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Jordans MJD, Bakolis I, Arnous M, Koppenol-Gonzalez GV, Tossyeh F, Chen A, Miller KE. Effectiveness of the caregiver support intervention on child psychosocial wellbeing among Syrian refugees in Lebanon: Mediation and secondary analysis of a Randomized Controlled Trial. CHILD ABUSE & NEGLECT 2025; 162:106335. [PMID: 37400323 DOI: 10.1016/j.chiabu.2023.106335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/07/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND War and violence have a serious negative impact on the wellbeing and mental health of many children. Caregivers play an important role in mitigating or exacerbating this impact. OBJECTIVE This study evaluates the impact of the nine session Caregiver Support Intervention on improving children's wellbeing and examines putative mediators of changes in children's psychosocial wellbeing. PARTICIPANTS AND SETTING 240 female caregivers were randomly allocated (1:1) to the CSI or a waitlist control comparison condition. The study was implemented in Lebanon, in an area characterized by high levels of poverty and a high number of the Syrian refugees. METHODS A parallel group Randomized Controlled Trial reporting on caregiver-reported child-level wellbeing. We used a combination of the Kid- and Kiddy-KINDL (parent version) for index children ages three to 12. Putative mediators of the CSI on children's psychosocial wellbeing included harsh parenting, caregiver psychological distress, caregiver wellbeing. Measurements were conducted at baseline, post-intervention and 3-months follow-up. RESULTS We demonstrated a statistically significant change in caregiver reported children's psychosocial wellbeing at post-intervention (Mdiff =4.39, 95 % CI = 1.12, 7.65, p < 0.01, d = 0.28) but not at follow-up (Mdiff = -0.97, 95 % CI = -4.27, 2.32, p > 0.05). The proportion of the total effect of the CSI intervention on child psychosocial wellbeing mediated by caregiver distress, caregiver wellbeing and harsh parenting was 77 %. CONCLUSION The CSI holds potential for down-stream short-term effect on improving children's psychosocial wellbeing, beyond the previously reported positive caregiver outcomes. This effect was not sustained three months post intervention. The study confirms caregiver wellbeing and parenting support as dual pathways mediating child psychosocial wellbeing. Prospective trial registration: ISRCTN22321773.
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Affiliation(s)
- M J D Jordans
- Research and Development, War Child Holland, Amsterdam, the Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, the Netherlands; Health Service and Population Research Department & Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - I Bakolis
- Health Service and Population Research Department & Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | | | - A Chen
- Department of Psychology, Harvard University, United States of America
| | - K E Miller
- Research and Development, War Child Holland, Amsterdam, the Netherlands; Faculty of Education, University of British Columbia, Canada
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Alegría M, Cruz-Gonzalez M, Yip T, Wang L, Park IJK, Fukuda M, Valentino K, Giraldo-Santiago N, Zhen-Duan J, Alvarez K, Barrutia XA, Shrout PE. Yearly and Daily Discrimination-Related Stressors and Mexican Youth's Mental Health and Sleep: Insights From the First Wave of a Three-Wave Family Study. J Am Acad Child Adolesc Psychiatry 2024; 63:1134-1148. [PMID: 38367767 PMCID: PMC11324854 DOI: 10.1016/j.jaac.2023.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/14/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Research is needed to examine discrimination-related stressors and their social and psychological shaping of mental health and sleep outcomes of Latinx youth. The background, design, and methodology of a longitudinal study of Mexican families in Indiana and the initial findings of associations between discrimination-related stressors and youth mental health and sleep outcomes are presented. METHOD Initiating wave 1 of a 3-wave (yearly) longitudinal study, investigators surveyed an ethnically homogeneous sample of 344 Mexican-origin adolescents (ages 12-15) and their primary caregivers, assessing risks and protective factors for mental health and sleep outcomes. Youth also completed a one-time 21-day daily diary after wave 1. Self-reported measures of youth mental health, sleep, and discrimination across wave 1 and the daily diary were evaluated to compare the cross-sectional (wave 1) and daily associations between discrimination and youth mental health and sleep outcomes. RESULTS Of youth, 88.1% reported at least one incident of lifetime discrimination. Almost one-third had elevated depressive symptoms, 44.5% had probable generalized anxiety disorder, and 50.9% had poor sleep quality. Between-youth correlations at wave 1 and in the daily diary were consistent in that perceived racial discrimination was positively correlated with worse mental health and poorer sleep quality. Smaller within-youth correlations were observed in the daily diary, but there was striking variability in the effect of discrimination across youth. CONCLUSION The present results illustrate the powerful methods of combining yearly and daily time data to investigate how and for whom discrimination-related stressors lead to adverse outcomes. PLAIN LANGUAGE SUMMARY Latinx youth are the largest and fastest growing minoritized youth group in the United States. This study surveyed 344 Mexican-origin adolescents and their primary caregivers to assess risk and protective factors for mental health and sleep outcomes. The authors found that 88.1% of youth reported at least one incident of lifetime discrimination, 29.7% reported elevated depressive symptoms, 44.5% reported elevated anxiety symptoms, and 50.9% reported poor sleep quality. Youth who experienced racial discrimination were more likely to have worse mental health and lower sleep quality than those who did not experience racial discrimination. DIVERSITY & INCLUSION STATEMENT We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. CLINICAL TRIAL REGISTRATION INFORMATION Seguimos Avanzando - Latino Youth Coping With Discrimination; https://clinicaltrials.gov/; NCT04875208.
