Psychology
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Item Experiences of substance use and medication for opioid use disorder stigmas in an underserved, rural community(2024) Anvari, Morgan; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Overdose rates related to opioid and stimulant use have been steadily increasing in underserved, rural areas of the U.S. for over 10 years. Access to and retention in medication for opioid use disorder (MOUD) care are persistent challenges nationally and in underserved rural communities. Stigma around substance use (SU) and MOUD specifically are barriers to engagement in opioid use disorder and MOUD care. However, little is known regarding how SU and MOUD stigmas manifest and affect patients in rural settings. Given their shared lived experiences, peer recovery specialists (PRSs), individuals with lived substance use and recovery experience who are formally trained to support others’ recovery, may be unique resources to shifting stigma barriers. Yet, few studies have examined if and how PRS engagement shifts stigma, particularly in underserved, rural communities. This qualitative study sought to understand: 1) how substance use and MOUD stigmas manifest in a low-resource, rural community; 2) how these stigmas influence patients’ treatment experiences and preferences; 3) if and how PRS-delivered intervention may shift these stigmas and improve MOUD outcomes. Patients (n = 25) and staff (n = 5) at a telemedicine-mobile treatment unit (MTU) in an underserved, rural community completed semi-structured qualitative interviews. Transcripts were analyzed using thematic analysis, guided by the interview guide and Stigma Mechanisms Framework. Study findings demonstrated the pervasive role of multiple forms of stigma in a rural community, negatively impacting substance use treatment outcomes. Experiences of these stigmas were found to be uniquely influenced by rural living conditions. Additionally, results revealed that PRS-delivered interventions have potential in shifting these stigmas and improving MOUD outcomes by leveraging PRSs’ shared lived experiences. Identifying and understanding patient experiences of substance use and MOUD stigmas are vital in developing innovative solutions to target stigma reduction and support recovery. Future research may continue to develop and evaluate how PRS interventions can reduce stigma and support positive recovery outcomes.Item REAL-WORLD EMOTION DYNAMICS ARE ASSOCIATED WITH CURRENT AND FUTURE INTERNALIZING SYMPTOMS(2024) Didier, Paige Ryan; Shackman, Alexander J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Most studies of internalizing disorders have emphasized the role of emotional traits in the development of internalizing disorders, however more proximal pathology-promoting processes like momentary emotional experiences remain underexplored. Given that the current treatments for these debilitating illnesses are far from curative, understanding proximal processes is critical to optimize interventions and alleviate suffering. Here, we utilized smart-phone ecological momentary assessment (EMA) to identify the relevance of real-world emotional dynamics in internalizing symptomatology and change over a 2.5-year follow-up period. Results demonstrate that one’s event-independent (tonic) level of affect are predictive of broadband (Dysphoria) and narrow-band (Panic and Well-being) internalizing symptoms, whereas positive and negative event exposure is not. Notably, increased emotional reactivity to negative events predicts greater concurrent and future Dysphoria symptoms but not its trajectory. Whereas tonic levels of negative affect lose predictive value for future Dysphoria when controlling for baseline symptoms, elevated tonic positive affect uniquely predicts healthier Well-being trajectories. These findings advance our understanding of real-world emotional dynamics in internalizing illnesses and lay the groundwork for improved research paradigms and targeted interventions.Item “It's how they found relief and comfort from all the tragedies that life throws at them on a regular basis”: Exploring the association between trauma, opioid use, and opioid use disorder in Washington D.C.(2024) Brown, Imani; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In Washington D.C, African American residents of underserved neighborhoods are disproportionately affected by opioid use (OU), opioid use disorder (OUD), and opioid overdose deaths (OOD), highlighting the need for a more effective intervention to address these issues. Existing literature indicates an association between OUD and trauma, but this relationship is minimally explored in urban, African American communities. This study aimed to qualitatively explore the association between trauma, OU, and OUD from the perspective of community leaders and clinicians (N=78) working in Wards 7&8 of DC, the neighborhoods hardest hit by the problem. Data showed that interpersonal and intergenerational trauma contributed directly to OU and OUD, and that historical trauma and structural violence act synergistically with other traumas to contribute to OU and OUD. Findings suggest a need for early interventions to address the harmful effects of interpersonal and intergenerational trauma and underscore a need for culturally informed political and socio-economic interventions to address structural violence and historical trauma that perpetuate trauma, OU, and OUD.Item “It’s more than just the act of not using. It's a feeling of finally completing something.”: Patient-centered definitions of successful treatment outcomes in methadone treatment in Baltimore City(2024) Bradley, Valerie Diane; Magidson, Jessica F.