BackgroundTrust and respect may be an important component of client-provider relationships. This study aimed to develop and report preliminary psychometric analyses of a new brief measure to evaluate a patient’s level of trust and respect for their clinician. The scale was designed to be applicable in multiple healthcare contexts, with a particular focus on mental healthcare.MethodsAdult patients completed the study survey in an academic outpatient psychiatric clinic waiting room. Classical and Item Response Theory (IRT) analyses were utilized to examine the adequacy of scale items. Validity was examined in relation to the patient-therapist alliance and to willingness to share private information (social media content) with one’s clinician.ResultsBeginning with 10 items, a final 8-item version of the measure was created with an internal consistency reliability of .91. Principal components analysis indicated that the scale was best viewed as capturing one overall dimension. A Graded Response Model IRT model indicated that all items contributed information on the latent dimension, and all item curves were not flat at any region. The correlation of the trust/respect total score with the alliance was .53 when respect-related items were deleted from the alliance score. The trust/respect scale was significantly associated with patient willingness to share social media posts with their clinician but the alliance was not.ConclusionsThe brief measure of patient trust and respect towards their clinician was unidimensional, showed good internal consistency, and was not redundant with existing measures of the alliance. The scale has the potential to be used in a wide variety of healthcare settings.

Objective: In response to the 2019 novel coronavirus pandemic, portions of the U.S. government implemented social distancing policies that, while necessary, yield unintended consequences. This article explores how risk for gender-based violence (GBV) has been exacerbated across the social-ecological model (SEM; e.g., by increasing economic stress and decreasing social support) and highlights differential impact across social locations (e.g., considering race, gender, social class). Method: Drawing on gender-based violence prevention and response research, considerations for researchers, policymakers, and practitioners are delineated. Results: A comprehensive framework adapting an intersectional lens and the SEM is used to explain the changes in risk and protective factors for GBV. Policy recommendations that serve to augment (not replace) social distancing policies are proposed. Conclusion: The pandemic has uprooted life in a way that impacts GBV prevention and response. Yet, this is also an opportunity to define a new way forward rather than return to "business as usual"; psychologists should strive to improve social services by utilizing the SEM and intersectionality. Clinical Impact StatementThis article is a resource to researchers, practitioners, and policymakers to support ongoing efforts combating and preventing gender-based violence now and beyond this pandemic. First, a framework for how social distancing policies' unintended consequences on gender-based violence can be considered is presented. Second, policy recommendations to augment social distancing policies are posited.

Objective: Our goal was to evaluate treatment attendance patterns, including both treatment completion and premature termination from treatment, for 2 evidence-based psychotherapies for major depressive disorder (MDD) delivered in a community mental health setting. We explored rates of premature termination across the course of treatment as well as the factors that predicted and moderated premature termination and treatment completion. Method: This investigation included 237 patients with MDD who participated in a noninferiority trial comparing short-term dynamic psychotherapy (DT) to cognitive therapy (CT). Patients in both conditions were offered 16 sessions of treatment and had up to 5 months to complete treatment. All patients completed an extensive self-report battery at treatment baseline as well as measures of the therapeutic alliance and opinions about treatment following Session 2. Results: Premature termination from both treatments was high with 27% of patients discontinuing treatment very early after only an intake session or a single treatment session. Patients in CT were significantly more likely to terminate treatment prematurely, 2 (3) ϭ 14.35, p ϭ .002. Baseline physical health functioning, subthreshold psychotic symptoms, Session 2 ratings of agreement on tasks, and Session 2 ratings of treatment sensibility all independently predicted premature termination of services. Trauma history significantly moderated very early termination of treatment, 2 (3) ϭ 10.26, p ϭ .017, with patients with high trauma histories more likely to complete DT but terminate prematurely from CT. Conclusions: Very early termination from services was higher in CT compared with DT. Including techniques to improve engagement in both therapies and matching patients to treatment based on predictors/moderators may be effective ways to optimize treatment engagement. What is the public health significance of this article?This study suggests that depressed patients with high trauma histories were more likely to discontinue cognitive therapy early compared with short-term dynamic therapy. It may be that dynamic techniques are useful to initially engage some patients in the treatment process.

Objective.-To introduce readers to instrumental variable analyses for causal inferences using as an example a test of the hypothesis that the quality of the therapeutic alliance has a causal role in relation to the outcome of psychotherapy.Method.-We used data from a recent non-inferiority trial of cognitive and dynamic therapies for major depressive disorder in a community mental health setting. The data (N = 161) were analyzed using standard approaches as well as a multilevel 2-stage instrumental variables approach that allows for causal interpretations by removing the influence of unmeasured confounds.Results.-Instrumental variables were created at the patient and therapist level using baseline patient and therapist variables. These baseline variables predicted the alliance but were otherwise unrelated to treatment outcome other than through their effects on the alliance. Standard multilevel mixed effects analyses revealed statistically significant associations of the alliance with outcome at the therapist level of analysis. The therapist level effect remained statistically significant when using the instrumental variables approach.Conclusion.-Our results support the hypothesis that, at least at the therapist level, the alliance plays a causal role in producing better outcomes. Instrumental variable analyses can be a useful tool to supplement standard analyses.

BackgroundPsychiatry research has begun to leverage data collected from patients’ social media and smartphone use. However, information regarding the feasibility of utilizing such data in an outpatient setting and the acceptability of such data in research and practice is limited.ObjectiveThis study aimed at understanding the outpatients’ willingness to have information from their social media posts and their smartphones used for clinical or research purposes.MethodsIn this survey study, we surveyed patients (N=238) in an outpatient clinic waiting room. Willingness to share social media and passive smartphone data was summarized for the sample as a whole and broken down by sex, age, and race.ResultsMost patients who had a social media account and who were receiving talk therapy treatment (74.4%, 99/133) indicated that they would be willing to share their social media posts with their therapists. The percentage of patients willing to share passive smartphone data with researchers varied from 40.8% (82/201) to 60.7% (122/201) depending on the parameter, with sleep duration being the parameter with the highest percentage of patients willing to share. A total of 30.4% of patients indicated that media stories of social media privacy breaches made them more hesitant about sharing passive smartphone data with researchers. Sex and race were associated with willingness to share smartphone data, with men and whites being the most willing to share.ConclusionsOur results indicate that most patients in a psychiatric outpatient setting would share social media and passive smartphone data and that further research elucidating patterns of willingness to share passive data is needed.