Psychiatry and Psychology Commons^™

Examining Predictors Of Cocaine Withdrawal Syndrome At The End Of Detoxification Treatment In Women With Cocaine Use Disorder, Bernardo Aguzzoli Heberle, Bruno Kluwe-Schiavon, Carla Bicca, Leonardo Melo Rothmann, Rodrigo Grassi-Oliveira, Thiago Wendt Viola

Faculty, Staff and Student Publications

BACKGROUND: Detoxification is frequently recommended as a treatment for moderate to severe Cocaine Use Disorder (CUD). However, the response to detoxification varies among patients, and previous studies have focused mostly on patterns of drug use behavior to test associations with treatment outcomes, overlooking the potential impact of psychosocial factors, other clinical variables, and individual life experiences. In this study we comprehensively examined several variables aiming to find the most relevant predictors to classify patients with severe versus non-severe cocaine withdrawal symptoms at the end of detoxification.

METHODS: Data from 284 women with CUD who enrolled in a 3-week detoxification program …

"They Are Expecting Us To Stay Strong": How Ambulance Personnel Navigate And Manage Their Emotions In A Rural Region Of Northern California, Tina M. Orton-Owens

Cal Poly Humboldt theses and projects

This research examines how emergency medical service (EMS) workers navigate and manage their calls in Humboldt County, a rural region of Northern California. The primary theoretical framework is drawn from Arlie Hochschild’s theory of Emotional Labor. This paper examines how emotional labor impacts EMS workers within a rural environment and with limited resources. I also look at how COVID-19 complicated EMS workers’ experiences. This paper is based on qualitative research where I conducted 13 mostly face-to-face interviews with EMS workers throughout the County between 2020 and 2022. Interviews consisted of 30 questions and interviews ranged in length from 1 to …

Perspective: The Evolution Of Hormones And Person Perception-A Quantitative Genetic Framework, Christopher I Gurguis, Tyler S Kimm, Teresa A Pigott

Faculty, Staff and Student Publications

Evolutionary biology provides a unifying theory for testing hypotheses about the relationship between hormones and person perception. Person perception usually receives attention from the perspective of sexual selection. However, because person perception is one trait in a suite regulated by hormones, univariate approaches are insufficient. In this Perspectives article, quantitative genetics is presented as an important but underutilized framework for testing evolutionary hypotheses within this literature. We note tacit assumptions within the current literature on psychiatric genetics, which imperil the interpretation of findings thus far. As regulators of a diverse manifold of traits, hormones mediate tradeoffs among an array of …

Nlrp3 Activation Contributes To Memory Impairment In An Experimental Model Of Pneumococcal Meningitis, Jaqueline S Generoso, Cristiano Julio Faller, Allan Collodel, Carlos Henrique Rocha Catalão, Diogo Dominguini, Fabricia Petronilho, Tatiana Barichello, Vijayasree V Giridharan

Faculty, Staff and Student Publications

Bacterial meningitis is considered a life-threatening condition with high mortality rates. In response to the infection, signaling cascades, producing pro-inflammatory mediators trigger an exacerbated host immune response. Another inflammatory pathway occurs through the activation of inflammasomes. Studies highlight the role of the NLR family pyrin domain containing 3 (NLRP3) in central nervous system disorders commonly involved in neuroinflammation. We aimed to investigate the role of NLRP3 and its inhibitor MCC950 on neurochemical, immunological, and behavioral parameters in the early and late stages of experimental pneumococcal meningitis. For this, adult male Wistar rats received an intracisternal injection of Streptococcus pneumoniae or …

Grief On Pain And Quality Of Life In Combat Veterans With Ptsd, Melba A Hernandez-Tejada, Madeleine Desrochers, Ron Acierno

Faculty, Staff and Student Publications

Background: Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health.

Objective: This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment.

