Katherine Grill, PhD

The collaborative STEMSEL initiative was developed by Neolth & the MIL at the University of Miami. Neolth was introduced in the classroom by school staff. Students’ health needs were assessed upon first login and used by the Neolth app to create individualized mental health education plans (IEP-MH). Additionally, Neolth's AI system flagged those who exhibited signs of depression or self-harm, serving as a supplementary safety measure for educational institutions. [In press].

Digital resources for prevention and mitigation of mental health disorders among AYAs can provide a cost-effective way to enhance access and equity in the distribution of limited resources during public health crises. Neolth, a MH app created for young adults and adolescents, provides information and practices tailored to each user. This study's goal was to identify meaningful changes in self-reported symptoms and behaviors in AYAs using the app.

Metastatic cancer patients report elevated stress levels and unique stressors compared to other adults. This study tested the feasibility and efficacy of a mental health app with comedy content delivered to women living with advanced cancer (WLAC).

We all know that stress can drastically impact your mental health. From feelings of sadness and anxiety to isolation and substance abuse, stress has the potential to completely derail your emotional wellbeing. That’s not all. Stress can also have negative effects on your physical health, all the way down to the immune system.

El 67% de los estadounidenses de entre 18 y 23 años están algo o muy preocupados por el impacto del cambio climático en su salud mental.

One thing COVID has undeniably brought to light is the youth mental health crisis. Reports show dramatic increases in the rates of teen anxiety, depression and suicidal ideation. While understanding the role of stressors on youth mental health is vital, what’s equally as important is discussing how adolescent stress impacts physical health, namely chronic pain and somatization.

During the COVID-19 pandemic, the communities worldwide experienced sharp increases in stress, anxiety, depression and suicidality. Systemic shortcomings in access to mental health services emerged, with billions in funding allocated to improved solutions. But those solutions need to be supported by an in-depth understanding of how certain factors impact mental health — not least, climate change.

Few digital resources offer mental health support designed for adolescents. This study investigates the user satisfaction of a mental health app co-created with adolescents.

College students report elevated stress levels and unique stressors compared to adults. This study tested the feasibility and efficacy of a mental health app delivered to college students.

SEL (social-emotional learning) helps kids build the cognitive, physical, and social skills needed to be successful with relationships, academic learning, and healthy decision-making. And digital programs present a compelling solution for SEL within homeschool environments. They not only remove the burden on parents to develop this curriculum, but they can provide a virtual community for social support and serve as a stepping stone for students who are facing mental health challenges but are… Show more

SEL (social-emotional learning) helps kids build the cognitive, physical, and social skills needed to be successful with relationships, academic learning, and healthy decision-making. And digital programs present a compelling solution for SEL within homeschool environments. They not only remove the burden on parents to develop this curriculum, but they can provide a virtual community for social support and serve as a stepping stone for students who are facing mental health challenges but are not ready to talk to an adult. Show less

Social and emotional learning is a top priority in the education system. Another top priority, elevated by the pandemic and the need for virtual learning, is access to technology and implementation of technology in sustainable and equitable ways. An emerging innovation in the field is the merger of these two things to create digital programs that provide SEL and mental health access to more people.

The U.S. Surgeon General’s Youth Mental Health Advisory states that the country needs to invest in mental health support along the continuum of care, from prevention and education through clinical care and crisis response (Murthy, 2021). This means supporting individuals with existing mental health issues as well as providing preventative and educational resources (Murthy, 2021). This guidance left some stakeholders wondering, what is a preventative mental health resource and why is it… Show more

The U.S. Surgeon General’s Youth Mental Health Advisory states that the country needs to invest in mental health support along the continuum of care, from prevention and education through clinical care and crisis response (Murthy, 2021). This means supporting individuals with existing mental health issues as well as providing preventative and educational resources (Murthy, 2021). This guidance left some stakeholders wondering, what is a preventative mental health resource and why is it important? Show less

