Referrals to Community and State Agencies to Address Social Determinants of Health for Improving Mental Health, Functioning, and Quality of Care Outcomes for Diverse Adults.

To examine whether referral for social determinants of health (SDH) needs decreases psychological distress and posttraumatic stress disorder (PTSD) symptoms and improves level of functioning and quality of care among diverse adults. Data are from control participants (n = 503 adults) in a randomized controlled trial testing a mental health intervention in North Carolina and Massachusetts. We fitted multilevel mixed-effects models to repeated assessments (baseline, 3, 6, and 12 months) collected between September 2019 and January 2023.

Role of social determinants in anxiety and depression symptoms during COVID-19: A longitudinal study of adults in North Carolina and Massachusetts.

Trajectory studies of the COVID-19 pandemic have described patterns of symptoms over time. Yet, few have examined whether social determinants of health predict the progression of depression and anxiety symptoms during COVID-19 or identified which social determinants worsen symptom trajectories. Using a racially, ethnically, and linguistically diverse sample of adults participating in a randomized clinical trial with pre-existing moderate to severe depression and/or anxiety symptoms, we compare symptom patterns before and during COVID-19; characterize symptom trajectories over a 20-week follow-up period; and evaluate whether social determinants are associated with within- and between- person differences in symptom trajectories.

Self-Report Measures of Anhedonia and Approach Motivation Weakly Correspond to Anhedonia and Depression Assessed via Clinical Interviews.

Self-report scales are popular tools for measuring anhedonic experiences and motivational deficits, but how well do they reflect clinically significant anhedonia? Seventy-eight adults participated in face-to-face structured diagnostic interviews: 22 showed clinically significant anhedonia, and 18 met criteria for depression. Analyses of effect sizes comparing the anhedonia and depression groups to their respective controls found large effects, as expected, for measures of depressive symptoms, but surprisingly weak effect sizes (all less than =.50) for measures of general, social, or physical anhedonia, behavioral activation, and anticipatory and consummatory pleasure.

Appetitive Motivation in Depressive Anhedonia: Effects of Piece-Rate Cash Rewards on Cardiac and Behavioral Outcomes.

Deficits in self-regulation and motivation are central to depression. Using motivational intensity theory (Brehm & Self, 1989), the present research examined how depressive anhedonia influences effort during a piece-rate appetitive task. In piece-rate tasks, people can work at their own pace and are rewarded for each correct response, so they can gain rewards more quickly by expending more effort.

The impact of prior day sleep and physical activity on the cortisol awakening response.

The cortisol awakening response (CAR) describes the increase in cortisol within the first 30-60 min after waking from nocturnal sleep, and is a common biomarker used within psychoneuroendocrinology, but the effect of sleep on the CAR is currently unclear. A previous study suggested that reported discrepancies may be due to other lifestyle behaviors such as physical activity; given the role of the CAR in energy regulation and preparation for the day, it is theoretically plausible that activity level would influence the CAR. However, no study has yet utilized objective monitoring of day-to-day sleep and physical activity to investigate potential effects on the CAR.

RZ Interval as an Impedance Cardiography Indicator of Effort-Related Cardiac Sympathetic Activity.

Research on effort and motivation commonly assesses how the sympathetic branch of the autonomic nervous system affects the cardiovascular system. The cardiac pre-ejection period (PEP), assessed via impedance cardiography, is a common outcome, but assessing PEP requires identifying subtle points on cardiac waveforms. The present research examined the psychometric value of the RZ interval (RZ), which has recently been proposed as an indicator of sympathetic activity, for effort research.

Reward-Seeking Deficits in Major Depression: Unpacking Appetitive Task Performance with Ex-Gaussian Response Time Variability Analysis.

Major depressive disorder (MDD) has extensive ties to motivation, including impaired response time (RT) performance. Average RT, however, conflates response speed and variability, so RT differences can be complex. Because recent studies have shown inconsistent effects of MDD on RT variability, the present research sought to unpack RT performance with several key improvements: (1) a sample of adults ( = 78; 18 MDD, 60 Control) free of antidepressant medication; (2) an unambiguously appetitive task with appealing incentives at stake; and (3) ex-Gaussian RT modeling, which can unconfound speed and variability by estimating parameters for the mean (Mu) and standard deviation (Sigma) of the normal component and the mean of the exponential component (Tau).

The impact of goal adjustment and caregiver burden on psychological distress among caregivers of cancer patients.

