Randomized Face-to-face vs. Home exercise interventions in pregnant women with gestational diabetes

ObjectivesEvaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM).DesignRandomized control trial with two intervention arms and control (standard care).MethodParticipants (N = 65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ∼20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records.ResultsAt the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < 0.05) and significantly higher exercise min and subjective norm than the Home group (p's < 0.05); these effect sizes were medium-large (η² = 0.11-0.23). There was a medium effect (η² = 0.13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups.ConclusionA theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.     

Perceptions of the roles of behaviour and genetics in disease risk: Are they associated with behaviour change attempts

Objective: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.

Design: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.

Measures: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.

Results: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.

Conclusion: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.     

Young women with and without non-suicidal self-injury: A comparison of romantic relationship functioning

IntroductionThe interpersonal context of an individual struggling with non-suicidal self-injury (NSSI) is of critical importance.ObjectiveThe purpose of the current study is to offer, through a dyadic perspective, a unique portrait of the relevant indicators of romantic relationship functioning (i.e., romantic attachment, dyadic trust, dyadic coping, relationship satisfaction, and caregiving) that distinguish young women who have engaged in NSSI from those who have not.MethodParticipants consisted of 20 women who indicated having engaged in NSSI in the past six months and 20 women who indicated having never engaged in NSSI, along with their respective partner.ResultsResults revealed that women who engaged in NSSI were more likely to report subjective distress in the form of attachment anxiety and distrust, as well as lower relationship satisfaction and adaptive dyadic coping strategies, compared to women who had never engaged in NSSI. Findings also showed that partners of women who engaged in self-injury reported more attachment anxiety than partners of women who do not engage in NSSI.ConclusionThese results highlight the importance of romantic relationship dynamics and the potential associations with engagement in self-injurious behaviors, which has implications for the development of effective prevention and intervention strategies.     

Enhanced counselling for women undergoing BRCA1/2 testing: Impact on knowledge and psychological distress–results from a randomised clinical trial

This randomised controlled trial evaluated the impact of an enhanced counselling (EC) intervention on knowledge about the heritability of breast and ovarian cancer and distress, as a function of BRCA test result, among high-risk women. Before deciding about whether or not to undergo genetic testing, participants were randomly assigned to the EC intervention (N = 69), designed to promote cognitive and affective processing of cancer risk information (following the standard individualised counselling session), or to the control condition (N = 65), which involved standard individualised counselling followed by a general health information session to control for time and attention. Women in the EC group exhibited greater knowledge than women in the control group, 1 week after the intervention. Further, at the affective level, the intervention was found to be the most beneficial for women testing positive: specifically 1 week after test result disclosure, women in the intervention group who tested positive experienced lower levels of distress than women in the control group who tested positive. The findings suggest that the design of counselling aids should include a component that explicitly activates the individual's cognitive–affective processing system.     

Increasing calcium intake in young women through gain-framed,targeted messages: A randomised controlled trial

Background: Adequate calcium consumption during early adulthood can help prevent osteoporosis in women.

Purpose: The effects of gain-framed, targeted messaging on calcium intake were examined over 12 months.

Methods: Young women (18–19 years) not consuming sufficient calcium were randomly assigned to receive standard care materials (control) or gain-framed, targeted materials (experimental). Health belief model (HBM) constructs, calcium intake and markers of bone formation, resorption and bone mineral density were assessed at various time points throughout the year.

Results: Calcium intake increased significantly more in the experimental versus the control condition (p?<?0.01). Self-efficacy was the only HBM construct to improve significantly more in the experimental condition versus control (p?=?0.05). The HBM did not mediate changes in calcium intake. Measures of bone health did not differ between conditions by the end of this nonpharmacological intervention (p's?>?0.05).

Conclusions: It is possible to increase young women's calcium consumption through gain-framed, targeted messages.     

The theory of agency and breastfeeding

Objective: In this paper, we apply psychological agency theory to women’s interviews of their breastfeeding experiences to understand the role of agency in relation to breastfeeding initiation, maintenance and duration.