Objective: We examined factors influencing end-of-life care preferences among persons living with HIV (PLWH).
Methods: 223 PLWH were enrolled from 5 hospital-based clinics in Washington, DC. They completed an end-of-life care survey at baseline of the FACETM-HIV Advance Care Planning clinical trial.
Findings: The average age of patients was 51 years. 56% were male, 66% heterosexual, and 86% African American. Two distinct groups of patients were identified with respect to end-of-life… Show more

Objective: We examined factors influencing end-of-life care preferences among persons living with HIV (PLWH).
Methods: 223 PLWH were enrolled from 5 hospital-based clinics in Washington, DC. They completed an end-of-life care survey at baseline of the FACETM-HIV Advance Care Planning clinical trial.
Findings: The average age of patients was 51 years. 56% were male, 66% heterosexual, and 86% African American. Two distinct groups of patients were identified with respect to end-of-life care preferences: (1) a Relational class (75%) who prioritized family and friends, comfort from church services, and comfort from persons at the end-of-life; and (2) a Transactional/Self-Determination class (25%) who prioritized honest answers from their doctors, and advance care plans over relationships. African Americans had 3x the odds of being in the Relational class versus the Transactional/Self-determination class, Odds ratio = 3.30 (95% CI, 1.09, 10.03), p = 0.035. Males were significantly less likely to be in
the relational latent class, Odds ratio = 0.38 (CI, 0.15, 0.98), p = 0.045. Compared to non-African-Americans, African-American PLWH rated the following as important: only taking pain medicines when pain is severe, p = 0.0113; saving larger doses for worse pain, p = 0.0067; and dying in the hospital, p = 0.0285. PLWH who were sexual minorities were more afraid of dying alone, p = 0.0397, and less likely to only take pain medicines when pain is severe, p = 0.0091.
Conclusion: Integrating culturally-sensitive palliative care services as a component of the HIV care continuum may improve health equity and person-centered care.
Keywords: HIV/AIDS, palliative care, African American, sexual minority, gender, health disparities Show less

Purpose: Understanding how religion and spirituality influence health-related quality of life (HRQoL) is important for developing holistic, patient-centered treatment. This study determined distinct latent classes of religiousness/spirituality for adult persons living with HIV (PLWH) and associations between latent class membership and HRQoL.

Methods: Baseline data was collected from 223 patients in the FAmily CEntered (FACE) Advance Care Planning (ACP) clinical trial for PLWH. Patients… Show more

Purpose: Understanding how religion and spirituality influence health-related quality of life (HRQoL) is important for developing holistic, patient-centered treatment. This study determined distinct latent classes of religiousness/spirituality for adult persons living with HIV (PLWH) and associations between latent class membership and HRQoL.

Methods: Baseline data was collected from 223 patients in the FAmily CEntered (FACE) Advance Care Planning (ACP) clinical trial for PLWH. Patients completed the Brief Multidimensional Measurement of Religiousness/Spirituality (BMMRS-adapted), Patient Health Questionnaire (PHQ-9), Medical Outcome Study-HIV Survey (MOS-HIV) and the Palliative care Outcome Scale (POS). The optimal number of latent classes was determined by comparing K-Class model with (K-1)-Class model iteratively. The relationship between latent class membership, HRQoL and demographic characteristics was assessed.

Results: Patients were 56.1% male, 86.1% Black/African American, aged 22-77 (Mean=50.83). 75.3% were Christian. LCA identified three classes: traditionally religious (35%), privately religious (47.1%), and spiritual but not religious (17.9%). MOS-HIV mental health ( p < 0.001), MOS-HIV quality of life ( p = 0.014) and MOS-HIV health transition ( p = 0.016) scores were significantly higher among patients who were traditionally religious. These patients were more likely to be 40+ years and Black. Patients in the privately religious group had the lowest levels of mental health and HRQoL.

Conclusions: Understanding how religiousness and spirituality influence HRQoL can help the medical community develop holistic, patient-centered and culturally-sensitive interventions that could improve outcomes for PLWH and potentially mitigate the impact of health disparities within the Black and LGBTQ communities.

