Kerry A. Reynolds

A meta-analytic review of benefit finding and growth.

The authors conducted a meta-analysis to examine the relations of benefit finding to psychological and physical health as well as to a specific set of demographic, stressor, personality, and coping correlates. Results from 87 cross-sectional studies reported in 77 articles showed that benefit finding was related to less depression and more positive well-being but also more intrusive and avoidant thoughts about the stressor. Benefit finding was unrelated to anxiety, global distress, quality of life, and subjective reports of physical health. Moderator analyses showed that relations of benefit finding to outcomes were affected by the amount of time that had passed since stressor onset, the benefit finding measured used, and the racial composition of the sample.

Children with diabetes compared to peers: depressed? Distressed? A meta-analytic review.

BackgroundIt is not clear from the literature whether children with diabetes have more psychological difficulties than their peers.PurposeThis study aims to use meta-analysis to determine if children with diabetes differ from children without a chronic illness in a variety of domains reflecting psychological well-being.MethodA meta-analysis was undertaken of 22 studies that compared children with diabetes to a comparison group. Outcomes included depression, anxiety, behavioral problems, and related constructs.ResultsChildren with diabetes were more likely than comparison groups to experience a variety of psychological difficulties. However, these effects were small to medium in magnitude and were typically smaller among more recent studies and studies with well-matched comparison groups.ConclusionsThis meta-analysis suggests that children with diabetes are at slightly elevated risk for psychological difficulties. Future work will need to help identify children at the highest risk, and to identify factors associated with resilience.

Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes

The goals of the study were to describe the transition of youth with Type 1 diabetes from paediatric to adult healthcare services, examine the link of this transition with self care and glycaemic control, and distinguish youth who received medical treatment from different physicians in terms of demographic and parent relationship variables.

Population-Level Trends in Posttreatment Cancer Survivors’ Concerns and Associated Receipt of Care: Results from the 2006 and 2010 LIVESTRONG Surveys

There is a need to better understand the posttreatment concerns of the nearly 14 million survivors of cancer alive in the United States today and their receipt of care. Using data from 2,910 posttreatment survivors of cancer from the 2006 or 2010 LIVESTRONG Surveys, the authors examined physical, emotional, and practical concerns, receipt of care, and trends in these outcomes at the population level. Results: 89% of respondents reported at least one physical concern (67% received associated posttreatment care), 90% reported at least one emotional concern (47% received care), and 45% reported at least one practical concern (36% received care). Female survivors, younger survivors, those who received more intensive treatment, and survivors without health insurance often reported a higher burden of posttreatment concerns though were less likely to have received posttreatment care. These results reinforce the importance of posttreatment survivorship and underscore the need for continued progress in meeting the needs of this population. Efforts to increase the availability of survivorship care are extremely important to improve the chances of people affected by cancer living as well as possible in the posttreatment period.

Emerging adults with type 1 diabetes: a comparison to peers without diabetes.

OBJECTIVE This longitudinal study compared emerging adults with and without type 1 diabetes on life path decisions, health behaviors, and psychological well-being during the transition out of high school. METHODS Administered questionnaires during the senior year of high school and 1 year later to 117 emerging adults with diabetes and 122 emerging adults without diabetes. Comparisons were conducted with respect to health status, sex, and school status. RESULTS Those with and without diabetes chose similar life paths and engaged in similar levels of risky behaviors, but disturbed sleep increased for males with diabetes only. Having diabetes was not associated with depressive symptoms, loneliness, or bulimic symptoms, but was associated with lower life satisfaction and lower life purpose over time. CONCLUSIONS Emerging adults with and without diabetes fare similarly on most dimensions studied during the first year out of high school.

Relationships and health among emerging adults with and without Type 1 diabetes.

OBJECTIVE The studys goal was to examine the impact of parent and peer relationships on health behaviors and psychological well-being of those with and without Type 1 diabetes over the transition to emerging adulthood. Emerging adulthood is an understudied developmental period and a high-risk period--especially for those with Type 1 diabetes. METHOD Youth with (n = 117) and without Type 1 diabetes (n = 122) completed questionnaires during their senior year of high school and 1 year later. Measures included supportive and problematic aspects of parent and peer relationships, health behaviors, psychological well-being, and, for those with diabetes, self-care behavior and glycemic control. RESULTS Prospective multiple and logistic regression analysis revealed that friend conflict was a more potent predictor than friend support of changes in health behaviors and psychological well-being. Parent support was associated with positive changes in psychological well-being and decreases in smoking, whereas parent control was related to increases in smoking and depressive symptoms. There was some evidence of cross-domain buffering such that supportive relationships in one domain buffered adverse effects of problematic relationships in the other domain on health outcomes. CONCLUSIONS This longitudinal study showed that parent relationships remain an important influence on, and peer relationships continue to influence, the health behaviors and psychological well-being of emerging adults with and without Type 1 diabetes. Parent relationships also have the potential to buffer the adverse effects of difficulties with peers.