Design: Qualitative, video interviews were collected from 49 women in the UK from a wide range of ethnic, religious, educational and employment backgrounds about their breastfeeding experiences. We undertook secondary analysis of the data focusing on their accounts of vulnerability and agency.

Findings: Women’s agency was impacted by a variety of factors including their own vulnerability, knowledge, expectations and experience, the feeding environment and the support of health professionals in sharing decision-making and dealing with uncertainty.

Conclusion: Health professionals as co-agents with women are well positioned to maintain, enhance or restore women’s sense of agency. Breastfeeding goals should be included in women’s birth plans. Training related to agency, continuity of care, and staffing and workload management supported by national breastfeeding policies could improve breastfeeding rates and experiences.     

The role of repetitive thought in determining posttraumatic growth and distress following interpersonal trauma

Background and Objectives: Repetitive thought (RT) strategies have been linked to a range of negative outcomes following traumatic interpersonal events but are proposed to serve an adaptive function under particular circumstances. This study examined outcomes following RT within a transdiagnostic framework, and explored the potentially adaptive nature of trait-like and event-related RT. Design: The centrality of a traumatic event to one's identity was explored as a context under which the adaptive nature of RT might change. Young adults with interpersonal violence experiences (N = 163) reported use of trait-like and event-related RT, centrality of the event, depressive, anxious, and posttraumatic stress symptoms (PTSS), posttraumatic depreciation and posttraumatic growth. Methods: Hierarchical multiple regression analyses were used to examine main and moderating effects of four types of RT and event centrality on outcome variables. Results: Centrality positively predicted depressive symptoms and PTSS, depreciation, and growth. Brooding RT positively predicted all negative outcomes. Reflecting RT positively predicted anxious symptoms and PTSS and depreciation. Only deliberate RT positively predicted growth. Centrality did not moderate any examined relationships. Conclusions: Findings highlight the importance of addressing specific types of RT in interventions with survivors and of considering centrality as a robust contributor to outcomes following interpersonal violence.     

Interpersonal loss in the context of family caregiving: Implications of communal relationships theory

Abstract

Much is known about the emotional costs of providing care to an ill or disabled family member. However, surprisingly little attention has been devoted to investigating how caregiver distress is related to interpersonal loss (i.e., reactions to changes in the typical day-to-day support behaviors that formerly characterized the caregiver–care recipient relationship). Drawing on the theory of communal relationships (e.g., Clark & Mills, 1979, 1993), this study proposes that the magnitude of interpersonal loss that caregivers experience, as well as its contributions to depressed affect, both directly and indirectly (through impact of interpersonal loss on perceived caregiving burden) are likely to depend on the type of relationship that existed between caregiver and care recipient prior to the onset of illness or disability. In this context, several hypotheses and directions for further research are proposed. It is hoped that future researchers will incorporate loss measures into their research and consider how aspects of preexisting relationships influence associations among interpersonal loss and variables (e.g., burden, social support) known to predict caregiver well-being.     

Screening for and Preventing Perinatal Depression

New York City (NYC) public hospitals recently mandated that all pregnant women be screened for depression, but no funds were allocated for screening or care coordination/treatment, and research suggests that unfunded mandates are not likely to be successful. To address this, we implemented an on-site depression prevention intervention (NYC ROSE) for positive depression screens among pregnant, mostly Black and Hispanic, lower-income women in one public hospital. In this paper, we used Aarons’ implementation model to describe the successes and challenges of screening and intervention. Patient tracking sheets and electronic medical records were abstracted. Key informant interviews and an informal focus group were conducted, and staff observations were reviewed; common implementation themes were identified and fit into Aarons’ model. We found that a lack of funding and staff training, which led to minimal psychoeducation for patients, were outer context factors that may have made depression screening difficult, screening results unreliable, and NYC ROSE enrollment challenging. Although leadership agreed to implement NYC ROSE, early involvement of all levels of staff and patients would have better informed important inner context factors, like workflow and logistical/practical challenges. There was also a mismatch between the treatment model and the population being served; patients often lived too far away to receive additional services on site, and economic issues were often a higher priority than mental health services. Screening and interventions for perinatal depression are essential for optimal family health, and a detailed, thoughtful and funded approach can help ensure effectiveness of such efforts.     

