To help providers better target services toward specii c patient needs, we conducted a prospectiv... more To help providers better target services toward specii c patient needs, we conducted a prospective study of parents' health beliefs, insurance status and demographics as they predicted paediatric emergency room (ED) utilization. Parents/legal guardians (n 5 388) of children ages 0–17 years with minor illnesses completed demographic and health belief questionnaires while waiting for their child to be seen. Post-discharge, children's medical records were reviewed for insurance and utilization information. Higher perceived barriers, higher perceived bene ts of care and public insurance status predicted higher ED utilization. Qualitative data indicated that parents used the ED primarily because their regular clinic was closed or had no available appointments. Results are discussed as they relate to a risk pro le for higher ED utilization, and practice implications are presented. In the USA, the medical community has expressed concern over rapidly growing paediatric emergency department (ED) utilization because it involves increased cost, discontinuous and/or inadequate care and reallocation of medical staff away from potentially more serious emergencies (Feigelman et al., 1990). Furthermore, paediatric ED visits may disrupt family living patterns and children's school performance (Wasilewski et al., 1996). Our goal in this study was to examine how parental attitudes, specii cally health beliefs, and contextual factors predicted paediatric ED utilization. Information on predictors of ED utilization could help clearly identify appropriate target points for direct intervention, eventually leading to more appropriate and exible use of medical services. This study also identi es speci c ED patient needs, including those that are potentially unmet within the current system of care.
The number of children in nontraditional families is growing. The objective of this study was to ... more The number of children in nontraditional families is growing. The objective of this study was to determine the effects of family structure on the course of childhood steroid-sensitive idiopathic nephrotic syndrome (SSNS). Sixteen children, 2–15 years of age, with SSNS were enrolled in the study. The effects of family structure (traditional versus nontraditional) on the number of hospitalizations and outpatient visits for the previous 2 years and disease relapses for the preceding year were evaluated. Behavior differences were assessed using the Child Behavior Checklist (CBCL). Of the 16 families, 9 were traditional and 7 nontraditional. Hospitalizations , outpatient visits, and behavior were not different between family groups. However, children from nontraditional homes relapsed 3 times more than children from traditional homes (P=0.003). We conclude that children with SSNS from nontraditional homes may be at risk for more relapses compared with children from traditional families. Heightened support and monitoring is necessary for these children. Keywords Steroid-sensitive nephrotic syndrome · Relapse · Psychosocial functioning · Behavior problems · Family structure · Child behavior checklist
Objective: To examine maternal prenatal expectations for epidural uptake with their intrapartum a... more Objective: To examine maternal prenatal expectations for epidural uptake with their intrapartum actual epidural uptake followed by maternal postpartum reporting. Background: Childbearing women may or may not expect to have an epidural in childbirth, but the match between expected and actual epidural uptake has not been examined. The issue is important because childbirth expectations have been associated with actual experiences and later adjustment. Methods: Prospective, longitudinal study of 55 obstetric clinic patients from the US Pacific Northwest region. In the third trimester of pregnancy, participants reported on epidural expectation and fear of childbirth pain. Postpartum reports included birth characteristics, satisfaction, and description of epidural uptake. Results: Of the 21 participants who expected to have an epidural, 18 (86%) did; of those who did not expect one, 6/16 (38%) did not have one. Fourteen (78%) of the 18 who expected to 'wait and see' had an epidural. Birth satisfaction was significantly higher in confirmed vs. violated expectation subgroups. Qualitative data identified factors potentially involved in epidural uptake expectancy violations. Conclusions: This study on expected vs. actual epidural uptake has identified specific factors in the pathway to expectancy violation such as late-term pregnancy concerns, labour onset timing, and medical induction, which has important implications for research and counselling on birth options.
The maternal patient-provider relationship is important in birth experiences. However, no measure... more The maternal patient-provider relationship is important in birth experiences. However, no measures of obstetric patient-provider relationship quality exist, perhaps partially explaining why the concept has not been systematically studied in pre-and perinatal psychology and related fields. As a first step in this line of inquiry, we examined a care provider trust measure completed by 70 obstetric clinic patients along with state anxiety, fear of childbirth, and postpartum satisfaction measures. The trust measure performed similarly with our sample as in the original validation. Trust scores were similar across provider type (midwife vs. physician) and demographic variables. Correlations between trust, anxiety, and childbirth fear were low to moderate. The provider trust measure shows promise for advancing understanding of maternal and provider influences on the care relationship and outcomes.