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Affiliation(s)
- Margarita Alegría
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Mario Cruz-Gonzalez
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Lijuan Wang
- University of Notre Dame, Notre Dame, Indiana
| | - Irene J K Park
- Indiana University School of Medicine-South Bend, South Bend, Indiana
| | - Marie Fukuda
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Jenny Zhen-Duan
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kiara Alvarez
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Vázquez AL, Culianos D, Gudiño OG, Navarro Flores CM, Barrett TS, Domenech Rodríguez MM. Dimensions of caregiver strain may partially mediate the relationship between youth symptomology and counseling utilization among Latinxs. PLoS One 2024; 19:e0302575. [PMID: 38669267 PMCID: PMC11051588 DOI: 10.1371/journal.pone.0302575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Whether Latinx families use youth mental health services (MHS) depends on complex influences of barriers and facilitators within and outside of the home. This research sought to shed light on caregiver strain as part of the equation focused on parental identification and responses to youth mental health needs. We examined multiple dimensions of caregiver strain as potential mediators between youth mental health symptom severity and psychological counseling utilization. The present sample consisted of 598 Latinx caregivers to youths ages 6-18 who provided information on youth internalizing and externalizing problems, caregiver strain, and youth psychological counseling service utilization within the last year. Our findings suggest that youth symptom severity (internalizing and externalizing problems) was generally positively associated with dimensions of caregiver strain. Youth symptom severity through objective and subjective internalized strain pathways were associated with greater odds of youth MHS utilization. In contrast, youth symptom severity through subjective externalized strain reduced the odds that Latinx caregivers would report utilizing youth MHS. These models only partially mediated the relationship between youth problems and service use. Findings suggest that Latinx caregivers may navigate conflicting sources of strain related to their child's mental health problem severity in ways that may differentially impact the odds that they access youth MHS. Along with addressing structural and systemic barriers to care, utilization of psychological counseling services may also be improved through interventions that help Latinx caregivers view youth services as avenues for addressing caregiver strain and providing psychoeducation that frames externalized strain within a mental health lens.
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Affiliation(s)
- Alejandro L. Vázquez
- Department of Psychology, University of Tennessee, Knoxville, Knoxville, Tennessee, United States of America
| | - Demi Culianos
- Department of Psychology, Utah State University, Logan, Utah, United States of America
| | - Omar G. Gudiño
- Department of Psychology, University of Kansas, Lawrance, Kansas, United States of America
| | - Cynthia M. Navarro Flores
- Department of Psychology, University of Tennessee, Knoxville, Knoxville, Tennessee, United States of America
| | - Tyson S. Barrett
- Highmark Health, Pittsburgh, Pennsylvania, United States of America
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Semken C, Rossell D. Specification analysis for technology use and teenager well‐being: Statistical validity and a Bayesian proposal. J R Stat Soc Ser C Appl Stat 2022. [DOI: 10.1111/rssc.12578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christoph Semken
- Universitat Pompeu Fabra BarcelonaSpain
- Barcelona School of Economics BarcelonaSpain
| | - David Rossell
- Universitat Pompeu Fabra BarcelonaSpain
- Barcelona School of Economics BarcelonaSpain
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Video conferencing during emergency distance learning impacted student emotions during COVID-19. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2022; 7:100199. [PMID: 35607704 PMCID: PMC9117165 DOI: 10.1016/j.chbr.2022.100199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022] Open
Abstract
Research during the pandemic has demonstrated that the rapid shift to emergency distance learning has impacted students' emotions. What explains this link remains a sparsely explored question. Because many students report negative experiences while video conferencing during emergency distance learning, one avenue that has yet to be explored is whether students' attitudes towards video conferencing may explain the link between video conferencing and students’ emotions. As such, to explore this question, a total of 558 college students and 219 parents or guardians of K-12 students completed a survey about their video conferencing attitudes while emergency distance learning and their positive and negative emotions while video conferencing during emergency distance learning. Across both samples, even after controlling for student learning and teacher evaluations, when students held the attitude that video conferencing during emergency distance learning felt like a forced interaction, students reported greater negative emotions. Because instructors can use the lessons learned from the COVID-19 pandemic to improve distance learning in the future, video conferencing attitudes that are most strongly related to negative emotions should continue to be explored.
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Zhang L, Bo A, Lu W. To Unfold the Immigrant Paradox: Maltreatment Risk and Mental Health of Racial-Ethnic Minority Children. Front Public Health 2021; 9:619164. [PMID: 33681132 PMCID: PMC7925415 DOI: 10.3389/fpubh.2021.619164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
Children of immigrants are often considered to be at increased risk of mental health problems due to families' immigration-related stress and perceived discrimination and prejudice from the host country. However, many studies found them to have better developmental outcomes than children with native-born parents in the U.S. This study aims to unfold this paradoxical phenomenon using data from a population-based cohort of children born in large U.S. cities. Specifically, we investigated differences in mental health outcomes between children of immigrants and those with native-born parents, stratified by children's race-ethnicity. We also explored the mediating role of child maltreatment risk in the association of parental nativity status and race-ethnicity with children's mental health. Our findings supported the immigrant paradox, with better self-reported and parent-reported internalizing and externalizing outcomes in Hispanic and Black children of immigrants than their same race-ethnicity peers and White children of native-born. Such immigrant-native variations were partially explained by parents' physically and psychologically abusive behaviors. Hispanic and Black children with immigrant parents were less likely to be physically or psychologically abused than their peers of native-born at ages 4-5, which translated into mental health advantages of children of immigrants at age 9. Our findings shed light on future research to further clarify the mechanism underlying different parenting practices between same race-ethnicity immigrants and native-born families so that culturally responsive interventions can be developed to safeguard racial-ethnic minority children's mental health.
