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Telephone-based depression self-management in Hispanic adults with epilepsy: a pilot randomized controlled trial

Spruill, Tanya M; Friedman, Daniel; Diaz, Laura; Butler, Mark J; Goldfeld, Keith S; O'Kula, Susanna; Montesdeoca, Jacqueline; Payano, Leydi; Shallcross, Amanda J; Kaur, Kiranjot; Tau, Michael; Vazquez, Blanca; Jongeling, Amy; Ogedegbe, Gbenga; Devinsky, Orrin
Depression is associated with adverse outcomes in epilepsy but is undertreated in this population. Project UPLIFT, a telephone-based depression self-management program, was developed for adults with epilepsy and has been shown to reduce depressive symptoms in English-speaking patients. There remains an unmet need for accessible mental health programs for Hispanic adults with epilepsy. The purpose of this study was to evaluate the feasibility, acceptability, and effects on depressive symptoms of a culturally adapted version of UPLIFT for the Hispanic community. Hispanic patients with elevated depressive symptoms (n = 72) were enrolled from epilepsy clinics in New York City and randomized to UPLIFT or usual care. UPLIFT was delivered in English or Spanish to small groups in eight weekly telephone sessions. Feasibility was assessed by recruitment, retention, and adherence rates and acceptability was assessed by self-reported satisfaction with the intervention. Depressive symptoms (PHQ-9 scores) were compared between study arms over 12 months. The mean age was 43.3±11.3, 71% of participants were female and 67% were primary Spanish speakers. Recruitment (76% consent rate) and retention rates (86-93%) were high. UPLIFT participants completed a median of six out of eight sessions and satisfaction ratings were high, but rates of long-term practice were low. Rates of clinically significant depressive symptoms (PHQ-9 ≥5) were lower in UPLIFT versus usual care throughout follow-up (63% vs. 72%, 8 weeks; 40% vs. 70%, 6 months; 47% vs. 70%, 12 months). Multivariable-adjusted regressions demonstrated statistically significant differences at 6 months (OR = 0.24, 95% CI, 0.06-0.93), which were slightly reduced at 12 months (OR = 0.30, 95% CI, 0.08-1.16). Results suggest that UPLIFT is feasible and acceptable among Hispanic adults with epilepsy and demonstrate promising effects on depressive symptoms. Larger trials in geographically diverse samples are warranted.
PMID: 33963873
ISSN: 1613-9860
CID: 4866912

Coping With Health Threats: The Costs and Benefits of Managing Emotions

Smith, Angela M; Willroth, Emily C; Gatchpazian, Arasteh; Shallcross, Amanda J; Feinberg, Matthew; Ford, Brett Q
How people respond to health threats can influence their own health and, when people are facing communal risks, even their community's health. We propose that people commonly respond to health threats by managing their emotions with cognitive strategies such as reappraisal, which can reduce fear and protect mental health. However, because fear can also motivate health behaviors, reducing fear may also jeopardize health behaviors. In two diverse U.S. samples (N = 1,241) tracked across 3 months, sequential and cross-lagged panel mediation models indicated that reappraisal predicted lower fear about an ongoing health threat (COVID-19) and, in turn, better mental health but fewer recommended physical health behaviors. This trade-off was not inevitable, however: The use of reappraisal to increase socially oriented positive emotions predicted better mental health without jeopardizing physical health behaviors. Examining the costs and benefits of how people cope with health threats is essential for promoting better health outcomes for individuals and communities.
PMID: 34143697
ISSN: 1467-9280
CID: 4916762

The Health Behavior Model of Personality in the Context of a Public Health Crisis