Primary Care Providers' Initial Treatment Decisions and Antidepressant Prescribing for Adolescent Depression

Objective: Adolescent depression is a serious and undertreated public health problem. Nonetheless, pediatric primary care providers (PCPs) may have low rates of antidepressant prescribing due to structural and training barriers. This study examined the impact of symptom severity and provider characteristics on initial depression treatment decisions in a setting with fewer structural barriers, an integrated behavioral health network. Methods: A cross-sectional survey was administered to 58 PCPs within a large pediatric practice network. PCP reports of initial treatment decisions were compared in response to 2 vignettes describing depressed adolescents with either moderate or severe symptoms. PCP depression knowledge, attitudes toward addressing psychosocial concerns, demographics, and practice characteristics were measured. Results: Few PCPs (25% for moderate, 32% for severe) recommended an antidepressant. Compared with treatment recommendations for moderate depression, severe depression was associated with a greater likelihood of child psychiatry referral (odds ratio [OR], 5.50; 95% confidence interval [CI], 2.47–12.2] p < .001). Depression severity did not affect the likelihood of antidepressant recommendation (OR, 1.58 [95% CI, 0.80–3.11] p = .19). Antidepressants were more likely to be recommended by PCPs with greater depression knowledge (OR, 1.72 [95% CI, 1.14–2.59] p = .009) and access to an on-site mental health provider (OR, 5.13 [95% CI, 1.24–21.2] p = .02) and less likely to be recommended by PCPs who reported higher provider burden when addressing psychosocial concerns (OR, 0.85 [95% CI, 0.75–0.98] p = .02). Conclusion: PCPs infrequently recommended antidepressants for adolescents, regardless of depression severity. Continued PCP support through experiential training, accounting for provider burden when addressing psychosocial concerns, and co-management with mental health providers may increase PCPs’ antidepressant prescribing.

Friendship and Romantic Relationships Among Emerging Adults With and Without Type 1 Diabetes

OBJECTIVE To examine whether friendship and romantic relationships of emerging adults with type 1 diabetes differed from those of a comparison group, and to determine whether these relationships were associated with psychological and diabetes health outcomes. METHODS High school seniors with (n = 122) and without (n = 118) type 1 diabetes were assessed annually for 3 years. Friend and romantic relationship variables, psychological distress, life satisfaction, eating disturbances, and, for those with diabetes, diabetes outcomes were assessed. RESULTS Those with diabetes reported less friend support but similar friend conflict compared with controls. Aspects of romantic relationships and friend relationships were associated with health outcomes, but there were more effects involving romantic relationships. On some indices, romantic support was more beneficial for controls and romantic conflict was more troublesome for those with diabetes. CONCLUSIONS Both friendship and romantic relationships were associated with psychological and diabetes outcomes among emerging adults.

Primary care providers' beliefs about teen and parent barriers to depression care

Objective: Only one-third of US adolescents with depression obtain treatment for depression. Teen and parent barriers differ, but both contribute to low treatment rates. Primary care providers (PCPs) may be able to elicit and address such barriers, but little is known about their perceptions of teen and parent barriers, and whether they recognize these differences. Methods: We administered a survey to 58 PCPs assessing their perceptions of the importance of specific barriers to depression care for teens and parents using McNemars test to examine differences. Results: Most PCPs believed barriers for parents included difficulty making appointments, worry about what others would think, and cost. PCPs believed barriers for teens included not wanting treatment and worry about what others would think. PCPs believed parents and teens differed in the extent to which they would perceive cost, difficulty in making appointments, and not wanting care as a barrier (p < .001). Conclusions: Primary care providers recognize that teens and parents have different barriers to care, but may have discordant perceptions of the importance of certain barriers for teens and their parents. PCPs may need to probe parents and teens individually about barriers, which impede depression care to enhance shared decision making and treatment uptake.

Relations of Behavioral Autonomy to Health Outcomes Among Emerging Adults With and Without Type 1 Diabetes

OBJECTIVE To examine the relation of behavioral autonomy to psychological, behavioral, and physical health among emerging adults with and without type 1 diabetes. METHODS High school seniors with (n = 118) and without type 1 diabetes (n = 122) completed online questionnaires for three consecutive years. Behavioral autonomy, psychological health, risk behaviors, and diabetes outcomes were assessed. Regression analyses were conducted to predict Time 2 and 3 outcomes, controlling for Time 1 outcomes. RESULTS There were no group differences in behavioral autonomy. Behavioral autonomy predicted better psychological health but only for emerging adults without diabetes. Behavioral autonomy was related to increased risk behavior for both groups. Behavioral autonomy was unrelated to self-care but predicted better glycemic control for females. CONCLUSIONS Behavioral autonomy may be beneficial for psychological health, but is related to increased risk behavior. The implications of behavioral autonomy for emerging adults with type 1 diabetes require careful consideration.