We compared new Medicaid enrollees with similar ongoing enrollees for evidence of pent-up demand using claims data following Minnesota’s 2014 Medicaid expansion. We hypothesized that if new enrollees had pent-up demand, utilization would decline over time as testing and disease management plans are put in place. Consistent with pent-up demand among new enrollees, the probability of an office visit, a new patient office visit, and an emergency department visit declines over time for new enrollees relative to ongoing Medicaid enrollees. The pattern of utilization suggests that the newly insured are connecting with primary care after the 2014 Medicaid expansion and, unlike ongoing Medicaid enrollees; the newly insured have a declining reliance on the emergency department over time.

Background/Aims: Mismanagement of asthma, a prevalent chronic illness in which breathing airways are narrowed, can be life-threatening. Although psychiatric diagnoses are known to hinder self-care, less is known about the individual and combined impact of three relatively common psychiatric diagnoses (i.e. depression, anxiety, attention deficit disorder) on the management of asthma during adolescence, a developmental stage at which risk for psychiatric diagnoses is heightened and enduring health habits are established. The goal of this study was to examine whether the co-occurrence of adolescent psychiatric diagnoses (i.e. comorbidities) interferes with the management of asthma, specifically by contributing to more asthma-related emergency health care visits across three years. Methods: Health insurance claims records were extracted for a sample of 1,158 adolescents (age 10–19 years; 47% female) diagnosed with asthma who had continuous enrollment across three years in a regional health plan. Diagnostic grouping software identified diagnoses of depression, anxiety and attention deficit disorder as well as their comorbidities. Place of service codes captured asthma-related emergency department and urgent care visits. General linear modeling was used to examine whether psychiatric comorbidities predicted the average number of asthma-related emergency health care visits across three years. Specifically, for the focal independent variable, adolescents were categorized according to the number of psychiatric diagnoses present; for the focal dependent variable, the number of emergency department and urgent care visits were averaged for each month of enrollment across the three study years. Results: In the comprehensive model, which controlled for potential covariates (i.e. gender, age, SES, months of enrollment), the number of psychiatric comorbidities significantly positively predicted the average number of emergency visits across three years (χ2 = 8.41, P < 0.01). Conclusion: Adolescents with greater psychiatric comorbidities experienced significantly more asthma-related emergency health care visits over three years. Findings highlight the need to consider the complex interplay between psychological health and chronic illness management during adolescence

Background/Aims: Medicaid enrollees face many unique barriers when it comes to maintaining their health. Unfortunately, it is not always easy to identify these barriers and measure their consequences. One approach to understanding these disparities is to examine emergency room (ER) visitation patterns. By comparing ER utilization for individuals enrolled in Medicaid versus commercial insurance products, this study hopes to identify disparities in order to direct future research and shape public policy. Methods: Claims for all ER visits in 2011 were obtained from a regional health plan for individuals enrolled in Medicaid or commercial fully insured products. Data from over 130,000 ER visits were captured. Diagnostic grouping software was used to determine the reason for each visit and visit frequencies for these groupings were calculated and compared across populations. Results: The percentage of visits among Medicaid versus commercial enrollees was substantially larger for upper respiratory infections (URI; 10.3% vs. 5.9%), otitis media (OM; 4.7% vs. 2.2%) and disorders of the teeth and jaw (DTJ; 3.3% vs. 1%). Follow-up analysis examining these differences by age found that URI and OM accounted for the first and second highest disparity for individuals aged 0-12 years (18% vs. 14% and 11% vs. 8%, respectively), but this difference quickly dropped as age increased. Visits for DTJ were low among the 0–12 age group (< 1% vs. < 1%) but were responsible for the largest visitation disparity for individuals age 13–25 (1% vs. 5%) and 26–38 (2% vs 6%). DTJ accounted for the second-largest disparity for individuals age 39–64 (4% vs. 1%). Conclusion: A number of avenues for future research can be drawn from these findings, particularly those involving DTJ. Though patterns involving children may indicate environmental influences, they also may be a result of parents using the ER for primary care. Differences involving DTJ, however, are highly suggestive of unmet needs –– most likely a mix of access to adequate dental care and treatment for drug addiction. Future research and policy implementation in this area will be crucial to improving the health and well-being of low-income populations.

