- Browse by Author
Browsing by Author "Rand, Kevin"
Now showing 1 - 10 of 14
Results Per Page
Sort Options
Item A Pilot Study Of A Mental Health Education Program (AMUSE) For Restaurant Employees(2024-08) Muth, A. J.; Salyers, Michelle; Cyders, Melissa; Williams, Jane; Rand, KevinRestaurant workers in the United States (US) face multiple stressors and mental health concerns. Additionally, there are indications that restaurant workers may hold stigmatizing mental health beliefs and are less likely to seek help for mental health concerns. Despite this, there have been no interventions assessed that target restaurant workers’ mental health, well-being, and mental health stigma. The purpose of this study is to provide an initial evaluation of one such intervention, a mental health education course (AMUSE) developed by a restaurant nonprofit (CHOW) focused on mental health in the restaurant industry. As an initial pilot study, we assessed the feasibility and acceptability of AMUSE, and sought to identify potential outcomes, and explore potential moderators and confounds. A combination of quantitative (pre and post measures) and qualitative (follow-up interviews) methods were utilized to collect data. Initial indications show that AMUSE is feasible to deliver and well accepted by those who have taken it. Additionally, participants demonstrated positive changes in help-seeking and self-efficacy after completing the course. Positive changes appeared to be moderated by characteristics of participants’ restaurant work. Despite our expectations, no significant changes were observed for stigma, motivation, social support, well-being, psychological distress, or stress. Future directions and recommendations for AMUSE were discussed based on these findingsItem Associations between coping skills practice and symptom change in a psychosocial symptom management intervention for lung cancer patients and their family caregivers(2017) Winger, Joseph G.; Mosher, Catherine; Rand, Kevin; McGrew, John; Frankel, RichardLittle research has explored the degree to which specific intervention components predict improved health outcomes for cancer patients and their family caregivers. The present study examined relations of intervention components (i.e., coping skills) to symptoms in a telephone symptom management (TSM) intervention delivered concurrently to symptomatic lung cancer patients and their family caregivers. Guided by Social Cognitive Theory (SCT) and cognitive behavioral therapy (CBT) frameworks, patient-caregiver dyads were taught coping skills including: a mindfulness exercise (i.e., noticing sounds and thoughts), pursed lips breathing, guided imagery, cognitive restructuring, and assertive communication. Symptom measures were administered at baseline and 2 and 6 weeks post-intervention. The measures assessed patient and caregiver depressive and anxiety symptoms as well as patient pain severity, distress related to breathlessness, and fatigue interference. Data were examined from patient-caregiver dyads enrolled in TSM (N = 51 dyads). Patients and caregivers were predominantly female (55% and 73%, respectively) and Caucasian (87%). The average patient was 63 years of age (SD = 8) and the average caregiver was 56 years of age (SD = 14). Seven autoregressive panel models tested relations of coping skills to symptoms. All models had at least adequate fit to the data (χ2 ps > 0.05, RMSEA values < 0.06). For patients, more assertive communication practice during the intervention was related to less pain severity, fatigue interference, and depressive and anxiety symptoms at 6 weeks post-intervention. Additionally, more guided imagery practice during the intervention was related to less fatigue interference and anxiety at 6 weeks post-intervention. In contrast, more cognitive restructuring practice during the intervention was related to more distress related to breathlessness and depressive and anxiety symptoms at 6 weeks post-intervention. Similarly, more practice of a mindfulness exercise during the intervention was related to more fatigue interference and anxiety at 6 weeks post-intervention. For caregivers, more guided imagery practice was related to more anxiety at 2 weeks post-intervention. All other pathways from coping skills to symptoms at 2 and 6 weeks post-intervention were non-significant for both patients and caregivers. Findings suggest intervention effectiveness may have been reduced by competing effects of certain coping skills. For lung cancer patients, future studies should consider focusing on assertive communication and guided imagery, as these two coping skills were most consistently associated with reduced symptoms. However, more studies are needed to better understand these findings and particular caution should be used when applying CBT-based interventions that have not been validated in lung cancer populations.Item Employment specialists' competencies as predictors of employment outcomes.