Browsing by Author "Johnson-Kwochka, Annalee V."

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    Examining Potential Barriers to mHealth Implementation and Engagement in Schizophrenia: Phone Ownership and Symptom Severity
    (Springer Nature, 2022) Luther, Lauren; Buck, Benjamin E.; Fischer, Melanie A.; Johnson-Kwochka, Annalee V.; Coffin, George; Salyers, Michelle P.; Psychology, School of Science
    Objective: Implementation of mobile health (mhealth) interventions remains limited among those with schizophrenia. This study examined several logistical barriers to the implementation of mHealth interventions, particularly text message interventions, for people with schizophrenia. Methods: This study examined the feasibility of leveraging personal mobile phones to deliver mHealth interventions by using data from a pilot randomized controlled trial (RCT) of a text message intervention delivered on personal mobile phones to 56 people with schizophrenia with motivation reductions. Results: Among those screened for the RCT (n =100), 91% had a mobile phone. For randomized participants (n = 56), 82.1% had a smartphone, with almost all (93.5%) having an Android processing system. Most randomized participants had unlimited text messages (96.4%) or voice calls (76.8%) with their mobile service plan, with 32.1% having unlimited data each month. At baseline, most used text messages (85.2%) and the internet (59.3%), while fewer participants used mobile applications (35.2%) at least once a week. Finally, there were no significant associations between engagement in the text message intervention and participant demographics, symptoms (positive, mood, negative), neurocognition, or mobile phone or plan characteristics or changes made during the 8 week intervention. Conclusions: Even those with schizophrenia with perceived symptom barriers to mHealth engagement (i.e., motivation reductions) may have access to mobile phones and plans and familiarity with mobile features to engage meaningfully with a text message intervention. These results help to support future implementations of text message interventions, which may enhance the provision of care for those with schizophrenia.
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    Investigating Religious Orientation and the Attribution Model of Mental Illness Stigma
    (2019-05) Johnson-Kwochka, Annalee V.; Salyers, Michelle P.; Minor, Kyle S.; Stull, Laura; Ashburn-Nardo, Leslie
    Objectives: The Attribution Model of mental illness stigma posits that attributions about the causes and controllability of mental illness contribute to prejudicial emotional reactions, which in turn may lead to discriminatory behaviors towards people with mental illnesses. Given that people make different assumptions about different mental illnesses, if this model is correct, it suggests that specific diagnoses would elicit different types of stigma. Another important, but unexamined, predictor is extrinsic religious orientation, which correlates positively with other types of prejudice and may predict higher levels of mental illness stigma. The purpose of this study was to test the Attribution Model of stigma and examine the relationships between diagnosis, religious orientation, and stigma. Methods: Participants (n = 334) were recruited via Amazon Mechanical Turk, randomized to read one of three vignettes about a person with a mental illness (i.e., schizophrenia, anorexia nervosa, depression), and completed measures of mental illness stigma, religious orientation and affiliation, familiarity with mental illness, and authoritarianism. Using latent variable path analysis, analysis of covariance, and multiple regression analyses, relationships in the Attribution Model of mental illness stigma were assessed, as well as the impact of diagnosis and extrinsic religiosity on specific aspects of stigma as measured by the Attribution Questionnare-27 subscales (i.e., blame, anger, pity, danger/fear, avoidance, segregation, and coercion). Results: Assessment of the Attribution Model indicated moderate overall model fit after respecification. Path coefficients indicated strong relationships between variables that were generally consistent with paths predicted by the model. One notable exception was that feelings of pity were not associated with greater helping behaviors. Analysis of covariance suggested that diagnosis was a key predictor of stigma, and that schizophrenia was the most stigmatized. Multiple regression analyses revealed that extrinsic religiosity was also an important predictor of stigma; extrinsic religiosity appeared to increase certain types of stigma, and moderate the relationship between diagnosis and stigma overall. Discussion: Although the respecified Attribution Model fit the data fairly well, the findings suggest that either the scale or the model would benefit from further refinement. Results support prior evidence that severe mental illnesses like schizophrenia are more stigmatized than other diagnoses. Extrinsic religiosity was also predictive of increased stigma, both directly and indirectly. As a moderator, extrinsic religiosity may decrease the impact of diagnosis on stigma, raising stigma for diagnoses perceived as more “controllable” (i.e., anorexia nervosa, depression) such that levels were similar to schizophrenia. Limitations and suggestions for future research are discussed.