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Affiliation(s)
- Liwei Zhang
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Ai Bo
- Department of Social Work, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, City University of New York, New York, NY, United States
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Poulain T, Vogel M, Meigen C, Spielau U, Hiemisch A, Kiess W. Parent-child agreement in different domains of child behavior and health. PLoS One 2020; 15:e0231462. [PMID: 32271851 PMCID: PMC7145111 DOI: 10.1371/journal.pone.0231462] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/24/2020] [Indexed: 12/27/2022] Open
Abstract
AIM The present study aimed to investigate and compare parent-child agreement in different domains of child health and behavior. METHODS Data were collected between 2011 and 2019 within the framework of the LIFE Child study (Germany). Different subgroups of 10- to 12-year-old children and their parents (n (max) = 692) completed questionnaires on several health behaviors (diet, media use, physical activity, sleep), parameters of health (behavioral strengths and difficulties, psychosomatic complaints), and school grades. Agreement between child and parent reports was evaluated using weighted kappa coefficients. Furthermore, the frequencies of different types of (dis)agreement (parent report > child report, same response, child report > parent report) were assessed and checked for associations with child or parent gender. RESULTS Agreement between child and parent reports varied from low to almost perfect, with the greatest levels of agreement for school grades and organized physical activity, and the lowest for dizziness, sleep duration, and the consumption of potatoes. Child gender had no significant effect on parent-child agreement. In contrast, the findings suggest that parent gender had some effect on agreement levels, with higher agreement for certain psychosomatic complaints when parent reports were completed by the mother, and higher agreement for white bread consumption if they were completed by the father. For some of the questionnaire items (especially those relating to behavioral difficulties and psychosomatic complaints, but also to the consumption of individual food products and mobile phone use), the type of (dis)agreement differed depending on child or parent gender. CONCLUSIONS The findings suggest that the perceptions and reporting strategies of children and their parents can diverge considerably, in particular for behavior that is not easily observable or measurable.
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Affiliation(s)
- Tanja Poulain
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Sachsen, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Sachsen, Germany
- * E-mail:
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Sachsen, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Sachsen, Germany
| | - Christof Meigen
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Sachsen, Germany
| | - Ulrike Spielau
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Sachsen, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig University, Leipzig, Sachsen, Germany
| | - Andreas Hiemisch
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Sachsen, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Sachsen, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Sachsen, Germany
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Dixon De Silva LE, Ponting C, Ramos G, Guevara MVC, Chavira DA. Urban Latinx parents' attitudes towards mental health: Mental health literacy and service use. CHILDREN AND YOUTH SERVICES REVIEW 2020; 109:104719. [PMID: 37842164 PMCID: PMC10575228 DOI: 10.1016/j.childyouth.2019.104719] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Latinx youth report elevated internalizing symptomatology as compared to their non-Latinx White counterparts and are less likely to access mental health care for these problems. This qualitative study examined the knowledge, beliefs and perceptions that Latinx parents (86% foreign-born; 66.7% monolingual Spanish speakers) living in urban communities have about mental health and service use for anxiety and depression in children. We used thematic analysis to analyze interview data from 15 Latinx parents who expressed concerns about their child's (age 6-13) worry or sadness. Analyses revealed that Latinx parents often have difficulty identifying mental health problems, report stigma about mental health problems and help-seeking and want more information about how they can help their children. Although Latinx parents report significant mental health and treatment-seeking stigma, the majority were open to seeking mental health services for their children or were already receiving services. Findings suggest that stigma although prevalent, may not deter service utilization for some Latinx families. Implications for community health and future research are discussed.
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Affiliation(s)
| | - Carolyn Ponting
- Department of Psychology, University of California Los Angeles
| | - Giovanni Ramos
- Department of Psychology, University of California Los Angeles
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Makol BA, Polo AJ. Parent-Child Endorsement Discrepancies among Youth at Chronic-Risk for Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1077-1088. [PMID: 29124497 DOI: 10.1007/s10802-017-0360-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Depression is one of the most common mental health problems among U.S. adolescents, particularly among Latinos. Parent-child ratings of the presence and severity of child depressive symptoms show only low-to-moderate agreement. However, research has failed to examine discrepancies in populations with the highest levels of unmet need and little is known about patterns and predictors of parent-child agreement in ratings of depressive symptoms among ethnic minority families in community settings. Using a sample of 184 low-income, predominantly Latino, 5th through 7th grade students (63.6% female) at chronic risk for depression, this study utilized exploratory Latent Class Analysis (LCA) to uncover patterns of parent-child endorsement of core diagnostic depressive symptoms. Overall, children reported higher levels of core (i.e., depressed mood, anhedonia, irritability) and secondary (e.g., sleep disturbances) depressive symptoms relative to their parents. The three latent classes identified include a low endorsement and high agreement class (LH), high endorsement and high agreement class (HH), and high child endorsement and low agreement class (HCL). Multinomial regression models revealed that previous mental health service use and higher externalizing problems were associated with HH class membership, relative to HCL class membership. Findings provide evidence that a substantial number of children may have depressive symptoms that go undetected by their parents. Access to services among children at-risk for depression may be increased with psychoeducation to improve parental awareness and stigma reduction.