Anxiety symptoms are common during pregnancy. However, predictors of prenatal anxiety have not be... more Anxiety symptoms are common during pregnancy. However, predictors of prenatal anxiety have not been well researched. We tested a model of pregnancy anxiety conceptualized from a stress and coping framework in which pregnancy wantedness, maternal attachment style, and attachment history were expected to predict anxiety in late pregnancy. Controlling for parity and risk, maternal attachment history significantly predicted general anxiety symptoms. Current relationship and/or attachment difficulties predicted general anxiety and prenatal anxiety subdimensions. Pregnancy wantedness significantly predicted one pregnancy-specific anxiety dimension. Pregnancy wantedness, suboptimal personal attachment experiences, and current relationship and/or attachment difficulties are risk factors for prenatal anxiety.
In the U.S. and other industrialized nations, the prevailing childbirth approach has been describ... more In the U.S. and other industrialized nations, the prevailing childbirth approach has been described as medicalized, a view in which safe birth is characterized as requiring specialized intervention. From the perspective that birth attitudes are largely enculturated, we assessed medical and natural birth attitudes among 1,467 nulliparous university women and men, expecting that pre-parents would endorse medical more strongly than natural birth attitudes. We analyzed data in subgroups categorized by sex, race, and future childbearing plans. White men and women who did not plan to have children scored significantly higher on the medical than natural birth scale whereas non-white women and men rated the natural birth scale higher. Our results reflect the complex interplay between demographics and birth philosophy and indicate the need for awareness of enculturated beliefs, particularly in developing childbirth informational campaigns to address growing evidence indicating that intensive intervention has not led to measurably increased maternal or newborn health.
Contemporary models of family adjustment, namely the goodness of fit model and the organizational... more Contemporary models of family adjustment, namely the goodness of fit model and the organizational ecology conceptual frameworks, are limited in their application to the complexities of family foster care. However, the family adjustment and adaptation response (FAAR) model exists as a viable model for research and clinical applications in family foster care. In this article we discuss the FAAR model's relative advantages in understanding family foster placement and review available studies based on specific FAAR model components. Working with foster families using the FAAR model is described. We conclude by discussing research and practice implications derived from family foster placement research based on a FAAR conceptual framework. Finally, a case example involving application of the FAAR model is offered.
The effects of a widely used expressive writing intervention on adolescents' somatic symptoms, di... more The effects of a widely used expressive writing intervention on adolescents' somatic symptoms, distress, and positive psychological functioning were evaluated. Eighth-grade (n = W6) students were randomly assigned to write about either an emotional or a neutral topic for 3 consecutive days. Students completed measures of somatic symptoms, medical visits, distress, and positive functioning at baseline, postinter-vention, and 2 and 6 weeks later. Somatic symptoms and medical visits were unchanged as a result of the intervention. However, significant Time x Condition effects indicated thai optimism scores increased, negative-affect scores decreased, and positive affect words in student essays increased in the experimental condition. Expressive writing shows promise as a cost-efficient intervention to address the emotional concerns of young adolescents: further work with clinical populations may lead to even more robust results.
Objectives: Women across the globe seek acupuncture to treat pregnancy concerns. Randomized contr... more Objectives: Women across the globe seek acupuncture to treat pregnancy concerns. Randomized controlled trials have indicated limited benefits of acupuncture in pregnancy, but field studies involving practitioners are needed to better understand the outcomes of usual care. To advance research on pregnancy acupuncture, this study engaged field-based practitioners to discuss research strategies. Settings/Location: U.S. Pacific Northwest region. Design and participants: Live focus group with regional specialized acupuncturists. Content analysis involved research team and interviewees. Results: Practitioners generally focused on patient care, although they discussed valuing research for communicating with patients and biomedical practitioners. To increase research in this area, practitioners proposed partnering with professional organizations, using social media, assuring confidentiality, and designing brief measurement tools. Conclusions: Practitioners valued evidence for specific uses and proposed several novel research strategies. On the basis of these results, a framework is proposed for building a patient-centered collaboration between research and practice communities that is responsive to paradigmatic preferences and the overarching goals of science.
