Katherine Ramos

Authenticity, Social Context, and Well-Being in the United States, England, and Russia: A Three Country Comparative Analysis

The study investigated interrelationships among trait authenticity, context-specific authenticity, and well-being in three samples drawn from England, the United States, and Russia. Six hundred and twenty-eight adults participated: 196 from the United States, 240 from England, and 192 from Russia. The overall sample consisted of 151 men and 477 women with a mean age of 27 years (range = 18 to 56). Authenticity was rated both as a general trait and specific to four contexts: with partner, parents, friends, and work colleagues. Well-being was measured using a measure of positive mental health. English and American samples showed higher mean authenticity levels than the Russian sample. In all three subsamples, within-subjects differences in the context-specific ratings were in the same ordinal series; authenticity was rated highest with partner, followed by friends and parents, and lowest with work colleagues. Context and country showed an interaction in their effect on authenticity; United States and England were higher than Russia in partner, friend, and parent contexts but not in the work context. Trait and context-specific authenticity measures contributed unique and significant variance to a prediction of well-being in all three subsamples.

An Exploration of Gender and Career Stage Differences on a Multidimensional Measure of Work Meaningfulness

In recent years, the constructs of work meaning and work meaningfulness have been differentiated, and multidimensional measures of the latter have been developed. In the present study, we administered one such measure—the Comprehensive Meaningful Work Scale (CMWS)—to a gender-balanced and age-diverse sample of managers and conducted a multivariate analysis of CMWS scores that explored the contributions of participants’ gender and their adult career stage. As hypothesized, the CMWS subscale scores were negatively correlated with participants’ scores on an independent measure of work stress. Results also revealed a significant multivariate effect associated with their career stage that was limited to one CMWS subscale (i.e., “balancing tensions”), with managers in their “prime work years” (i.e., 40–54) evidencing less favorable scores than those in either the “settling in” (i.e., 25–39) or “approaching retirement” (i.e., 55–65) stages. The implications of these findings for future research on work meaningfulness are discussed.

Vida Calma: CBT for Anxiety with a Spanish-Speaking Hispanic Adult

ABSTRACT Background: Hispanic adults aged 55 years and older are the fastest growing ethnic minority group in the United States facing significant mental health disparities. Barriers in accessing care have been attributed to low income, poor education, language barriers, and stigma. Cultural adaptations to existing evidence-based treatments have been encouraged to improve access. However, little is known about mental health treatments translated from English to Spanish targeting anxiety among this Hispanic age group. Objctive: This case study offers an example of how an established, manualized, cognitive-behavioral treatment for adults 55 years and older with generalized anxiety disorder (known as “Calmer Life”) was translated to Spanish (“Vida Calma”) and delivered to a monolingual, Hispanic 55-year-old woman. Results: Pre- and post-treatment measures showed improvements in symptoms of anxiety, depression, and life satisfaction. Conclusion: Findings suggest Vida Calma is a feasible treatment to use with a 55-year-old Spanish-speaking adult woman. Clinical Implications: Vida Calma, a Spanish language version of Calmer Life, was acceptable and feasible to deliver with a 55-year-old participant with GAD. Treatment outcomes demonstrate that Vida Calma improved the participant’s anxiety, depression, and life satisfaction.

Anxiety Disorders in Late Life

Anxiety disorders in later life are some of the most significant mental health problems affecting older adults. Prevalence estimates of anxiety disorders in late life vary considerably based on multiple methodological issues. Current diagnostic criteria may not adequately capture the nature and experience of anxiety in older people, particularly those in ethnic and racial minority groups. This article reviews late-life anxiety disorders. Pharmacologic and psychotherapy approaches to treat late-life anxiety are reviewed, including a summary of current innovations in clinical care across settings, treatment models, and treatment delivery.

Predicting well-being in managers: Test of a positive psychology model

Contemporary scholars in vocational, applied, and organizational psychology have emphasized that working must be understood as a relational act with important implications for worker well-being. Drawing upon emergent research extending the constructs of adult attachment security and authenticity to the workplace, this study tested a positive psychological model linking adult attachment orientations, and both experienced and expressed features of work authenticity, to the prediction of well-being within a sample of business managers. Findings indicated that, controlling for their gender and length of managerial experience, managers’ levels of adult attachment security and work authenticity accounted for significant and incremental variance in their reported levels of work stress and job satisfaction. In general, managers with high levels of adult attachment security and work authenticity reported lower work stress and higher job satisfaction. Implications of these findings for the counseling of distressed managers are briefly discussed.

