies often show increased anxiety and depression rather than considering school-based predictors that may contribute to increasing rates. Aims: Despite these global findings, there are few investigations of the impact of COVID-19 on teachers in Latin America and Spain. To address these notable global and regional research gaps, this study examined the prevalence and predictors of depression and anxiety symptoms among teachers in Latin America and Spain. Method: An online survey collected data on demographics, work-related characteristics, COVID-19 experiences, and measures of mental health from teachers in 19 Latin American countries and Spain using a snowball sampling approach. The sample comprised 2004 teachers, with 81.8% female participants and a mean age of 44.46 years (SD = 9.8). Descriptive statistics and hierarchical multiple linear regressions were conducted with depression and anxiety as outcome variables. Results: Consistent predictors of increased anxiety and depression symptomology included being female or transgender, being younger, having lower socioeconomic status, having pre-existing mental health conditions or chronic illness, having increased workload during the pandemic, being dissatisfied with teaching resources, and having negative changes in relationships with students, parents, or colleagues. The predictors collectively explained 16.4% of the variance in depression and 17.5% of the variance in anxiety symptoms. Conclusions: The significant mental health needs of teachers in Latin America and Spain during the COVID-19 pandemic highlight the pressing necessity of prioritizing the mental health needs of educators to improve their psychological health and children’s educational environments. These results also suggest the practical need to provide teachers with additional school-based supports and resources for future transitions to online learning or disruptions to traditional instruction. Full article

Objectives: Religiosity has generally been shown to be a protective factor against adverse mental health in the general population. Transgender and gender non-conforming (TGNC) individuals, however, may not experience the same protective effects, as many religions are unsupportive of diverse gender identities. This study examined whether increased religiosity and having been rejected by a religious community because of one’s gender identity were associated with mental health issues in TGNC individuals. Methods: A sample of TGNC adults (n = 154), predominantly from the United States, completed an online survey assessing these constructs. Results: These constructs were highly represented in the sample, with 46.1% of participants having experienced religious rejection at some point throughout their lifetime because of their gender identity, 40.3% currently experiencing symptoms of elevated depression and 34.4% of elevated anxiety, and 48.7% with suicidal ideation over the past 2 weeks. Religious rejection was associated with increased depression, anxiety, and suicidal ideation. Neither interpersonal nor intrapersonal religiosity was associated in a bivariate way with any of the three mental health outcomes. However, among participants who experienced rejection by one’s religious community, interpersonal religiosity was strongly associated with increased depression symptoms and suicidal ideation, whereas conversely among TGNC individuals who had not experienced rejection by their religious community, interpersonal religiosity was weakly associated with depression and suicidal ideation. Conclusion: The results underscore the extremely harmful effects of religious rejection due to one’s gender identity on religious TGNC individuals, pointing to the active contributions of the behaviors of traditional religious groups towards TGNC mental health problems and suicide. Full article

The COVID-19 pandemic severely affected teaching and student outcomes throughout the world, yet the long-term impacts of the pandemic on teachers and students in Latin America and Spain remain largely underexamined. This study examined the experiences of 5416 teachers from 20 Spanish-speaking countries during and after the pandemic, with an emphasis on teachers’ health, teaching experiences, and school-based support; perceptions of their students’ experiences and struggles; and relationships with students, families, and colleagues. The study used an online survey design with recruitment primarily based on snowball sampling, with most variables being collected using Likert-style responses. Descriptive statistics as well as bivariate correlations between variables were calculated. The results suggested that teachers were mostly healthy and reported moderate fear of COVID-19, though there was much variability. While, on average, teachers did not believe the pandemic had had a negative impact on their relationships with parents, colleagues, and students, they believed that the pandemic had a meaningful negative impact on their students by increasing problems in five key domains: educational, behavioral, social, emotional, and familial. Teachers had received very little training regarding online teaching, although they were moderately satisfied with the resources they had received to teach online and the safety measures their schools had implemented. Schools should provide additional support to teachers, students, and families during times of prolonged stress such as pandemics to help mitigate their lasting effects on students’ academic and psychosocial functioning. Full article

Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide and often leads to long-lasting emotional, physical, and cognitive changes and results in reduced functioning across multiple domains. These changes often lead to strain in marital relationships as the uninjured spouse grapples with adapting to the changes in their partner. Aims: The purpose of this study was to examine the probability of marital stability after TBI at 6 and 12 months following injury (i.e., probability trajectory across those two time points), as well as predictors of that probability trajectory. Methods: The study design was repeated-measures and observational. Patient recruitment and follow-up took place from January 2018 to March 2020 in Quito, Ecuador. Ninety-seven TBI survivors were recruited while hospitalized in the neurosurgery unit of Hospital Eugenio Espejo, a tertiary care center. Patients were assessed at 6 and 12 months after their injury. Hierarchical linear modeling (HLM) was used to examine baseline predictors of linear marital probability trajectories across 6 and 12 months after injury. A final set of HLMs included each of the previously significant predictors from the first model, time, and the interaction terms between time and the previously significant predictor. Results: The first HLM found that marital probability remained stable between 6 and 12 months after TBI. Individuals who were employed at baseline had higher marital probability trajectories than those who had been unemployed. Older individuals had higher marital probability trajectories than younger individuals, and women had higher marital probability trajectories than men. Conclusions: This is the first study to examine marital probability trajectories for an Ecuadorian adult population with TBI, and the data are of great value to understanding post-TBI outcomes in the region. These results can inform interventions and support systems to bolster marital resilience in the aftermath of TBI. Further research is warranted to explore the nuances of these relationships and to validate these findings in diverse populations. Full article