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    Metacognition moderates the relationship between self-reported and clinician-rated motivation in schizophrenia
    (Elsevier, 2020-03-01) Luther, Lauren; Bonfils, Kelsey A.; Fischer, Melanie W.; Johnson-Kwochka, Annalee V.; Salyers, Michelle P.; Psychology, School of Science
    Introduction Prior work has found varied relationships between self-reported and clinician-rated motivation measures in schizophrenia, suggesting that moderators might impact the strength of this relationship. This current study sought to identify whether metacognition – the ability to form complex representations about oneself, others, and the world – moderates the relationship between self-reported and clinician-rated motivation measures. We also explored whether clinical insight and neurocognition moderated this relationship. Methods Fifty-six participants with a schizophrenia-spectrum disorder completed the Motivation and Pleasure Self-Report Scale and the clinician-rated motivation index from the Heinrichs-Carpenter Quality of Life Scale. Results Metacognition significantly moderated the relationship; self-reported and clinician-rated motivation were positively and significantly correlated only when metacognition was relatively high. Neither clinical insight nor neurocognition moderated the relationship. Discussion Metacognition appears to be a key variable impacting the strength of the relationship between self-reported and clinician-rated motivation measures and may help to partly explain the varied relationships observed in prior work. Using a metacognitive framework to guide assessment interviews and targeting metacognition in psychosocial treatments may help to improve the synchrony between self-perceptions and clinician ratings of motivation.
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    A Mixed-Methods Investigation of the Implications of Substance Use Disorder Stigma for Justice-Involved Youth
    (2023-08) Johnson-Kwochka, Annalee V.; Salyers, Michelle; Cyders, Melissa; Zapolski, Tamika; Aalsma, Mathew
    Objectives: Compared to youth without justice-involvement, justice-involved youth are more likely to experience substance use disorders. Yet, few justice-involved youth receive appropriate, evidence-based treatment for substance use disorders. Although there are numerous barriers to the accessibility of appropriate treatment, research also suggests that it is difficult to engage justice-involved youth in treatment even when it is available and accessible. It is possible that substance use disorder stigma, or negative attitudes towards youth with substance use disorders, may contribute to low treatment accessibility, and make it more difficult for justice-involved youth to engage with available treatment. Few researchers have examined substance use disorder stigma among this population. The purpose of this study was to 1) explore the nature of substance use disorder stigma among justice-involved youth, at multiple ecological levels and 2) examine the role of substance use disorder stigma in limiting the accessibility of and engagement in treatment and justice-involved youth’s engagement in treatment. Methods: Participants (n = 44 youth-guardian dyads) were referred to the study by juvenile probation departments in two Indiana counties. In addition, 66 system personnel participants who work with justice-involved youth with substance use disorders were recruited from community mental health centers and juvenile probation departments in rural and suburban Indiana counties. All participants completed survey measures of substance use disorder stigma and familiarity with substance use; youth-guardian dyads also provided information about the youth’s substance use history and treatment utilization. A subset of participants (n = 9 youth, 11 guardians, 12 system personnel) completed qualitative interviews, providing perspectives on substance use disorder stigma and the role of stigma in discouraging treatment. Using analysis of covariance, multiple regression analyses, and qualitative grounded theory analysis, I explored the nature of stigma toward justice-involved youth with substance use disorders and examined the impact of stigma on treatment accessibility and engagement. Results: For aim 1, as hypothesized, public stigma (assessed by survey data) varied significantly according to participant role and specific substance, with guardians endorsing greater stigma than system personnel. All participants expressed greater negative emotions towards youth with opioid use disorder compared to marijuana use disorder. Interview data revealed particularly nuanced attitudes about marijuana use. Contrary to expectations, youth reported little self-stigma. Both youth and guardians described limited knowledge of problematic substance use. For aim 2, interview data suggests that youth and guardians may identify more stigma associated with seeking treatment for problematic substance use than with using substances. All participants reported that perceived stigma has improved in recent years, and that youth feel more comfortable discussing their substance use. However, guardians identified family attitudes about behavioral health treatment as negatively impacting engagement among youth. In addition, system personnel reported that stigma continues to limit the accessibility of youth SUD treatment. Discussion: Youth endorsed lower than expected levels of self-stigma with no difference by primary substance type; this may have been affected by youth’s limited understanding of problematic substance use and lower than expected heterogeneity in substance use type among participants. Consistent with prior research, self-stigma was directly related to the severity of mental health symptoms. The high prevalence of public stigma among guardians of JIY with SUDs suggests that parents and guardians would benefit from interventions to better support their caregiving experiences. All participants identified complex attitudes about marijuana use, suggesting that the increasing public acceptability and endorsement of marijuana as a helpful substance may complicate treatment seeking when use becomes problematic. Although youth did not conceptualize self-stigma as a barrier to treatment, given that the primary substance used in this study was marijuana, these results may be complicated by changing societal attitudes about marijuana in particular. Qualitative perspectives from guardians and system personnel suggest that substance use disorder stigma may limit both the accessibility of treatment and youth’s likelihood to engage with treatment; this may depend on type of substance used. Particularly for the participants in this study, extremely limited treatment accessibility posed the largest barrier to evidence-based substance use disorder treatment for adolescents, making it difficult to accurately assess the role of stigma in actual treatment use. Finally, findings suggest that measuring substance use disorder stigma may be dependent on participants’ ability to accurately identify problematic substance use. It may also be important to refine both qualitative and quantitative measurement of stigma specifically with adolescents. Limitations and suggestions for future research are discussed.
