Melba A. Hernandez-Tejada

• PhD DHA
• Professor (Associate) at The University of Texas Health Science Center at Houston

Adult Protective Services (APS) clients are commonly characterized as socially isolated and depressed, and recently, lonely. The only evidence-based interventions for this population target depression and none have focused on social isolation and loneliness (SIL). This study is the first to provide a formal assessment of loneliness in a large sampl...

In this chapter, we delineate a review of the literature on combining evidence-based psychotherapies to address common comorbidities and presenting concerns. We first provide guidance on the safety of using PE when patients present with various degrees of suicidality, emotional dysregulation, and substance use, emphasizing that delaying PE is often...

This chapter provides an overview of current research on peer-based interventions for adults in individual treatment. We focus particularly on peer support as an adjunct to evidence-based treatment provided by a professional. Peer support in this therapeutic context refers to individuals with relevant lived experience, such as those who had the sam...

Prolonged Exposure (PE) is a highly effective treatment for posttraumatic stress disorder (PTSD). Yet, with an unfortunately high dropout rate, efforts to retain patients are being developed. The PE+Peers program, integrating social support directly during in-vivo exposure, helped military veterans who previously dropped out of PE return to and suc...

Military sexual trauma-related post-traumatic stress disorder (PTSD) is highly prevalent and costly among women veterans, making the need for effective and accessible treatment of critical importance. Access to care is a key mechanism of mental health disparities and might affect differential response to treatment. The goal of this study was to est...

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, P...

Objective Both structural (e.g., ageism) and personal (e.g., stigma) barriers hinder older adult’s access to and engagement with mental health care). These barriers are particularly problematic for those vulnerable to interpersonal violence and abuse (e.g., due to social isolation). This study presents a quality improvement program aimed at older a...

Objective Self-neglect (SN) is the most common report to Adult Protective Services (APS) and is associated with significant morbidity and mortality risks for older adults. Lack of instrumental support is a well-evidenced etiologic factor in the development and continuation of SN, but little is known about other modifiable social connection characte...

Exposure-based treatments such as prolonged exposure therapy (PE) are effective for veterans with PTSD. However, dropout rates as high as 50% are common. The Department of Veterans Affairs employs peers to increase mental health treatment engagement, however peers are not routinely used to help patients complete PE homework assignments. The present...

Objectives Limited research exists that outlines the predictive relevance of the treatment components of prolonged exposure (PE) for post‐traumatic stress disorder (PTSD) on PTSD and depression symptom outcomes. The goal of the present study was to investigate relations between participant completion of breathing retraining, in vivo exposure, and i...

A specialty clinic addressing psychological trauma secondary to elder abuse opened a few months before the pandemic began. The aim was to provide evidence-based psychotherapy for post-trauma psychological sequalae. We leveraged technology in the form of home-based telemedicine, to deliver effective treatment directly into older adults’ homes. We he...

Persons living with dementia experience higher rates of abuse and neglect than their cognitively intact peers. Caregiver burden, including stress related to management of behavioral symptoms, has been repeatedly shown as a risk factor for family caregivers’ use of abusive and neglectful behavior. However, interventions intended to reduce caregiver...

Introduction Chronic pain and posttraumatic stress disorder (PTSD) are prevalent comorbid conditions, particularly in Veterans; however, there are few integrated treatments for chronic pain and PTSD. Instead, interventions are typically implemented separately and may involve addictive opioids. Although there are highly effective, non-pharmacologica...

Objective: We evaluated components of an integrated, mobile health-based intervention "Activate for Life" (AFL) on health outcomes in lower-income older adults (≥ 60 years). Methods: AFL incorporates balance (Otago; OG), physical strength (Gentle Yoga and yogic Breathing; GYYB), and mental engagement (Behavioral Activation; BA) components. Thirt...

Background Pain and fatigue are common chronic conditions faced by older adults. Integrated interventions to address pain and fatigue may therefore be particularly useful for older adults, especially those interventions that target mobility and psychosocial well-being. The present study describes feasibility and participant satisfaction for an inte...

Objective We evaluated components of an integrated mobile (m)Health-based intervention "Activate for Life" (AFL) on health outcomes in lower-income older adults (65 years and older). Method: AFL incorporates balance (Otago; OG), physical strength (Gentle Yoga and Yogic Breathing; GYYB), and mental engagement (Behavioral Activation; BA) components....

This study describes the feasibility and patient satisfaction for an integrated treatment to address multiple health outcomes in a sample of older adults living in a low-income independent residence facility and their own homes in the community. Specifically, 30 older adults were offered the opportunity to participate in a feasibility study of diff...