Method: Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression. Veterans experiencing grief reported symptoms related to physical health, emotional problems, energy, …

Acute Exposure To Diisopropylfluorophosphate In Mice Results In Persistent Cognitive Deficits And Alterations In Senescence Markers In The Brain, Alvin V Terry, Wayne D Beck, Victoria Zona, Yutaka Itokazu, Ashutosh Tripathi, Amit Kumar Madeshiya, Anilkumar Pillai

Faculty, Staff and Student Publications

Organophosphates (OPs) are found in hundreds of important products used worldwide; however, they have been associated with adverse long-term health consequences ranging from neurodevelopmental deficits to age-related neurological diseases. OP exposure has also been implicated in Gulf War Illness; a cluster of medically unexplained chronic symptoms estimated to affect 25-32% of veterans of the Persian Gulf war in 1991. The development of multiple types of chronic illnesses in these veterans at an early age compared to the general population has led to the suggestion that they are experiencing signs of premature or accelerated aging. The process of cellular senescence and …

Enablers And Barriers Of Online Mindfulness-Based Interventions For Informal Carers: A Mixed-Methods Systematic Review, Charunya Amilani Kumarihami Rambukwella Abeysinghe Mudiyanselage, Beverley Ewens, Aisling Smyth, Joanne Dickson, Seng Giap Marcus Ang

Research outputs 2022 to 2026

Objectives: Informal carers are an integral part of any health care system. However, provision of informal care is associated with caregiver burden and decreased wellbeing. Mindfulness programs can reduce caregiving burden and improve wellbeing among informal carers, but they face challenges when participating in face-to-face programs. Studies have explored the effects of online delivery of mindfulness programs for informal carers. However, the enablers and barriers for participation are not well understood. This review aimed to synthesise the evidence and provide a comprehensive understanding of the enablers and barriers to participation in online mindfulness programs among this population. Methods: A mixed-methods …

Cigarette Smoking Behaviors And Nicotine Dependence At The Intersection Of Sexual Identity And Sex In The United States: Findings From The National Survey On Drug Use And Health, Ollie Ganz, Jonathan A. Schulz, Sarah J. Ehlke, Jessica L. King Jensen, Andrea C. Villanti

Psychology Faculty Publications

Introduction: Cigarette smoking is disproportionately high among lesbian, gay, and bisexual (LGB) adults. Yet, collapsing these identities into a monolith can disguise important within group disparities (e.g., lesbian/gay versus bisexual female). The purpose of this study is to report recent national prevalence estimates and trends of cigarette smoking behaviors and nicotine dependence by sexual identity and sex. Methods: Data were from the 2015–2019 National Survey on Drug Use and Health (n = 210,392; adults 18+), a nationally representative, repeated cross-sectional study of substance use and mental health in the U.S. We examined bivariate and multivariable associations between sexual identity and …

Assessment Of Simultaneous Alcohol And Cannabis Use And Its Related Consequences And Cognitions In College Students: A Narrative Review, Jennifer L. Shipley, Abby L. Braitman

Psychology Faculty Publications

As rates of students using cannabis continue to rise, simultaneous use of alcohol and cannabis (such that their effects overlap; commonly referred to as simultaneous alcohol and marijuana [SAM] use) is prevalent among college students who use both substances. Although research focusing on SAM use and related cognitions and consequences continues to grow, there are no common established measures, as approaches vary across studies. This narrative review identifies current methods for assessing SAM use and measures of SAM-related consequences and cognitions (motives and expectancies) among college students, evaluates how they were developed, identifies gaps in the literature, and provides recommendations …

Mental Workload Modulates The Effects Of Baroreceptor Afferents On Sensorimotor Processing, Xiao Yang, Katie Herberlein, Anthony Reid, Dongfang Jiao, Fang Fang

Psychology Faculty Publications

The heart–brain interaction is the main mechanism for maintaining normative physiological processes, and its dysregulation underlies the somatic symptoms of various mental disorders. Cortical inhibition, triggered by afferent signals from baroreceptor activation, induces systematic variations in sensorimotor responses within a cardiac cycle, with reaction times (RTs) slower at cardiac systole compared to diastole (known as cardiac cycle time effects). However, recent data suggest that baroreceptor afferents not only inhibit simple responses but also facilitate complex sensorimotor responses during cardiac systole. The mental workload that is implicated in complex responses may modulate the cardiac cycle time effects. The current study aimed …

Insights Into Child Abuse And Neglect: Findings From The Minnesota Longitudinal Study Of Risk And Adaptation, Marissa D. Nivison, Madelyn H. Labella, K. Lee Raby, Jenalee R. Doom, Jodi Martin, William F. Johnson, Osnat Zamir, Michelle M. Englund, Jeffry A. Simpson, Elizabeth A. Carlson, Glennn I. Roisman