Background/Aims: Type 1 diabetes (T1D) is a chronic illness involving failure to produce insulin, and requires a demanding management regime to protect against serious ailments including stroke and cardiovascular disease. Although psychiatric diagnoses hinder self-care, less is known about the impact of three relatively common psychiatric diagnoses (i.e. depression, anxiety, attention deficit disorder) on the management of T1D during adolescence, a developmental stage at which risk for psychiatric diagnoses is heightened, metabolic control declines and enduring health habits are established. The goal of this study was to examine whether the co-occurrence (i.e. comorbidity) of psychiatric diagnoses interferes with the management of T1D, specifically by contributing to a higher number of T1D-related emergency health care visits across three years in adolescence. Methods: Health insurance claims records were extracted for a sample of 145 adolescents (age 10–19 years; 52% female) diagnosed with T1D who had continuous enrollment in a regional health plan across the three study years. Diagnostic grouping software identified diagnoses of depression, anxiety and attention deficit disorder, and their comorbidities. Place of service codes captured T1D-related emergency department and urgent care visits. Results: A random effect logistic regression was used to examine whether psychiatric comorbidities increased the probability of T1D-related emergency health care visits within a study year. Potential covariates (i.e. gender, age, insurance policy type, months of enrollment) were included; the no psychiatric diagnosis group was used for comparison. Although single psychiatric diagnoses did not increase the probability of an emergency health care visit (P > 0.50), psychiatric comorbidities significantly positively predicted emergency health care visits (P < 0.001). Follow-up analysis revealed a marginal effect of +22%, indicating that the presence of psychiatric comorbidities substantially increased the likelihood of an emergency health care visit. Conclusion: Results supported the hypothesis that psychiatric diagnoses have a synergistic effect on adolescents’ ability to successfully manage T1D. These findings highlight the need to consider the complex interplay between psychological health and chronic illness management across adolescence.

Background/Aims: Many state agencies, insurers and providers expected newly insured individuals under the Affordable Care Act (ACA) to inundate the health care market with high demand for health care. High health care utilization among newly insured individuals could indicate higher health risk and/or pent-up demand, defined as initial utilization caused by foregoing or delaying care while uninsured or underinsured. This study provides evidence regarding the relative health risk and pent-up demand for health care among newly insured adults in Medicaid as health reform rolls out. Methods: We used claims data from a large health insurer to examine the first six months of Medicaid coverage for Minnesota adults 18–64 years old who were newly enrolled between January and March 2014 (n = 4,252). The comparison group was nonelderly Minnesota adults with Medicaid coverage with this insurer in 2013 (n = 21,556). We compared seven types of health care utilization over six months for new and ongoing enrollees: all office visits, new patient office visits, emergency department visits, inpatient stays, diagnostic procedures, all prescriptions filled, and new prescriptions filled. We estimated logit models of the probability of having each type of health care utilization adjusting for age, gender, race/ethnicity and enrollee neighborhood characteristics. We used the coefficient estimates from these models to predict the likelihood of utilizing services as new enrollees compared to ongoing enrollees. Results: We found lower average predicted rates of health care utilization among new Medicaid enrollees compared to similar ongoing enrollees, with one exception –– new enrollees were more likely to have a new patient visit. In addition, we found that utilization among new enrollees declined during the first six months of coverage in every category except prescriptions filled. Conclusion: Our analysis of the first six months of Minnesota’s 2014 Medicaid expansion suggests both lower health care needs relative to similar ongoing enrollees and the presence of pent-up demand. This preliminary evidence suggests that both the long-term costs of covering the newly insured and the ongoing pressure on provider supply under the ACA may be lower than expected.

The arrogance dimension of the circumplex contrasts people who seemingly value power over affiliation (high arrogance) versus those who do not (low arrogance). Following this line of thinking, and building on an incentive salience model of approach motivation, three studies (total N = 284) examined the differential processing of power versus affiliation stimuli in categorization, perception and approach–avoidance paradigms. All studies found interactions of the same type. In study 2, for example, people high in arrogance perceived power stimuli to be larger than affiliation stimuli, but this differential pattern was not evident at low arrogance levels. People high, but not low, in arrogance also approached power stimuli faster than affiliation stimuli in a motor movement task (study 3). The results contribute to a process–based understanding of how interpersonal arrogance functions while linking such differences to the manner in which power versus affiliation cues are perceived and reacted to. Copyright © 2014 European Association of Personality Psychology

Objective: The objective was to examine an executive control difficulty perspective on individual differences in cortisol reactivity using a daily protocol.Design: Fifty participants competed a laboratory stressor task and individualdifferences in cortisol reactivity were quantified.Main outcome measures: Daily attentional control, conflicting thoughts, error reactivity, worry and mindfulness were assessed.Results: The findings support the idea that as cortisol responses to stress get larger (as an individual difference), attentional control ceases to function as it should in terms of variables that should predict (mindfulness) and follow from (e.g. worry) it.Conclusion: The findings support the idea that individual differences in cortisol reactivity can be conceptualised in terms of ineffectual attentional control.

Theories of self-regulation emphasize the special role that the symbolic self may play in approach and avoidance movements, but experimental evidence is lacking. In two experiments (total N = 157), participants moved either a self-relevant (e.g., "me") or non-self (e.g., "not me") agent to one of two locations, one occupied by a positive word and the other occupied by a negative word. In both experiments, the movement agent interacted with the destination valence such that it was only the symbolic self that moved more quickly to positive rather than negative locations. These results established a role for the symbolic self in approach/avoidance that had been questioned, thereby supporting both classic and contemporary self-related theories of approach and avoidance.

