Behavioral Medicine最新文献

Research on acculturation stress and its effects on alcohol-related outcomes among Hispanics has been the subject of many studies. However, these studies are limited because they generally use a single measure of acculturation stress to account for this complex construct, and most studies do not examine demographic factors or coping resources that may moderate the link between acculturation stress and alcohol-related outcomes. Our study examined two distinct components of acculturation stress-the pressure to acculturate and the pressure against acculturation-and their respective associations with alcohol use severity and the extent to which nativity status, self-esteem, and resilience moderate those associations. Participants were obtained from a convenience sample of 628 Hispanic emerging adult college students (aged 18-25 years) who completed a cross-sectional online survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Results indicated that pressure to acculturate was not associated with alcohol use severity; however, higher levels of pressure against acculturation were associated with greater alcohol use severity. Moderation analyses indicated that nativity status, self-esteem, and resilience functioned as moderators. Our findings suggest that this line of research warrants a more nuanced approach to understand whether and how the components of acculturation stress are associated with alcohol use severity. Nativity status is likely an important variable when considering these components and their respective associations with alcohol use. Self-esteem and resilience may be relevant coping resources that help mitigate the harmful link between acculturation stress and alcohol use.

This study analyzed trends and patterns of lonely deaths relative to total deaths and suicides in Korea and compared the characteristics of lonely death cases with those of the general population. We used the Lonely Death Statistics derived from on-site unattended death investigation data from the Korean National Police Agency. The lonely death rate increased from 4.7 to 7.2 per 100,000 people from 2017 to 2023. The rate among males was approximately five times that among females, and those in their 60s showed the highest rate. While both lonely death rates and suicide rates were higher among males, the lonely death rate showed an inverted U-shaped pattern with the highest rate among those in their 50s and 60s, in contrast to the suicide rate, which tended to increase with age, peaking among those aged 80 and over. Housing types associated with single-person living, particularly nonresidential dwellings, were markedly more common among lonely death cases than in the general population. Lonely deaths were increasingly discovered by non-family members; in 2023, only one-fourth were discovered by family, with the rest found by landlords, neighbors, acquaintances, and welfare service workers. Those who died a lonely death had substantially lower incomes than the general population. Our findings suggest that lonely death is not simply a consequence of population aging and increasing single-person households, but rather reflects the growing number of individuals who are disconnected from social networks and support systems.

Despite the documented safety and efficacy of the COVID-19 vaccination, parental pediatric vaccine hesitancy is common. Little is known about the concerns and beliefs held by caregivers that impact COVID vaccination decision-making on behalf of their minor children, as underlying attitudes toward pediatric COVID-19 vaccination have not been well described. Unvaccinated children and their caregivers underwent antibody testing and completed an electronic survey at four clinic-based practices in Northern and Central New Jersey from August 2022 to June 2023. Caregivers were grouped into four attitudinal classes based on how safe, effective, useful, and necessary they believed COVID-19 vaccination were. Caregivers in the lowest vaccine acceptance classes (1 and 2) were significantly less likely to plan to vaccinate their children compared to those in the higher classes (3 and 4) (8.9% and 5.6% vs. 30.4% and 61%). Those in Class 2 were significantly less likely to have at least one adult household member fully vaccinated or boosted against COVID-19 than those in higher classes and marginally more likely to be from households where at least one adult had been diagnosed with COVID-19 in the past year than those in Class 3 (52% vs. 40%). The majority of caregivers viewed their pediatrician as a trusted source of information (89%). Caregiver attitudes toward vaccination are associated with household vaccination status and family COVID-19 infection history. Pediatricians play an important role in aiding vaccine uptake among children. Educational efforts should target differing caregiver profiles to address vaccine hesitancy and make future pediatric vaccine programming more successful.