This paper describes feasibility and patient satisfaction for an integrated treatment to address multiple health outcomes in a sample of older adults living in a low-income independent residence facility and their own homes in the community. Specifically, 30 older adults were offered the opportunity to participate in a feasibility study of differen...

Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence o...

This manuscript describes a two-pronged approach to addressing elder abuse in community-residing older adults. Part 1 of the program involves briefly training community healthcare providers to screen for elder abuse and refer for services; Part 2 is an intervention program that addresses mental health impacts of elder abuse in a non-stigmatizing, n...

This paper describes feasibility of and patient and peer satisfaction with a Veteran-to-Veteran peer support program purposefully integrated into prolonged exposure (PE) for post-traumatic stress disorder (PTSD) to address barriers contributing to dropout from both in person and telemedicine delivered PE. Specifically, patients who had dropped out...

Background: Effective treatments for posttraumatic stress disorder (PTSD) (e.g., prolonged exposure (PE); cognitive processing therapy (CPT)) exist and are widely adopted by the Departments of Veterans Affairs (VA) and Defense (DoD). Unfortunately, dropout from these treatments regularly exceeds 30%. However, in a recent survey of patients who dro...

Background Effective treatments for posttraumatic stress disorder (PTSD) (e.g., Prolonged Exposure (PE); Cognitive Processing Therapy (CPT)) exist and are widely adopted by the Departments of Veterans Affairs (VA) and Defense (DoD). Unfortunately, dropout from these treatments regularly exceeds 30%. However, in a recent survey of patients who dropp...

The purpose of this study was to conduct an 8-year follow-up of the National Elder Mistreatment Study (NEMS) and specify risk ratios for negative outcomes of elder abuse, including DSM-5 defined depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and poor self-reported health. Methodology: Attempts were made to re...

Understanding help-seeking among victims of elder abuse is a critical challenge in the field. The vast majority of elder abuse victims remain hidden from formal support/protective response systems, such as adult protective services, legal/justice, law enforcement, or other agencies responsible for addressing this issue in the community. Guided by t...

Objective: Whereas prevalence of elder financial mistreatment has received increased attention over the past decade, health and mental health correlates are rarely studied. Thus, the potential relevance of financial abuse to mental health and perceived health is relatively unknown, and the objective of this article is to illustrate this relationshi...

Objective: Whereas prevalence of elder financial mistreatment has received increased attention over the past decade, health and mental health correlates are rarely studied. Thus, the potential relevance of financial abuse to mental health and perceived health is relatively unknown, and the objective of this article is to illustrate this relationshi...

Background: Posttraumatic stress disorder (PTSD) is often a chronic, disabling illness for which antidepressant medications (ie, SSRI) are considered the primary psychopharmacological treatment. However, many patients remain refractory to antidepressants alone or in combination with psychotherapy. Safe and effective treatments for individuals with...

Objectives: Past year elder mistreatment rate is about 11% of community residing older adults, with significant demographic-based variations in prevalence. However, very little research on demographic variable-based differences in correlates of elder abuse, such as mental health, exist. The National Elder Mistreatment Study 8-year follow-up (NEMS...

The purpose of this research was to explore mental and physical perceptions in older adults living independently but facing the challenge of poverty and being away from family. Focus groups were conducted at a low-income facility for independently capable older adults for a period of three months. Mental health was a major component of concern, par...

Objectives: The vast majority of elder abuse (EA) victims remain hidden from formal institutional response systems. Guided by the Behavioral Model of Health Services Use, this study examined factors that facilitate or impede formal help-seeking among victims of elder emotional abuse, physical abuse, and sexual abuse. Method: Data came from a nat...

Objective: The National Elder Mistreatment Study (NEMS) found that 5.2% of community older adults experienced financial abuse, and 4.6% experienced emotional mistreatment in the past year. Unfortunately, the majority of abuse was not reported to the authorities. This study investigated reasons for non-reporting. Method: In all, 774 NEMS particip...

Objective Prolonged exposure is characterized by reported dropout rates ranging from 25% to 40%. This premature attrition is also observed in other evidence-based treatments for posttraumatic stress disorder. While home-based telehealth delivery of prolonged exposure resolves logistical barriers to care such as travel time and cost, dropout appears...

Objectives: To conduct an 8-year follow-up of the National Elder Mistreatment Study (NEMS) and specify risk ratios for negative outcomes of elder abuse, including DSM-5 defined depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and poor self-reported health. Methods: Attempts were made to re-contact, via Computer...