Several theories of psychopathy link it to an egocentric mode of perceiving the world. This explanatory perspective is quite plausible given that psychopaths are viewed as callous, uncaring, and narcissistic. This explanatory perspective, though, has been an insufficient focus of research, particularly in basic cognitive tasks. Building on the work of Wapner and Werner ( 1957 ), an implicit measure of cognitive egocentrism was developed. Continuous variations in primary and secondary psychopathy were assessed in a sample of college undergraduates ( N = 80). Individuals high in primary psychopathy exhibited cognitive egocentrism, whereas individuals low in primary psychopathy did not. On the other hand, variations in secondary psychopathy were non-predictive of performance in the task. Results are discussed in terms of theories of psychopathy, distinctions between its primary and secondary components, and the utility of modeling egocentrism in basic cognitive terms.

The two hemispheres of the brain appear to play different roles in emotion and/or motivation. A great deal of previous research has examined the valence hypothesis (left hemisphere = positive; right = negative), but an increasing body of work has supported the motivational hypothesis (left hemisphere = approach; right = avoidance) as an alternative. The present investigation (N = 117) sought to provide novel support for the latter perspective. Left versus right hemispheres were briefly activated by neutral lateralized auditory primes. Subsequently, participants categorized approach versus avoidance words as quickly and accurately as possible. Performance in the task revealed that approach-related thoughts were more accessible following left-hemispheric activation, whereas avoidance-related thoughts were more accessible following right-hemispheric activation. The present results are the first to examine such lateralized differences in accessible motivational thoughts, which may underlie more "downstream" manifestations of approach and avoidance motivation such as judgments, decision making, and behavior.

Several theories and self-reported sources of data link individual differences in negative affectivity to avoidance motivation. Chronic avoidance motivation, through repeated practice, may result in a relatively cognitive distance-enhancing dynamic whereby events and stimuli are perceived as further away from the self, even when they are not threatening. Such predictions are novel but follow from cybernetic theories of self-regulation. In 5 studies (total N = 463), relations of this type were investigated. Study 1 presented participants with phrases that were ambiguous and found that trait negative affect predicted phrase interpretation in a distance-enhancing temporal direction. Study 2 replicated this effect across a systematic manipulation of event valence. Study 3 asked individuals to estimate the size of words and found that individuals higher in neuroticism generally perceived words to be smaller than did individuals lower in neuroticism. In Study 4, people high (but not low) in neuroticism perceived words to be shrinking faster than they were growing. In Study 5, greater perceptual distancing, in a font size estimation task, predicted more adverse reactions to negative events in daily life. Although normative effects varied across studies, consistent support for a chronic distancing perspective of individual differences in negative affectivity was found.

Warmth-coldness is a fundamental dimension of social behavior. Cold individuals are egocentric in their social relations, whereas warm individuals are not. Previous theorizing suggests that cognitive egocentrism underlies social egocentrism. It was hypothesized that higher levels of interpersonal coldness would predict greater cognitive egocentrism. Cognitive egocentrism was assessed in basic terms through tasks wherein priming a lateralized self-state biased subsequent visual perceptions in an assimilation-related manner. Such effects reflect a tendency to assume that the self's incidental state provides meaningful information concerning the external world. Cognitive egocentrism was evident at high, but not low, levels of interpersonal coldness. The findings reveal a basic difference between warm and cold people, encouraging future research linking cognitive egocentrism to variability in relationship functioning.

It was hypothesised that affect-amplifying individuals would be more reactive to affective events in daily life. Affect amplification was quantified in terms of overestimating the font size of positive and negative, relative to neutral, words in a basic perception task. Subsequently, the same (N=70) individuals completed a daily diary protocol in which they reported on levels of daily stressors, provocations, and social support as well as six emotion-related outcomes for 14 consecutive days. Individual differences in affect amplification moderated reactivity to daily affective events in all such analyses. For example, daily stressor levels predicted cognitive failures at high, but not low, levels of affect amplification. Affect amplification, then, appears to have widespread utility in understanding individual differences in emotional reactivity.

Four experiments (total N = 391) examined predictions derived from a biologically based incentive salience theory of approach motivation. In all experiments, judgments indicative of enhanced perceptual salience were exaggerated in the context of positive, relative to neutral or negative, stimuli. In Experiments 1 and 2, positive words were judged to be of a larger size (Experiment 1) and led individuals to judge subsequently presented neutral objects as larger in size (Experiment 2). In Experiment 3, similar effects were observed in a mock subliminal presentation paradigm. In Experiment 4, positive word primes were perceived to have been presented for a longer duration of time, again relative to both neutral and negative word primes. Results are discussed in relation to theories of approach motivation, affective priming, and the motivation-perception interface.