This study examined the relationships among prenatal distress, negative pregnancy perception, fetal health locus of control, and anxiety and depression in women with high-risk pregnancies. A descriptive correlational design was used. The study was conducted between January and May 2025 and included 327 high-risk pregnant women hospitalized in the perinatology unit of a tertiary hospital in Central Anatolia, Turkey. Data were collected using standardized self-report instruments. Elevated anxiety symptoms were observed in 43.7% of participants, and 57.8% reported elevated depressive symptoms. Prenatal distress was significantly associated with perceived income, education level, pregnancy intention, diagnostic knowledge, social support, fear during pregnancy, and anxiety and depressive symptoms, with psychological symptoms emerging as the strongest predictors in a hierarchical regression analysis. Negative pregnancy perception was significantly related to perceived income, pregnancy intention, social support, and anxiety and depressive symptoms and was independently predicted by greater psychological symptoms, unintended pregnancy, lower income, and inadequate social support. An internal health locus of control was associated with education level, pre-pregnancy chronic disease status, and diagnostic knowledge, whereas chance-oriented beliefs were related primarily to chronic disease status. A powerful others health locus of control was significantly associated with education level and adequacy of diagnostic information. Overall, the findings indicate that prenatal distress and negative pregnancy perception in high-risk pregnancies are closely linked to psychological symptoms and selected sociodemographic and obstetric factors. These results emphasize the importance of routine mental health screening, targeted patient education, and integrated psychosocial support to promote adaptive pregnancy perceptions and health-related control beliefs in high-risk pregnancy care.

Minority stress contributes to worse mental health among sexual minority men (SMM). However, minority stress measurement is absent from most clinical trials and rarely examined as a treatment outcome. For this study, we analyzed data from an existing comparative effectiveness trial of group-based, peer-delivered Motivational Interviewing (MI) using the standard protocol versus MI plus affirmative care for trauma and minority stress (MI+AC). Participants (N = 354) were sexual trauma-exposed SMM who screened positive for depression at baseline, randomized 1:1 MI (n = 178) or MI+AC (n = 176). Minority stress was assessed at baseline, posttreatment, and two- and four-month follow-up. We did not observe any significant time by treatment condition interactions, suggesting similar effects between treatment conditions. However, significant main effects of time suggest significant decreases in expected discrimination and expected rejection from family as well as increases in internalized homophobia toward others in both treatment conditions. Peer-delivered MI may contribute to reductions in certain proximal minority stress processes among SMM with sexual trauma. Future research should assess minority stress as a primary outcome, and as a potential mechanism of change regarding other primary psychiatric outcomes.

Pulmonary Tuberculosis (TB) continues to impose a significant multidimensional burden on patients. Despite considerable research on pulmonary TB in Ethiopia, the subjective experiences of patients remain insufficiently explored. Therefore, this study aimed to explore the psychological, socioeconomic, and physical experiences of pulmonary TB patients in Northern Ethiopia. A qualitative study design was utilized among pulmonary TB patients. Participants were selected using a purposive sampling technique. The sample size was determined based on information saturation. Data were collected using an interview guide through in-depth interviews (IDIs) and focused group discussions (FGDs). Data were analyzed using Reflexive Thematic Analysis (RTA) and supported by NVivo 12.0 software for data management. A total of 27 participants were involved in the study. The study generated three overarching themes. First theme: Psychological experiences as loss of self and future perspective encompassed depressive and anxiety symptoms, fear, and hopelessness that disrupted identity and treatment motivation. Second theme: Socioeconomic experiences as disruption of social standing and survival, indicated stigma, social isolation, and economic hardship challenges in maintaining family roles, while emphasizing the importance of family and social support. Third theme: Physical experiences as an obstacle to daily life and treatment adherence demonstrated that fatigue, medication side effects, transportation challenges, and anti-TB medication issues create compound barriers to daily functioning and treatment adherence. This study revealed that pulmonary TB patients experienced interconnected psychological, socioeconomic, and physical burdens extending beyond medical disease. Integrating psychosocial support, stigma-reduction, and patient-centered care into TB service may improve patient well-being and treatment outcomes.