Keywords: HIV/AIDS; health-related quality of life; religion; spirituality; inclusivity Show less

You don’t have to look far to find them — wellness programs offering healthier and happier lives. At the end of 2018, the Global Wellness Institute valued the global wellness economy at a whopping $4.2 trillion. While the connections between stress management and mental health are clear, the connections between stress and physical wellbeing are just beginning to emerge, giving us new insights into what it means to be well. This article was awarded one of the top ten reads on Health Innovation… Show more

You don’t have to look far to find them — wellness programs offering healthier and happier lives. At the end of 2018, the Global Wellness Institute valued the global wellness economy at a whopping $4.2 trillion. While the connections between stress management and mental health are clear, the connections between stress and physical wellbeing are just beginning to emerge, giving us new insights into what it means to be well. This article was awarded one of the top ten reads on Health Innovation in 2019 by Startup Health. Show less

Objectives: The Open Source Wellness (OSW) model was designed to function as a behavioral pharmacy; an affordable, accessible delivery system for a universal experiential prescription: MOVE (physical activity), NOURISH (healthy meals), CONNECT (social support), and BE (stress reduction). This study evaluates the OSW model in a billable group medical visit (GMV) format in a federally qualified health center (FQHC).

Methods and results: Longitudinal data were analyzed with linear mixed… Show more

Objectives: The Open Source Wellness (OSW) model was designed to function as a behavioral pharmacy; an affordable, accessible delivery system for a universal experiential prescription: MOVE (physical activity), NOURISH (healthy meals), CONNECT (social support), and BE (stress reduction). This study evaluates the OSW model in a billable group medical visit (GMV) format in a federally qualified health center (FQHC).

Methods and results: Longitudinal data were analyzed with linear mixed models. Participants (n = 49) demonstrated significant increases in daily servings of fruits and vegetables, b = 0.31, p < 0.01, and exercise, b = 11.50, p < 0.01, as well as significant reductions in body mass index, b = −0.10, p = 0.05. Acute care utilization decrease was not statistically significant, b = −0.07, p = 0.14. Depressed patients (n = 11) saw reductions in depression, b = −1.72, p < 0.01, and hypertensive patients (n = 24) saw reductions in systolic blood pressure, b = −4.04, p < 0.01, but not diastolic blood pressure, b = 0.04, p = 0.95.

Conclusions: This study demonstrates the effectiveness of the OSW behavioral pharmacy model within a GMV context; pathways for adaptation, spread/scale, and incorporation of this work as a component of the broader health ecosystem and national commitment to health equity are discussed. Show less

PURPOSE. Physicians and caregivers rate patient quality of life (QOL) lower than patients rate their own QOL. This study investigated discrepancies between self-assessments of patient QOL by adults with HIV and their surrogate decision-makers.

METHODS. We collected baseline data from 223 adult dyads in the FAmily-CEntered (FACE) Advance Care Planning (ACP) clinical trial, consisting of HIV positive patients and their chosen surrogates. Participants independently completed the Medical… Show more

PURPOSE. Physicians and caregivers rate patient quality of life (QOL) lower than patients rate their own QOL. This study investigated discrepancies between self-assessments of patient QOL by adults with HIV and their surrogate decision-makers.

METHODS. We collected baseline data from 223 adult dyads in the FAmily-CEntered (FACE) Advance Care Planning (ACP) clinical trial, consisting of HIV positive patients and their chosen surrogates. Participants independently completed the Medical Outcome Study-HIV Survey (MOS-HIV) and the Palliative care Outcome Scale (POS). We used Wilcoxon Signed-Rank Test to assess differences in overall patient–surrogate means. We used Prevalence Adjusted Bias Adjusted Kappa (PABAK) statistics to assess dyadic agreement, with surrogate HIV status and cohabitation status as grouping variables.

