Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression.Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to 1 year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n = 112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n = 102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. Results: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P < .001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P < .001).Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.

The present research examined attributions of shy persons in the interpersonal situation of romantic relationships. Two hundred fifteen undergraduate psychology students were administered the Beck Depression Inventory (BDI), the Social Avoidance and Distress Scale (SAD), and the Romantic Relations Attributions Questionnaire (RRAQ). Correlations are reported for both the SAD and the BDI with the RRAQ. Partial correlations of the SAD with the RRAQ with depression removed also are reported. Results suggest that shy people attribute causality in romantic relationships in ways typically associated with depressed people. Moreover, observed gender differences suggest that shy females may be more committed to making a relationship work, whereas shy males may be more willing to abandon a problematic relationship.

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Studies indicate parent conversations focused on child weight, shape, or size are associated with unhealthy child weight and weight-related behaviors, whereas health-focused conversations are not. Little research has examined what these types of conversations sound like, how parents respond to them, and whether households with or without a child with overweight/obesity approach these conversations differently. This study used qualitative data to identify the weight-and health-focused conversations occurring in racially/ethnically diverse households. Children aged 5-7 years and their families (n ϭ 150) from 6 racial/ethnic groups (i.e., African American, Hispanic, Hmong, Native American, Somali, White) participated in this mixed-methods study. Results showed that parents from households with and without a child with overweight/obesity engaged in similar weight-and health-focused conversations (qualitative themes ϭ focus on growth; health consequences of having overweight/obesity; focus on dietary intake and physical activity; being direct about weight, shape, or size; mixing weight-and health-focused conversations). In addition, findings showed that parents also engaged in different types of weight-and health-focused conversations, depending on whether the household had a child with overweight/obesity (qualitative themes ϭ weight-based teasing; critiquing own weight) or without overweight/obesity (qualitative themes ϭ differences in body shape and size are the norm; focus on modeling rather than talking). Results may be useful for informing public health interventions and for health care providers working with parents regarding weight-and health-focused conversations occurring in home environments of diverse children.

Background and Objectives: The United States has seen an evolving perspective on the medical use of cannabis in recent years. Although a majority of states have enacted medical cannabis programs, physicians practicing in these states report a lack of knowledge, lingering concerns, and a need for more training regarding medical cannabis. This study provides a current snapshot of medical cannabis education in an academic family medicine department in a state with a medical cannabis program.