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Affiliation(s)
- Bridget A Makol
- Department of Psychology, University of Maryland, Biology/Psychology Building, Room 3123J, College Park, MD, 20742, USA.
| | - Antonio J Polo
- Department of Psychology, DePaul University, 2219 N. Kenmore Ave., Chicago, IL, USA
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Barrett C, DuPaul GJ. Impact of Maternal and Child Race on Maternal Ratings of ADHD Symptoms in Black and White Boys. J Atten Disord 2018; 22:1246-1254. [PMID: 26655892 DOI: 10.1177/1087054715616489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Examine the influence of maternal and child race on ADHD symptom ratings. METHOD Participants were Black ( n = 63) and White ( n = 68) mothers randomly assigned to view a 13-min videotape of either a Black or White boy displaying similar levels of ADHD-related behaviors during free play and meal situations. Mothers then completed an ADHD rating scale. RESULTS With maternal age and socioeconomic status (SES) as covariates, Black mothers provided significantly higher ratings of inattentive and hyperactive-impulsive symptoms than did White mothers regardless of child race. The effect of child race was not statistically significant. CONCLUSIONS Maternal race appears to be more important than child race in accounting for differences in ADHD symptom ratings between Black and White boys. It is critical to understand variables related to these differences and develop assessment measures that lead to equivalent, accurate diagnostic decisions across racial subgroups.
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11
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Stevens GWJM, Thijs J. Perceived group discrimination and psychological well-being in ethnic minority adolescents. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2018. [DOI: 10.1111/jasp.12547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gonneke W. J. M. Stevens
- Department of Interdisciplinary Social Science, Utrecht Centre for Child and Adolescent Studies; Utrecht University
| | - Jochem Thijs
- Department of Interdisciplinary Social Science; European Research Centre on Migration and Ethnic Relations, Utrecht University
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Vazquez AL, Sibley MH, Campez M. Measuring impairment when diagnosing adolescent ADHD: Differentiating problems due to ADHD versus other sources. Psychiatry Res 2018; 264:407-411. [PMID: 29679844 DOI: 10.1016/j.psychres.2018.03.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/28/2022]
Abstract
The DSM-5 requires clinicians to link ADHD symptoms to clinically meaningful impairments in daily life functioning. Measuring impairment during ADHD assessments may be particularly challenging in adolescence, when ADHD is often not the sole source of a youth's difficulties. Existing impairment rating scales are criticized for not specifying ADHD as the source of impairment in their instructions, leading to potential problems with rating scale specificity. The current study utilized a within subjects design (N = 107) to compare parent report of impairment on two versions of a global impairment measure: one that specified ADHD as the source of impairment (Impairment Rating Scale-ADHD) and a standard version that did not (Impairment Rating Scale). On the standard family impairment item, parents endorsed greater impairment as compared to the IRS-ADHD. This finding was particularly pronounced when parents reported high levels of parenting stress. More severe ADHD symptoms were associated with greater concordance between the two versions. Findings indicate that adolescent family related impairments reported during ADHD assessments may be due to sources other than ADHD symptoms, such as developmental maladjustment. To prevent false positive diagnoses, symptom-specific wording may optimize impairment measures when assessing family functioning in diagnostic assessments for adolescents with ADHD.
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Affiliation(s)
| | - Margaret H Sibley
- Department of Psychiatry & Behavioral Health, Florida International University, Miami, Florida, United States
| | - Mileini Campez
- Department of Psychology, Florida International University, Miami, Florida, United States
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Roberts RE, Duong HT. Is there an association between short sleep duration and adolescent anxiety disorders? Sleep Med 2016; 30:82-87. [PMID: 28215269 DOI: 10.1016/j.sleep.2016.02.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study is to provide the first data on the prospective, reciprocal association between short sleep duration and DSM-IV anxiety disorders among adolescents. METHODS A community-based two-wave cohort study included 4175 youths aged 11-17 years at baseline, with 3134 of these followed up a year later, drawn from a metropolitan area with a population of over 4 million. Anxiety is defined as any DSM-IV anxiety disorder in the past year generalized anxiety: panic disorder, agoraphobia without panic, social phobia, and post-traumatic stress disorder. Short sleep duration is defined as ≤6 h of sleep per night. RESULTS/CONCLUSIONS In multivariate analyses, short sleep duration every night at baseline predicted anxiety disorders at follow-up, controlling for anxiety at baseline. Examining the reciprocal association, anxiety disorders at baseline did not predict short sleep duration at follow-up. We are the first to examine the reciprocal effects for anxiety disorders and sleep duration among adolescents using prospective data. The data suggest that reduced quantity of sleep may increase risk for anxiety, but anxiety does not increase risk for decreased sleep duration.
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Affiliation(s)
- Robert E Roberts
- UTHealth School of Public Health, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, San Antonio Regional Campus, John Smith Drive, Suite 1100, San Antonio, Texas 78229, USA.
| | - Hao T Duong
- HAIVN: Partnership for Health Advancement in Vietnam, 1st floor, 15-Floor building, 217 Hong Bang, District 5, Ho Chi Minh, Viet Nam
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Roberts RE, Duong HT. Is there an association between adolescent sleep restriction and obesity. J Psychosom Res 2015; 79:651-6. [PMID: 26055094 PMCID: PMC4670598 DOI: 10.1016/j.jpsychores.2015.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/12/2015] [Accepted: 05/18/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This is the first prospective study of the reciprocal association between sleep restriction and weight among adolescents. Evidence on sleep duration and obesity in youth is sparse and the results have been equivocal. METHODS Data are from a community-based, two-wave cohort study. The setting was a metropolitan area with a population of over 4 million. The cohort consisted of 4175 youths 11-17 at baseline and 3134 of these followed up a year later. Obesity was defined as body mass index >95th percentile for children of the same age and sex. Sleep restriction was defined as 6 or fewer hours of sleep per night on weeknights or on both weekends and weeknights. Covariates examined were age, gender, family income and depression. RESULTS Results clearly demonstrated that there was no association between sleep restriction and obesity at baseline. In prospective analyses, sleep restriction did not increase future risk of obesity, nor did obesity increase risk of future sleep restriction. CONCLUSIONS These findings call into question previous research based primarily on cross-sectional data suggesting a positive correlation between sleep restriction and obesity. However, the results for adolescents in this study are supported by one study of adolescents and by studies of adults using prospective designs. At this point, there appears to be little evidence for a temporal relation between sleep duration and obesity among adults or adolescents.