Psychology Faculty Publications

The Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) is a landmark prospective, longitudinal study of human development focused on a sample of mothers experiencing poverty and their firstborn children. Although the MLSRA pioneered a number of important topics in the area of social and emotional development, it began with the more specific goal of examining the antecedents of child maltreatment. From that foundation and for more than 40 years, the study has produced a significant body of research on the origins, sequelae, and measurement of childhood abuse and neglect. The principal objectives of this report are to document the …

Short-Term Blood Pressure Variability Among Young Adults At High Or Low Risk For Depression, Balázs Bence Nyárády, Miklós Vértes, Edit Dósa, Xiao Yang, Charles J. George, Enikõ Kiss, Iidiko Baji, Krisztina Kapornai, Maria Kovacs

Psychology Faculty Publications

Background: Depression has been shown to have adverse effects on blood pressure (BP) and is associated with high blood pressure variability (BPV). In turn, high short-term BPV has been related to eventual cardiovascular risk. But it is not clear how early in adulthood the detrimental effects of depression on BPV may be discerned, if being at high risk for depression also compromises BPV, and whether the clinical features of depression moderate its adverse effects. We investigated these three issues among young adults using an office-like setting. Methods: In total, 218 subjects with a history of childhood-onset major depressive episodes (probands), …

Neuroticism Mediates The Association Between Autistic Traits And Choice Reaction Time Among Young Adults, Kassandra De Jesus Cintron, Xiao Yang

Psychology Faculty Publications

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that influences an individual’s cognitive functions and social interaction. While most studies have focused on children and adolescents diagnosed with ASD, elevated levels of autistic traits in subclinical populations may also influence individuals’ daily functioning. Autistic traits are also linked to the Big Five personality. In particular, neuroticism (emotion instability) has been shown to be positively associated with autistic traits, which may contribute to behavioral symptoms of autistic traits. The present study aimed to investigate the association between autistic symptoms and sensorimotor processing among a subclinical population. One hundred young adults (M …

Facilitating Thought Progression To Reduce Depressive Symptoms: Randomized Controlled Trial, Shai-Lee Yatziv, Paola Pedrelli, Shira Baror, Sydney Ann Decaro, Noam Shachar, Bar Sofer, Sunday Hull, Joshua Curtiss, Moshe Bar

Psychology Faculty Publications

Background:

The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health-based intervention designed to systematically facilitate thought progression would substantially alleviate depression.

Objective:

The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was …

Insights From A National Database For Programs Supporting Neuropsychiatric Symptoms Of Dementia In Australia, Mustafa Atee, Thomas Morris, Daniel Whiting, Stephen Macfarlane, Marie Alford

Research outputs 2022 to 2026

No abstract provided.

Psychedelic Trip Sitting, Dosages And Intensities: Supplementing Clinical Studies With Anecdotal Reports, Liam B. Engel, Sascha Thal, Stephen J. Bright, Mitchell Low

Research outputs 2022 to 2026

Background and aims: Online communities provide insights into psychedelic consumption, assisting in identification of trends, informing both harm reduction provisions and clinical research. This study extracts forum data on psychedelic substances, dosages, and administration routes, categorising and analysing self-reported consumption to inform care services and guide clinical work with psychedelics. Methods: Posts (n = 660) from online psychedelic forums (The Shroomery and DMT Nexus) on 'trip sitting' were analysed. Using a Delphi-style expert panel review facilitated by LE, we created drug weight and intensity charts (threshold, light, common, strong and heavy dosages) for psychedelics discussed in these posts. The psychedelic …

Experiences Of The Change Process During Emotion Focused Group Therapy, Jason M. Sharbanee, Kirra Rauchelle, Marina Nelson, Eyal Gringart

Research outputs 2022 to 2026

Emotion Focused Group Therapy has demonstrated preliminary efficacy for multiple syndromes. The groups involve individual chair-work in the context of the group, followed by interpersonal processing of the aroused emotions. So far there has been limited investigation of the mechanisms of change, including participants’ experiences of the change process. This study aimed to qualitatively examine participants’ experiences of the change process during Emotion Focused Group Therapy. Sixteen participants were interviewed about their experiences of the change process during the therapy group. The interview was structured to move from overarching reflections on the process of change, to specific experiences of their …