Problem-solving training for family caregivers of women with disabilities: A randomized clinical trial

ObjectiveTo examine the effectiveness of an individualized problem-solving intervention provided to family caregivers of women living with severe disabilities.DesignFamily caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year.ParticipantsFamily caregivers (64 women, 17 men) and their care recipients (81 women with various disabilities) consented to participate.Main outcome measuresCaregivers completed the Social Problem-Solving Inventory – Revised, the Center for Epidemiological Studies Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in three additional assessments throughout the year.ResultsMultilevel modeling was used to conduct intent-to-treat analyses of change trajectories for each outcome variable. Caregivers who received PST reported a significant linear decrease in depression over time; no effects were observed for caregiver health or life satisfaction. Caregivers who received PST also displayed an increase in constructive problem-solving styles over the year.ConclusionsPST may benefit community-residing family caregivers of women with disabilities, and it may be effectively provided in home-based sessions that include face-to-face visits and telephone sessions.     

Predicting dental attendance from dental hygienists’ autonomy support and patients’ autonomous motivation: A randomised clinical trial

Objective: To test the hypothesis that a Self-Determination Theory (SDT) intervention designed to promote oral health care competence in an autonomy-supportive way would predict change in caries competence relative to standard care. Further, to test the SDT process path-model hypotheses with: (1) the intervention and individual differences in relative autonomous locus of causality (RALOC) predicting increases in caries competence, which in turn would positively predict dental attendance; (2) RALOC negatively predicting dental anxiety, which would negatively predict dental attendance; (3) RALOC and caries disease referred to the dentist after an autonomy-supportive clinical exam directly positively predicting dental attendance; and (4) the intervention moderating the link between RALOC and dental attendance.

Design: A randomised two-group experiment was conducted at a dental clinic with 138 patients (M_age = 23.31 yr., SD = 3.5), with pre- and post-measures in a period of 5.5 months.

Results: The experimental model was supported. The SDT path model fit the data well and supported the hypotheses explaining 63% of the variance in dental attendance.

Conclusions: Patients personality (RALOC) and hygienists promoting oral health care competence in an autonomy-supportive way, performance of autonomy-supportive clinical exams and reductions of anxiety for dental treatment have important practical implications for patients’ dental attendance.     

Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder. This study examined the role of health practitioner support and personal control during birth as predictors of post-traumatic stress (PTS) symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms.

Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, 3 weeks and 3 months after the birth.

Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (β?=??0.41, R ²?=?16%) at both 3-weeks and 3-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms 3 months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention.

Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth.     

This Girl Can,can’t she? Perspectives from physical activity providers and participants on what factors influence participation

AimsThe present study used a multi-method approach to qualitatively explore whether the perceptions of young women and girls and exercise providers are aligned in terms of the factors that influence participation with the aim to better understand how these factors influence participation.DesignThematic analysis was used to synthesise focus groups and interview data within the intrapersonal, interpersonal, organisation, environmental, and policy levels of an ecological model.MethodsInterviews were conducted with 4 experienced exercise providers (2 men, 2 women). Focus groups were conducted with 21 young women and girls (M = 17.9, SD = 2.4) who had participated in one of the exercise interventions developed and delivered by the providers.ResultsThe perceptions of participants and providers were often disparate but revolved around the same themes especially at the intrapersonal and interpersonal levels. They expressed contrasting views regarding the importance of skill development and enjoyment, and the role of boys and instructors. At the organisational level, both participants and providers agreed that schools offer opportunities as well as barriers to engagement in physical activity and exercise. At the environmental level, urbanisation, safety, culture, and social media appeared as main themes where the perspectives of participants and providers complemented each other. Finally, at the policy level the main themes were derived from providers and concerned issues around programme funding. Participants provided valuable commentary about a nationwide campaign to promote physical activity to females.ConclusionsIn order to provide engaging physical activity and exercise for young women and girls it is necessary to align the needs and expectations of participants and providers at the intrapersonal and interpersonal levels. For sustainable exercise provision that impacts young women and girls, it is essential to align funding strategies and deliverables between exercise providers, local and national stakeholders.     