Coronary heart disease is the leading cause of mortality in adult women, and recent trends indica... more Coronary heart disease is the leading cause of mortality in adult women, and recent trends indicate that risk for women, particularly working mothers, has worsened during the last decade. The absence of a biological explanation for this gender discrepancy has led some to look to psychosocial risk factors. This literature review examines the effect of multiple roles on women's cardiovascular health. Further, a conceptual model of heart disease risk is proposed, which introduces background stress, a chronic stress burden, as a potential pathway between multiple roles and heart disease. Trends in the literature largely support the proposed conceptual model. Multiple roles that often place conflicting demands on women may affect health outcomes through an increase in total background stress.j abr_ 4..22
This study examined a mediated-effects stress and coping model among cancer patients with carcino... more This study examined a mediated-effects stress and coping model among cancer patients with carcinoid tumors to identify specific pathways with a view toward determining (a) which coping strategies predict more positive adjustment, (b) which strategies predict less positive adjustment, and (c) whether coping would mediate the effect of optimism on psy-chosocial outcomes. Coping strategies partially mediated the effects of optimism on the psychological adjustment in cancer patients with carcinoid tumors. Specifically, self-blame and active coping significantly predicted outcomes of distress. Thirty-seven percent of the respondents met criteria for elevated depressive symptoms warranting intervention. Generalizability of the mediated-effects stress and coping model and findings unique to the carcinoid population are discussed. As technological advances have improved the prognosis for cancer patients and have contributed to prolonged survival, understanding the psychosocial consequences of disease has become increasingly important to patients, families, and health care providers. More than 9,000 articles have been published in the past decade on the psychosocial aspects of cancer, but only 9 articles have been published on the psychosocial aspects of carcinoid cancer (Berglund & Sjoeden,
Although mood disturbance is a common manifestation in all cancers that require clinical attentio... more Although mood disturbance is a common manifestation in all cancers that require clinical attention, very little is known regarding the psychiatric management of depression in patients with gastrointestinal carcinoid tumors. The goal of this study was to evaluate the degree of depression among patients with gastrointestinal carcinoid tumors, determine the prevalence of selective serotonin reuptake inhibitor (SSRI) use among these patients, and determine whether SSRI users differed from nonusers on demographic and general medical variables. Approximately 22% of the respondents in this study met screening criteria for clinically elevated or borderline depression. Moreover, 7% of respondents were following an SSRl regimen, whereas 7% were following a non-SSRI antidepressant regimen. Analyses revealed no differences on demographic or general medical indicators between SSRI users and nonusers. The growing appreciation of quality of life in the treatment of cancer has expanded the scope of comprehensive care guidelines to include mental health domains rather than focusing exclusively on physical health domains. Prior studies have found that more than 50% of cancer patients suffer a level of depression that compromises quality of life and health (
Although mood disturbance is a common manifestation in all cancers that require clinical attentio... more Although mood disturbance is a common manifestation in all cancers that require clinical attention, very little is known regarding the psychiatric management of depression in patients with gastrointestinal carcinoid tumors. The goal of this study was to evaluate the degree of depression among patients with gastrointestinal carcinoid tumors, determine the prevalence of selective serotonin reuptake inhibitor (SSRI) use among these patients, and determine whether SSRI users differed from nonusers on demographic and general medical variables. Approximately 22% of the respondents in this study met screening criteria for clinically elevated or borderline depression. Moreover, 7% of respondents were following an SSRl regimen, whereas 7% were following a non-SSRI antidepressant regimen. Analyses revealed no differences on demographic or general medical indicators between SSRI users and nonusers. The growing appreciation of quality of life in the treatment of cancer has expanded the scope of comprehensive care guidelines to include mental health domains rather than focusing exclusively on physical health domains. Prior studies have found that more than 50% of cancer patients suffer a level of depression that compromises quality of life and health (