Changes In Psychiatric Diagnosis Associated With Sars-Cov-2 Infection And Predicting The Development Of New Psychiatric Illness In Covid Patients By Using Machine Learning Approach: A Study Using The Us National Covid Cohort Collaborative (N3c), Asif Rahman

Graduate Theses, Dissertations, and Problem Reports (ETD)

The enduring impact of COVID-19 extends beyond acute illness, with potential long-term psychiatric consequences raising significant concern among healthcare professionals and researchers alike. Emerging evidence suggests a multifaceted relationship between COVID-19 and the development of different psychiatric illnesses like Schizophrenia Spectrum and Psychotic Disorders (SSPD), Depression, Bipolar disorder, Personality disorder, Trauma, and a range of other mental health conditions. Considering these emerging connections, our study endeavors to rigorously assess the associations between COVID-19 and various psychiatric illnesses while simultaneously employing machine learning techniques to predict the development of new psychiatric disorders in individuals affected by the virus. Leveraging the extensive …

Genetic Knowledge And Causal Beliefs: Implications For Health Behavior In Clinical And Non-Clinical Samples, Jamey T. Brumbaugh

Graduate Theses, Dissertations, and Problem Reports (ETD)

Objective: As the genomic era in healthcare continues to surge, it is vital to examine genetically-related psychological concepts, such as genetic knowledge and genetic causal beliefs, in genetically relevant clinical groups. Parents /caregivers of children born with cleft lip and/or palate represent a population whose knowledge and beliefs about genetics may be influenced by their frequent utilization of genetically-related healthcare services (e.g., genetic testing and genetic counseling). To date, little is known about how such beliefs vary across disease types. Even less is known regarding how disease-specific genetic causal beliefs relate to perceived behavioral control for disease development. Method: A …

The Relationship Between Moral Thought-Action Fusion And Scrupulosity Across Judaism, Christianity, And Islam, Kelsey Evey

Graduate Theses, Dissertations, and Problem Reports (ETD)

Scrupulosity is a subtype of obsessive-compulsive disorder (OCD) where individuals are upset by intrusive thoughts related to religious or moral issues. Current research suggests that scrupulosity occurs across the major world religions—including the Abrahamic religions (i.e., Judaism, Christianity, and Islam). Some research suggests that moral thought-action fusion (moral TAF), a dysfunctional belief that thinking something is equal to doing it, may only be pathological under certain circumstances (e.g., if it is not culturally normative). If this is true, the current cognitive model of scrupulosity may need to be amended to reflect how cultural differences impact the role of moral TAF …

Self-Efficacy And Parental Miscarried Helping In Adherence And Transition Readiness Among Adolescents And Young Adults With Epilepsy, Kirby-Estar G. Laguerre

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Given the complex regimen associated with epilepsy, ensuring that adolescents and young adults (AYAs) adhere to their medications, and are ready to transition from pediatric to adult care, is crucial to optimizing their health outcomes. Several social and ecological factors such as self-efficacy and parental miscarried helping can strengthen or weaken an adolescent’s medication adherence and readiness to shift from pediatric to adult care. Intending to contribute to informing and improving clinical care, this study sought to understand the relationships between self-efficacy, parental miscarried helping, medication adherence, and transition readiness. Methods: Using a cross-sectional observational design, 46 AYAs with …

Psychedelic Expectancies And Post-Traumatic Stress Disorder Symptoms, Samantha Gomez

Electronic Theses & Dissertations (2024 - present)

Millions of Americans struggle with posttraumatic stress disorder (PTSD) every year. Though typical treatments work for some, patients often drop out of treatment. Given that patients are often retelling their traumatic experiences, or confronting stimuli and situations that are relevant to the experience, psychotherapy for PTSD can be psychologically demanding and intensive. These factors provide a further understanding for the high rates of PTSD treatment attrition. Psychedelic assisted psychotherapy (PAP) is a potential option to mitigate these concerns. Preliminary research on PAP has revealed effective and promising results. However, questions about PAP and their public perception remain. Furthermore, treatment expectancies, …