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    Mobile Enhancement of Motivation in Schizophrenia: A Pilot Randomized Controlled Trial of a Personalized Text Message Intervention for Motivation Deficits
    (APA, 2020-10) Luther, Lauren; Holden, Richard; McCormick, Bryan; Fischer, Melanie W.; Johnson-Kwochka, Annalee V.; Minor, Kyle S.; Lapish, Chris L.; Salyers, Michelle P.; Psychology, School of Science
    Objective: Motivation deficits remain an unmet treatment need in schizophrenia. Recent research has identified mechanisms underlying motivation deficits (i.e., impaired effort-cost computations, reduced future reward-value representation maintenance) that may be effective treatment targets to improve motivation. This study tested the feasibility and preliminary effectiveness of Mobile Enhancement of Motivation in Schizophrenia (MEMS), an intervention that leverages mobile technology to target these mechanisms with text messages. Method: Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over 8 weeks. Participants in the MEMS group additionally received personalized, interactive text messages on their personal cellphones each weekday. Results: Retention and engagement in MEMS were high: 92.6% completed 8 weeks of MEMS, with an 86.1% text message response rate, and 100% reported being satisfied with the text messages. Compared to participants in the control condition, the participants in the MEMS condition had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and attained significantly more recovery-oriented goals at 8 weeks. There were no significant group differences in purported mechanisms (performance-based effort-cost computations and future reward-value representations) or in self-reported motivation, quality of life, or functioning. Conclusion: Results demonstrate that MEMS is feasible as a brief, low-intensity mobile intervention that could effectively improve some aspects of motivation (i.e., initiation and maintenance of goal-directed behaviors) and recovery goal attainment for those with schizophrenia-spectrum disorders. More work is needed with larger samples and to understand the mechanisms of change in MEMS.
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    Opioid Use Disorder Stigma, Discrimination, and Policy Attitudes in a National Sample of U.S. Young Adults
    (Elsevier, 2021) Adams, Zachary W.; Taylor, Bruce G.; Flanagan, Elizabeth; Kwon, Elizabeth; Johnson-Kwochka, Annalee V.; Elkington, Katherine S.; Becan, Jennifer E.; Aalsma, Matthew C.; Psychiatry, School of Medicine
    Purpose: A small fraction of people with opioid use disorder (OUD) receives appropriate care. Public opinion about addiction contributes to the availability and accessibility of effective treatment services. Little is known about such attitudes toward OUD among young adults, a population at heightened risk for OUD onset. The current study examined endorsement of social stigma, discrimination, and policy attitudes about OUD and hypothesized correlates of such attitudes (familiarity with OUD, criminal justice involvement, respondent demographic characteristics). Methods: A national sample of 190 young adults (weighted n = 408; 69% female, 42% White, non-Hispanic) aged 19-29 years completed web and telephone surveys covering opioid social stigma, discrimination, policy attitudes, personal experience with opioids, and criminal justice, and participant characteristics (age, sex, race, education, employment, income). Linear regressions were performed to examine associations between respondent characteristics and attitudes. Results: Young adults, on average, endorsed moderate levels of stigma and discrimination toward people with OUD and support for treatment-oriented policies. Stigma was positively associated with discrimination and negatively associated with support for policies favorable to people with OUD. Regression results revealed that more negative attitudes toward OUD were endorsed as a function of older age and less personal experience or familiarity with OUD. Conclusions: Heterogeneity in young adults' attitudes about OUD may be explained, in part, by personal characteristics and familiarity with OUD. Adolescence may be an opportune developmental period to prevent or reduce public stigma related to OUD and MOUD and increase public attitudes in support of expanded access to effective OUD treatments.
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    Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth
    (Elsevier, 2020-11) Dir, Allyson L.; Clifton, Richelle L.; Magee, Lauren A.; Johnson-Kwochka, Annalee V.; Wiehe, Sarah E.; Aalsma, Matthew C.; Psychiatry, School of Medicine
    Background Substance use is prevalent among justice-involved youth and given the risk of recidivism and other poor outcomes associated with substance use, justice systems have implemented efforts to improve substance use screening and connection to treatment. Although many justice systems use drug screening to monitor substance use, research on patterns of substance use based on drug screen records is lacking. The current study examined court records of drug screens among youth to explore patterns of substance use as well as rates of court-ordered referral to substance use treatment and treatment completion. We also examined differences in these patterns of use and treatment referral and completion by race, ethnicity, and gender. Method We examined court records for N = 3440 youth with records of positive oral drug screen (ODS) between 2011 and 2016 to assess patterns of ODS results (e.g., number and of positive screens), court-ordered referrals to substance use treatment, and rates of treatment completion. Results Of 3440 youth with a positive ODS, 96% tested positive for cannabis and 9.8% for opioids at least once; 48.5% were court-ordered to substance use treatment. Of those referred, 67% had history of completing at least one treatment episode; black youth ( OR = 0.54, p < .01) were less likely to have history of completing substance use treatment. Conclusion Our results underscore the need to utilize objective measures as well as validated self-reports of substance use history in both research and justice system decision-making to aid in identifying youth in need of services. Additional research should identify barriers to substance use treatment completion among this population.