Elder abuse, including emotional, physical, sexual, financial, and neglectful mistreatment is widespread in the United States, with as much as 11% of community-residing older adults experiencing some form of abuse in the past year. Little data exist regarding the prevalence of polyvictimization, or experience of multiple forms of abuse, which may e...

As it is increasingly clear that traumatic brain injury (TBI) leads to cognitive problems, particularly posttraumatic memory and attention difficulties at different levels of severity (Arciniegas et al., 2002; Arciniegas and Silver, 2006; McAllister, 1992 ; Spikman et al., 2000), leading to disability and increased burden not only on sufferers but...

This is the first randomized controlled trial to evaluate non-inferiority of Prolonged Exposure (PE) delivered via home-based telehealth (HBT) compared to standard in-person (IP) PE. One-hundred thirty two Veterans recruited from a Southeastern Veterans Affairs Medical Center and affiliated University who met criteria for posttraumatic stress disor...

The latest research on elder abuse suggests that more than 10% of community-residing older adults over age 60 have experienced some form of abuse in the past year. These forms of abuse include psychological, physical, and sexual abuse, as well as neglect and financial maltreatment. Sadly, rates of abuse are even higher among older adults in nursing...

Objective: Combat veterans returning to society with impairing mental health conditions such as PTSD and major depression (MD) report significant barriers to care related to aspects of traditional psychotherapy service delivery (e.g., stigma, travel time, and cost). Hence, alternate treatment delivery methods are needed. Home-based telehealth (HBT...

Posttraumatic stress disorder (PTSD) is a significant problem for combat veterans. Fortunately, effective treatments, such as Prolonged Exposure (PE), are available and widely disseminated in the Veterans Affairs (VA) health-care system. Nonetheless, despite well-documented effectiveness, attrition remains high at approximately 30% across evidence-...

Many older adults with major depression, particularly veterans, do not have access to evidence-based psychotherapy. Telemedicine could increase access to best-practice care for older adults facing barriers of mobility, stigma, and geographical isolation. We aimed to establish non-inferiority of behavioural activation therapy for major depression de...

Objective: To examine the association between serious psychological distress (SPD) and the Physical and Mental Health components of Quality of Life (QOL) while controlling for depression in a national sample of adults with diabetes. Methods: SPD was assessed in 1,659 adults with diabetes who participated in the 2007 Medical Care Expenditure Surv...

Objective: To determine differences in reported barriers to treatment completion associated with telemedicine vs. in-person delivery of evidence-based treatment for PTSD in combat veterans. Method: The present study was derived from two ongoing randomized controlled trials (RCTs) comparing in-person vs. telemedicine delivery of exposure therapy...

Objective: This study examined the effect of self-efficacy on glycemic control, self-care behaviors, and quality of life in low-income, minority adults with diabetes. Methods: Data on 378 participants were examined. Multiple linear regression assessed associations between self-efficacy, hemoglobin A1c, medication adherence, diabetes knowledge, s...

Commercialism in health care is an application of operating and managing principles typically found in business and commerce (financial incentivizing, profit-making, competition, marketing/advertising, and focus on the bottom line) to health care delivery. The US health care system ranks the highest on commercialism among Western industrialized dem...

Health outcomes in the United States are influenced by multifactorial components. The impact of factors such as race, racism, ethnicity, and culture has been debated throughout history as possible contributors to health outcomes within specific communities. In concordance with this ongoing discussion, these concepts remain urgent and frequently rev...

The prevalence of elder mistreatment with respect to race and ethnicity was examined in an unweighted sample of 5,777 participants (5,776 participants in weighted sample). Random Digit Dialing methodology was used to select a representative sample of community-dwelling older adults, and the survey was available in English and Spanish. Mistreatment...

PurposeThe objective of this study is to examine the differences in receipt of diabetes education according to risk factors that are associated with the disease, including race/ ethnicity, region, and rural/urban location.Methods National data from the 2007 Medical Expenditure Panel Survey (MEPS) were analyzed to examine likelihood of receipt of di...

This review outlines the effect of depression on quality of life (QoL) in patients with Type 2 diabetes mellitus (T2DM). The prevalence and medical, psychological and financial burden of T2DM in the USA are briefly discussed, similar to the findings related to patients living with T2DM and depression in terms of health-related QoL. Recommendations...

Context: Little systematic research has been conducted to understand pain among persons with end-stage liver disease, especially among liver transplant candidates. Appropriate pain assessment and management are important areas of consideration as treatment options are limited. Objective: To describe the nature of chronic pain in patients with en...

This article offers a brief review of the necessary steps involved in becoming a professional psychologist in the United States of America. We describe the training and general models upon which doctoral degree programs are based and describe doctoral programs that are typical of those accredited by the American Psychological Association. These mod...