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Affiliation(s)
- Robert E Roberts
- UTHealth School of Public Health, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, San Antonio Regional Campus, John Smith Drive, Suite 1100, San Antonio, TX 78229, United States.
| | - Hao T Duong
- HAIVN: Partnership for Health Advancement in Vietnam, 1st floor, 15-Floor building, 217 Hong Bang, District 5, Ho Chi Minh, Vietnam.
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Roberts RE, Fisher PW, Turner JB, Tang M. Estimating the burden of psychiatric disorders in adolescence: the impact of subthreshold disorders. Soc Psychiatry Psychiatr Epidemiol 2015; 50:397-406. [PMID: 25358512 DOI: 10.1007/s00127-014-0972-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We examine the impact of including subthreshold disorders on estimating psychiatric morbidity burden in adolescents. To more fully understand this burden it is important to focus on both full syndrome and subthreshold disorders and the impairment associated with each, since evidence suggests prevalence of subthreshold disorders is substantial as is impairment. METHODS Data were analyzed from a probability sample of 4,175 youths 11-17 years of age. We examine the prevalence of DSM-IV disorders (FS) and subthreshold (SUB) disorders, with and without impairment. Diagnostic categories examined were anxiety, mood, attention deficit hyperactivity disorder, disruptive, and substance use disorders in the past year. RESULTS The prevalence of any FS disorders was 16.1 and 42.3 % for SUB. The combined prevalence was 58.4 %. By requiring impairment, the prevalence of any FS in the past year dropped to 8 % and for SUB to 15.7 %, with a combined overall rate of 23.7 %. For FS disorders, 49.6 % met criteria for moderate to severe impairment, compared to 37.8 % for SUB. One in four adolescents had either an FS or SUB disorder with impairment. CONCLUSION The results indicate that SUB disorders constitute a major public health burden in terms of psychiatric morbidity among adolescents. Given their substantial impairment and their high prevalence, consideration should be given to including SUB disorders in estimates of the public health burden psychiatric morbidity. Doing so would provide a more accurate estimate of psychiatric morbidity.
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Affiliation(s)
- Robert E Roberts
- UTHealth School of Public Health, University of Texas Health Science Center, San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA,
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Roberts RE, Duong HT. The prospective association between sleep deprivation and depression among adolescents. Sleep 2014; 37:239-44. [PMID: 24497652 DOI: 10.5665/sleep.3388] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To examine the prospective, reciprocal association between sleep deprivation and depression among adolescents. DESIGN A community-based two-wave cohort study. SETTING A metropolitan area with a population of over 4 million. PARTICIPANTS 4,175 youths 11-17 at baseline, and 3,134 of these followed up a year later. MEASUREMENTS Depression is measured using both symptoms of depression and DSM-IV major depression. Sleep deprivation is defined as ≤ 6 h of sleep per night. RESULTS Sleep deprivation at baseline predicted both measures of depression at follow-up, controlling for depression at baseline. Examining the reciprocal association, major depression at baseline, but not symptoms predicted sleep deprivation at follow-up. CONCLUSION These results are the first to document reciprocal effects for major depression and sleep deprivation among adolescents using prospective data. The data suggest reduced quantity of sleep increases risk for major depression, which in turn increases risk for decreased sleep.
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Affiliation(s)
- Robert E Roberts
- Division of Health Promotion and Behavioral Sciences, UTHealth, School of Public Health, University of Texas Health Science Center, Houston, TX
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Understanding ethnic differences in mental health service use for adolescents' internalizing problems: the role of emotional problem identification. Eur Child Adolesc Psychiatry 2013; 22:413-21. [PMID: 23400427 DOI: 10.1007/s00787-013-0380-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
Although immigrant adolescents are at least at equal risk of developing internalizing problems as their non-immigrant peers, immigrant adolescents are less likely to use mental health care. The present study is the first to examine ethnic differences in problem identification to find explanations for this disparity in mental health service use. Specifically, the extent to which emotional problem identification mediates the relationship between immigrant status and mental health service use for internalizing problems in three immigrant populations in the Netherlands (i.e., Surinamese, Turkish, and Moroccan) was investigated. A two-phase design was used to include adolescents at risk for internalizing problems. Data were used from the second phase, in which 349 parents and adolescents participated (95 native Dutch, 85 Surinamese, 87 Turkish, and 82 Moroccan). Results indicated that mental health service use for internalizing problems is far lower among immigrant adolescents than among native Dutch adolescents, although differences between immigrant groups were also substantive. A lack of emotional problem identification was identified as an essential mediator in the relationship between immigrant status and mental health service use. Since the results suggest the low levels of problem identification in our immigrant samples may serve an explanatory role in the relationship between immigrant status and mental health service use, future research should aim at understanding these ethnic differences in problem identification.