Testing mediator variables in a physical activity intervention for women with type 2 diabetes

ObjectivesA limited understanding of the mechanisms of behavior change has hindered the development of more effective interventions. The aim of this study was to identify potential mediators of objectively measured physical activity (PA) behavior change in women with type 2 diabetes (T2DM).DesignMediation test of a randomized controlled trial.MethodWomen with T2DM (n = 93) from the control group (standard PA materials, n = 44) and the full intervention group (control + stage-matched printed material and telephone counseling, n = 49) of a larger PA intervention trial were included. PA outcomes were minutes of MET weighted moderate and vigorous PA/week (self-report) and steps/3-days (objective) recorded at baseline and 12-months. Social-cognitive constructs were measured and tested in a mediating variable framework.ResultsPerceived behavioral control and barrier self-efficacy mediated intervention effects on objective PA (proportion of intervention effect mediated = 18% and 24% respectively). Intention was a mediator of objective PA (23%).ConclusionPerceived behavior control, barrier self-efficacy, and intention are effective mechanisms of PA behavior change in women with T2DM.     

Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial

BackgroundWomen reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.AimsTo adapt and evaluate the effects of the Internet-based prevention program “Student Bodies?” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies?+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies?” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.ResultsAt 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.ConclusionThe adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.     

Psychosocial mediators of a lifestyle physical activity intervention in women

ObjectivesA lifestyle physical activity intervention in women based on the transtheoretical model and social–cognitive theory effectively increased physical activity. The aim of the present study was to examine possible mediators (perceived benefits and barriers of physical activity, self-efficacy, processes of change, and social support) of these physical activity changes.MethodsMembers of four units of a women's organization followed a six-month minimal-contact physical activity program. The intervention program included one group meeting, a self-help booklet and five monthly reminder letters. Members of two other units served as control group. Physical activity (accelerometer counts), and psychosocial constructs (self-report questionnaires) were assessed at baseline (pretest) and directly after the intervention (posttest). Women who completed all measurements (n = 101) were included in the mediation analyses.ResultsParticipants in the intervention group reported significantly greater increases in the use of behavioral processes from pretest to posttest than participants in the control group. None of the proposed psychosocial constructs showed a mediating effect on changes in physical activity.ConclusionsThe mechanisms proposed by the transtheoretical model and social–cognitive theory could not explain the positive effect of the intervention on physical activity. Identifying the working components of an intervention remains a challenging and necessary step in the development of effective low-cost and high-reach physical activity interventions.     

Life skills development in physical education: A self-determination theory-based investigation across the school term

ObjectivesGrounded in self-determination theory (SDT), the main aim of this study was to examine the longitudinal associations between teacher autonomy support, students’ basic psychological need satisfaction and life skills development in physical education (PE).DesignThis study employed a two-wave longitudinal research design.MethodStudents (N = 266, Mage = 12.94 years, SD = 0.70) completed measures assessing perceived autonomy-supportive teaching, need satisfaction (autonomy, competence, and relatedness), and life skills development in PE (teamwork, goal setting, social skills, problem solving and decision making, emotional skills, leadership, time management, and interpersonal communication). Data collections took place during week 6 (timepoint 1; T1) and week 15 (timepoint 2; T2) of the autumn school term.ResultsCross-lagged panel analyses showed that T1 teacher autonomy support did not significantly predict students’ three basic psychological needs, total need satisfaction or life skills development at T2. Students’ T1 total need satisfaction positively predicted their development of all eight life skills at T2. Additionally, students’ T1 autonomy satisfaction positively predicted their teamwork, social skills, emotional skills, leadership, and interpersonal communication skills at T2, T1 competence satisfaction positively predicted students’ teamwork skills at T2, and students’ T1 relatedness satisfaction positively predicted their social skills at T2.ConclusionsProviding partial support for SDT, the findings highlighted that satisfaction of students’ three basic psychological needs had some positive effects on students’ life skills development in PE. As such, a climate that satisfies students’ basic psychological needs should help to develop their life skills in PE.     

