Standing up for psychology

Suzanne Bennett Johnson, PhD, had been on the faculty of the University of Florida’s medical school for less than a year when she found herself in trouble with the chief of pediatric endocrinology. He called Johnson to his office to ask why she, a psychologist, thought she should be the principal investigator on the National Institutes of Health grant she had written to study pediatric diabetes management. The physician disagreed, arguing that he had the medical bona fides it would take to get the grant funded. Johnson, however, insisted she be treated as an equal by her physician colleagues.

“I didn’t want to be relegated to being this guy’s grant writer for the rest of my professional career,” she says. “The stakes were high.”

For Johnson, that was just the start of a 30-year career contributing psychological expertise to medical research and practice. She’s been a principal investigator on 15 NIH grants, conducting groundbreaking studies on diabetes management, childhood obesity, family therapy, genetic testing and more. In doing so, she’s improved the lives of countless children who struggled to control chronic illness while helping pioneer the field of health psychology, says Larry C. Deeb, MD, a pediatric endocrinologist in Tallahassee, Fla., and former president of the American Diabetes Association.

“Psychologists have become welcome additions to diabetes teams, partly because of Suzanne and a handful of other leading psychologists,” Deeb says. “She is held in such high regard in the medical community. She was the first distinguished professor elected at Florida State’s medical school, and she’s not even a physician.”

As APA’s 2012 president, Johnson will take her message, that psychology has much to contribute to the larger medical and research community, to a national stage. “I have learned from experience that when psychologists join health-care and medical research teams, their contributions become obvious very quickly ... and the quality of care you can deliver is so much better,” she says.

Her presidential-year aims — maximizing APA’s organizational effectiveness, expanding psychology’s role in advancing health and increasing recognition of psychology as a science — mirror APA’s new strategic plan. That’s no accident — Johnson helped draft the plan and strongly supports its goals. “This is the first strategic plan APA has ever had, and I think it’s a very important way to coordinate, prioritize and focus our resources.”

Showing psychology’s value

When Johnson began her career in the 1970s, she wanted to study a more traditional topic for psychologists: dyslexia. But when she fell in love and married Nate Perry, PhD, then the University of Florida’s Health Science Center’s Clinical and Health Psychology Department chair, nepotism rules exiled her to the medical school’s department of psychiatry. That move ended up working out for her and for the children at the inpatient pediatric diabetes program Johnson was assigned to. These children, some physicians posited, had a particularly virulent form of diabetes. However, when children were housed in this inpatient program, it quickly became obvious that there was no medical cause for their especially severe symptoms. Instead, the culprit was poor family coping strategies and poor adherence to the diabetes management regimen.

Managing Type-1 diabetes — which is typically diagnosed in childhood — is an incredibly challenging task. People with Type-1 diabetes must take multiple insulin injections daily and calibrate insulin dosage and timing by taking into account their current blood sugar levels, how much they’ve eaten and their level of physical activity. That picture is further complicated by children’s natural desire for independence and other family dynamics. To help health-care professionals understand the factors at play, Johnson and her colleagues have developed more sophisticated ways to assess how well patients are managing their diabetes. For example, she urges health teams to routinely ask diabetes patients to detail their insulin administration, blood glucose levels, eating and exercising over the past 24 hours. These systematic self-reports work much better than the old method in which physicians simply conducted a blood hemoglobin A1C test and inferred how well patients were managing their diabetes, Johnson says.

She has also developed ways to screen children and families to determine which will be most likely to have conflicts over diabetes management. Johnson’s measures are now standard practice among diabetes teams and have resulted in much better diabetes management, says Deeb.

Work ahead

These days, Johnson is collaborating on one of the most ambitious diabetes studies to date — a large-scale longitudinal study known as the Environmental Determinants of Diabetes in the Young Study. Researchers at three sites in the United States and in Sweden, Finland and Germany are following thousands of babies who are genetically predisposed to diabetes to see what environmental factors trigger the disease. Johnson co-chairs the psychosocial studies of the NIH international trial.

It’s important that participants stay in the study for its 15-year duration, so Johnson drew from the psychological literature and developed a “dropout risk score” for each family. The study’s researchers have used the score to reduce study dropout rates by targeting those families at high risk for drop out and delivering a tailored intervention to better retain them in the study.

“Using psychological measures to understand enrollment and retention in clinical trials is another way psychologists can contribute to interdisciplinary research,” she says. “I think that’s something we should be doing more of.”

Given her background, it’s no surprise that Johnson will use her APA presidency to ensure psychologists have a central role in primary care and medical research. To that end, she has convened a group of psychologists to identify what competencies psychologists should have to practice in primarycare interdisciplinary teams. Unlike many previous task forces, the group is interorganizational in its composition.

“I hope to have an actual product at the end of my presidency that will be shared by a number of organizations besides APA,” says Johnson. The effort, she says, will also serve to educate health professionals about the important ways psychologists can contribute as members of primary healthcare teams.

“We have so much to contribute as scientists and health-care professionals; it’s incumbent upon us to make that known,” she says.