Background: This study provides a detailed examination of older Veterans with traumatic brain injury (TBI) and dementia and their caregivers, focusing on Veterans’ demographic, clinical, functional, safety risk, and behavioral characteristics and caregivers’ demographic, clinical, and care-related characteristics and well-being. Methods: Veterans’ caregivers (N = 110) completed a telephone-based survey. Results: Veterans averaged eight comorbid health conditions, with over 60% having chronic pain, hypertension, post-traumatic stress disorder, or depression. Caregivers reported helping with an average of three activities of daily living, with the highest percentages of Veterans needing assistance with grooming, dressing, and bathing. Almost all Veterans needed assistance with shopping, cooking, medication management, housework, laundry, driving, and finances. Veterans averaged two safety risks, the most common being access to dangerous objects, access to a gun, and not being able to respond to emergency situations. Although Veterans averaged 14 behavioral concerns, caregivers reported that their family needs relating to TBI were generally met or partly met, and they voiced confidence in their ability to respond to behaviors and control their upsetting thoughts. Caregivers’ mean burden score was severe, while mean depression and anxiety scores were mild. Caregivers reported an average of 10.5 h per day providing care and 20.1 h per day on duty. Conclusions: The findings demonstrate the increased presence of impairments, safety risks, and behavioral issues in Veterans with comorbid TBI and dementia, as well as increased impacts on families’ burdens and care provision requirements. Clinicians should be alert for and educate TBI patients and caregivers on the warning signs of post-TBI dementia and its associated functional, behavioral, and safety risk profile, as well as challenges related to caregiver well-being. Healthcare policymakers must consider the increased caregiver demands associated with comorbid TBI and dementia, as well as the need for expanded long-term support and services. Full article

Background: Given the aging of the overall U.S. population, the resulting changes in healthcare needs especially among veterans, and the high prevalence of traumatic brain injury (TBI) among older adults, additional research is needed on community participation after TBI in older veterans. The current study examined predictors of community participation trajectories over the 5 years after TBI in veterans who were 55 years of age or older upon injury. Method: This study included data from 185 participants in the U.S. Department of Veterans Affairs TBI Model System national study who had sustained a TBI at age 55 or older and had completed at least one of each Participation Assessment with Recombined Tools-Objective (PART-O) subscale scores at one or more follow-up time points (1, 2, and 5 years post-TBI). Results: PART-O Productivity, Social, and Out and About scores remained constant over time. Lower PART-O Productivity trajectories were seen among participants who were unemployed at the time of injury (p = 0.023). Lower PART-O Social trajectories were seen among participants who had a lower education level (p = 0.021), were unmarried at injury (p < 0.001), and had private insurance coverage (p < 0.033). Conclusion: These findings add to the growing body of literature on TBI and community participation by focusing on an older adult veteran population. There is an urgency to understand the needs of this group, many of whom are aging with service-connected disabilities including TBI. Veterans with characteristics identified herein as being associated with lower community participation trajectories would be prime candidates for interventions that aim to increase community and social engagement after later-life TBI. Full article

The study’s aim was to examine alcohol consumption patterns and predictors of consumption across time among Hispanics with traumatic brain injury (TBI) in the U.S. within ten years post-injury. This longitudinal cohort study included 1342 Hispanic individuals (77.6% males) from the multi-site, longitudinal TBI Model Systems (TBIMS) database. The main outcome measures were consumption information, demographic, and injury characteristics. Across the full sample, alcohol consumption variables generally demonstrated quadratic movement characterized by an initial increase followed by a plateau or slight decrease over the ten years post-injury. The predictors of higher consumption were being men, single, with a history of excessive alcohol use, with a nonviolent mechanism of injury, shorter duration of PTA, and higher levels of education. Participants had a greater number of 5+ drinks/episode occurrences in the past month if they were men and had had a greater number of 5+ drinks/episode occurrences in the month before injury. There was no differential change in alcohol consumption over time as a function of these predictors. This study identified a profile of at-risk Hispanics with TBI for increased alcohol consumption. These individuals should be identified and targeted for early evidence-based alcohol intervention after TBI when results might be most favorable. Full article