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background. Successful outcomes in substance use disorder treatment are often narrowly defined as retention in care, substance use cessation, and the prevention of recurrent substance use. These widely utilized benchmarks may overlook key patient-centered indicators of success. Few studies have sought patient perspectives to establish a representative definition of successful treatment outcomes for opioid use disorder (OUD), with historically marginalized individuals facing the least representation and the largest inequities in care. With overdose-related deaths increasing to over 112,000 in the 12 months preceding May 2023 and a disproportionate impact on racially minoritized populations, understanding comprehensive patient-centered definitions of successful treatment in minoritized populations is an imperative endeavor for research, treatment planning, and policy. This study aimed to understand how patients and providers at an outpatient methadone treatment program in Baltimore City describe patient-centered successful treatment outcomes.Methods. We conducted qualitative interviews and focus groups with 32 patients, staff, and peer recovery specialists (PRSs) at a Baltimore-based outpatient methadone treatment program predominantly serving low-income, racially minoritized individuals with OUD. Semi-structured interview guides prompted patients (n=20) to describe success in methadone treatment and staff and PRSs (n=12) to describe their observations of patients' success in treatment. Qualitative data were transcribed, coded, and analyzed using thematic analysis. We utilized the Health Equity Implementation Framework to contextualize findings across multiple domains and explore potential influences on equitable outcomes of treatment success. Results. Five key themes emerged to demonstrate how patients and their providers define patient-centered successful methadone treatment outcomes, including (1) improvements in general health, (2) productivity and accomplishment, (3) social improvements, (4) substance use changes, and (5) treatment engagement. Patients and providers were generally in agreement on these five overarching themes. Conclusion: Findings suggest patient-centered definitions of success in methadone treatment span psychosocial, environmental, behavioral, health-related, and other factors beyond the traditionally measured outcomes of treatment retention and substance use abstinence. Working toward a more representative definition of methadone treatment success—integrating patient perspectives, particularly minoritized individuals who often face the greatest obstacles in care—may have significant clinical, research, and policy implications for improving the patient experience and outcomes in methadone treatment.Item VARIATION IN SOCIAL ANXIETY DISORDER AND EXECUTIVE FUNCTIONING: IDENTIFYING AND VALIDATING LATENT CLASSES AMONG EARLY ADOLESCENTS IN THE ADOLESCENT BRAIN AND COGNITIVE DEVELOPMENT (ABCD) STUDY(2024) Qasmieh, Noor; De Los Reyes, Andres; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Social anxiety disorder (SAD) in adolescence is heterogeneous in presentation and often associated with substance use behaviors. Yet, little is known about the link between these constructs. One framework of SAD identifies a subtype of behaviorally dysregulated, socially anxious individuals. Because the suite of goal-directed, cognitive processes known as executive functioning serves as a precursor to behavior regulation, we sought to explore whether heterogeneity in social anxiety presentation meaningfully varied with executive functioning in early adolescence and if this model of heterogeneity could predict substance use and other clinical outcomes. Using a person-centered approach to modeling, latent class analysis, a sample of over 10,000 children from the longitudinal Adolescent Brain and Cognitive Development (ABCD) study was used to model variation in social anxiety symptoms and performance on assessments of working memory, cognitive flexibility, and inhibition. We also examined construct validity of the model by exploring associations with concurrent measures of behavioral inhibition, behavioral activation, and impulsivity. Finally, we tested the extent to which the identified model predicted later measures of substance use behavior, peer problems, and psychopathology. Support for a four-class solution of SAD symptoms and executive functioning performance was identified. Classes of individuals meaningfully differed on measures of behavioral inhibition and facets of impulsivity. Class membership was also predictive of later internalizing psychopathology. However, class membership did not predict later substance use, externalizing psychopathology, or peer problems. Future work should explore the generalizability of this model to older adolescents and whether alternative measurements of SAD and EF strengthen our prediction of later outcomes.Item The Intersecting Effect of Substance Use Stigma, Methadone Treatment Stigma, and Racial Discrimination on Methadone Treatment Outcomes(2024) Kleinman, Mary Buckley; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Methadone treatment (MT) has demonstrated efficacy for treating opioid use disorder (OUD), but adequate engagement in treatment is a persistent challenge. Racially minoritized individuals with OUD disproportionately evidence poor outcomes. Stigma surrounding both substance use disorder (SUD) and MT negatively impact MT engagement. Racially minoritized individuals with OUD also routinely experience race-related stigma. This study aims to evaluate experiences of stigma in a population of patients receiving MT who identify as Black/African American and assess the impact on MT engagement. Participants (N=76) were recruited from an outpatient addiction treatment center in Baltimore City. Self-reported perception of enacted (experience of discrimination from others) and internalized (negative beliefs applied to self) stigma related to MT, SUD, and race were measured using the MT Stigma Mechanism Scale, SU Stigma Mechanism scale, Everyday Discrimination Scale, and an adapted internalized