Mental illness stigma among Pacific Islanders

Trauma and mental health in Pacific Islanders

BACKGROUND

Little is known about trauma and its mental health impact on Native Hawaiians/Pacific Islanders (NH/PI), an understudied Indigenous-colonized population that endures severe mental health disparities.

AIMS

This novel investigation assessed trauma prevalence and its mental health and substance use correlates in NH/PIs in the U.S.

METHOD

Using community-based participatory research methods, survey data on NH/PI trauma, depression, anxiety, substance use, and treatment need were collected from 306 NH/PI adults using online, telephone, and in-person methods. Descriptive statistics and adjusted regression models were employed.

RESULTS

Sixty-nine percent of participants experienced lifetime trauma, reporting mean exposure to 2.5 different trauma types. Childhood physical and sexual abuse, and lifetime forced sexual assault rates were 34%, 25%, and 27%, respectively, exceeding general population rates. Women and men reported equivalent total mean exposure to different trauma types, as well as equal prevalence for every trauma type examined (e.g. sexual abuse/assault). Confirming hypotheses, after controlling for key demographic and mental health risk factors, increased exposure to multiple trauma types uniquely associated with greater depression, anxiety, alcohol symptomology, and greater likelihood for needing treatment and using illicit substances.

CONCLUSIONS

Trauma is prevalent in NH/PI populations and significantly impacts NH/PI mental health; serving as an important but overlooked contributor to NH/PI mental health disparities. Current findings fill critical gaps in our knowledge of NH/PI trauma and mental health while revealing the importance of screening and treating NH/PIs for trauma exposure to alleviate existing mental health disparities.

Discrimination Experiences among Asian American and Pacific Islander Adults during the COVID-19 Pandemic and Their Association with Mental Health Outcomes: Updated Findings from the COMPASS Study

BACKGROUND

Reports of escalated discrimination experiences among Asian American and Native Hawaiian Pacific Islanders (AANHPI) continue.

METHODS

Using the original and follow-up surveys of the COVID-19 Effects on the Mental and Physical Health of AAPI (Asian American and Pacific Islanders) Survey Study (COMPASS I and COMPASS II) (n = 3177), we examined changes over approximately a 1-year period in discrimination experiences attributable to being AAPI and factors associated with worse mental health outcomes.

RESULTS

Experiences of discrimination remained high in COMPASS II with 60.6% (of participants (compared to 60.2% among the same people in COMPASS I) reporting one or more discrimination experiences, and 28.6% reporting worse mental health outcomes. Experiences of discrimination were associated with modest but significant increase in the odds of worse mental health: adjusted OR 1.02 (95% CI 1.01-1.04). Being younger, being of Native Hawaiian/Pacific Islander or Hmong descent (relative to Asian Indian), and having spent 50% or less of their lifetime in the US (vs. US born), were significantly associated with worse mental health.

CONCLUSIONS

The fall-out from the pandemic continues to adversely impact AANHPI communities. These findings may help influence policy initiatives to mitigate its effects and support interventions designed to improve mental health outcomes.

Mental health literacy in Polynesian Native Hawaiian and Other Pacific Islanders

The high prevalence of mental health problems and underutilization of mental health treatment are more severe among the Native Hawaiian and Other Pacific Islander (NHPI) populations and remain misunderstood and understudied. Examining mental health literacy (MHL) - the knowledge and beliefs about mental disorders - aids their recognition, management, or prevention - has been shown to identify barriers to seeking and receiving care. This study aimed to assess the level of MHL in NHPIs and identify associated demographic variables. Data for this cross-sectional study were collected from 298 US NHPIs via an online questionnaire of the Mental Health Literacy Scale (MHLS). The overall mean MHLS score was 121 (SD = 17.3), with statistically significant higher scores in female participants, >31 years old, Tongan, more educated, and with higher income. This study demonstrated that overall MHL is comparable among NHPI compared to the current literature. However, NHPI men ≤30 years old and with lower income had lower MHL, which may be linked to the mental health disparities specific to this population. Current interventions should focus on increasing knowledge of risk factors, causes, self-treatments, and available professional help regarding mental disorders. Efforts to improve the MHL of NHPI should target men ≤30 years with lower income (<$50 000).

