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Open Access Publications from the University of California

Scholarly Works (15 results)

  • Article
  • Peer Reviewed
UC Davis Previously Published Works (2019)

Objective

The primary purpose of the study was to assess the prevalence of adverse childhood experiences (ACEs) in a cohort of third-year medical students and characterize their childhood protective factors.

Methods

The authors developed a web-based anonymous survey distributed to all third-year medical students in one school (N = 98). The survey included the 10-item ACE Study questionnaire, a list of childhood protective factors (CPF) and questions to assess students' perception of the impact of ACEs on their physical and mental health. The medical school's IRB approved the student survey as an exempt study. The authors computed descriptive and comparative statistical analyses.

Results

Eighty-six of 98 students responded (88% response rate). Forty-four students (51%) reported at least one ACE exposure and 10 (12%) reported ≥ 4 exposures. The latter were all female. The average difference in the ACE score between male and female medical students was - 1.1 (independent t test with unequal variances t(57.7) = - 2.82, P = .007). Students with an ACE score of ≥ 4 were significantly more likely to report a moderate or significant effect on their mental health, compared with students with scores ≤ 3 (chi-square test, P = < .0001). Most students reported high levels of CPF (median score = 13 of a maximum score = 14). ACEs and CPF were inversely associated (Pearson correlation = - 0.32, P = .003).

Conclusions

A sizeable minority of medical students reported exposure to multiple ACEs. If replicated, findings suggest a significant vulnerability of these medical students to health risk behaviors and physical and mental health problems during training and future medical practice.
    Cover page: Adverse Childhood Experiences in Medical Students: Implications for Wellness.
    • Article
    • Peer Reviewed
    UC Davis Previously Published Works (2017)

    Context

    Exposure to traumatic events is common in primary care patients, yet health care professionals may be hesitant to assess and address the impact of childhood trauma in their patients.

    Objective

    To assess patient preferences for discussing traumatic experiences and posttraumatic stress disorder (PTSD) with clinicians in underserved, predominantly Latino primary care patients.

    Design

    Cross-sectional study.

    Main outcome measure

    We evaluated patients with a questionnaire assessing comfort to discuss trauma exposure and symptoms using the Adverse Childhood Experiences (ACE) Study questionnaire and the Primary Care-PTSD screen. The questionnaire also assessed patients' confidence in their clinicians' ability to help with trauma-related issues. Surveys were collected at an integrated medical and behavioral health care clinic.

    Results

    Of 178 adult patients asked, 152 (83%) agreed to participate. Among participants, 37% screened positive for PTSD, 42% reported 4 or more ACEs, and 26% had elevated scores on both measures. Primary Care-PTSD and ACE scores were strongly positively correlated (r = 0.57, p < 0.001). Most patients agreed they were comfortable being asked about trauma directly or through screening questionnaires and did not oppose the inclusion of trauma-related information in their medical record. In addition, most patients perceived their clinician as comfortable asking questions about childhood trauma and able to address trauma-related problems.

    Conclusion

    Screening is acceptable to most primary care patients regardless of trauma exposure or positive PTSD screening. Findings may aid primary care clinicians to consider screening regularly for ACEs and PTSD to better serve the health care needs of trauma-exposed patients.
      Cover page: Patient Preferences for Discussing Childhood Trauma in Primary Care
      • Article
      • Peer Reviewed
      UC Davis Previously Published Works (2018)
      INTRODUCTION:Adults exposed to traumatic events during childhood commonly seek medical services, but health care practitioners hesitate to address and assess early trauma despite its known negative health effects. This study examines medical students' perspectives on a brief course that addressed the health care needs of patients exposed to adverse childhood experiences. METHODS:A convenience sample of 20 University of California, Davis medical students from the Summer Institute on Race and Health received 6 hours of trauma-informed care training. The course was delivered in 2-hour modules during the course of 3 days, and included lectures, discussions, and practice. A questionnaire assessing students' perspectives on training benefits, current practice challenges, and necessary resources to provide trauma-informed medical care was distributed posttraining. RESULTS:From the students' perspectives, this course increased their ability to recognize various clinical manifestations of adverse childhood experience exposure in adult patients. Students said they learned how to ask about and respond to adverse childhood experience disclosures and identify necessary resources to responsibly implement trauma-informed care in medical settings. Students identified provision of adequate resources and links to appropriate treatment identified as common challenges in providing health care to trauma-affected patients. CONCLUSION:Study findings illustrate that trauma training can fill a knowledge gap and provide associated benefits for medical students. Initial training may pique students' interest by demonstrating the relevance of trauma knowledge in clinical practice; additional training likely is needed to support skills and confidence.
        Cover page: Medical Students’ Perspectives on Trauma-Informed Care Training
        • Article
        Psychiatry and Behavioral Sciences (2021)