Diabetes fatalism is defined as "a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness" and associated with poor glycemic control. This study examined the association between diabetes fatalism and medication adherence and self-care behaviors in adults with diabetes. Data on 378 subjects with type 2 d...

Few studies have examined the emotional approach to coping on diabetes outcomes. This study examined the relationship between emotional coping and diabetes knowledge, medication adherence and self-care behaviors in adults with type 2 diabetes. Data on 378 subjects with type 2 diabetes recruited from two primary care clinics in the southeastern Unit...

Evidence suggests that empowerment is an important factor to address everyday aspects of dealing with a chronic disease. This study evaluated the effect of diabetes empowerment on medication adherence and self-care behaviors in adults with type 2 diabetes. Data on 378 subjects with type 2 diabetes recruited from two primary care clinics in the sout...

The purpose of the study was to examine the association between spirituality and depression among patients with type 2 diabetes. This study included 201 adult participants with diabetes from an indigent clinic of an academic medical center. Participants completed validated surveys on spirituality and depression. The Daily Spiritual Experience (DSE)...

To examine the relationship between perceived control of diabetes and physical and mental health components of quality of life in indigent adults with diabetes. The primary variables, perceived control of diabetes and quality of life, were evaluated among188 patients from a low-income clinic located at an academic medical center. Over a 12-month pe...

Although two recent major studies provide some insight into the prevalence and correlates of elder mistreatment, the relationship between elder mistreatment and mental health remains unclear. This study begins to address this issue by examining the relationship between elder mistreatment (i.e., a recent history of emotional and physical abuse) and...

The purposes of this study were to (a) derive prevalence estimates for elder mistreatment (emotional, physical, sexual, neglectful, and financial mistreatment of older adults [age 60 +]) in a randomly selected sample of South Carolinians; (b) examine correlates (i.e., potential risk factors) of mistreatment; and (c) examine incident characteristics...

Perpetrator and incident characteristics were studied in regard to incidents of emotional, physical, and sexual mistreatment of older adults (age 60+) in a national sample of older men and women. Random digit dialing across geographic strata was used to compile a nationally representative sample; computer assisted telephone interviewing was used to...

Exposure to potentially traumatic events (PTEs), including interpersonal violence, is associated with poorer physical health in young adults. This relation has not been well-investigated among older adults in specific populations. The present study was designed to investigate whether exposure to PTEs and elder mistreatment are associated with physi...

Despite its subjective nature, self-report of health status is strongly correlated with long-term physical morbidity and mortality. Among the most reliable predictors of self-reported poor health is older age. In younger adult populations, the second reliable predictor of reported poor health is the experience of domestic and other interpersonal vi...

In this investigation of the Cardiovascular Response to Stress, Perceived Task Difficulty and physiological responding were measured. The study used a sample of 115 undergraduate students of a Simon Bolivar University. Results show that a great elevation of heart rate and blood pressure was observed during exposure to the two versions of the Stroop...

This paper evaluated the cardiovascular response to stress in a laboratory situation, the computational self-efficacy, and the perceived difficulty of the task, in a sample of 115 undergraduate students of Simon Bolivar University. Results show that the sample distribution of systolic blood pressure (SBP) has a tendency to high values in the classi...

We estimated prevalence and assessed correlates of emotional, physical, sexual, and financial mistreatment and potential neglect (defined as an identified need for assistance that no one was actively addressing) of adults aged 60 years or older in a randomly selected national sample. We compiled a representative sample by random digit dialing acros...

Este estudio evaluó la respuesta cardiovascular al estrés en el laboratorio, la autoeficacia computacional y la percepción de dificultad de la tarea en 115 estudiantes de la Universidad Simón Bolívar (Venezuela). Los resultados evidencian que la presión arterial sistólica tiende a valores altos ante el Stroop clásico; mientras que la presión arteri...

The field of child clinical psychology has increasingly focused on how to assess the occurrence and impact of traumatic events on children with the explicit goal of determining effective and efficient therapeutic techniques for helping children manage the sequelae of such events. This paper provides an overview of the psychological literature in ch...

In the present study we measured risk and protective factors in cardiovascular diseases, in young adults. The group consisted by 100 (39 female and 61 male), volunteers who were undergraduate students of Simon Bolivar University. This was non-experimen tal field and cross-sectional study. Data were collected via the following instruments: Dinamap,...

Objectives. We estimated prevalence and assessed correlates of emotional, physical, sexual, and financial mistreatment and potential neglect (defined as an identified need for assistance that no one was actively addressing) of adults aged 60 years or older in a randomly selected national sample. Methods. We compiled a representative sample by rando...