Disparities in the Prevalence of Psychiatric Illness in Hawaii's Houseless Population: A Retrospective Chart Review

In the State of Hawaii, previous research has suggested that minority groups such as Native Hawaiians and Other Pacific Islanders are disproportionately affected by mental health disorders and have less access to mental health services. The purpose of this study was to determine if similar disparities in the prevalence of psychiatric disorders among different ethnic groups are also present among Hawaii's houseless population. A retrospective chart review of records from one of Oahu's major houseless outreach clinics was performed to gather patient demographics and reported histories of psychiatric diagnoses. Reported disease prevalence rates were compared between larger ethnic categories as well as ethnic sub-groups. Results demonstrated higher rates of certain serious mental illnesses among the houseless; however, several other psychiatric diagnoses were unexpectedly found to be less prevalent than in the general population. Additionally, houseless Pacific Islander groups were unexpectedly found to often have disproportionally lower rates of psychiatric diagnoses despite being identified as high risk by other studies. Overall, our findings may indicate unique ethnic trends in the prevalence of mental health disorders among the houseless in Hawaii or may suggest increased social and/or cultural barriers to diagnosis among certain groups that will require more diligent screening and culturally competent care from providers.

A Community Assessment of Psychological Distress in Pacific Islanders Across San Francisco Bay Area Churches During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has exacerbated health and social disparities among US Pacific Islanders (PI). Historically, PIs have experienced a high burden of mental illness yet have underutilized mental health services. These already large treatment gaps in mental health care among PIs may worsen during the COVID-19 pandemic. In the face of pre-existing challenges, little is known about the impacts of the COVID-19 pandemic on mental health outcomes among PIs.

METHODS

A community-based, cross-sectional survey was administered to members of 13 PI churches across the San Francisco Bay Area. We assessed the burden of psychological distress among PIs and its associations with demographic, sociocultural, and health factors.

KEY RESULTS

Among 439 PI respondents, nearly half reported moderate or severe psychological distress. Only about one-tenth took prescription medication for mental health and less than half utilized a mental health provider in the past year. Most trusted PI churches to provide health and social services. Respondents reporting moderate or severe psychological distress were less likely to utilize a mental health provider in the past year and more likely to feel marginalized, excluded, isolated, or alienated from society "most of the time" or "always." Psychological distress was also associated with "fair" or "poor" health status, female gender, older adults, low trust in PI churches to provide health and social services, and concern over household finances.

CONCLUSION

Partnerships with faith-based and community-based organizations are essential to address unmet mental health needs and promote support-seeking behaviors among PIs during this ongoing pandemic and beyond.

The stigma of mental health problems: A cross-sectional study in a representative sample of Spain

BACKGROUND

Mental health stigma is a relevant phenomenon with implications for the people who suffer from it. Despite its importance, no studies have been carried out in Spain at national level with a representative sample of the population.

AIMS

The aim of this research is to analyze the stigma associated with MHPs in a representative sample of the Spanish population for the first time.

METHOD

A cross-sectional quantitative descriptive study was carried out with a representative sample of the population (N = 2746). Descriptive analyses and regressions are carried out on the different dimensions of stigma such as attitude, attribution and intention of social distance.

RESULTS

Medium levels of stigma are obtained in stigmatizing attitudes and attributions, and medium-low levels in the intention of social distance. The best predictors of stigma in its different dimensions are attitudes, attributions and intention of social distance themselves. Progressive political ideology is related to less stigma in all dimensions. Knowing someone with mental health problems and talking openly about it together with higher education are also relevant protectors. Mixed results are obtained regarding age, gender and help-seeking.

CONCLUSION

National programs and campaigns focused on attitudes, attributions and behavioral intentions are necessary to reduce the stigma still present in Spanish society.