        Objectives: Latino individuals report high rates of childhood trauma, but the impact of parenting styles on childhood maltreatment (CM) in this population is unknown. This study examined the association between CM and parental bonding (PB) among adult Mexican Americans and Mexican nationals seeking services at primary care and mental health clinics on both sides of the California-Mexico border.

        Methods: The Childhood Trauma Questionnaire and Parental Bonding Instrument were administered to 516 patients at one of 8 clinics in San Diego and Imperial, CA and Tijuana, Mexico between 2007 and 2008. Statistical analyses included Chi-square tests and multivariable logistic regression.

        Results: Among respondents, 305 reported moderate to severe CM and 210 reported mild or no CM. PB style of mothers [N=503, χ2 (3)=115.69, p < .001] and fathers [N = 417, χ2 (3)=70.4, p < .001] was significantly associated with CM history. Patients who characterized their maternal bonding as “affectionless control” had an 8.94-fold higher odds of reporting moderate to severe CM compared to patients who characterized their maternal bonding as “optimal parenting” (95% CI, 4.51 to 17.73). Patients who characterized their paternal bonding as “affectionless control” had a 10.90-fold higher odds of reporting moderate to severe CM compared to patients who characterized their paternal bonding as “optimal parenting” (95% CI, 4.96 to 23.96). Maternal and paternal “affectionless control” were associated with higher odds of emotional, physical, and sexual abuse and of emotional and physical neglect compared to “optimal parenting.”

        Conclusions: Suboptimal parenting near the California-Mexico border is associated with CM, which may negatively impact patients’ physical and mental health and socioeconomic opportunities into adulthood. These results may be used to develop and test parenting interventions in the border region to increase “optimal parenting” and decrease “affectionless control” practices.

          Cover page: Parental Bonding Styles and Their Association with Childhood Maltreatment Along the California-Mexico Border
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2011)
          A history of childhood sexual abuse (CSA) has been associated with adult depression, but data on abuse severity and disclosure are scant, particularly among low-income ethnic minorities. CSA often co-occurs with other adversities, which also increase the risk of depression. This study examined the peritrauma variable of abuse severity and the posttrauma variables of disclosure and self-blame as predictors of current depression symptoms in 94 low-income African-American and Latina women with histories of CSA. After controlling for nonsexual childhood adversity and adult burden (i.e., chronic stress), severe CSA overall was associated with higher depression scores, especially among Latinas who disclosed their abuse. Depression symptoms among African-American women were highest in those who disclosed and reported high levels of self-blame at the time of the incident. The link between depression and specific peri- and post-CSA factors in minority women may help guide future interventions.
            Cover page: Childhood Sexual Abuse Severity and Disclosure as Predictors of Depression Among Adult African-American and Latina Women
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2017)

            Background

            Family members often play important roles in the lives of depressed older men and frequently attend primary care visits with their loved ones, yet surprisingly little is known about how to most effectively engage and include family members in depression treatment. However, including family in depression treatment may be difficult due to several factors, such as depression stigma and family conflicts. The objective of this study was to describe challenges in engaging family members in older men's depression treatment and potential strategies to overcome those challenges.

            Methods

            A cross-sectional, qualitative descriptive interview study was conducted in a safety-net, Federally Qualified Health Center in California's Central Valley. A total of 37 stakeholders were recruited, including 15 depressed older (i.e. age ≥ 60) men, 12 family members, and 10 clinic staff. Depressed men were identified through mail outreach, waiting room screening, and referral. Depressed men identified family members who were later approached to participate. We also recruited a purposeful sample of clinic staff. Interviews explored stakeholder perspectives on family involvement in men's depression treatment as part of a primary care intervention. Interviews were conducted using a semi-structured interview guide, tape-recorded, transcribed verbatim, and translated if the interview was conducted in Spanish.

            Results

            Four themes were identified representing core challenges: engaging men at the right time; preserving men's sense of autonomy; managing privacy concerns; and navigating family tensions. Stakeholders also provided practical suggestions and advice about how each of these challenges might be addressed.