Objectives: Research has demonstrated that serving in the caregiver role is often associated with increased symptoms of depression, stress, and anxiety, but some people fare better than others in managing the burden of caregiving. The goal of the present study was to examine the potential moderating role of goal adjustment (the ability to disengage from unattainable goals and reengage in alterative ones) on the relation between caregiver burden and distress in family caregivers of cancer patients.

Methods: Caregivers of adult family members diagnosed with cancer in the past 3 years participated (N = 102).

Conscientiousness and Effort-Related Cardiac Activity in Response to Piece-Rate Cash Incentives.

Although conscientiousness predicts many aspects of motivation, from delay of gratification to higher achievement, its relationship to responses to monetary incentives is surprisingly inconsistent. Several studies have found null or relationships between conscientiousness and behavioral performance in piece-rate, pay-for-performance tasks, in which people earn money for each unit of work completed. In the present study, we examined the role of conscientiousness in effort-related cardiac activity and behavioral performance during a pay-for-performance task.

Single session real-time fMRI neurofeedback has a lasting impact on cognitive behavioral therapy strategies.

To benefit from cognitive behavioral therapy (CBT), individuals must not only learn new skills but also strategically implement them outside of session. Here, we tested a novel technique for personalizing CBT skills and facilitating their generalization to daily life. We hypothesized that showing participants the impact of specific CBT strategies on their own brain function using real-time functional magnetic imaging (rt-fMRI) neurofeedback would increase their metacognitive awareness, help them identify effective strategies, and motivate real-world use.

Psychopathology, everyday behaviors, and autonomic activity in daily life: An ambulatory impedance cardiography study of depression, anxiety, and hypomanic traits.

Discrepancies regarding the link between autonomic nervous system (ANS) activity and psychopathology may be due in part to inconsistent measurement of non-psychological factors, including eating, drinking, activity, posture, and interacting with others. Rather than sources of noise, behaviors like being active and being with others may be the behavioral pathways that connect psychopathology symptoms to autonomic activity. The present study examined whether behaviors mediate the association of depression, anxiety, and hypomanic traits with ANS by using experience sampling methodology and ambulatory impedance cardiography.

Reports of Therapy Skill Use and Their Efficacy in Daily Life in the Short-term Treatment of Depression.

Previous studies have shown that the use of therapy skills in between sessions is an important mechanism of symptom improvement. The current study expands this line of research by using a diary approach to examine the use of therapy skills in daily life. A sample of 39 depressed adults (85% female, mean age 38) were signaled twice per week throughout the course of either cognitive-behavioral therapy (CBT) or self-system therapy (SST).

Discrepancies in Radiograph Interpretation Between Pediatric Radiologists and Pediatric Intensivists in the Pediatric or Neonatal Intensive Care Unit.

Background: In pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), patient management decisions are sometimes based on preliminary interpretations of radiographs by pediatric intensivists (PIs) before a formal interpretation by a pediatric radiologist (PR).

Objective: To quantify and classify discrepancies in radiographic interpretation between PRs and PIs in the PICU and NICU.

Materials And Methods: This institutional review board-approved multi-institutional prospective study included three PRs and PIs at two PICUs and three NICUs.

The Effects of Psychotherapy for Major Depressive Disorder on Daily Mood and Functioning: A Longitudinal Experience Sampling Study.

Experience sampling methodology (ESM) was used in a randomized controlled trial of short-term therapy to examine changes in daily affect and reactivity to daily event appraisals among depressed patients. Fifty-five depressed adults (mean age 37 years, 80% female) were randomly assigned to one of two therapy conditions. Using an interactive voice response system, participants rated activities and emotional functioning eight times per day for seven days.

Treatment of Depression From a Self-Regulation Perspective: Basic Concepts and Applied Strategies in Self-System Therapy.

Self-regulation models of psychopathology provide a theory-based, empirically supported framework for developing psychotherapeutic interventions that complement and extend current cognitive-behavioral models. However, many clinicians are only minimally familiar with the psychology of self-regulation. The aim of the present manuscript is twofold.

Individual Differences in Expectancies for Change in Depression: Associations with Goal Pursuit and Daily Experiences.

More optimistic expectations for change in patients entering treatment often predict more favorable outcomes. However, our understanding of the nature and function of those expectancies is limited. The current study tested the proposal that optimistic expectancies among patients seeking outpatient psychotherapy for major depressive disorder may be explained in part by having a more adaptive self-regulatory style.