Postpartum depression (PPD), postpartum anxiety (PPA), and post-traumatic stress disorder (PTSD) among birthing people have increased substantially, contributing to adverse maternal/infant dyad outcomes, with a high prevalence in the neonatal intensive care unit (NICU). Despite calls for trauma-informed care in the NICU and high rates of post-traumatic stress, little research has examined the rates of or the relationships between peripartum mood and adverse child experiences (ACEs) in NICU mothers or evaluated which peripartum traumas are most distressing. This study employed structural equation modeling (SEM) to explore whether peripartum-related traumas and NICU-related stressors mediated the associations between ACEs and mental health outcomes in 119 lower-income, racially diverse mothers in a Level IV NICU. Mental health concerns were prevalent and highly comorbid, including 51.3% PPA, 34.5% PPD, 39.5% post-traumatic stress, and 37% with ≥4 ACEs. The majority (53.8%) of mothers endorsed multiple peripartum traumas; NICU admission was the most common trauma (61%), followed by birth (19%), pregnancy (9%), and a medical event in the NICU (9%). Our SEMs had good fit and demonstrated that ACEs predicted peripartum distress. Trauma-informed care efforts should employ transdiagnostic approaches and recognize that women commonly present to the NICU with childhood trauma history and cumulative peripartum traumas. Full article

Participation is of major importance for individuals with traumatic brain injury (TBI). This study evaluates participation over a period of one year among persons with TBI in the chronic phase and explores sociodemographic, psychological, and environmental predictors of levels and trajectories of participation. One hundred and twenty home-living survivors of TBI with persistent injury-related consequences at least two years post-injury who participated in a goal-oriented randomized trial were assessed at baseline and after four and twelve months. Linear mixed-effects model analysis was applied to evaluate height, trajectory slope, and predictors of the Participation Assessment with the Recombined Tools-Objective (PART-O) total score and the subscales Productivity, Social Relations, and Being Out and About. Being married, having a higher education, and having good global functioning predicted more frequent participation. Education, executive- and global functions predicted Productivity, while age and being married predicted Social Relations. Participating in the study during the COVID-19 pandemic had a negative impact on Productivity. Participation was relatively stable over 12 months, with a slight decline, but may be influenced by demographic factors and functional consequences. Rehabilitation services should particularly focus on people with TBI living alone with lower levels of global and executive function. Full article

Background: Older adults who sustain a traumatic brain injury (TBI) have been shown to have reduced functional independence and life satisfaction relative to younger individuals with TBI. The purpose of this study was to examine the covarying patterns of functional independence and life satisfaction over the 10 years after TBI in adults who were 60 years of age or older upon injury. Method: Participants were 1841 individuals aged 60 or older at the time of TBI, were enrolled in the longitudinal TBI Model Systems database, and had Functional Independence Measure and Satisfaction with Life Scale scores during at least one time point at 1, 2, 5, and 10 years after TBI. Results: A k-means cluster analysis identified four distinct group-based longitudinal patterns of these two variables. Three cluster groups suggested that functional independence and life satisfaction generally traveled together over time, with one group showing relatively high functional independence and life satisfaction over time (Cluster 2), one group showing relatively moderate functional independence and life satisfaction (Cluster 4), and one group showing relatively low functional independence and life satisfaction (Cluster 1). Cluster 3 had relatively high functional independence over time but, nonetheless, relatively low life satisfaction; they were also the youngest group upon injury. Participants in Cluster 2 generally had the highest number of weeks of paid competitive employment but lower percentages of underrepresented racial/ethnic minority participants, particularly Black and Hispanic individuals. Women were more likely to be in the cluster with the lowest life satisfaction and functional independence (Cluster 1). Conclusion: Functional independence and life satisfaction generally accompany one another over time in older adults, although this does not always occur, as life satisfaction can still be low in a subgroup of older individuals after TBI with higher functioning. These findings contribute to a better understanding of post-TBI recovery patterns in older adults over time that may inform treatment considerations to improve age-related discrepancies in rehabilitation outcomes. Full article

The COVID-19 pandemic transformed the delivery of psychological services as many psychologists adopted telepsychology for the first time or dramatically increased their use of it. The current study examined qualitative and quantitative data provided by 2619 practicing psychologists to identify variables facilitating and impeding the adoption of telepsychology in the U.S. at the beginning of the COVID-19 pandemic. The top five reported barriers were: inadequate access to technology, diminished therapeutic alliance, technological issues, diminished quality of delivered care or effectiveness, and privacy concerns. The top five reported facilitators were: increased safety, better access to patient care, patient demand, efficient use of time, and adequate technology for telepsychology use. Psychologists’ demographic and practice characteristics robustly predicted their endorsement of telepsychology barriers and facilitators. These findings provide important context into the implementation of telepsychology at the beginning of the pandemic and may serve future implementation strategies in clinics and healthcare organizations attempting to increase telepsychology utilization. Full article