            Conclusions

            While engaging family is a promising approach to strengthen depression care for older men in primary care settings, several potential challenges exist. Family- centered depression intervention development and clinical practice need to anticipate these challenges and to develop approaches and guidelines to address them.
              Cover page: Family-centered depression treatment for older men in primary care: a qualitative study of stakeholder perspectives
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2021)

              Objective

              The objective of the study is to present results of a depression and suicide screening and treatment referral program for physicians at an academic medical center.

              Methods

              An anonymous web-based screening questionnaire was sent to all physicians at a large academic center. Responses were classified as indicating either high, moderate, or low risk for depression and suicide. Physicians at high and moderate risk were contacted by a counselor through a messaging system. The counselor's message contained information on risk level and an invitation to meet in person. High-risk respondents who did not reply to the message or declined to meet received mental health resources. Respondents who met with the counselor were offered individualized treatment referrals and to participate in a 1-year follow-up of self-reports every 3 months.

              Results

              The questionnaire was sent to approximately 1800 residents, fellows, and faculty from February 2013 through March 2019. A total of 639 questionnaires were received, 100 were excluded for various reasons, and 539 were used to conduct analyses (14.4% response rate). The majority of respondents were classified at moderate (333 [62%]) or high (193 [36%]) risk for depression or suicide. Eighty-three respondents were referred for mental health care, and 14 provided data for the follow-up study.

              Conclusions

              Results of screening physicians for depression and suicide at one academic medical center highlight the challenges of engaging most of them in this activity and the satisfaction of the minority who successfully engaged in a treatment referral program.
                Cover page: The Suicide Prevention, Depression Awareness, and Clinical Engagement Program for Faculty and Residents at the University of California, Davis Health.
                • Article
                Psychiatry and Behavioral Sciences (2024)
                Studies in recent years widely suggest that adverse childhood experiences (ACEs) may have a detrimental impact on the health of individuals.Less is known about this association among health professions students in particular. One recent study showed that ACEs may be associated with engaging in risk behaviors among medical students (Sciolla et al., 2019).In contrast, fewer studies have examined positive childhood experiences (PCEs) as a possible protective factor with respect to health outcomes such as psychological distress. Furthermore, research on the mechanisms that link PCEs to outcomes among professional health students is scant, although studies have suggested that resilience may also protect professional health students from experiencing psychological distress (Bacchi et al., 2017; Clark et al., 2023).
                  Cover page: Assessing Resilience as a Mediator in the Association between Positive Childhood Experiences and Psychological Distress among Health Professions Students
                  • Article
                  • Peer Reviewed
                  UC Davis Previously Published Works (2023)
                  Stressors inherent to training and stemming from the learning environment are associated with high rates of burnout, depression, and mental health problems in health professions students (HPS). There is evidence that disadvantaged or stigmatized groups are particularly affected. These problems not only impact students after graduation but may also have detrimental effects on patient outcomes. Resilience, conceptualized as the process of adapting well in the face of adversity, has inspired an increasing number of interventions aimed at addressing those problems in HPS. These interventions have mostly targeted individual students and their psychological traits while ignoring social and structural factors that may enhance or undermine individual resilience. To address this gap in the literature, the authors reviewed the evidence for psychosocial determinants of resilience and proposed a model inspired by the social determinants of health literature and the "upstream-downstream" metaphor. In this theoretical paper, the authors propose that upstream determinants such adverse childhood experiences and socioeconomic and sociodemographic markers of disadvantage have a direct effect on psychological adjustment and an indirect effect mediated by resilience. Additionally, the authors propose that the institutional downstream drivers of learning environment, social support, and sense of belonging moderate the direct and indirect effects of the upstream determinants on psychological adjustment. Future research should test these hypotheses and gather evidence that may guide the development of interventions. The authors present their model as part of a comprehensive response to recent calls to action to address diversity, equity and inclusion in health professions education.
                    Cover page: Modeling the social determinants of resilience in health professions students: impact on psychological adjustment
                    • Article
                    • Peer Reviewed
                    UC Davis Previously Published Works (2021)

                    Objective

                    Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress.

                    Methods

                    Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models.

                    Results

                    Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were "extremely" or "very" concerned about family members getting infected (n = 71, 76% School of Medicine (SOM); n = 31, 76% School of Nursing (SON); n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM; n = 28, 68% SON; n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001).

                    Conclusions

                    Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.
                      Cover page: Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students
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