Willroth, Emily C; Smith, Angela M; Shallcross, Amanda J; Graham, Eileen K; Mroczek, Daniel K; Ford, Brett Q
OBJECTIVE:The US Centers for Disease Control and Prevention recommended behavioral measures to slow the spread of COVID-19, such as social distancing and wearing masks. Although many individuals comply with these recommendations, compliance has been far from universal. Identifying predictors of compliance is crucial for improving health behavior messaging and thereby reducing disease spread and fatalities. METHODS:We report preregistered analyses from a longitudinal study that investigated personality predictors of compliance with behavioral recommendations in diverse US adults across five waves from March to August 2020 (n = 596) and cross-sectionally in August 2020 (n = 405). RESULTS:Agreeableness-characterized by compassion-was the most consistent predictor of compliance, above and beyond other traits, and sociodemographic predictors (sample A, β = 0.25; sample B, β = 0.12). The effect of agreeableness was robust across two diverse samples and sensitivity analyses. In addition, openness, conscientiousness, and extraversion were also associated with greater compliance, but effects were less consistent across sensitivity analyses and were smaller in sample A. CONCLUSIONS:Individuals who are less agreeable are at higher risk for noncompliance with behavioral mandates, suggesting that health messaging can be meaningfully improved with approaches that address these individuals in particular. These findings highlight the strong theoretical and practical utility of testing long-standing psychological theories during real-world crises.
PMID: 33790198
ISSN: 1534-7796
CID: 4858432

Nonpharmacologic Treatments for Opioid Reduction in Patients With Advanced Chronic Kidney Disease

Brintz, Carrie E; Cheatle, Martin D; Dember, Laura M; Heapy, Alicia A; Jhamb, Manisha; Shallcross, Amanda J; Steel, Jennifer L; Kimmel, Paul L; Cukor, Daniel
Opioid analgesics carry risk for serious health-related harms in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease. In the general population with chronic noncancer pain, there is some evidence that opioid reduction or discontinuation is associated with improved pain outcomes; however, tapering opioids abruptly or without providing supportive interventions can lead to physical and psychological harms and relapse of opioid use. There is emerging evidence that nonpharmacologic treatments such as psychosocial interventions, acupuncture, and interdisciplinary pain management programs are effective approaches to support opioid dose reduction in patients experiencing persistent pain, but research in this area still is relatively new. This review describes the current evidence for nonpharmacologic interventions to support opioid reduction in non-CKD patients with pain and discusses the application of the available evidence to patients with advanced CKD who are prescribed opioids to manage pain.
PMID: 33896475
ISSN: 1558-4488
CID: 4872022

An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility, Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Shallcross, A J; Duberstein, Z T; Sperber, S H; Visvanathan, P D; Lutfeali, S; Lu, N; Carmody, J; Spruill, T M
Mindfulness-based cognitive therapy (MBCT) is a promising intervention for reducing depressive symptoms in individuals with comorbid chronic disease, but the program's attendance demands make it inaccessible to many who might benefit. We tested the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered adaptation of the in-person mindfulness-based cognitive therapy (MBCT-T) program in a sample of patients with depressive symptoms and hypertension. Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology-Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale-Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention. Sixty-four percent of participants (n = 9) attended >=4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039). Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.
ISSN: 1077-7229
CID: 4824472

Evaluation of the Psychometric Properties of the Five Facet of Mindfulness Questionnaire

Shallcross, Amanda; Lu, Nathaniel Y; Hays, Ron D
Objective/UNASSIGNED:The Five Facet of Mindfulness Questionnaire (FFMQ) is widely used to assess mindfulness. The present study provides a psychometric evaluation of the FFMQ that includes item response theory (IRT) analyses and evaluation of item characteristic curves. Method/UNASSIGNED:We administered the FFMQ, the Beck Depression Inventory-II, the Ruminative Response Scale, and the Emotion Regulation Questionnaire to a heterogenous sample of 240 community-based adults. We estimated internal consistency reliability, item-scale correlations, categorical confirmatory factor analysis, and IRT graded response models for the FFMQ. We also estimated correlations among the FFMQ scales and correlations with the other measures included in the study. Results/UNASSIGNED:Internal consistency reliabilities for the five FFMQ scales were 0.82 or higher. A five-factor categorical model fit the data well. IRT-estimated item characteristic curves indicated that the five response options were monotonically ordered for most of the items. Product-moment correlations between simple-summated scoring and IRT scoring of the scales were 0.97 or higher. Conclusions/UNASSIGNED:The FFMQ accurately identifies varying levels of trait mindfulness. IRT-derived estimates will inform future adaptations to the FFMQ (e.g., briefer versions) and the development of future mindfulness instruments.
PMID: 32655208
ISSN: 0882-2689
CID: 4529252