The Effect Of Presenting Concerns On Providers’ Assessment Of Patients' Suicide Risk, Alexandria Brunkow

Electronic Theses & Dissertations (2024 - present)

Objective: Suicide is the 10^th leading cause of death in the U.S. with nearly 50,000 people per year dying by suicide. Public health approaches to suicide prevention focus on screening people in primary and mental health care settings and offering treatment to those who screen positive. Research shows that mental health providers may not recognize risk factors for suicide and miss opportunities to screen patients who may be at risk. Providers’ mental representations of suicide risk may be influencing their perception of patient risk and contributing to low screening rates. This study used an experimental vignette case design to …

Fitness Consequences Of Depressive Symptoms Vary Between Generations: Evidence From A Large Cohort Of Women Across The 20th Century, Christopher I Gurguis, Renée A Duckworth, Nicole M Bucaro, Consuelo Walss-Bass

Faculty, Staff and Student Publications

Depression has strong negative impacts on how individuals function, leading to the assumption that there is strong negative selection on this trait that should deplete genetic variation and decrease its prevalence in human populations. Yet, depressive symptoms remain common. While there has been a large body of work trying to resolve this paradox by mapping genetic variation of this complex trait, there have been few direct empirical tests of the core assumption that there is consistent negative selection on depression in human populations. Here, we use a unique long-term dataset from the National Health and Nutrition Examination Survey that spans …

Envisaging A Thriving Future: The Integration Of Positive Psychology Into Brief Psychotherapy And Family Therapy Practice, Richard Lakeman

Research outputs 2022 to 2026

This paper delves into the pragmatic integration of positive psychology, particularly Seligman's PERMA model, and brief psychotherapy to foster a vision of a thriving future for clients. Despite the entrenched tribalism within psychotherapy that often resists the incorporation of new techniques, a deliberate and flexible approach to integration, rooted in congruence with theoretical frameworks, can overcome these barriers. Positive psychology dovetails neatly with the goals of family therapy by highlighting strengths and resilience. The PERMA model—encompassing Positive emotions, Engagement, Relationships, Meaning and Accomplishment—captures the essence of a flourishing life. While primarily applied in non-clinical settings, its potential to enhance wellbeing …

Findings Of Ptsd-Specific Deficits In Default Mode Network Strength Following A Mild Experimental Stressor, Christopher L Averill, Lynnette A Averill, Teddy J Akiki, Samar Fouda, John H Krystal, Chadi G Abdallah

Staff and Researcher Publications

Reductions in default mode (DMN) connectivity strength have been reported in posttraumatic stress disorder (PTSD). However, the specificity of DMN connectivity deficits in PTSD compared to major depressive disorder (MDD), and the sensitivity of these alterations to acute stressors are not yet known. 52 participants with a primary diagnosis of PTSD (n = 28) or MDD (n = 24) completed resting-state functional magnetic resonance imaging immediately before and after a mild affective stressor. A 2 × 2 design was conducted to determine the effects of group, stress, and group*stress on DMN connectivity strength. Exploratory analyses were completed to …

The Seroprevalence Of Sars-Cov-2-Specific Antibodies In Australian Children: A Cross-Sectional Study, Archana Koirala, Jocelynne Mcrae, Philip N Britton, Marnie Downes, Shayal A Prasad, Suellen Nicholson, Noni E Winkler, Matthew V N O'Sullivan, Fatima Gondalwala, Cecile Castellano, Emma Carey, Alexandra Hendry, Nigel Crawford, Ushma Wadia, Peter Richmond, Helen S Marshall, Julia E Clark, Joshua R Francis, Jeremy Carr, Adam Bartlett, Brendan Mcmullan, Justin Skowno, Donald Hannah, Andrew Davidson, Britta S Von Ungern-Sternberg, Paul Lee-Archer, Laura L Burgoyne, Edith B Waugh, John B Carlin, Zin Naing, Nicole Kerly, Alissa Mcminn, Guillian Hunter, Christine Heath, Natascha D'Angelo, Carolyn Finucane, Laura A Francis, Sonia Dougherty, William Rawlinson, Theo Karapanagiotidis, Natalie Cain, Rianne Brizuela, Christopher C Blyth, Nicholas Wood, Kristine Macartney

Staff and Researcher Publications

Background: Following reduction of public health and social measures concurrent with SARS-CoV-2 Omicron emergence in late 2021 in Australia, COVID-19 case notification rates rose rapidly. As rates of direct viral testing and reporting dropped, true infection rates were most likely to be underestimated.