Improving Medication Adherence in Coronary Heart Disease

Purpose of ReviewThe purpose of this review was to synthesize research findings from recently published randomized controlled trials (RCTs) targeting any phase of medication adherence, from initiation to discontinuation, among patients with coronary heart disease (CHD).Recent FindingsWe identified successful strategies and promising practices for improving medication adherence among patients diagnosed with CHD. Consistent intervention strategies included the following: (1) facilitating patient-provider communication, (2) using mHealth technologies with emphasis on two-way communication, (3) providing patient education in tandem with lifestyle and behavioral counseling, and (4) providing psychosocial support. Regarding medication adherence phases, all studies examined implementation (i.e., taking medications as prescribed over time) and one also addressed treatment initiation (i.e., beginning a new medication). None identified addressed discontinuation. Studies varied by use of objective, self-report, and a combination of outcome measures with a greater number reporting only subjective measures of adherence. Key findings remained mixed in supporting specific intervention designs or delivery formats.SummaryThis review addresses available data of promising practices for improving CHD medication adherence. Future studies are needed to examine intervention effectiveness, scalability, and durability of observed outcome effects.

Reliability and Validity of the Vietnamese Depression Interview (VDI)

Current instruments used to aid in the diagnosis of psychological disorders have limited effectiveness with clients from Asian backgrounds. The Vietnamese Depression Interview (VDI) is a diagnostic instrument created to assess the presence of current and lifetime history of major depressive disorder specifically among Vietnamese refugees and immigrants. The purpose of the present study is to provide a description of the VDI, while also noting it as a reliable and valid means by which to assess depression in Vietnamese individuals. Using the Longitudinal, Expert, and All Data (LEAD; Spitzer in Compr Psychiatry 24:399–411, 1983) standard and the VDI, experienced clinicians conducted the diagnosis process with 127 Vietnamese refugees and immigrants. Assessment of the reliability and validity of the VDI yielded good to excellent AUC and kappa values, indicating the reliability of the VDI and the agreement between the LEAD procedure and the VDI. These study results imply that the VDI performs successfully as a diagnostic instrument specifically created for Vietnamese refugees and immigrants in their native language. Current and future contributions of the VDI with Vietnamese individuals are discussed.

Development and initial validation of a measure of attachment security in late adulthood.

Attachment theory-guided studies of older adults have generally relied on self-report measures that were validated on young adult samples and that focus on fears of rejection by romantic partners and on experiences of chronic discomfort with romantic intimacy as the key indicators of adult attachment security. These assessment characteristics raise important questions as to whether these measures are appropriate for use with older adults. Unlike their younger adult counterparts, older adults may face distinctive life stage-related threats to their attachment security such as declining health and autonomy, spousal loss, and increased dependence on younger family members for instrumental and emotional support. In response to these concerns, we conducted two independent studies aimed at developing and validating a novel measure of attachment security in older adults—the Late Adulthood Attachment Scale (LAAS). In study one (N = 287), exploratory structural equation modeling (ESEM) methods were used to identify and support a 2-factor structure (Fearful Avoidance, Secure Engagement) underlying LAAS scores. In study two (N = 417), ESEM and regression analyses confirmed the 2-factor structure and demonstrated the ability of LAAS scores to predict participants’ well-being over a 3-month interval (n = 93). Findings from both studies support the psychometric adequacy of the LAAS as an alternative measure of attachment security for use with older adult samples.

Improving Emergency Department Discharge Care with Telephone Follow-Up. Does It Connect?