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Betancourt TS, Yudron M, Wheaton W, Smith-Fawzi MC. Caregiver and adolescent mental health in Ethiopian Kunama refugees participating in an emergency education program. J Adolesc Health 2012; 51:357-65. [PMID: 22999836 DOI: 10.1016/j.jadohealth.2012.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/29/2011] [Accepted: 01/03/2012] [Indexed: 01/30/2023]
Abstract
PURPOSE To examine the role of caregiver mental health and risk and protective factors in influencing levels of internalizing and externalizing emotional and behavioral symptoms over time among a sample of refugee adolescents. METHODS Prospective study of 153 Kunama refugee adolescents receiving an emergency education intervention while living in a camp in Ethiopia. Surveys were collected in 2001 (T1) and 2002 (T2). Adolescent and caregiver mental health were assessed using a Kunamenga adaptation of the Youth Self Report; caregiver mental health was assessed using the Hopkins Symptom Checklist-25. Attitudes toward education, satisfaction with education programming, socioeconomic status, and perceptions of access to services were also explored as variables potentially influencing adolescent mental health at follow-up. RESULTS Caregiver distress was significantly associated with youth externalizing behavior symptoms (β = 8.34, p < .001) and internalizing symptoms (β = 4.02, p < .05). Caregiver perceived access to services had a protective effect on externalizing behaviors (β = -7.54, p < .05) and internalizing behaviors (β = -13.67, p < .001). Higher socioeconomic status (β = -1.47, p < .05) had a protective effect on internalizing symptoms. In terms of modifying effects, among youth with distressed caregivers, those who were satisfied with the International Rescue Committee education intervention had a lower internalizing score (β = -6.34, p < .001) compared with those who were not satisfied with the program. CONCLUSIONS This study presents a rare prospective investigation of caregiver-adolescent mental health during an active refugee displacement. Results suggest that programs targeting mental health in refugee children should consider children within the larger family system, including caregiver influence on child and adolescent mental health adjustment over time.
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Affiliation(s)
- Theresa S Betancourt
- Department of Global Health and Population, Research Program on Children and Global Adversity, François-Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Alegría M, Lin JY, Green JG, Sampson NA, Gruber MJ, Kessler RC. Role of referrals in mental health service disparities for racial and ethnic minority youth. J Am Acad Child Adolesc Psychiatry 2012; 51:703-711.e2. [PMID: 22721593 PMCID: PMC3652396 DOI: 10.1016/j.jaac.2012.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 04/27/2012] [Accepted: 05/02/2012] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate racial/ethnic differences in teachers' and other adults' identification and/or encouragement of parents to seek treatment for psychiatric problems in their children and to evaluate if and whether identification/encouragement is associated with service use. METHOD Data on identification/encouragement to seek treatment for externalizing disorders (i.e., attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and/or conduct disorder) and internalizing disorders (i.e., major depressive episode/dysthymia and/or separation anxiety disorder) and services used were obtained for 6,112 adolescents (13-17 years of age) in the National Comorbidity Survey Adolescent Supplement. Racial/ethnic differences were examined for Latinos, non-Latino blacks, and non-Latino whites. RESULTS There were few racial/ethnic differences in rates of youth identification/encouragement and how identification/encouragement related to service use. Only non-Latino black youth with low severity internalizing disorders were less likely to be identified/encouraged to seek services compared with non-Latino white youth with the same characteristics (odds ratio [OR] = 0.4, 95% confidence interval [CI] = [0.2-0.7]). Identification/encouragement increased the likelihood of seeking services for externalizing and internalizing disorders for all youth. However, compared with their non-Latino white counterparts, non-Latino black youth who met criteria for internalizing disorders appeared less likely to have used any services (OR = 0.4, 95%, CI = 0.2-0.7), after adjusting for identification/encouragement, clinical, and sociodemographic characteristics. Non-Latino black youth with internalizing disorders and without identification/encouragement were less likely to use the specialty care sector than their non-Latino white counterparts. CONCLUSIONS In this study of a nationally representative sample of adolescents, almost no ethnic/racial differences in identification/encouragement were found. However, identification/encouragement may increase service use for all youth.
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Affiliation(s)
- Margarita Alegría
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, MA, USA.
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20
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Burnett-Zeigler I, Walton MA, Ilgen M, Barry KL, Chermack ST, Zucker RA, Zimmerman MA, Booth BM, Blow FC. Prevalence and correlates of mental health problems and treatment among adolescents seen in primary care. J Adolesc Health 2012; 50:559-64. [PMID: 22626481 DOI: 10.1016/j.jadohealth.2011.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 10/06/2011] [Accepted: 10/08/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE In this study, we describe the characteristics of adolescents with mental health problems among those presenting to primary care clinics in urban areas. METHODS The sample included 1,076 adolescents aged 12-18 years who presented to federally qualified community health clinics in urban cities in the Midwest. Bivariate and multivariate logistic regression analyses were conducted to examine the associations between having a mental health problem with demographic characteristics, health-related variables, and other risk and promotive factors. We also examined the use of health services and involvement in activities among those with mental health problems. RESULTS Approximately 14% of adolescents screened positive for a mental health problem; among those with a mental health problem, 42.8% received mental health services in the past 3 months. In the multivariate logistic regression analysis, adolescents who were female, with poorer grades, fair to poor self-reported health, using drugs, and lower parental monitoring were more likely to have a mental health problem. In bivariate analyses, adolescents with mental health problems were less likely to participate in school activities and community activities and more likely to use emergency room services. CONCLUSIONS Adolescents with mental health problems were more likely to have several other difficulties including poor grades, poor self-rated health, drug/alcohol use, and sexual activity. This study highlights the importance of screening youth with multidimensional needs and referring them to the appropriate services.