RESULTS. Patients were 56.1% male, 86.1% Black/African-American, aged 22–77 (mean = 50.83, SD = ± 12.33). Surrogates were 43.8% male, 84.1% Black/African-American, aged 18–82 (mean = 49.73, SD = ± 14.22). 46.2% of surrogates lived with the patient. 64.6% of surrogates reported negative HIV status. Surrogates were more likely to state patients were ill, p = 0.032. Among patient–surrogate dyads, most QOL assessments showed poor (0.00–0.39) or fair (0.40–0.59) agreement and agreement tended to be even poorer among patient–surrogate dyads where the surrogate had a shared HIV diagnosis.

CONCLUSIONS. QOL discrepancies are said to arise from healthy surrogates overestimating the effects of chronic illness. In this novel assessment, many surrogates had a shared HIV diagnosis, without increased agreement. These findings highlight the challenge of accurately assessing patient QOL by surrogates, even when there is a shared HIV diagnosis. Improved communication is needed between patients and surrogates about the patients’ representation of illness. Show less

Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to their children about end of life (EOL) care yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating… Show more

Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to their children about end of life (EOL) care yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating the efficacy of FAmily CEntered disease-specific advance care planning (ACP) for teens with cancer (FACE-TC). A total of 130 dyads (260 subjects) composed of AYAs 14–20 years old with cancer and their family decision maker (≥ 18 years old) will be recruited from pediatric oncology programs at Akron Children's Hospital and St. Jude Children's Research Hospital. Dyads will be randomized to either the FACE-TC intervention or Treatment as Usual (TAU) control. FACE-TC intervention dyads will complete three 60-minute ACP sessions held at weekly intervals. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention by a blinded research assistant (RA). The effects of FACE-TC on patient-family congruence in treatment preferences, quality of life (QOL), and advance directive completion will be analyzed. FACE-TC is an evidenced-based and patient-centered intervention that considers QOL and EOL care according to the AYA's representation of illness. The family is involved in the ACP process to facilitate shared decision making, increase understanding of the AYA's preferences, and make a commitment to honor the AYA's wishes.

Keywords
Pediatric advance care planning; Cancer; End of life care; Medical decision-making; Advance directive Show less

Background: This cross-sectional study investigated the relationship between chronic musculoskeletal pain (CMP), ruminative anxiety and mindfulness to determine if (1) ruminative anxiety is a risk factor for developing chronic pain and (2) mindfulness is a potential treatment for breaking the cycle of chronic pain.

Methods: Middle-aged adults ages 35–50 years (N = 201) with self-reported CMP were recruited online. Participants completed standardized questionnaires assessing elements of… Show more

Background: This cross-sectional study investigated the relationship between chronic musculoskeletal pain (CMP), ruminative anxiety and mindfulness to determine if (1) ruminative anxiety is a risk factor for developing chronic pain and (2) mindfulness is a potential treatment for breaking the cycle of chronic pain.

Methods: Middle-aged adults ages 35–50 years (N = 201) with self-reported CMP were recruited online. Participants completed standardized questionnaires assessing elements of chronic pain, anxiety, and mindfulness.

Results: Ruminative anxiety was positively correlated with pain catastrophizing, pain-related fear and avoidance, pain interference, and pain severity but negatively correlated with mindfulness. High ruminative anxiety level predicted significantly higher elements of chronic pain and a significantly lower level of mindfulness. Mindfulness significantly predicted variance (R2) in chronic pain and anxiety outcomes. Pain severity, ruminative anxiety, pain catastrophizing, pain-related fear and avoidance, and mindfulness significantly predicted 70.0% of the variance in pain interference, with pain severity, ruminative anxiety and mindfulness being unique predictors.

Conclusions: The present study provides insight into the strength and direction of the relationships between ruminative anxiety, mindfulness and chronic pain in a CMP population, demonstrating the unique associations between specific mindfulness factors and chronic pain elements.

Implications: It is possible that ruminative anxiety and mindfulness should be added into the Fear-Avoidance Model of Chronic Pain. This updated Fear-Avoidance Model should be explored further to determine the specific mechanism of mindfulness on chronic pain and anxiety and which of the five facets of mindfulness are most important to clinical improvements. This could help clinicians develop individualized mindfulness treatment plans for chronic pain patients. Show less