racism scale. Dosing data were collected from medical records over the subsequent 30 days. Correlations between stigma scores were calculated and negative binomial regressions conducted predicting MT engagement by individual stigma measures as well as moderation models looking at the impact of racial stigma on relationship between MT/SUD stigma and MT engagement. All stigma measures were positively correlated with one another. Longitudinal models indicated significant association between higher SU stigma enacted by healthcare providers and lower MT engagement, but no other direct relationships between stigma measures and MT engagement. In moderation models, across all significant moderating effects observed between racial stigma and MT/SU stigma, lower racial stigma appeared to heighten the negative effect of MT/SU stigma on MT engagement. This finding contradicts our original hypothesis based on an expected compounding effect of multiple sources of stigma. Attribution theory, especially related to perceived controllability and blame associated with stigmatized identities, may explain these findings and warrants further exploration in future research within this population. Shame associated with perceived controllability of substance use or need for methadone treatment may cause some patients to engage in avoidance coping strategies, such as disengaging in healthcare or treatment. Better understanding the role of racial identity in this context could help inform integration of intervention strategies to best support MT in the future.Item Impact of COVID-19 on Parent and Child Mental Health in India: A Mixed-methods Longitudinal Study(2023) Havewala, Mazneen Cyrus; Wang, Cixin; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The COVID-19 pandemic has affected individuals around the world. Parents of young children have experienced significant strain as they have attempted to balance their work obligations as well as take care of household duties and attend to the needs of their young children. Several studies have demonstrated the detrimental impacts of COVID-19 on parent and child mental health. However, the majority of studies are quantitative, cross-sectional in nature, and were conducted during the early phases of the pandemic. Moreover, there is limited work on the topic of parent and child mental health within the COVID-19 context among families in India. Thus, the current mixed-methods longitudinal study aimed to fill these gaps in the literature by attempting to examine the impact of COVID-19 on child mental health and parent mental health among families with young children in India. The study also aimed to understand the moderating effects of parenting behaviors with relation to child COVID-19-related stress and child mental health difficulties, and the moderating effects of social support with relation to parent COVID-19-related stress and parent mental health difficulties. One hundred and forty parents of children between the ages of 4 to 8 completed a survey between October 2020 and February 2021 (Time 1), of which 85 parents completed it between May 2021 and July 2021 (Time 2), and 70 completed it between July 2022 and October 2022 (Time 3). Qualitative in-depth individual interviews were conducted with a subset of the sample (n=20) between July 2022 and December 2022 to gain a better understanding of challenges experienced by parents and how the pandemic impacted them and their children in various ways over the course of the pandemic. The findings indicated that the stress caused by changes brought about by the pandemic was related to parent and child mental health in India. Parents in India experienced several challenges that impacted their mental health. Factors contributing to those challenges, and in turn, possibly their mental health are discussed. Parenting behaviors such as parental nurturance and restrictiveness were also related to child mental health and served as moderators of the relation between child COVID-19-related stress and child mental health difficulties; parental nurturance emerged as a protective factor while parental restrictiveness was a possible risk factor. Perceived social support was negatively linked with parent mental health difficulties, and it also served as a buffer in the relation of parent COVID-19-related stress and parent mental health difficulties at Time 1. Qualitative findings also indicated that support from spouse, other family members, friends and co-workers helped parents cope with the challenges associated with the pandemic. In sum, the findings of this study helped identify important risk and protective factors for parent and child mental health within the COVID-19 context in India. The findings have important clinical implications that inform future intervention efforts to support children and families during related stressful events.Item ADHD and Cannabis Use in College Students: Examining Indirect Effects of Coping Motives(2024) Taubin, Daria; Chronis-Tuscano, Andrea; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)ADHD is a developmental risk factor for cannabis misuse and cannabis use disorder. Individuals with ADHD also struggle to cope with negative affect and are more likely to engage in maladaptive, avoidant coping behaviors. This may be particularly salient in college, a developmental period characterized by increased stress and autonomy and easy access to highly reinforcing substances. However, despite this increased risk, little is known about mechanisms underlying why college students with ADHD use cannabis more frequently than their peers. This study examined associations between ADHD, coping motives (i.e., using cannabis to avoid or reduce negative affect), and frequency of cannabis use in a sample of college students (49% female) with (n=42) and without (n=30) ADHD using a two-week daily diary protocol. Results showed that ADHD was significantly associated with elevated coping