Social status experiences, such as perceiving control over one's life and feeling socially connected, are thought to influence health through stress pathways, yet evidence from Latin America is limited. This study tested the status syndrome framework in a cross sectional sample of 386 Chilean adults aged 50 and older, examining associations between psychosocial indicators of autonomy, social integration, emotional distress, and physiological risk markers including C reactive protein (CRP) and mean arterial pressure (MAP). Multinomial logistic regression models were estimated to examine associations with physiological risk categories. No associations were observed for MAP, whereas inflammatory risk indexed by CRP was associated with perceived discrimination and emotional burden. Emotional burden was particularly linked to CRP among men but not women, suggesting sex-specific patterns in this association. These findings highlight discrimination-related experiences and emotional burden as psychosocial correlates of inflammatory risk among older adults in a Latin American context.

Active surveillance (AS) is a viable, yet underutilized option for managing low-risk cancers. Patients struggle psychologically with the inherent uncertainty, and physicians are hesitant to recommend AS due to concerns about professional risks should the disease progress. This online experimental study examined whether and how physicians' empathic and uncertainty-reframing communication increases patients' immediate AS acceptance at the point of clinical decision and reduces their intentions to engage in medical litigation and to spread negative word-of-mouth (N-WOM). Using a 2 × 2 × 2 between-subjects factorial design, 968 South Korean adults were randomly assigned to one of eight vignettes that manipulated empathic communication (low vs. high) and uncertainty-reframing communication (absent vs. present), and hospital setting (local general hospital vs. top-tier tertiary hospital). Results showed that empathic communication significantly improved AS acceptance and reduced litigation and N-WOM intentions. Mediation analyses revealed that reduced anxiety and increased trust in the AS plan mediated its beneficial effect on AS acceptance; enhanced physician credibility mediated the effect on litigation intention; and decreased anxiety mediated the effect on N-WOM intention. Uncertainty-reframing was beneficial only when empathic communication was absent, indicating a compensatory effect. These core patterns were consistent across different hospital settings (a local general hospital vs. a top-tier tertiary hospital in the capital city). These findings provide empirical evidence that physician communication can bridge the gap between evidence and current practice by attenuating key barriers for both patients and physicians.

Depression is common among adolescents and can have severe impacts on their well-being. We aimed to determine if delaying high school start times impacts adolescents' depression risk. Measurement in the START cohort began in Spring 2016 when participants were in 9th grade (baseline, n = 2,134) and all five participating schools started early (7:30 or 7:45 am). Follow-ups 1 and 2 occurred when participants were in 10th and 11th grades by which time two of the schools ("policy-change schools") had delayed their start times by roughly one hour. Our outcome was the Kandel-Davies depressed mood scale. Difference-in-differences analyses were employed after missing data were multiply imputed with fully conditional specification. Depressed mood scores increased for students in comparison schools relative to policy-change schools at follow-up 1 and at follow-up 2. These differences were primarily driven by the items in the scale related to fatigue. Implementing school schedule policy that is aligned with adolescent circadian biology has the potential to reduce the prevalence of symptoms of depression among cases where fatigue is a primary presenting symptom.

Given the importance of a healthy lifestyle for cancer patients' health outcomes and quality of life, this study aimed to synthesize the literature on factors (perceived as) hindering or facilitating healthcare providers' provision of lifestyle information in oncology. Based on this synthesis, we additionally derived recommendations to improve this practice, which were independently validated by experts. A systematic literature review was conducted. PubMed, Web of Science, CINAHL Ultimate, and PsycINFO were searched. We screened titles and abstracts, aided by ASReview, and full texts. Peer-reviewed articles published from 2007-2022 were included, reporting non-interventional studies on factors that HCPs associated with lifestyle information provision to adult cancer patients. We identified 20,176 unique articles, of which 108 articles were included. Most articles studied factors related to information provision about physical activity, smoking, or a combination of lifestyle behaviors. Factors associated with lifestyle information provision fell into four main groups; factors related to the (1) HCP (e.g., knowledge), (2) patient (e.g., interest), (3) relationships between HCPs, patients, and stakeholders (e.g., support), and (4) organization (e.g., resources). The factors were linked to whether, how, and when information is provided. The review provides an overview of factors associated with communication about different lifestyle behaviors across HCPs and cancer types. Based on the findings, we formulated recommendations for future research and for clinical practice, which were validated via interviews with nine oncology HCPs, confirming feasibility with minor adjustments. Overall, lifestyle information provision as a whole and associated factors deserve more attention in clinical practice and scientific research.