Perfectionism and Effort-Related Cardiac Activity: Do Perfectionists Try Harder?

Do perfectionists try harder? Previous research on perfectionism and effort has used self-report items and task performance as indicators of effort. The current study investigated whether individual differences in perfectionism predicted effort-related cardiac activity during a mental effort task. Based on past research that suggests adaptive perfectionism is associated with higher effort, it was hypothesized that self-oriented perfectionism (SOP) would predict increased effort on the task.

Do depressive symptoms "blunt" effort? An analysis of cardiac engagement and withdrawal for an increasingly difficult task.

Research on depression and effort has suggested "depressive blunting"-lower cardiovascular reactivity in response to challenges and stressors. Many studies, however, find null effects or higher reactivity. The present research draws upon motivational intensity theory, a broad model of effort that predicts cases in which depressive symptoms should increase or decrease effort.

Motivational deficits differentially predict improvement in a randomized trial of self-system therapy for depression.

Objective: A randomized trial compared the time course and differential predictors of symptom improvement in 2 treatments for depression.

Method: Forty-nine adults (84% female) who were not taking antidepressant medications and met diagnostic criteria for major depressive disorder or dysthymia were randomly assigned either to cognitive-behavioral therapy (CBT) or self-system therapy (SST), a treatment that targets problems in self-regulation, the ongoing process of evaluating progress toward personal goals. Self-regulatory variables (promotion and prevention focus and goal disengagement and reengagement) were assessed as potential moderators of efficacy.

Effort Deficits and Depression: The Influence of Anhedonic Depressive Symptoms on Cardiac Autonomic Activity During a Mental Challenge.

Motivational approaches to depression emphasize the role of dysfunctional motivational dynamics, particularly diminished reward and incentive processes associated with anhedonia. A study examined how anhedonic depressive symptoms, measured continuously across a wide range of severity, influenced the physiological mobilization of effort during a cognitive task. Using motivational intensity theory as a guide, we expected that the diminished incentive value associated with anhedonic depressive symptoms would reduce effort during a "do your best" challenge (also known as an unfixed or self-paced challenge), in which effort is a function of the value of achieving the task's goal.

Creative motivation: creative achievement predicts cardiac autonomic markers of effort during divergent thinking.

Executive approaches to creativity emphasize that generating creative ideas can be hard and requires mental effort. Few studies, however, have examined effort-related physiological activity during creativity tasks. Using motivational intensity theory as a framework, we examined predictors of effort-related cardiac activity during a creative challenge.

Evaluation of the internal consistency, factor structure, and validity of the Depression Change Expectancy Scale.

The psychometric properties and predictive validity of the Depression Change Expectancy Scale (DCES), a modification of an expectancy scale originally developed for patients with anxiety disorders, were examined in two studies. In Study 1, the 20-item scale was administered along with a battery of questionnaires to a sample of 416 dysphoric undergraduate students and demonstrated good internal consistency. A two-factor solution most parsimoniously accounted for the variance, with one factor containing all pessimistically worded items (DCES-P) and the second containing all optimistically worded items (DCES-O).

Gritty people try harder: grit and effort-related cardiac autonomic activity during an active coping challenge.

Grit, a recently proposed personality trait associated with persistence for long-range goals, predicts achievement in a wide range of important life outcomes. Using motivational intensity theory, the present research examined the physiological underpinnings of grit during an active coping task. Forty young adults completed the Short Grit Scale and worked on a self-paced mental effort task.

Contrasting Regulatory Focus and Reinforcement Sensitivity: A Daily Diary Study of Goal Pursuit and Emotion.

This study examined the moderating effects of motivational orientation on daily affect and goal pursuit. Based on recent revisions to Reinforcement Sensitivity Theory, measures of BIS (BIS-r and Fight-Flight-Freeze System or FFFS), BAS, and regulatory focus (Promotion and Prevention) were administered to 84 college students who participated in a 14-day diary study. Diary items assessed goal-directed activities and positive and negative affect (PA and NA).

Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study.

Introduction: In adults, small (< 50%) serum creatinine (SCr) increases predict mortality. It is unclear whether different baseline serum creatinine (bSCr) estimation methods affect findings of acute kidney injury (AKI)-outcome associations. We characterized pediatric AKI, evaluated the effect of bSCr estimation approaches on AKI-outcome associations and evaluated the use of small SCr increases to predict AKI development.