Mind the (racial) gap: Considerations for culturally adapting mindfulness-based interventions for depression among black or African Americans [Meeting Abstract]

Sperber, S; Shallcross, A
Purpose: Evidence suggests that mindfulness-based interventions (MBIs) can effectively treat depression. Unfortunately, studies of MBIs for depression have focused predominantly on White samples. Thus, it is unclear whether existing MBIs are culturally relevant or effective for Black or African Americans (AAs). This is a critical question given the prevalence of depression and need for effective treatment in this community. To justify culturally adapting evidence-based interventions, at least one of these key conditions should be met (1) ineffective clinical engagement, (2) unique risk/resilience factors, and (3) unique symptoms of a common disorder. We aimed to quantitatively ascertain whether these conditions are met in the context of MBIs among Black or AAs at risk for depression.
Method(s): Black and White adults with elevated stress levels (n=143) completed inventories to assess domains relevant to each of the above conditions (ie, engagement with and perceptions of mindfulness, depression stigma, coping styles, and depressive symptom profiles). t Test and chi2 analyses were conducted to identify whether any of these domains differed by race.
Result(s): Compared to White Americans, Black or AAs (1) were less likely to have heard the term "mindfulness" (P=.001), had less experience with mindfulness (P=.034), and were more likely to perceive mindfulness as a religious practice (P=.026); (2) scored higher on depression risk factors including depression stigma (P=.006), experience of discrimination (p=.008), emotion suppression (P =.005), and rumination (P=.004); and (3) reported higher levels of somatic depressive symptoms (P=.001), suggesting unique symptomatic experience of depression. Overall, 3 key conditions for cultural adaptation were supported.
Conclusion(s): This study offers quantitative evidence in support for cultural adaptation of MBIs for Black or AAs with depression. Results highlight misconceptions of mindfulness, depression stigma, unique sociocultural stressors, maladaptive emotion regulation strategies, and somatic depressive symptoms as potential targets for adaptation to improve the approachability and clinical relevance of MBIs for depression
ISSN: 2164-9561
CID: 4756912

Depression self-management in people with epilepsy: Adapting project UPLIFT for underserved populations

Quarells, Rakale C; Spruill, Tanya M; Escoffery, Cam; Shallcross, Amanda; Montesdeoca, Jacqueline; Diaz, Laura; Payano, Leydi; Thompson, Nancy J
Data from the 2015 National Health Interview Survey found that the prevalence of active epilepsy has increased to three million adults. Although findings have been mixed, some research indicates that Blacks and Hispanics share a higher burden of epilepsy prevalence compared with non-Hispanic whites. Moreover, depression is a common comorbid condition among people with epilepsy (PWE), affecting up to 55% of the epilepsy population. Widespread use and increased public health impact of evidence-based self-management interventions is critical to reducing disease burden and may require adapting original interventions into more culturally relevant versions for racial and ethnic minority groups. Project UPLIFT provides access to mental health self-management skills training that is distance-delivered, does not interfere with medication management, and has been shown to be effective in reducing depressive symptoms. This paper presents the process of exploring the adaptation of Project UPLIFT for Black and Hispanic PWE and herein suggests that evidence-based interventions can be successfully adapted for new populations or cultural settings through a careful and systematic process. Additional key lessons learned include the importance of community engagement and that language matters. Ultimately, if the adapted Project UPLIFT intervention produces positive outcomes for diverse populations of PWE, it will extend the strategies available to reduce the burden of depression. Implementing evidence-based interventions such as Project UPLIFT is critical to reducing disease burden; however, their delivery may need to be tailored to the needs and culture of the populations of interest.
PMID: 31371202
ISSN: 1525-5069
CID: 4011432

Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors

Matsuzawa, Yuka; Lee, Yuen Shan Christine; Fraser, Felicia; Langenbahn, Donna; Shallcross, Amanda; Powers, Scott; Lipton, Richard; Simon, Naomi; Minen, Mia
BACKGROUND/OBJECTIVES/OBJECTIVE:Nonpharmacological interventions, such as biofeedback, cognitive behavioral therapy, and relaxation techniques are Level-A evidence-based treatments for headache. The impact of these interventions is often equivalent to or greater than pharmacological interventions, with fewer side effects. Despite such evidence, the rate of participation in nonpharmacological interventions for headache remains low. Once obstacles to optimizing use of behavioral interventions, such as local access to nonpharmacological treatment and primary headache providers are traversed, identification of barriers contributing to low adherence is imperative given the high levels of disability and cost associated with treating headache disorders. In this review of factors in adults associated with underuse of nonpharmacological interventions, we discuss psychological factors relevant to participation in nonpharmacological treatment, including attitudes and beliefs, motivation for change, awareness of triggers, locus of control, self-efficacy, acceptance, coping styles, personality traits, and psychiatric comorbidities associated with treatment adherence. Finally, future prospects and approaches to optimizing treatment matching and minimizing adherence issues are addressed. METHODS:An interdisciplinary team conducted this narrative review. Neuropsychologists conducted a literature search during the month of July 2017 using a combination of the keywords ("headache" or "migraine") and ("adherence" or "compliance") or "barriers to treatment" or various "psychological factors" discussed in this narrative review. Content experts, a psychiatrist, and a complementary and integrative health specialist provided additional commentary and input to this narrative review resulting in integration of additional noteworthy studies, book chapters and books. RESULTS:Various psychological factors, such as attitudes and beliefs, lack of motivation, poor awareness of triggers, external locus of control, poor self-efficacy, low levels of acceptance, and engagement in maladaptive coping styles can contribute to nonadherence. CONCLUSIONS:To maximize adherence, clinicians can assess and address an individual's level of treatment acceptance, beliefs that may present as barriers, readiness for change, locus of control, self-efficacy and psychiatric comorbidities. Identification of barriers to adherence as well as the application of relevant assessment and intervention techniques have the potential to facilitate adherence and ultimately improve treatment success.
PMID: 30367821
ISSN: 1526-4610
CID: 3386202

Factors Related to Migraine Patients' Decisions to Initiate Behavioral Migraine Treatment Following a Headache Specialist's Recommendation: A Prospective Observational Study

Minen, Mia T; Azarchi, Sarah; Sobolev, Rachel; Shallcross, Amanda; Halpern, Audrey; Berk, Thomas; Simon, Naomi M; Powers, Scott; Lipton, Richard B; Seng, Elizabeth
Objective/UNASSIGNED:To evaluate the frequency with which migraine patients initiated behavioral migraine treatment following a headache specialist recommendation and the predictors for initiating behavioral migraine treatment. Methods/UNASSIGNED:We conducted a prospective cohort study of consecutive patients diagnosed with migraine to examine whether the patients initiated behavioral migraine treatment following a provider recommendation. The primary outcome was scheduling the initial visit for behavioral migraine treatment. Patients who initiated behavioral migraine treatment were compared with those who did not (demographics, migraine characteristics, and locus of control) with analysis of variance and chi-square tests. Results/UNASSIGNED:Of the 234 eligible patients, 69 (29.5%) were referred for behavioral treatment. Fifty-three (76.8%) patients referred for behavioral treatment were reached by phone. The mean duration from time of referral to follow-up was 76  (median 76, SD = 45) days. Thirty (56.6%) patients initiated behavioral migraine treatment. There was no difference in initiation of behavioral migraine treatment with regard to sex, age, age of diagnosis, years suffered with headaches, health care utilization visits, Migraine Disability Assessment Screen, and locus of control (P > 0.05). Patients who had previously seen a psychologist for migraine were more likely to initiate behavioral migraine treatment than patients who had not. Time constraints were the most common barrier cited for not initiating behavioral migraine treatment. Conclusions/UNASSIGNED:Less than one-third of eligible patients were referred for behavioral treatment, and only about half initiated behavioral migraine treatment. Future research should further assess patients' decisions regarding behavioral treatment initiation and methods for behavioral treatment delivery to overcome barriers to initiating behavioral migraine treatment.
PMID: 29878178
ISSN: 1526-4637
CID: 3144562