The Michigan infant mental health home visiting model

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent–child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.     

Exploring emotions in dialog between health provider,parent and child. An observational study in pediatric primary care

IntroductionThis paper is part of the theoretical thread of health psychology and it presents a study aimed to recognize information useful to implement psychological interventions finalized to personalize medical treatments and engage users in pediatrics.ObjectiveIn this paper is presented an observational study aimed to explore doctor-patient dialog about worries in pediatric primary care; it has been carried out identifying dialogical interaction patterns, or typical dialog between health providers, parent and child.MethodWe documented conversations in 265 visits; we audio-recordered, transcribed and analyzed them with Verona Coding Definitions of Emotional Sequences. Dialogs between participants were analyzed one by one. Frequencies of emotions’ signals (cues/concerns) and responses were analyzed through Redundancy Analysis, aimed to establish a quantitative relationship between these pair of groups of variables considering the asymmetrical relationship between them.ResultsSix “Dialogical Interaction Patterns” were obtained by interpreting these relationships; they show dialogs mainly aimed at obtaining information useful for diagnosis and treatment, with a limited exploration of worries or issues related to the condition of the child. Pediatric conversations seem to be characterized by a very high attention to cognitive aspects of medical questions with a poor consideration of emotions as useful information to medical practice.ConclusionsThese dialogs seem to ensure the rapidity and the efficiency of medical visits. Nevertheless, it could be useful to implement psychological interventions to achieve an enrichment of the dialog between participants, helping them to recognize users’ emotions as useful to define shared medical strategies.     

Water contaminant levels interact with parenting environment to predict development of depressive symptoms in adolescents

Contaminants in drinking water, such as lead, nitrate, and arsenic, have been linked to negative physical health outcomes. We know less, however, about whether such pollutants also predict mental health problems and, if so, the conditions under which such effects are strongest. In this longitudinal study, we examined whether drinking water contaminants interact with negative family environments (parental psychological control) to predict changes in depressive symptoms in 110 adolescents—a developmental period when symptoms often first emerge. We found that for adolescents in psychologically controlling families, levels of drinking water contaminants prospectively predicted depressive symptoms 2 years later; this effect was not present in adolescents in non‐controlling families. Importantly, these associations were not accounted for by family‐ or community‐level socioeconomic resources, demographic features, or by the adolescents’ stress exposure. These findings highlight the interplay of physical and psychological environments in influencing depressive symptoms in adolescents. A video abstract of this article can be viewed at https://youtu.be/thBV-DwnGcY     

Daily relations between social perceptions and physical activity among college women

ObjectivesThere is a need to develop more effective physical activity (PA) promotion programs for college women. Theory and evidence suggest that perceptions of the social environment play a role in college women’s PA, though little is known about how these perceptions are associated with PA at the day level. The goal of this study was to examine relations between changes in college women’s daily social perceptions and objectively assessed PA over seven days.DesignDaily diary method.MethodCollege women (n = 80, M_Age = 20, M_BMI = 23.1 kg/m²) wore Fitbit wristbands and completed daily self-reports of (1) the quantity and perceived intensity of their social interactions (positive/negative), and (2) the occurrence of social comparisons (based on appearance/health/status) for seven days.ResultsMultilevel models showed daily variability in predictors and outcomes (ps < 0.0001), as well as relations between within-person changes in social perceptions and PA. Increases in negative interactions (particularly those with friends) were consistently associated with decreases in daily PA, whereas increases in positive interactions showed limited relations (srs = −0.22-0.34). Days with health comparisons were days with greater PA for women who had stronger overall interest in comparisons, but were days with less PA for women with weaker overall interest (srs = 0.22–0.33). PA did not differ between days with vs. without appearance comparisons.ConclusionsSocial perceptions show meaningful day-to-day variability and relations with college women’s daily PA, and specific associations may be useful for improving tailored interventions for college women.     

Counselling and psychotherapy post‐COVID‐19

We consider how the prolonged, complex and uncertain aftermath of the COVID‐19 crisis will present challenges and opportunities for counselling and psychotherapy. Increased mental strain on populations, individuals and professionals is likely to be compounded by further constraints in therapeutic resources. Nevertheless, emerging needs and priorities will offer ground for systems thinking in linking the application of a range of therapeutic frameworks, theories to address global challenges, integration of counselling and psychotherapy into new sectors, service models for the most vulnerable, use of digital approaches, support mechanisms for professionals and interdisciplinary research.     

Pox Parties for Grannies? Chickenpox,Exogenous Boosting,and Harmful Injustices

Abstract

Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person’s ability to keep VZV suppressed can be ‘boosted’ through exposure to active chickenpox infections. We argue that even if this hypothesis were true, immunization policies that discourage routine childhood varicella vaccination in order to prevent shingles for other people are unethical. Such policies harm children and treat them as mere means for the benefit of others, and are inconsistent with how parents should treat their children and physicians should treat their patients. These policies also seem incompatible with institutional transparency.     

Ethically Allocating COVID-19 Drugs Via Pre-approval Access and Emergency Use Authorization

Abstract

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research. In conditions of scarcity, prioritization approaches should minimize harm, maximize benefit, and promote fairness. To promote continued data collection, patients seeking access to unproven COVID-19 drugs should receive lower priority for allocation when they decline to participate in clinical trials, either of the requested drug or other investigational products, offering a comparable balance of risks and benefits; special attention should be paid to concerns of voluntariness and distrust. In addition, institutional treatment protocols that can contribute more robust real world data should be preferred to single patient requests for access, with priority for inclusion based on traditional clinical allocation criteria relying on available evidence. Fairness demands distribution of these protocols across a diverse range of sites, particularly those serving marginalized populations, among other protections.     

Mental Health Literacy and Peer-to-Peer Counseling Referrals Among Community College Students

Mental health literacy (MHL) has utility for promoting peer-to-peer referrals to mental health support services among university students. However, there is a gap in the extant literature about the potential usefulness of MHL for supporting the mental health of community college students, a population facing a number of mental health conditions. The authors examined the construct validity and the utility of 3 dimensions of MHL as predictors of peer-to-peer referrals to the counseling center among community college students. Results of confirmatory factor analyses supported the dimensionality of the instrumentation and a hierarchical logistic regression analysis revealed that MHL was a significant positive predictor of peer-to-peer referrals to the counseling center. Implications for counseling practice and future research are discussed.     

Decision-making styles and mental health—A person-oriented approach through clustering

Previous research examining the associations between decision-making styles and mental health has neglected to look at the configurations of styles. The study identifies mutually exclusive groups of people according to their combination of the five decision-making styles and examines the differences between them in mental health-related variables in two studies. In Study 1, decision-making styles, mental health indicators (well-being, depression, stress) and socio-psychological protective factors (resilience, optimism, social support) were examined in university students in two rounds 1 year apart. A cluster analysis revealed three distinct decision profiles—independent/nonintuitive, avoidant/spontaneous and rational/nonavoidant. The best values of mental health-related variables were found in the rational/nonavoidant profile and the most negative values in the avoidant/spontaneous profile. The decision-making styles were stable after 1 year although they were not able to explain changes in mental health-related variables. Study 2 identified three similar clusters in a more general sample—spontaneous/irrational, dependent/avoidant and rational/nonavoidant—with the lowest level of psychological distress symptoms in the rational/nonavoidant cluster. The study highlights the usefulness of combinations of decision-making styles with regard to mental health as well as noting their specificity according to sample characteristics.