Association Between Stress and Social Support Among Young Adult Pacific Islander Smokers

Recent studies have found high levels of stress among Americans, particularly amongst young adults and ethnic minority groups. The purpose of this secondary data analysis was to explore the association between stress and social support among a sample of 276 young adult smokers of Pacific Islander ancestry, specifically Samoans and Tongans with an average age of 25.3 years. Previous research had documented the protective role of social support on stress, and thus it is hypothesized that young adult Pacific Islander smokers who perceived higher levels of social support will have less perceived stress. Social support was assessed using a 12-item scale which measured participant's perceived social support from family, friends, and significant others. Perceived stress was measured using a 10-item scale with 2 subscales - self efficacy and helplessness. Standardized parameter estimates from structural equation modeling indicated a statistically significant inverse relationship between perceived social support from family and perceived stress related to helplessness. More specifically, young adult Samoans and Tongans who report higher levels of social support from family do not feel as much stress stemming from being helpless. The results highlight the importance of family social support on stress management among this population. Most importantly, these findings add to the limited research around mental health within Pacific Islander (Samoan and Tongan) communities in the US.

Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021

OBJECTIVES

Minimal research has assessed COVID-19's unique impact on the Native Hawaiian/Pacific Islander (NH/PI) population-an Indigenous-colonized racial group with social and health disparities that increase their risk for COVID-19 morbidity and mortality. To address this gap, we explored the scope of COVID-19 outcomes, vaccination status, and health in diverse NH/PI communities.

METHODS

NH/PI staff at partner organizations collected survey data from April through November 2021 from 319 community-dwelling NH/PI adults in 5 states with large NH/PI populations: Arkansas, California, Oregon, Utah, and Washington. Data were analyzed with descriptive statistics, Pearson χ2 tests, independent and paired t tests, and linear and logistic regression analyses.

RESULTS

During the COVID-19 pandemic, 30% of survey participants had contracted COVID-19, 16% had a close family member who died of the disease, and 64% reported COVID-19 vaccine uptake. Thirty percent reported fair/poor health, 21% currently smoked cigarettes, and 58% reported obesity. Survey participants reported heightened COVID-19-related psychosocial distress (mean score = 4.9 on 10-point scale), which was more likely when health outcomes (general health, sleep, obesity) were poor or a family member had died of COVID-19. Logistic regression indicated that age, experiencing COVID-19 distress, and past-year use of influenza vaccines were associated with higher odds of COVID-19 vaccine uptake (1.06, 1.18, and 7.58 times, respectively).

CONCLUSIONS

Our empirical findings highlight the acute and understudied negative impact of COVID-19 on NH/PI communities in the United States and suggest new avenues for improving NH/PI community health, vaccination, and recovery from COVID-19.

Sociocultural influences on dietary behavior and meal timing among Native Hawaiian and Pacific Islander women at risk of endometrial cancer: a qualitative investigation

PURPOSE

Determine sociocultural influences on dietary behavior, body image, weight loss, and perceptions of the cultural appropriateness of a meal-timing intervention design and menu among Native Hawaiian and Pacific Islander (NHPI) women at risk of endometrial cancer.

METHODS

Six 90-min videoconference focus groups among NHPI women (n = 35) recruited by a community champion in Utah. Eligible women were aged ≥ 18 years at risk of endometrial cancer (i.e., BMI ≥ 25 kg/m², history of non-insulin-dependent diabetes or complex atypical endometrial hyperplasia) had a working cell phone capable of downloading a phone app, could use their cell phone during the day, and were not night-shift workers. Twelve semi-structured questions were posed during the focus groups. Using inductive qualitative methods based on Hatch's 9-step approach, de-identified transcript data were analyzed.

RESULTS

Overarching themes included economic factors, cultural influences, meal choice and timing, and perceptions of health. Subthemes included affordability, waste avoidance, inundated schedules, and cultural influences. Perceptions of body size and weight loss were influenced by family, community, and social media, whose messages could be conflicting. Important intervention components included satisfying, convenient pre-made meals, while barriers included the need to cook for family members.

CONCLUSIONS

Dietary interventions targeting metabolic health among NHPI women should consider the multitude of sociocultural and economic factors that influence food choices and meal timing in this population, including affordability, hectic schedules, and immigrant adjustment. Promoting the link between physical and mental well-being as opposed to weight loss is a key approach to reaching this population.

Experiences and impacts of COVID-19 among Pacific Islanders in Los Angeles County

Objective

To explore and document the experiences and impacts of COVID-19 among Pacific Islander (PI) adults living in Los Angeles County.

Methods

Study participants completed a brief online demographic questionnaire followed by a 45- to 60-min semi-structured one-on-one interview conducted via Zoom. Participants were asked about two main areas: (1) reasons for high rates of COVID-19 cases among the PI community and its impacts on their community and (2) the impacts of COVID-19 on them as individuals.

