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Research Day at the Institute of Living Highlights Promising New Work

July 26, 2022

The mental health needs of student athletes, people who have attempted suicide and minority youth facing behavioral diagnoses were among the topics addressed in projects presented as part of Research Day at the Institute of Living (IOL).

Sponsored by the IOL’s Postdoctoral Fellowship Program, the presentations focused on quality improvement and meeting the needs of clients seeking mental health services through the Hartford HealthCare Behavioral Health Network, which includes the IOL.

“These projects have a meaningful impact on how we act on an interventional and programmatic level,” noted Stacy Cruess, PhD, director of psychology and training at the IOL. “A deep appreciation for and understanding of research is one of the things that sets psychologists apart.”

The presentations included:

• Dr. Margaret Azar, “Caring Connection Calls QI project: Are we saying and doing what we think we are?”
  • Caring Connection Calls (CCC) is the practice of reaching out to patients once they’ve been discharged from the IOL after a suicide attempt. Noting that the most vulnerable time for these patients is one month after discharge, Dr. Azar probed the impact of CCCs as support. Examining a subset of patients over five weeks, she discovered troubling details exist. These include: systematic barriers such as length of time for the patients to be seen in an outpatient setting; patients’ individual needs may impact their perception of the CCC as support; the variation in timing of the calls could alter their impact. She suggested more closely examining whether calling within 24 hours or up to 10 days after discharge can make a difference, as well as whether the CCCs reduce patient readmission rates.
• Dr. Samuel Bauer, “Utilization of Psychological Assessment in Diagnosis: An exploratory study.”
  • Curious as to how psychological testing is incorporated into a patient’s treatment plan and inpatient care, Dr. Bauer examined patient files to see if any diagnoses were changed after such assessment was conducted. Accuracy in mental health care, he said, is “not ideal” as indicated by frequent diagnostic errors and low levels of diagnostic agreement between mental health professionals. “There’s a lack of access to expert consultation and pressure to diagnose in a limited time,” he said. In a review of 300 patient charts between May 2021 and April 2022, he looked at diagnosis during the inpatient intake process, upon receiving psychological assessment and then at discharge. He found significant differences between the types of diagnoses patients received at these times. In particular, trauma-related and personality disorders were much more often diagnosed during psychological testing but not during intake or discharge. This could result from difficulty assessing for these disorders, a tendency to avoid diagnosing disorders that are less treatable through pharmacological treatment alone, or the sense that these disorders are not as relevant as mood or psychotic disorders during inpatient treatment. While the specific explanation for these findings is not yet clear, future research could help identify why these discrepancies in diagnosis occur.
• Dr. Jessica Stubbing, “Ideation to Action: Understanding the role of substances in the suicide attempts of adults with substance use disorder (SUD).”
  • Wondering why people with SUD are four times as likely as others to die by suicide, Dr. Stubbing investigated two categories: baseline vulnerability, in which patients agreed SUD contributed to their suicide attempt; and fluid vulnerability, in which SUD could precede a suicide trigger, serve as the suicide trigger, occur after a suicide attempt or serve as the means for the suicide attempt. The latter proved to be the majority of patients she reviewed. In all study subjects, she found that SUD contributed to acute risk of suicide in some way. Going forward, she suggested patients coming into the IOL not only be asked generally about substance use, but more pointed questions about what they use and how often. She also saw an opportunity for clinicians to work with patients on safety planning and provide education about how substances are used as coping strategies.
• Dr. Colin Stanton, “Associations between anxiety symptoms and coherences of fact vs. slow scalp-recorded brain electrical activity.”
  • Using electroencephalogram (EEG) technology, in which electrodes in a special cap are placed on the scalp to record the brain’s electrical activity, Dr. Stanton examined EEG results to investigate whether certain patterns of brain activity are associated more strongly with physical or cognitive symptoms of anxiety such as worrying. He discovered no significant associations between the brain activity patterns of interest and physical vs. cognitive anxiety. Dr. Stanton noted that the hypothesized associations might not exist or might be too small to detect, or that some aspects of the study design (such as examining only patients with high anxiety) could have interfered. He suggested that, in the future, more in-depth work should be conducted to clarify the brain networks that primarily contribute to observed patterns of electrical activity.
• Dr. Meghan Krasnow, “Student-athletes’ perceptions of an interest in sport psychology services.”
  • In her work through the Bone & Joint Institute with Trinity College student athletes, Dr. Krasnow wondered about the kinds of support services that may be of interest to students (group, individual or a combination). Through a survey, she discovered that an “overwhelming” number would welcome team and individual support in such areas as mindfulness, concentration, team cohesion, sports confidence and combatting performance anxiety. While no respondents perceived the potential help as negative, 50 percent felt it would be positive and the other 50 percent was undecided. Dr. Krasnow said one next step would be to determine how to reach those undecided. She also noted that many of the responding student athletes were first- and second-year students, meaning they might also be feeling the strain of being away from home for the first time. Stemming from this important work, Dr. Krasnow will work to develop worksheets for student athletes on the topics of identified need.
• Dr. Lyssa Micheel, “Differences in disruptive behavior diagnosis between White and Nonwhite students with elevated Achenback Externalizing Behavior Scale scores.”
  • Although there seems to be no difference between White and Nonwhite students when diagnosing Attention Deficit Hyperactivity Disorder, Dr. Micheel’s study found that Nonwhite students were diagnosed with disruptive behavior disorders at twice the rate of their White peers. She emphasized the importance of considering cultural and societal factors when evaluating all children. She suggested clinicians look at potential factors going forward to address any racial biases that might influence their conclusions.
• Dr. Brien Goodwin, “Staffing variables as predictors of restraint outcomes.”
  • The IOL’s focus on the use of restraints and seclusion for patients has examined patient factors such as diagnosis and history of violent outbursts. Dr. Goodwin went a step further with his research to examine staffing and organizational factors such as low morale, staffing changes and increased workloads to see if they caused an increase in the use of restraints or seclusion tactics. When delving into patient records, he discovered that patients being restrained or secluded averaged one episode a day, and episodes were more frequent on Fridays and Sundays. He found that good communication during a restraint or seclusion episode was linked to lower risk of staff injury. This led him to conclude that it was important for leadership to attend to staff variables as part of quality improvement.
• Dr. Katelyn Yunes, “The relationship between endocrine therapy patients’ subjective report of forgetfulness vs. objective data.”
  • Endocrine treatment is associated with the report of forgetfulness in 45 percent of breast cancer patients. Dr. Yunes examined if psychological assessment can corroborate the experience of patients. Tapping neuropsychological data from patients on endocrine therapy, she discovered no significant connection supporting patient reports of cognitive impairment, prompting her to wonder if the testing is sensitive enough to pick up on subtle changes. She noted that patients were only asked about impairment during one round of endocrine treatment, so the results may vary based on the length of treatment. For the future, she recommended testing patients before and after treatment, and using a larger sample in research.