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Gonzalez A, Weersing VR, Warnick E, Scahill L, Woolston J. Cross-ethnic measurement equivalence of the SCARED in an outpatient sample of African American and non-Hispanic White youths and parents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:361-9. [PMID: 22397682 DOI: 10.1080/15374416.2012.654462] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The present study evaluated the measurement equivalence of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a clinical sample of non-Hispanic White (NHW) and African American (AA) youths and parents. In addition, we explored the concurrent criterion validity of parent report on the SCARED to a parent diagnostic interview. Cross-ethnic measurement equivalence was examined in both youth self-report (ages 11-18; N = 374) and parent report (youth ages 5-18; N = 808) using multiple group analysis. Sensitivity, specificity, positive predictive value, and negative predictive value of the SCARED parent report were also examined. The original five-factor structure of the SCARED was replicated using confirmatory factor analysis for both groups using parent and youth report, although factor loadings were not equivalent across groups. Sensitivity and specificity of the SCARED-P clinical cutoff score (Total ≥25) to anxiety diagnoses were acceptable in both ethnic groups. Although evidence for the cross-ethnic equivalence of SCARED was limited, results suggest a similar structure of anxiety symptoms across NHW and AA youths while demonstrating sensitivity in symptom-level differences in anxiety expression. Overall, results provide preliminary evidence for the SCARED as an acceptable screening tool for anxiety symptoms in NHW and AA youths.
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Affiliation(s)
- Araceli Gonzalez
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, CA, USA.
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Esch P, Bocquet V, Pull C, Couffignal S, Graas M, Lair ML, Lehnert T, Fond-Harmant L, Ansseau M. Psychosocial risk and protective factors of secondary school dropout in Luxembourg: the protocol of an exploratory case-control study. BMC Public Health 2011; 11:555. [PMID: 21752239 PMCID: PMC3151235 DOI: 10.1186/1471-2458-11-555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/13/2011] [Indexed: 11/12/2022] Open
Abstract
Background In Luxembourg, the extensive phenomenon of school dropout is a prime policy concern in the light of individual, social and economic consequences. Although the authorities report an overall decrease of the national dropout rate, the proportion of early school leavers who remain without any specific occupation is still alarming. Therefore, this study intends a shift of focus from system-inherent to individual factors, including mental health and family correlates, to provide a more comprehensive analysis of the dropout phenomenon. Methods/Design The objectives of this study are to investigate the type and prevalence of psychiatric disorders among school dropouts and to compare the findings with those by a matched control group of regularly enrolled students. Furthermore, family variables and socioeconomic status will be analysed, as they are factors likely to interfere with both educational attainment and mental health. A trained psychologist will use structured interviews and self-report forms to investigate for mental health issues, information on schooling, socioeconomic situation and family life. Controls will be matched for gender, age, school type and educational grade. Discussion As school dropouts face a serious risk of long term professional and social marginalization, there is an evident need for action. Identifying psychosocial risk and protective factors of school dropout will deliver solid insight on how to conceive public health strategies for young people who may need a more customized support to carry out their academic potential. Trial registration ClinicalTrials.gov Identifier: NCT01354236
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Williams CD, Lindsey M, Joe S. Parent-adolescent concordance on perceived need for mental health services and its impact on service use. CHILDREN AND YOUTH SERVICES REVIEW 2011; 33:2253-2260. [PMID: 22628903 PMCID: PMC3357129 DOI: 10.1016/j.childyouth.2011.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Mental health service underutilization among African American adolescents is well documented, yet not fully understood. Discordance between adolescents and their parents on perceived need for seeing a counselor for an emotional need or psychiatrist for psychiatric or medical services may help explain low service use among this population. This exploratory, prospective study examined the relationship between parent-adolescent concordance on perceived need for emotional counseling or psychiatric services and mental health service use. The relationships between gender and perceived service need and concordance and adolescent severity of depressive symptoms were also explored. Parent-adolescent dyads (n=108) receiving community-based adolescent outpatient mental health services responded to interview questions concerning their perception of whether an emotional counselor and a psychiatrist were needed in the past six months. Findings revealed low parent-adolescent concordance on perceived need for an emotional counselor and a psychiatrist. A greater proportion of adolescents reported a need than parents. There was no association between gender and perceived need for an emotional counselor and a psychiatrist. Lower rates of parent-adolescent concordance were found among youth reporting elevated depressive symptoms compared to youth reporting normal range symptoms. Concordant dyads kept a higher number of appointments than discordant dyads. Implications for clinical social work practice and future research are discussed.
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Affiliation(s)
- Crystal D. Williams
- School of Social Work, University of Maryland, Baltimore, Louis L. Kaplan Hall, 525 W. Redwood Street, Baltimore, MD 21201, United States
| | - Michael Lindsey
- Schools of Social Work and Medicine, University of Maryland, Baltimore, Louis L. Kaplan Hall, 525 W. Redwood Street, Baltimore, MD 21201, United States
| | - Sean Joe
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, United States
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Tol WA, Komproe IH, Jordans MJD, Susanty D, de Jong JTVM. Developing a function impairment measure for children affected by political violence: a mixed methods approach in Indonesia. Int J Qual Health Care 2011; 23:375-83. [PMID: 21676960 DOI: 10.1093/intqhc/mzr032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Practitioners in political violence-affected settings would benefit from rating scales that assess child function impairment in a reliable and valid manner when designing and evaluating interventions. We developed a procedure to construct child function impairment rating scales using resources available in low- and middle-income countries. DESIGN We applied a mixed methods approach. First, rapid ethnographic methods (brief participant observation, collection of diaries and a focus group with children) were used to select daily activities that best represented children's functioning. Second, rating scales based on these activities were examined for their psychometric properties. Construct validity was assessed through a confirmatory factor analysis procedure. SETTING Central Sulawesi, Indonesia. PARTICIPANTS Qualitative data were collected for 53 children and psychometric testing was done with 403 children [average age: 9.9 (SD = 1.21), 49% girls] and 385 parents. RESULTS Using locally available resources, we developed separate child-rated and parent-rated scales, both containing 11 items. The child-rated scale evidenced good internal, test-retest and inter-rater reliability and acceptable convergent and discriminant validity. Construct validity was confirmed by fit of the theorized factor structure-a social-ecological clustering of daily activities. CONCLUSIONS The procedure resulted in a reliable and valid rating scale to assess child function impairment in the context of political violence. Practitioners can apply this procedure to develop new locally adequate rating scales to strengthen epidemiological surveys, baseline assessments, monitoring and evaluation and eventually, interventions. Further research should address the importance of gender differences and criterion-related validity.