Results

A total of 14 PI adults, a majority of whom were females (76%) with an average age of 39.2 years took part in the study. Participants cited underlying medical conditions, overrepresentation in the essential workforce, multigeneration households, and the collectivistic culture of PIs as possible reasons for high rates of COVID-19 cases in their communities. Impacts of the pandemic included loss of jobs, loss of family and friends, and poor mental health which have been exacerbated by the pandemic.

Conclusion

This study documents the perspectives of PIs on why rates of COVID-19 are high in their community, their experiences with COVID-19 testing, and the impacts that the pandemic has had on themselves and their community. Findings from this study will assist public health professionals and health care providers in refining services and programs for the PI community.

The extent to which the domestic conditions of cocoa farmers in Bougainville impede livelihoods

Background

Bougainville, an autonomous region of Papua New Guinea (PNG) is slowly improving services and infrastructure destroyed 20 years ago during the ten year civil war. However, the region still faces significant constraints to economic growth and human development and remains under-developed compared to PNG and close Pacific neighbours. PNG's 2017 Human Development Category (HDC) was one of the lowest at 0.544. The Bougainville Strategic Development Plan 2018–2022 noted significant gaps in health services and infrastructure, had inadequate water and waste disposal and experienced weak markets and cocoa quality. This research examines domestic conditions and the extent to which they impact on livelihoods.

Method

A cross-sectional livelihood survey was administered to cocoa growing households in 33 Village Assemblies (VAs) with 11 VAs in each of the three regions.

Results

Data was collected from 5172 individuals. A significant majority of households reported multiple health issues, rudimentary housing, unimproved sanitation and unimproved water. Over two-thirds of cocoa growers did not sell any cocoa bags in 2014–2016 resulting in low incomes and greater food insecurity compared to families selling cocoa. Families that produced no saleable cocoa were more likely to have rudimentary housing, unimproved toilet facilities and unsafe water, factors that increase the likelihood of chronic disease and exacerbate malnutrition and poor labour productivity.

Conclusion

This study provides key information about the health and livelihood status of cocoa growers in Bougainville. If productivity is to increase, farmer health needs to improve including improving water and sanitation practices and diets. Building a responsive health system for the community is a challenge when a majority of the population live in small villages with difficult access to health centres. Establishing and integrating outreach village health clinics will enable health care to be more accessible to these remote communities.

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Cocoa productivity in Bougainville remains low.

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There are major constraints improved livelihoods for cocoa farmers.

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Many households are food insecure with unimproved water and sanitation.

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An accumulation of conditions may limit capacity to sell cocoa.

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A One Health approach can identify and address many factors impacting cocoa farmers livelihoods.

Electronic Cigarette Use and Associated Risk Factors in U.S.-Dwelling Pacific Islander Young Adults

Background: E-cigarette use is rapidly increasing among US young adults, heightening their risk for vaping-related illnesses. Yet, little is known about e-cigarette use among young adult Native Hawaiians and Pacific Islanders (NHPI): an indigenous-colonized US racial group rarely described in research literature. This exploratory study provides the first known data on e-cigarette use and potential risk factors in NHPI young adults. Method: Self-report data were collected from 143 NHPI young adults (age 18-30 years) living in two large NHPI communities: Samoans in urban Los Angeles County and Marshallese in rural Arkansas. We assessed rates of e-cigarette, cigarette, alcohol, and marijuana use, and positive and negative outcome expectancies from e-cigarettes, that is expected outcomes from e-cigarette use. To identify potential risk factors for NHPI e-cigarette use, regressions explored associations between participants' current e-cigarette use with current cigarette, alcohol, and marijuana use, and e-cigarette outcome expectancies. Results: Among NHPI young adults, lifetime e-cigarette use rate was 53% and current use rate was 39%. Current rate of dual e-cigarette/cigarette, e-cigarette/alcohol, and e-cigarette/marijuana use was 38%, 35%, and 25%, respectively. In our regression models, current marijuana use and positive e-cigarette outcome expectancies were significantly associated with current e-cigarette use. Conclusions: E-cigarette use is common among NHPI young adults, exceeding rates for other at-risk racial groups. Marijuana use and positive expectations about e-cigarette use may represent potential e-cigarette use risk factors. Collectively, findings underscore the need for additional research to further explore the scope of, and risk and protective factors for, e-cigarette use in this understudied high-risk population.