To help providers better target services toward specii c patient needs, we conducted a prospectiv... more To help providers better target services toward specii c patient needs, we conducted a prospective study of parents' health beliefs, insurance status and demographics as they predicted paediatric emergency room (ED) utilization. Parents/legal guardians (n 5 388) of children ages 0–17 years with minor illnesses completed demographic and health belief questionnaires while waiting for their child to be seen. Post-discharge, children's medical records were reviewed for insurance and utilization information. Higher perceived barriers, higher perceived bene ts of care and public insurance status predicted higher ED utilization. Qualitative data indicated that parents used the ED primarily because their regular clinic was closed or had no available appointments. Results are discussed as they relate to a risk pro le for higher ED utilization, and practice implications are presented. In the USA, the medical community has expressed concern over rapidly growing paediatric emergency department (ED) utilization because it involves increased cost, discontinuous and/or inadequate care and reallocation of medical staff away from potentially more serious emergencies (Feigelman et al., 1990). Furthermore, paediatric ED visits may disrupt family living patterns and children's school performance (Wasilewski et al., 1996). Our goal in this study was to examine how parental attitudes, specii cally health beliefs, and contextual factors predicted paediatric ED utilization. Information on predictors of ED utilization could help clearly identify appropriate target points for direct intervention, eventually leading to more appropriate and exible use of medical services. This study also identi es speci c ED patient needs, including those that are potentially unmet within the current system of care.
The number of children in nontraditional families is growing. The objective of this study was to ... more The number of children in nontraditional families is growing. The objective of this study was to determine the effects of family structure on the course of childhood steroid-sensitive idiopathic nephrotic syndrome (SSNS). Sixteen children, 2–15 years of age, with SSNS were enrolled in the study. The effects of family structure (traditional versus nontraditional) on the number of hospitalizations and outpatient visits for the previous 2 years and disease relapses for the preceding year were evaluated. Behavior differences were assessed using the Child Behavior Checklist (CBCL). Of the 16 families, 9 were traditional and 7 nontraditional. Hospitalizations , outpatient visits, and behavior were not different between family groups. However, children from nontraditional homes relapsed 3 times more than children from traditional homes (P=0.003). We conclude that children with SSNS from nontraditional homes may be at risk for more relapses compared with children from traditional families. Heightened support and monitoring is necessary for these children. Keywords Steroid-sensitive nephrotic syndrome · Relapse · Psychosocial functioning · Behavior problems · Family structure · Child behavior checklist
Objective: To examine maternal prenatal expectations for epidural uptake with their intrapartum a... more Objective: To examine maternal prenatal expectations for epidural uptake with their intrapartum actual epidural uptake followed by maternal postpartum reporting. Background: Childbearing women may or may not expect to have an epidural in childbirth, but the match between expected and actual epidural uptake has not been examined. The issue is important because childbirth expectations have been associated with actual experiences and later adjustment. Methods: Prospective, longitudinal study of 55 obstetric clinic patients from the US Pacific Northwest region. In the third trimester of pregnancy, participants reported on epidural expectation and fear of childbirth pain. Postpartum reports included birth characteristics, satisfaction, and description of epidural uptake. Results: Of the 21 participants who expected to have an epidural, 18 (86%) did; of those who did not expect one, 6/16 (38%) did not have one. Fourteen (78%) of the 18 who expected to 'wait and see' had an epidural. Birth satisfaction was significantly higher in confirmed vs. violated expectation subgroups. Qualitative data identified factors potentially involved in epidural uptake expectancy violations. Conclusions: This study on expected vs. actual epidural uptake has identified specific factors in the pathway to expectancy violation such as late-term pregnancy concerns, labour onset timing, and medical induction, which has important implications for research and counselling on birth options.
The maternal patient-provider relationship is important in birth experiences. However, no measure... more The maternal patient-provider relationship is important in birth experiences. However, no measures of obstetric patient-provider relationship quality exist, perhaps partially explaining why the concept has not been systematically studied in pre-and perinatal psychology and related fields. As a first step in this line of inquiry, we examined a care provider trust measure completed by 70 obstetric clinic patients along with state anxiety, fear of childbirth, and postpartum satisfaction measures. The trust measure performed similarly with our sample as in the original validation. Trust scores were similar across provider type (midwife vs. physician) and demographic variables. Correlations between trust, anxiety, and childbirth fear were low to moderate. The provider trust measure shows promise for advancing understanding of maternal and provider influences on the care relationship and outcomes.