Objective: To better understand infection rates and immunity in this population, we aimed to estimate SARS-CoV-2 seroprevalence in Australians aged 0-19 years.

Methods: We conducted a national cross sectional serosurvey from June 1, 2022, to August 31, 2022, in children aged 0-19 years undergoing an anesthetic procedure at eight tertiary pediatric hospitals. Participant questionnaires were administered, and …

Towards Objective, Temporally Resolved Neurobehavioral Predictors Of Emotional State, Katherine E Kabotyanski, Han G Yi, Rahul Hingorani, Brian S Robinson, Hannah P Cowley, Matthew S Fifer, Brock A Wester, Bishal Lamichhane, Ashutosh Sabharwal, Anusha B Allawala, Sameer V Rajesh, Nabeel Diab, Raissa K Mathura, Victoria Pirtle, Joshua Adkinson, Andrew J Watrous, Eleonora Bartoli, Jiayang Xiao, Garrett P Banks, Sanjay J Mathew, Wayne K Goodman, Xaq Pitkow, Nader Pouratian, Benjamin Y Hayden, Nicole R Provenza, Sameer A Sheth

Staff and Researcher Publications

No abstract provided.

International Society For Pediatric And Adolescent Diabetes Clinical Practice Consensus Guidelines 2024: Diabetes Technologies - Insulin Delivery, Torben Biester, Cari Berget, Charlotte Boughton, Laura Cudizio, Laya Ekhlaspour, Marisa E Hilliard, Leenatha Reddy, Suzanne Sap Ngo Um, Melissa Schoelwer, Jennifer L Sherr, Klemen Dovc

Faculty, Staff and Students Publications

The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the technology behind insulin administration, with special emphasis on insulin pump therapy, especially on glucose-responsive integrated technology that is feasible with the use of automated insulin delivery (AID) systems in children and adolescents. The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive …

Predictors Of Making A Referral To Child Protective Services Prior To Expert Consultation, Danielle Zamalin, Irene Hamlin, Justine Shults, M Katherine Henry, Kristine A Campbell, James D Anderst, Angela N Bachim, Rachel P Berger, Lori D Frasier, Nancy S Harper, Megan M Letson, John D Melville, Daniel M Lindberg, Joanne N Wood

Faculty, Staff and Students Publications

OBJECTIVE: Suspicion for child abuse is influenced by implicit biases. Evaluation by a Child Abuse Pediatrician (CAP) may reduce avoidable child protective services (CPS) referrals. Our objective was to investigate the association of patient demographic, social and clinical characteristics with CPS referral before consultation by a CAP (preconsultation referral).

METHODS: Children <5 years-old undergoing in-person CAP consultation for suspected physical abuse from February 2021 through April 2022 were identified in CAPNET, a multicenter child abuse research network. Marginal standardization implemented with logistic regression analysis examined hospital-level variation and identified demographic, social, and clinical factors associated with pre-consultation referral adjusting for CAP’s final assessment of abuse likelihood.

RESULTS: Among the 61% (1005/1657) of cases with preconsultation referral, the CAP consultant had low concern for abuse in 38% (384/1005). Preconsultation referrals ranged from 25% to 78% of cases across 10 hospitals (P < .001). In multivariable analyses, preconsultation referral was associated with public insurance, caregiver history of CPS involvement, history of intimate partner violence, higher CAP level of concern for abuse, hospital transfer, and near-fatality (all P < .05). The difference in preconsultation referral prevalence for children with public versus private insurance was significant for children with low CAP concern for abuse (52% vs 38%) but not those with higher concern for abuse (73% vs 73%), (P = .023 for interaction of insurance and abuse likelihood category). There were no differences in preconsultation referral based on race or ethnicity.

CONCLUSIONS: Biases based on socioeconomic status and social factors may impact decisions to refer to …