(2010-05-25T20:16:20Z) Taylor, Amanda Christine; Bond, Gary R.; McGrew, John H., 1953-; Rand, Kevin; Devine, Dennis J. (Dennis John)Employment specialist competencies were examined as predictors of employment outcomes for consumers with severe mental illness participating in supported employment. Using a cross-sectional correlational design a variety of self-report and supervisor-rated performance measures were examined for their association with three consumer employment outcomes (e.g., the percentage of consumers on an employment specialist's caseload that were competitively employed, the percentage of consumers on an employment specialist's caseload that were employed 90 consecutive days, and the rate in which consumers dropped out of employment services). Six mental health agencies with a total of 57 employment specialists and 14 supervisors from across the nation participated in the study. Competitive employment rates ranged among employment specialists from 0% to 80%. Higher supervisor-rated job performance, supervisor-rated employment specialist efficacy, percentage of work time spent in the community during the past month, and number of contacts with consumers during the past month were related to improved consumer employment outcomes. However, employment specialist attitudes, knowledge of supported employment, conscientiousness, and self-efficacy were unrelated to employment outcomes. This study is one of the first of its kind to examine employment specialist competencies as they relate to supported employment for consumers with severe mental illness. While supported employment is a great improvement over traditional vocational programs, further examination of employment specialist competencies could hold the key to unlocking employment success for many more consumers.Item Examining Relationships Among Depression Treatment, Brain-Derived Neurotrophic Factor (BDNF), and Depressive Symptom Clusters in Primary Care Patients with Depression(2023-05) Crawford, Christopher A.; Stewart, Jesse; Rand, Kevin; Wu, WeiDepression is a heterogeneous mental health condition, varying in presentation across individuals. A candidate etiology that may help account for this heterogeneity is the neurotrophin hypothesis of depression, which proposes that stress downregulates brain-derived neurotrophic factor (BDNF) expression, leading to aberrant neurogenesis and depression. This etiology may manifest in a distinct symptom profile that may be reflected in depressive symptoms or symptom clusters. The effect of psychological interventions on BDNF is not known. Additionally, it is not known if BDNF levels mediate intervention effects on depressive symptom clusters. Using data from the eIMPACT trial (NCT02458690, supported by R01 HL122245), I examined baseline associations of BDNF with depressive symptoms and depressive symptom clusters. Also, I examined if the modernized collaborative care intervention for depression (internet CBT, telephonic CBT, and select antidepressant medications) affected BDNF and if changes in BDNF mediated intervention effects on cognitive/affective and somatic depressive symptom clusters. 216 participants (primary care patients with depression and elevated cardiovascular disease risk ≥50 years from a safety net healthcare system) were randomized to 12 months of the eIMPACT intervention (n=107) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and affiliated psychiatrists; n=109). Plasma BDNF was measured with commercial ELISA kits. Depressive symptoms were assessed by the PHQ-9 (M=15.1, SD=5.0) from which cognitive/affective and somatic subscale scores were computed. No significant baseline associations were observed between BDNF and individual depressive symptoms or depressive symptom clusters. The intervention did not improve BDNF over 12 months. Similarly, 12-month changes in BDNF were not associated with 12-month changes in PHQ-9 cognitive/affective or somatic subscale scores. However, the intervention significantly improved PHQ-9 cognitive/affective and somatic subscale scores over 12 months. 12-month changes in BDNF did not mediate the effect of the intervention on 12-month changes in the PHQ-9 subscale scores. These findings suggest that modernized collaborative care for depression does not improve BDNF. Modernized collaborative care does yield improvements in both cognitive/affective and somatic depressive symptom clusters, albeit not via changes in BDNF.Item Examining the Role of Dysfunctional Beliefs in Individuals with Schizotypy(2015) Luther, Lauren; Salyers, Michelle; Minor, Kyle; Rand, KevinIn accord with the cognitive model of poor functioning in schizophrenia, defeatist performance beliefs, or overgeneralized negative beliefs about one’s ability to perform tasks, have been linked to poor functional outcomes, cognitive impairment, and negative symptoms in schizophrenia and are a suggested therapeutic target in Cognitive Therapy for Schizophrenia. However, there is a paucity of research investigating these beliefs in schizotypy, or those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had three aims: to examine whether defeatist performance beliefs 1) are elevated in schizotypy compared to non-schizotypy, 2) are associated with functioning-related outcomes (i.e., quality of life, working memory, negative schizotypy traits), and 3) mediate the relationships between working memory and both negative schizotypy traits and quality of life. Schizotypy (n = 43) and non-schizotypy (n = 45) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory. Results revealed that the schizotypy group reported significantly more defeatist performance beliefs than the non-schizotypy group. Within the schizotypy group, defeatist performance beliefs were significantly positively associated with negative schizotypy traits and significantly inversely associated with quality of life. No associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory. Further, defeatist performance beliefs did not mediate the relationships between working memory and either quality of life or negative schizotypy traits. Findings are generally consistent with the cognitive model of poor functioning in schizophrenia and suggest that defeatist performance beliefs may be an important therapeutic target in early intervention services.Item Factors underlying metastatic breast cancer patients' perceptions of symptom importance: a qualitative analysis(Wiley, 2018-01) Mosher, Catherine E.; Daily, Susan; Tometich, Danielle; Matthias, Marianne S.; Outcalt, Samantha D.; Hirsh, Adam; Johns, Shelley A.; Rand, Kevin; Schneider, Bryan; Mina, Lida; Storniolo, Anna