Anxiety symptoms are common during pregnancy. However, predictors of prenatal anxiety have not be... more Anxiety symptoms are common during pregnancy. However, predictors of prenatal anxiety have not been well researched. We tested a model of pregnancy anxiety conceptualized from a stress and coping framework in which pregnancy wantedness, maternal attachment style, and attachment history were expected to predict anxiety in late pregnancy. Controlling for parity and risk, maternal attachment history significantly predicted general anxiety symptoms. Current relationship and/or attachment difficulties predicted general anxiety and prenatal anxiety subdimensions. Pregnancy wantedness significantly predicted one pregnancy-specific anxiety dimension. Pregnancy wantedness, suboptimal personal attachment experiences, and current relationship and/or attachment difficulties are risk factors for prenatal anxiety.
In the U.S. and other industrialized nations, the prevailing childbirth approach has been describ... more In the U.S. and other industrialized nations, the prevailing childbirth approach has been described as medicalized, a view in which safe birth is characterized as requiring specialized intervention. From the perspective that birth attitudes are largely enculturated, we assessed medical and natural birth attitudes among 1,467 nulliparous university women and men, expecting that pre-parents would endorse medical more strongly than natural birth attitudes. We analyzed data in subgroups categorized by sex, race, and future childbearing plans. White men and women who did not plan to have children scored significantly higher on the medical than natural birth scale whereas non-white women and men rated the natural birth scale higher. Our results reflect the complex interplay between demographics and birth philosophy and indicate the need for awareness of enculturated beliefs, particularly in developing childbirth informational campaigns to address growing evidence indicating that intensive intervention has not led to measurably increased maternal or newborn health.
Contemporary models of family adjustment, namely the goodness of fit model and the organizational... more Contemporary models of family adjustment, namely the goodness of fit model and the organizational ecology conceptual frameworks, are limited in their application to the complexities of family foster care. However, the family adjustment and adaptation response (FAAR) model exists as a viable model for research and clinical applications in family foster care. In this article we discuss the FAAR model's relative advantages in understanding family foster placement and review available studies based on specific FAAR model components. Working with foster families using the FAAR model is described. We conclude by discussing research and practice implications derived from family foster placement research based on a FAAR conceptual framework. Finally, a case example involving application of the FAAR model is offered.
The effects of a widely used expressive writing intervention on adolescents' somatic symptoms, di... more The effects of a widely used expressive writing intervention on adolescents' somatic symptoms, distress, and positive psychological functioning were evaluated. Eighth-grade (n = W6) students were randomly assigned to write about either an emotional or a neutral topic for 3 consecutive days. Students completed measures of somatic symptoms, medical visits, distress, and positive functioning at baseline, postinter-vention, and 2 and 6 weeks later. Somatic symptoms and medical visits were unchanged as a result of the intervention. However, significant Time x Condition effects indicated thai optimism scores increased, negative-affect scores decreased, and positive affect words in student essays increased in the experimental condition. Expressive writing shows promise as a cost-efficient intervention to address the emotional concerns of young adolescents: further work with clinical populations may lead to even more robust results.
Objectives: Women across the globe seek acupuncture to treat pregnancy concerns. Randomized contr... more Objectives: Women across the globe seek acupuncture to treat pregnancy concerns. Randomized controlled trials have indicated limited benefits of acupuncture in pregnancy, but field studies involving practitioners are needed to better understand the outcomes of usual care. To advance research on pregnancy acupuncture, this study engaged field-based practitioners to discuss research strategies. Settings/Location: U.S. Pacific Northwest region. Design and participants: Live focus group with regional specialized acupuncturists. Content analysis involved research team and interviewees. Results: Practitioners generally focused on patient care, although they discussed valuing research for communicating with patients and biomedical practitioners. To increase research in this area, practitioners proposed partnering with professional organizations, using social media, assuring confidentiality, and designing brief measurement tools. Conclusions: Practitioners valued evidence for specific uses and proposed several novel research strategies. On the basis of these results, a framework is proposed for building a patient-centered collaboration between research and practice communities that is responsive to paradigmatic preferences and the overarching goals of science.