Feasibility of a Self-Determination Theory-based exercise intervention promoting Healthy at Every Size with sedentary overweight women: Project CHANGE

ObjectivesTo examine feasibility, acceptability and preliminary results of a Self-Determination Theory (SDT) -based exercise intervention with a Healthy at Every Size (HAES) orientation for sedentary overweight/obese women.DesignProject CHANGE was an 8-week randomized controlled trial with follow-up at 4-week.MethodTwenty-five sedentary, overweight women (BMI = 25–34.9) were randomized to either the SDT-based intervention with a HAES orientation (S/H) or exercise only (EX) intervention. The S/H group received exercise training and a weekly behavioral intervention while the EX group received only traditional supervised exercise training. Information about acceptability and feasibility was collected from process evaluation (i.e., participants' satisfaction and feedback) and objective data (e.g., retention, attendance, adherence to the PA goal). Assessments of PA participation and physical/psychological variables were obtained at baseline, post-intervention, and 4-week follow-up.ResultsParticipants reported high levels of satisfaction. Participation in the S/H group averaged 95%. Retention was high for both groups (S/H = 83.3% vs. EX = 84.6%), while adherence to the PA goal was better for the S/H group at follow-up (S/H = 60% vs. EX = 36.4%). The S/H intervention also resulted in larger effect sizes for changes in key motivational variables, including self-determination, autonomy, as well as goal-setting, planning and scheduling self-efficacy.ConclusionThe 8-week SDT-based intervention promoting Healthy at Every Size is feasible and acceptable and may result in better exercise adherence and improvements in motivational variables relative to traditional supervised exercise. These results support conducting additional research to determine the efficacy of this approach for promoting PA in sedentary, overweight women.     

The Tarasoff Warning and the Duty to Protect

Summary

Since the case of Tarasoff v. Regents of the University of California, mental health professionals have had an explicit legal duty to warn potential adult victims of violence. Subsequent case law expanded this standard to a broader duty-to-protect. Primary health care providers are increasingly treating psychiatric patients for whom the duty to protect is applicable. However, these providers are often unaware of the legal, ethical, and clinical issues involved. Assessment of violence risk should include demographic, psychiatric, and social dimensions. Interventions include notifying law enforcement authorities, potential victims, and possible use of psychiatric hospitalization to prevent aggressive behavior. The duty-to-protect as a standard-of-care has been applied to several other clinical situations, including impaired driving capacity, high-risk HIV behavior, and child sexual abuse. The article includes a step-by-step clinical protocol for evaluation and intervention in dangerous situations.     

Social support coping style predicts women’s cortisol in the laboratory and daily life: the moderating role of social attentional biases

Background and Objectives: Social stress and associated coping responses can profoundly influence women’s stress physiology and health. Implicit social attentional biases can also influence psychological and physiological stress responses. The purpose of this study was to explore whether a coping style characterized by greater use of social support predicts indices of cortisol activity in laboratory and daily life contexts among female university students. We hypothesized that the relation of this coping style to cortisol activity would be moderated by women’s attentional biases.

Methods: Seventy-four women (M_age?=?19.44, range: 17.8–27.8, 64% White) completed an interpersonal stress task and an attentional bias task in the lab, along with a self-report coping inventory. Participants provided five saliva samples during the lab protocol, followed by three saliva samples per day for three consecutive weekdays. Outcome measures included cortisol response to lab tasks (AUCg), diurnal cortisol slope, diurnal AUCg, and cortisol awakening response (CARi).

Results: A coping style characterized by greater use of social support predicted lower lab AUCg and lower, flatter average diurnal cortisol slope for women with attentional avoidance compared to women with attentional vigilance (ps?<?.05).

Conclusions: Responding to stress by using social support is linked to lower cortisol responses to social stress and diurnal cortisol activity for women with implicit avoidance of social threat cues.