motives and more days of cannabis use during the daily diary period. Additionally, there was a significant indirect effect of ADHD on number of cannabis use days through coping motives; students with ADHD endorsed a stronger drive to use cannabis to cope with negative emotions, which in turn was associated with more cannabis use days. Findings align with theory linking ADHD to increased vulnerability for avoidant coping behaviors. Further work may explore the potential of targeted, proactive interventions to help youth with ADHD build and utilize adaptive substance-free coping skills, particularly in the college context.Item Early emotional caregiving environment and associations with memory performance and hippocampal volume in adolescents with prenatal drug exposure(2023) Kohn, Brooke Hannah; Riggins, Tracy; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Early adversities, including prenatal drug exposure (PDE) and a negative postnatal emotional caregiving environment, impact children’s long-term development. The protracted developmental course of memory and its underlying neural systems offer a valuable framework for understanding the longitudinal associations of pre- and postnatal factors on children with PDE. This study longitudinally examines memory and hippocampal development in 69 parent-child dyads with PDE histories to investigate how the early emotional caregiving environment affects children with PDE’s neural and cognitive systems. Measures of physical health, drug exposure, and the emotional caregiving environment were collected between 0-24 months. At age 14 years, adolescents (N=69, 52.17% Female) completed multiple measures of episodic memory. at ages 14 (n=27) and 18 (n=17) years, a subset of adolescents underwent magnetic resonance imaging (MRI) scans. Latent constructs of episodic memory and the caregiving environment were created using Confirmatory Factor Analysis. Multiple regressions revealed a negative emotional caregiving environment during infancy was associated with poor memory performance and smaller left hippocampal volumes at 14 years. Better memory performance at 14 years predicted larger right hippocampal volume at 18 years. At 18 years, the association between the emotional caregiving environment and hippocampal volume was moderated by sex, such that a negative emotional caregiving environment was associated with larger left hippocampal volumes in males but not females. Findings suggest that the postnatal caregiving environment may modulate the effects of PDE across development, influencing neurocognitive development.Item MENTAL HEALTH TREATMENT UTILIZATION: THE INTERSECTIONAL EFFECTS OF RACE, SEX, AND AREA-LEVEL DEPRIVATION AMONG VETERANS WITH PTSD(2022) Arenson, Melanie B; De Los Reyes, Andres; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: PTSD is a debilitating disorder impacting approximately 10-30% of veterans within their lifetime. While multiple efficacious treatment for PTSD have been developed, access to and utilization of mental health care remains a significant barrier. Models of health care utilization (e.g., Andersen, 1995; Fortney, 2011) implicate predisposing and enabling factors such as sex, race and/or ethnicity, and socioeconomic status (SES) or socioeconomic deprivation in healthcare access and utilization decisions. Although each of these factors has been examined in isolation, research on race and/or ethnicity and SES is limited, and almost no studies have examined the intersectional impacts of these factors on mental health service utilization among veterans. This study does so, hypothesizing that each will predict mental health service utilization individually, as well as show two and three-way interaction effects. Methods: All variables of interest were derived from the VA medical record, excepting area-level deprivation and geospatial access. Area-level deprivation was determined by linking veteran residential address to the Area Deprivation Index. Geospatial access was calculated by employing kernel density estimation, and linking ZIP-code level values to veteran residential address. All hypotheses were tested using negative binomial regression. Multiple imputation was employed for missingness. Results: Of the 245,574 veterans newly diagnosed with PTSD in 2017 or 2018, 75% attended at least one mental health appointment following diagnosis. The average number of follow-up appointments was 8.9 (mode = 1, median = 3). Sex, race-ethnicity, and area-level deprivation all predicted mental health service utilization individually. There was only one significant two-way interaction effect: identifying as a Black or African American male was positively associated with greater mental health service utilization following diagnosis (0.68, p=.007). There were no three-way interaction effects. Discussion: 1 in 4 veterans with PTSD in this sample did not attend any mental health appointments following diagnosis, highlighting the formidable gap between need and utilization. Furthermore, of those who did attend a follow up appointment, the modal number of appointments was 1, suggesting that entering care is not sufficient to ensure adequate treatment. Sex, race-ethnicity, and area-level deprivation all predicted mental health service utilization individually, but, with a singular exception, did not do so in combination with one another. It is possible that any variance explained by the well-documented compounding effects of societal bias, injustice, and disparities on (mental) health determinants and (mental) healthcare outcomes is more accurately measured by the covariates included in our models, rather than the socially-constructed identities themselves. Taken together, these study findings highlight the need for continued work in lowering barriers to mental health care for this population, as well as a greater understanding of the multitude of factors that influence access to and utilization of services.