Coronary heart disease is the leading cause of mortality in adult women, and recent trends indica... more Coronary heart disease is the leading cause of mortality in adult women, and recent trends indicate that risk for women, particularly working mothers, has worsened during the last decade. The absence of a biological explanation for this gender discrepancy has led some to look to psychosocial risk factors. This literature review examines the effect of multiple roles on women's cardiovascular health. Further, a conceptual model of heart disease risk is proposed, which introduces background stress, a chronic stress burden, as a potential pathway between multiple roles and heart disease. Trends in the literature largely support the proposed conceptual model. Multiple roles that often place conflicting demands on women may affect health outcomes through an increase in total background stress.j abr_ 4..22
This study examined a mediated-effects stress and coping model among cancer patients with carcino... more This study examined a mediated-effects stress and coping model among cancer patients with carcinoid tumors to identify specific pathways with a view toward determining (a) which coping strategies predict more positive adjustment, (b) which strategies predict less positive adjustment, and (c) whether coping would mediate the effect of optimism on psy-chosocial outcomes. Coping strategies partially mediated the effects of optimism on the psychological adjustment in cancer patients with carcinoid tumors. Specifically, self-blame and active coping significantly predicted outcomes of distress. Thirty-seven percent of the respondents met criteria for elevated depressive symptoms warranting intervention. Generalizability of the mediated-effects stress and coping model and findings unique to the carcinoid population are discussed. As technological advances have improved the prognosis for cancer patients and have contributed to prolonged survival, understanding the psychosocial consequences of disease has become increasingly important to patients, families, and health care providers. More than 9,000 articles have been published in the past decade on the psychosocial aspects of cancer, but only 9 articles have been published on the psychosocial aspects of carcinoid cancer (Berglund & Sjoeden,
Although mood disturbance is a common manifestation in all cancers that require clinical attentio... more Although mood disturbance is a common manifestation in all cancers that require clinical attention, very little is known regarding the psychiatric management of depression in patients with gastrointestinal carcinoid tumors. The goal of this study was to evaluate the degree of depression among patients with gastrointestinal carcinoid tumors, determine the prevalence of selective serotonin reuptake inhibitor (SSRI) use among these patients, and determine whether SSRI users differed from nonusers on demographic and general medical variables. Approximately 22% of the respondents in this study met screening criteria for clinically elevated or borderline depression. Moreover, 7% of respondents were following an SSRl regimen, whereas 7% were following a non-SSRI antidepressant regimen. Analyses revealed no differences on demographic or general medical indicators between SSRI users and nonusers. The growing appreciation of quality of life in the treatment of cancer has expanded the scope of comprehensive care guidelines to include mental health domains rather than focusing exclusively on physical health domains. Prior studies have found that more than 50% of cancer patients suffer a level of depression that compromises quality of life and health (
Although mood disturbance is a common manifestation in all cancers that require clinical attentio... more Although mood disturbance is a common manifestation in all cancers that require clinical attention, very little is known regarding the psychiatric management of depression in patients with gastrointestinal carcinoid tumors. The goal of this study was to evaluate the degree of depression among patients with gastrointestinal carcinoid tumors, determine the prevalence of selective serotonin reuptake inhibitor (SSRI) use among these patients, and determine whether SSRI users differed from nonusers on demographic and general medical variables. Approximately 22% of the respondents in this study met screening criteria for clinically elevated or borderline depression. Moreover, 7% of respondents were following an SSRl regimen, whereas 7% were following a non-SSRI antidepressant regimen. Analyses revealed no differences on demographic or general medical indicators between SSRI users and nonusers. The growing appreciation of quality of life in the treatment of cancer has expanded the scope of comprehensive care guidelines to include mental health domains rather than focusing exclusively on physical health domains. Prior studies have found that more than 50% of cancer patients suffer a level of depression that compromises quality of life and health (
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Papers by Elizabeth Soliday