James William Griffith

Background: Unemployment has economic consequences and is associated with emotional distress and impairment. Joblessness is often associated with depression, leading to a vicious cycle of reduced drive to seek work, deepening financial stress, and worsening depression. Few scalable interventions exist that integrate job-search strategies with cognitive behavioral techniques. Objective: The study aimed to determine the efficacy of a Distress-Informed Return-to-Work Intervention (DRIVEN). The primary hypothesis was that DRIVEN would be more efficacious than the control condition in improving job-search behavior. Secondary analyses examined job attainment, depression, and positive affect. Methods: A randomized controlled trial was conducted from August 2023 to September 2024. Assessments were at baseline, weeks 1 through 6, and 8 and 16 weeks postintervention. Participants were a nationwide sample of unemployed job seekers aged 18 years or older who had never earned more than US $100,000 in a year. Participants received either (1) DRIVEN, which included 6 weeks of cognitive behavioral exercises in a mobile app combined with three 1-hour coaching sessions over videoconference or (2) emailed articles containing job-search advice. Primary outcome measures were subscales of a modified Job Search Behavior Scale (preparatory and active job search). Secondary outcomes included job attainment and mental health outcomes. Results: Participants were a nationwide sample (N=126; mean age 33.6, SD 6.6 y), including 62 (49.2%) females. During the acute treatment phase, mixed-effects linear models showed that for DRIVEN, preparatory job-search behavior increased by an estimated 0.053 (95% CI 0.031-0.076) units per day from baseline, which was a larger effect than in the control condition (0.011, 95% CI −0.011 to 0.033 units per day; P =.008). Active job-search behavior increased by 0.061 (95% CI 0.038-0.084) units per day from baseline, which was significantly larger than in the control group (point estimate: 0.025, 95% CI 0.001-0.047; P =.03). Depression decreased more in the DRIVEN group vs control (DRIVEN point estimate=−0.214, 95% CI −0.255 to −0.172 vs control group point estimate=−0.122, 95% CI −0.163 to −0.081; P =.002), and participants were more likely to get a job in the DRIVEN group (68.3% vs 50.8%; P =.046). Self-report outcomes did not significantly differ during the follow-up periods. Conclusions: DRIVEN was superior to emailed job-search advice for the primary outcome (job-search behavior) and secondary outcomes (job attainment, depression, and positive affect). This intervention may be beneficial for distressed unemployed individuals seeking work.

Background: Patient-reported outcome measures (PROMs) are commonly used to monitor lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH). However, there is limited evidence on patients’ perspectives on integrating PROMs into clinical practice and on best practices to improve their implementation to better meet patient needs. The aim of this study is to explore patients’ experiences completing PROMs during routine BPH management, and to develop patient-informed strategies for PROM implementation in urologic care. Methodology: Virtual semi-structured telephone interviews were conducted with English-speaking patients aged 50 years or older with BPH who attended outpatient urology clinics between May and October 2025. Patients were purposively sampled based on the type of treatment received (medical or surgical). Interview data were analyzed using interpretive description. Themes were synthesized inductively, and practical implementation strategies were developed from participants’ suggestions. Results: Twenty patients participated (12 received medical treatment and 8 received surgical treatment). Four themes emerged regarding patient perspectives on PROM use in routine care: (1) Perceived benefits—patients viewed PROMs as valuable tools for tracking symptom progression, prompting self-reflection, and facilitating communication among the clinical care team; (2) Questionnaire content—patients questioned the relevance of specific domains, particularly the non-specificity of the PROMIS pain scales as well as mental health, and sexual health items; (3) Perceived barriers—participants criticized the excessive volume of questionnaires; and (4) Considerations for PROM Integration—participants emphasized the importance of visible follow-up actions based on PROM results. Practical recommendations for PROM integration in routine clinical practice included: (1) enhancing patient understanding of PROMs by providing a brief rationale prior to survey administration; (2) implementing a patient-preference PROM workflow in the electronic health record (EHR); and (3) providing tangible actions based on PROM results, such as summarizing scores in plain language and incorporating results into discussions during visits. Conclusions: This study provides patient-informed insights into the implementation of a broad PROM battery in LUTS/BPH care. Participants emphasized that PROMs are more acceptable when their purpose is clearly explained and when responses are visibly discussed or acted upon in care. Future research should examine how these patient-informed strategies can be operationalized within clinical workflows and integrated with clinician, administrator, and EHR perspectives to support sustainable PROM use in routine practice.