Maria; Newton, Erin; Miller, Kathy; Psychology, School of ScienceThe symptom literature in cancer has primarily examined symptom severity, frequency and distress. Assessing cancer patients' perceptions of symptom importance-how important it is for them to see improvement in a symptom following an intervention-and factors influencing these judgments would also inform patient-centred care, but this analysis has not been undertaken. This qualitative study aimed to identify factors underlying perceptions of symptom importance among 25 symptomatic metastatic breast cancer (MBC) patients. Participants were recruited from a cancer centre in the Midwestern USA. Semi-structured interviews focused on patients' rationale for considering common symptoms (i.e., anxiety, sadness, sleep problems, pain or fatigue) to be important. Thematic analyses revealed five interrelated factors underlying MBC patients' perceptions of symptom importance: activity restriction, concentration difficulties, exacerbation of other physical symptoms, symptom-related long-term health concerns and negative impact on their relationships with others. Patients most frequently stated that a physical or psychological symptom was important because of the resulting activity restriction. Additionally, some patients considered pain to be important because it signalled potential long-term health concerns, such as worsening metastatic disease. Findings suggest that clinicians should take into account MBC patients' perceptions of symptom importance and factors underlying these judgments when making shared treatment decisions.Item HamkeRun: Mobile infoVis app towards sustainable motivation in a context of running(2015-05) Moon, Sung Pil; Bolchini, Davide; Pfaff, Mark; Rand, Kevin; Voida, StephenAccording to the US Centers for Disease Control and Prevention, less than half of all adults in the US meet basic physical activity guidelines. Physical activity can help not just improve physical and mental health but also reduce the risk of heart disease and some cancers. Researchers and companies have tried to investigate the use of modern technologies to motivate people to increase and maintain physical activities. However, in spite of these efforts, there are criticisms. Those include low dietary effectiveness of the tools, lack of sustainable effects in the long-term, and proof of effectiveness only shown in laboratory settings. To overcome these limitations, first, the author developed a framework of overarching motivation theories and HCI factors and contextualized it within the running domain. Second, the author has developed a mobile application called HamkeRun within this framework, using the concepts of information visualization, gamification, and social grouping to increase a user’s motivation to run more frequently. Third, the HamkeRun application was empirically tested through a two-month-long longitudinal experiment and follow-up interviews. The results showed that the single runner type showed significant increases in the levels of their external motivation (motivational effect of the HamkeRun application), internal motivation and satisfaction, while the team runner type showed significant increases only in internal motivation. In addition, motivational effects were also different depending on the runners’ behavior change stage. Runners at the maintenance stage showed significant increases in external motivation, internal motivation, satisfaction, and total number of running activities performed during the study. Although action stage runners showed significant increase in internal motivation, female runners at the action stage showed significant decrease in their external motivation. Gamification greatly influenced increases of external motivation, internal motivation and total number of actual activities. Although both male and female runners showed increased internal motivation, significant increase in external motivation was only found in male runners. The dissertation closes with a series of design guidelines for application developers and designers which may help develop motivational tools in other health-related domains.Item The Influence of Patient Race and Socioeconomic Status on Providers' Assessment and Treatment Recommendations for Chronic Pain(2019-05) Anastas, Tracy; Adam, Hirsh; Stewart, Jesse; Rand, KevinCompared to White and high socioeconomic (SES) patients, Black and low SES patients are less likely to receive adequate pain care, including receiving fewer analgesic medications. Providers may, inadvertently or not, contribute to these disparities in pain care via biased decision-making. Prior work suggests there is a complex relationship in which race and SES uniquely and interactively affect providers’ clinical decisions, but few studies have examined the influence of patient race and SES simultaneously on providers’ pain-related decisions. Furthermore, previous studies suggest that providers’ attitudes about race and SES influence their clinical decisions. The present study examined the influence of patient race and SES and providers’ implicit and explicit attitudes about race and SES on providers' pain-related decisions. Four hundred and seven medical residents and fellows made pain assessment (interference and distress) and treatment (opioids, opioid contracts, and workplace accommodations) decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Subjects completed Implicit Association Tests to assess implicit attitudes and feeling thermometers to assess explicit attitudes about race and SES. Repeated measures ANOVAs indicated that patient race and/or SES had main effects on all pain-related decisions and had interaction effects on providers’ ratings for interference, distress, and workplace