The number of older adults requiring healthcare services is growing at a rate disproportionate to that of the general population. Older adults are increasingly turning to emergency departments (EDs) to address their healthcare needs. Older adults are more likely to use emergency care and have greater acuity, longer ED lengths of stay, and higher rates of adverse outcomes after discharge than younger individuals. Adverse outcomes include medical complications, functional decline, disability, and poorer health-related quality of life than before the ED visit. At the crossroads of outpatient and inpatient care, the ED sees nearly 1 out of every 2 older Americans (aged ≥65) each year. The ED also serves as a safety net for lapses in care, thus becoming an important partner in care coordination. Thus, opportunities to implement practical solutions for facilitating better care transitions after ED discharge are greatly needed and increasingly sought. In the study by Biese and colleagues, investigators evaluated a scripted telephone intervention for individuals aged 65 and older discharged from the ED to home. Trained nurses from a hospital call center screened eligible older adults and their caregivers and obtained informed consent for study participation. After randomization to intervention or control groups, the call center conducted one additional telephone call 1 to 3 days after discharge with all participants in each group. Participants receiving the intervention were surveyed about their understanding of their ED diagnoses, discharge medications or treatment instructions, and follow-up care with their primary care doctor or other specialist. During the follow-up call, the nurse provided clarification and instructions about medications and treatments and offered assistance in scheduling appointments with or providing information to local community resources. The control group participated in a short survey that assessed satisfaction with their care during the ED visit. Investigators found no significant difference in risk of a primary composite outcome of ED revisit, subsequent hospitalization, or death within 30 days. Biese and colleagues designed their randomized controlled trial (RCT) based on previous findings from a smaller RCT that they conducted exploring the effect of telephone call follow-up on care plan adherence for older adults discharged from the ED. In this earlier study, subjects were randomized to an intervention, placebo (satisfaction call), or control group (no call within 3 days after ED discharge). For that study, intervention participants were almost twice as likely to see a physician within 5 days of their ED visit as those in the control and placebo groups; there were no differences in ED visits or hospital admissions within 35 days of the ED discharge, but the study was underpowered to detect such effects. Revisit rates are often considered a proxy measure to reflect the quality of care transitions, but considering the results of the current larger scaled study, evidence remains limited that telephonic programs affect healthcare use. When evaluating the effect of telephone support programs after ED or even hospital discharge, most have found no differences in outcomes of readmission rates or ED use. Some telephone follow-up programs have demonstrated incremental improvement in process measures such as better follow-up appointment rates but little to no effect on hospital use. For these reasons, despite the hope of a pragmatic and operationally feasible solution, perhaps the findings of this more recent study should come as no surprise. Why did a follow-up telephone call focused on many of the known problem areas in care transitions (medications, follow-up care) not reduce repeat ED visits? Perhaps it was not sufficiently intensive. Comprehensive reviews recommend a “bridging” strategy (e.g., incorporating preand postdischarge interventions) with a dedicated transition provider to help reduce readmission or ED visit rates. More intensive programs implemented by dedicated nurses focused on comprehensive discharge planning and home follow-up protocols specifically designed for elderly adults at risk have demonstrated successful reduction of readmissions. Other types of programs have demonstrated early success with comprehensive geriatric assessments or extended access to interdisciplinary teams and discharge coordinators that have kept people from future admissions and ED visits. Perhaps it did not work because the intervention did not focus on individuals at highest risk of hospital use, such as older adults with complex medical regimens, those with functional or cognitive impairments, or those with high psychological distress. Nor did it focus on their caregivers. Given the critical role that caregivers play in the care of older adult family members, ED care interventions may benefit from greater family engagement in discharge planning, greater education for transition care needs, and general support of caregiver psychological needs. Individuals with comorbid mental health conditions with high-level social needs (e.g., homelessness) experiencing high This editorial comments on the article by Biese et al.

Assessing Key Stakeholders’ Knowledge, Needs, and Preferences for Head and Neck Cancer Survivorship Care Plans

Cancer survivorship care plans (SCPs) are endorsed to support quality care for cancer survivors, but uptake is slow. We assessed knowledge, needs, and preferences for SCP content and delivery from a wide variety of stakeholders. We focused SCP content for head and neck cancer as it is a disease prone to long-term side effects requiring management from multiple providers. We conducted telephone-based, qualitative interviews. We purposively sampled head and neck cancer survivors (n = 4), primary care physicians in the community (n = 5), and providers affiliated with a large academic medical center (n = 5) who treat head and neck cancer, cancer specialists (n = 6), and nurse practitioners/supportive care staff (n = 5). Interviews were recorded, transcribed, and analyzed using direct content analysis. Few participants reported personal experience with SCPs, but most supported the concept. Several key themes emerged: (1) perceived ambiguity regarding roles and responsibilities for SCPs, (2) a need to tailor the content and language based on the intended recipient, (3) documentation process should be as automated and streamlined as possible, (4) concerns about using the SCP to coordinate with outside providers, and (5) that SCPs would have added value as a “living document.” We also report SCP-related issues that are unique to serving patients diagnosed with head and neck cancer. Effort is needed to tailor SCPs for different recipients and optimize their potential for successful implementation, impact on care outcomes, and sustainability. Many cancer survivors may not receive a SCP as part of routine care. Survivors could engage their health care team by requesting a SCP.