Limited health literacy may contribute to systematic bias in health assessments relying on self-report. The present study aimed to examine how varying levels of health literacy might affect scores on the Patient-Reported Outcomes Measurement Information System Sleep Disturbance-Short Form 8a, a commonly used tool to assess self-reported perceptions of sleep quality. A community-based sample of adults (≥18 years) from Boston and Chicago was included in the study. Health literacy was measured using the Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT). We conducted a differential item functioning analysis using an ordinal logistic regression and a graded response model. Monte Carlo simulations were employed to establish effect size thresholds. We analyzed data from 702 participants, with a mean age of 49.1 ± 15.6 years. The sample included 61.5% females, 41.6% Black participants, and 27.8% Hispanic participants, with 58% demonstrating low health literacy. Participants in the low health literacy group reported higher sleep disturbance levels compared to those in the adequate health literacy group. Four of the eight items on the Patient-Reported Outcomes Measurement Information System Sleep Disturbance-Short Form 8a scale exhibited statistically significant differential item functioning by health literacy, indicating that individuals with varying levels of health literacy interpret or respond to these items differently, even when they have the same underlying sleep disturbance level. The overall impact of differential item functioning on total scores, however, was negligible. The psychometric properties of the Patient-Reported Outcomes Measurement Information System Sleep Disturbance-Short Form 8a support its use across populations with varying levels of health literacy. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Introduction: Cancer survivors are at-risk for transportation insecurity given the frequency of medical visits and cost of care. Little is known about how transportation insecurity relates to important social relationship measures adversely impacting cancer survivors (eg, loneliness, lack of emotional support). Thus, we evaluated the association between transportation insecurity and social relationship measures among patients with and without a history of cancer. Methods: Using data from the 2023 Behavioral Risk Factor Surveillance System, we characterized relationships between transportation insecurity and two social relationship measures: (1) loneliness and (2) emotional support among individuals with and without a history of cancer. We used multivariable logistic regression models to estimate associations between transportation insecurity and adverse social relationships, with sensitivity analyses for at-risk groups. Models were adjusted for sociodemographic and health-related covariates. Results: We identified 237,180 respondents with 29,579 reporting a history of cancer (12.5%). Transportation insecurity was more common among individuals who were younger, non-White, uninsured or publicly insured, unemployed, unable to work, and not partnered. Transportation insecurity was associated with both social relationship measures (loneliness: aOR = 1.24-3.00, 95% CI; lack of emotional support aOR = 1.31-2.47, 95% CI). Although these associations were consistent across cancer and non-cancer populations, in univariate analyses individuals with a history of cancer reported transportation insecurity more often if they were younger (18 to 49 years), non-White, had Medicaid, or no insurance compared to those without a history of cancer. Conclusion: These findings highlight intersections between transportation insecurity and unmet social relationship needs among individuals with and without a history of cancer.=

Pain clinical trials are notoriously complex and often inefficient in demonstrating efficacy, even for known efficacious treatments. A major issue is the difficulty in the a priori identification of specific phenotypes to include in the study population. Recent work has identified the extent of widespread pain as an important determinant of the likelihood of response to therapy, but it has not been tested in clinical trials for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). We explored this hypothesis using data from 3 previously published trials testing treatments for IC/BPS, which suggested modest benefits but did not meet a priori primary outcome statistical significance criteria. Importantly, these studies also collected symptom questionnaire data that allowed us to retrospectively identify participants with and without widespread pain. Analyzing the treatment by the degree of widespread pain revealed a difference in outcome and statistical significance level for each trial. Participants with predominately local pain (ie, limited widespread pain symptoms) responded to therapy targeting local symptoms, whereas those with widespread pain did not. Alternatively, participants with widespread pain beyond their local pelvic pain responded to more centrally acting treatments. Our results suggest that differentiating patients based on widespread vs more localized pain is a key consideration for designing future clinical trials for conditions with variable pain profiles, such as IC/BPS and potentially other pain-based syndromic disorders.