accommodations. Providers’ implicit attitudes about race and explicit attitudes about race and SES predicted their pain-related decisions, but these effects were not consistent across all decisions. The current study highlights the need to examine the effects of patient race and SES together, along with providers’ implicit and explicit attitudes, in the context of pain care. Results inform future work that can lead to the development of evidence-based interventions to reduce disparities in pain care.Item The Influence of Patient Race, Patient Gender, and Provider Pain-relate Attitudes on Pain Assessment and Treatment Recommendations for Children with Pain(2019-08) Miller, Megan M.; Hirsh, Adam T.; Williams, Amy E.; Zapolski, Tamika; Rand, KevinChronic pain is a common and costly health condition for children. Previous studies have documented racial and gender disparities in pain care for adults, with women and racial minorities receiving poorer pain assessment and treatment. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient demographic groups. Little is known about racial and gender disparities in children with chronic pain, or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as ‘providers’), Virtual Human (VH) methodology and a pain-related version of the Implicit Association Test (IAT) were used to assess the effects of patient race/gender and provider implicit racial/gender attitudes on providers’ pain assessment and treatment decisions for children with chronic pain. Findings indicated that, in the context of abdominal pain, providers rated Black patients as more distressed (mean difference [MD]=2.33, p<.01, SE=.71, 95% CI=.92, 3.73) and as experiencing more pain-related interference in daily activities (MD=3.14, p<.01, SE=.76, 95% CI=1.63, 4.64) compared to White patients. Providers were also more likely to recommended opioids for Black patients’ pain compared to White patients (MD=2.41, p<.01, SE=.58, 95% CI=1.05, 3.76). Female patients were also perceived to be more distressed by their pain (MD=2.14, p<.01, SE=.79, 95% CI=.58, 3.70), however they there were no differences in treatment recommendations based on patient gender (all ps>.05). The sample reported implicit attitudes that men and Black Americans were more pain-tolerant than their demographic counterparts; however, pain assessment and treatment decisions were not related to these implicit attitudes. This study represents a critical step in research on pain-related disparities in pediatric pain. Future studies are needed to further elucidate specific paths through which the pain experience and consequent treatment differ across racial and gender groups.Item Predicting mental health provider response to BREATHE, a burnout intervention program(2018) Dreison, Kimberly Christine; Salyers, Michelle; McGrew, John; Rand, Kevin; Rollins, AngelaWithin the mental health field, provider burnout is widespread and associated with far-reaching negative outcomes for providers, consumers, and organizations. Over the past four decades, various burnout interventions have been tested and found to be minimally effective, leading several researchers to suggest an increased focus on targeted recruitment (i.e., targeting providers who are most likely to benefit from a particular burnout intervention approach) and/or modifications to the interventions (e.g., format and content). Accordingly, the present study examined several person-related and intervention-related variables that were hypothesized to be predictive of response to BREATHE, a burnout intervention for mental health providers. Data from four prior studies that assessed the effectiveness of the BREATHE intervention were amalgamated. For the primary analyses, hierarchical linear regression was used to determine whether the person-related and/or intervention-related variables were predictive of treatment response. Additionally, the BREATHE studies were examined to determine whether the intervention became less effective at reducing burnout with each subsequent iteration. With respect to person-related predictors of response to the BREATHE intervention, age and turnover intentions were significant. Specifically, younger participants had higher post-intervention levels of depersonalization than older participants (β = -.13, p = .023), and higher baseline intentions to turnover were associated with greater post-intervention levels of emotional exhaustion (β = .11 p = .041) and depersonalization (β = .12, p = .023). In terms of intervention-related predictors of treatment response, participants who received the BREATHE intervention in a multi-session format had higher post-treatment levels of emotional exhaustion than those who received the BREATHE intervention in a single session format (β = .13, p = .015). Notably, across these primary analyses, baseline levels of burnout (i.e., emotional exhaustion, depersonalization, and personal accomplishment) were consistently the strongest predictors of post-intervention levels of burnout. Lastly, the data suggests that the BREATHE intervention became less effective with subsequent iterations. For example, earlier BREATHE studies had larger effect sizes than more recent studies. Additionally, there was a significant difference between the studies with respect to the change in emotional exhaustion (F(3, 230) = 4.86, p = .001, η2 = .06), such that participants in the first BREATHE study had a significantly larger reduction in emotional exhaustion than participants in the three subsequent studies. The present study was the first to examine potential predictors of response to the BREATHE intervention. Although the hypotheses were not supported, the implications of these findings are discussed and suggestions for future research directions are provided.