Depressed mood, suicidal behaviors, and health risk behaviors among youths in the Commonwealth of the Northern Mariana Islands: the 2017 CNMI Youth Risk Behavior Survey

BACKGROUND

The current study investigated the prevalence of depressed mood, suicide ideation, suicide plan, and suicide attempt and their associations with health risk behaviors among high school adolescents in the Commonwealth of the Northern Mariana Islands (CNMI).

METHODS

This is a cross-sectional study analyzing self-reported data from the 2017 CNMI Youth Risk Behavior Survey (n = 1943). Modified Poisson regression models were used to identify the associations between 17 health risk behavior variables, including violence-related behaviors, substance use behaviors, sexual behaviors, and early risk-taking behaviors, and four variables related to depressed mood and suicidal behaviors.

RESULTS

40.7% adolescents reported being depressed, 25.0% reported suicide ideation, 22.8% reported formulating a suicide plan, and 13.6% attempted suicide. Female adolescents were more likely to report depressed mood and all included suicidal behaviors (p < 0.001). Being in a physical fight and forced sexual intercourse were associated with depressed mood, suicide ideation, suicide plan, and suicide attempt for both female and male adolescents. Use of "soft drugs" such as current smoking was associated with depressed mood (ARR = 2.33, 95% CI = 1.56-3.45, p < 0.001), suicide ideation (ARR = 1.23, 95% CI = 1.08-1.43, p < 0.001), suicide plan (ARR = 1.19; 95% CI = 1.05-1.35; p < 0.001), and suicide attempt (ARR = 1.18; 95% CI = 1.06-1.30; p < 0.001) for females, whereas use of "hard drugs" such as heroin was associated with depressed mood (ARR = 2.27, 95% CI = 1.37-3.85, p < 0.01), suicide ideation (ARR = 1.30, 95% CI = 1.01-1.67, p < 0.05), suicide plan (ARR = 1.82; 95% CI = 1.22-2.70; p < 0.01), and suicide attempt (ARR = 2.78; 95% CI = 1.47-5.26; p < 0.01) for male adolescents.

CONCLUSION

The prevalence of depressed mood, suicide ideation, suicide plan, and suicide attempt among CNMI adolescents was high, especially in female adolescents. While there were gender differences, many of the health risk behaviors were associated with depressed mood and suicidal behaviors. As sociodemographic factors are difficult to change, modifiable factors should be targeted to improve the mental health of adolescents.

Hazardous drinking, alcohol use disorders, and need for treatment among Pacific Islander young adults

Pacific Islander (PI) young adults are suspected to bear heavy risk for hazardous drinking, alcohol use disorders (AUD), and alcohol-related harms. Yet, PIs remain among the most understudied racial groups in the United States-creating a lack of empirical data documenting their alcohol use problems and treatment needs. The present study presents the first known data on PI young adults' hazardous drinking, possible AUDs, alcohol-related harms, and treatment needs. Survey data were collected from 156 community-dwelling PI young adults (40% women, age 18-30 years) in 2 large PI communities: Los Angeles County and Northwest Arkansas. We screened participants for alcohol, cigarette, and marijuana use, hazardous drinking, possible AUD, alcohol-related harms, and past-year need for mental health and substance use disorder (SUD) treatment. Logistic regressions examined whether experiencing possible AUD and alcohol-related harms were associated with past-year need for treatment. PI young adults reported 78% lifetime rate of alcohol use with 56% screening positive for hazardous drinking, 49% for any possible AUD, and 40% experiencing significant alcohol-related harm (e.g., health, finances). Yet, just 25% of participants reported past-year need for SUD treatment. Although having possible AUD was not associated with perceived SUD treatment need, experiencing any alcohol-related harm associated with 4.7-13.2 times greater adjusted odds for needing treatment. Therefore, despite having low self-perceived treatment need, PI young adults experience excessive burden of hazardous drinking and alcohol-related harms. Given the profound negative social and health effects of AUDs, culturally grounded interventions should be designed to reduce PI young adults' elevated rates of hazardous drinking and alcohol-related harms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).