Background: Employment plays an important role in the maintenance of mental and physical health. Losing a job creates emotional distress, which can, in turn, interfere with effective job seeking. Thus, a program for job seekers that provides support for both the logistics of job seeking as well as emotional distress may help people find employment and improve emotional well-being. Objective: This study aims to test the efficacy of the 6-week intervention for job seekers in a randomized controlled trial. Methods: This is a parallel-assignment randomized control trial comparing a 6-week return-to-work intervention versus job seeking as usual for a stratified sample of job seekers (n=150). The intervention will be delivered through a mobile phone app and scheduled video counseling sessions with a job coach. Assessments will be taken weekly during the intervention as well as 8 and 16 weeks later. The intervention and control group procedures will be administered remotely, allowing the study to take place in several regions of the United States. Eligible participants will be adults aged 18 to 65 years, currently unemployed, and actively searching for work. Participants will be recruited from 7 major metropolitan areas in the United States using online advertisements on Craigslist. The primary outcome measure is the Job Search Behavior Scale, which has 2 subscales, preparatory job search behavior and active job search behavior. Employment status will also be assessed throughout the trial. A mixed-model regression analysis will be used to compare job searching behavior in the intervention group versus the control group. A time-to-event analysis (ie, survival analysis) will be used to compare employment status in the 2 experimental groups. Secondary outcomes will also be evaluated, including job search self-efficacy and mental health-related outcomes such as anxiety and depression. Results: This study started on August 7, 2023, and as of June 2024, we have enrolled 140 participants. Enrollment began in August 2023 and will conclude by October 2024. Half of the participants (75/150, 50%) will be assigned to the intervention arm while the other half (75/150, 50%) will be assigned to the control arm, job seeking as usual. Conclusions: The findings from this study will determine the efficacy of a mobile app–based intervention that uses both job training and psychological techniques on job seeking and employment outcomes. This first trial of Distress Return-to-Work Intervention (DRIVEN) will provide important information about blended support techniques for unemployed individuals, determine the usefulness of mobile apps to address large-scale mental health outcomes, and improve our understanding of the relationship between depression and unemployment status. Trial Registration: ClinicalTrials.gov NCT06026280; https://clinicaltrials.gov/study/NCT06026280 International Registered Report Identifier (IRRID): DERR1-10.2196/62715

Aims: Men with lower urinary tract symptoms (LUTS) represent a heterogeneous group, and treatment decisions are often based on severity of symptoms and physical examination findings. Identification of clinically meaningful subtypes could allow for more personalized care. This study advances phenotyping efforts from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) by adding data domains to previous phenotyping using urologic symptoms alone.Methods: Two‐hundred‐seventeen LUTS, demographics, medical history, and physical examination datapoints from the LURN Observational Cohort study were assessed among 519 men with at least one bothersome LUTS, using weighted Tanimoto indices, semi‐supervised learning, and resampling‐based consensus clustering to identify distinct clusters of participants. Differentially abundant serum proteins of 220 men were compared across identified clusters.Results: Five refined male clusters (RM1–RM5) were identified. Two clusters reported mild LUTS (RM1: n = 66; RM2: n = 84). RM1 was older than RM2 (70.3 vs. 56.1 years), had more comorbidities (functional comorbidity index 2.4 vs. 1.5) and erectile dysfunction. Two benign prostatic hyperplasia‐like symptom clusters were identified (RM3: n = 64; RM4: n = 188). RM3 has the largest postvoid residual volume (275 mL); RM4 reported more urinary frequency, urgency, urinary incontinence, pain, and psychosocial symptoms. RM5 (n = 119) was characterized by urgency urinary incontinence, frequency, and significant comorbidities and psychosocial symptoms. Fifteen (RM2) to 87 (RM1) differentially abundant proteins were identified within each cluster. Minimal overlap was observed between affected proteins and pathways across clusters.Conclusions: Protein signatures across newly discovered subgroups suggest identified subtypes are biochemically distinct. Findings should be validated, but may represent populations with separate pathophysiology and therapeutic needs.Clinical Trial Registration: The LURN ClinicalTrials.gov Identifier is NCT02485808.

Standardized, validated questionnaires are vital tools in research and healthcare, offering dependable self-report data. Prior work has revealed that virtual agent-administered questionnaires are almost equivalent to self-administered ones in an electronic form. Despite being an engaging method, repeated use of virtual agent-administered questionnaires in longitudinal or pre-post studies can induce respondent fatigue, impacting data quality via response biases and decreased response rates. We propose using large language models (LLMs) to generate diverse questionnaire versions while retaining good psychometric properties. In a longitudinal study, participants interacted with our agent system and responded daily for two weeks to one of the following questionnaires: a standardized depression questionnaire, question variants generated by LLMs, or question variants accompanied by LLM-generated small talk. The responses were compared to a validated depression questionnaire. Psychometric testing revealed consistent covariation between the external criterion and focal measure administered across the three conditions, demonstrating the reliability and validity of the LLM-generated variants. Participants found that the variants were significantly less repetitive than repeated administrations of the same standardized questionnaire. Our findings highlight the potential of LLM-generated variants to invigorate agent-administered questionnaires and foster engagement and interest, without compromising their validity.

Aims: The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is undertaking a new cohort study in LURN II including cases and controls.Methods: This new cohort was enrolled to specifically study urinary urgency and urgency urinary incontinence, lower urinary tract symptoms (LUTSs) that are often difficult to treat due to a lack of understanding of their phenotypes and pathophysiologies.Results: This paper will focus on the motivation for the second iteration of LURN and highlight the new research techniques and plans for more thorough phenotyping of this population.Conclusions: This paper will outline the gaps in understanding in treating LUTSs, specifically urinary urgency.