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Affiliation(s)
- Wietse A Tol
- Global Health Initiative, MacMillan Center, Yale University, New Haven, CT 06520-8206, USA.
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Chavez LM, Shrout PE, Alegría M, Lapatin S, Canino G. Ethnic differences in perceived impairment and need for care. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2010; 38:1165-77. [PMID: 20521095 PMCID: PMC3120015 DOI: 10.1007/s10802-010-9428-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos.
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Affiliation(s)
- Ligia M Chavez
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067, USA.
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Carson N, Lê Cook B, Alegria M. Social determinants of mental health treatment among Haitian, African American, and White youth in community health centers. J Health Care Poor Underserved 2010; 21:32-48. [PMID: 20453375 DOI: 10.1353/hpu.0.0297] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We examine adequate mental health treatment, emergency room (ER) use, and early treatment dropout for Haitian, African American and White youth with a psychiatric diagnosis treated in community health centers in the United States. We present associations with possible socioeconomic determinants of care. Adequate treatment was less likely among Haitian youth from areas with greater poverty and among all youth from areas with more female-headed households. Medicaid-insured youth had more ER visits, especially African Americans. The relative impact of poverty on adequate care was higher for Haitians than Whites, and the relative impact of Medicaid coverage on ER use was higher for African Americans than for Whites. Early dropout was more likely among youth who were uninsured or from areas with more female-headed households. Socioeconomic factors and insurance status were significant determinants of care. Haitians living in poverty in the U.S. may face barriers to mental health services relative to other racial/ethnic groups.
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Affiliation(s)
- Nicholas Carson
- Department of Psychiatry at the Harvard Medical School/Cambridge HealthAlliance, Somerville, MA 02143, USA.
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27
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Roberts RE, Roberts CR, Xing Y. One-year incidence of suicide attempts and associated risk and protective factors among adolescents. Arch Suicide Res 2010; 14:66-78. [PMID: 20112145 DOI: 10.1080/13811110903479078] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of this study was to estimate incidence of adolescent suicide attempts and predictors of attempts. Data were collected using diagnostic interviews and questionnaires with a sample of 4,175 youths 11-17 and 3,134 followed-up a year later. Total incidence was 0.95% and first incidence 0.84% for attempts. We found few significant independent predictors of attempts. Multivariate analyses identified only 2 independent predictors of first incidence (marijuana use and caregiver attempts). We did find evidence for cumulative effects of risk factors, with increased odds of attempts with increasing number of risk factors. The difficulty in identifying a common set of modifiable risk factors continues to make development of effective interventions difficult. However, based on our results and those of other researchers, the impact of the cumulative risk conferred by multiple factors would seem to offer a viable strategy for reducing risk of suicide attempts as well as other mental health outcomes among adolescents.
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Shannon LM, Walker R, Blevins M. Developing a new system to measure outcomes in a service coordination program for youth with severe emotional disturbance. EVALUATION AND PROGRAM PLANNING 2009; 32:109-118. [PMID: 19019436 DOI: 10.1016/j.evalprogplan.2008.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 09/15/2008] [Accepted: 09/16/2008] [Indexed: 05/27/2023]
Abstract
This paper presents information on re-developing an outcome evaluation for a state-funded program providing service coordination utilizing wraparound to youth with severe emotional disturbance (SED) and their families. Originally funded by the Robert Wood Johnson Foundation, the Kentucky IMPACT program has existed statewide since 1990. Changing data needs and limitations of the original evaluation required revamping the program's data collection system. The new evaluation uses the extant knowledge base to improve: (1) design, (2) measures, and (3) utility. A pre-post design with multiple follow-ups provides the framework for data collection. An ecological framework provides a conceptual structure for selecting measures focusing on both the service recipients and their environment. Data collection via a personal digital assistant (PDA) ensures utility of the data for both consumers and researchers. Issues ranging from conceptualization to implementation of the project as well as lessons learned are discussed.
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Affiliation(s)
- Lisa M Shannon
- Department of Behavioral Science, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-9824, United States.
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Roberts RE, Roberts CR, Chan W. One-year incidence of psychiatric disorders and associated risk factors among adolescents in the community. J Child Psychol Psychiatry 2009; 50:405-15. [PMID: 19175820 DOI: 10.1111/j.1469-7610.2008.01969.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We have few data on incidence of psychiatric disorders among adolescents. This study examined first incidence of disorders among adolescents and baseline factors which increased or decreased risk of new onset cases a year later. METHODS Data were analyzed from Teen Health 2000 (TH2K), a probability sample of 4,175 youths 11-17 and their parents assessed at baseline and 3,134 of these youth-parent dyads followed up a year later. Disorders examined were anxiety, mood, attention deficit hyperactivity disorder (ADHD), disruptive, and substance abuse/dependence disorders in the past year. Risk and protective factors were assessed from three domains: status factors, personal and social resources, and stressors. Logistic regression models were used to estimate odds of incident disorders for each risk and protective factor. RESULTS Incidence rates were 2.8% for anxiety, 1.5% for mood, 1.2% for ADHD, 2.5% for disruptive, 2.9% for substance abuse/dependence, and 7.5% for one or more DSM-IV disorders. Multivariate analyses identified few independent predictors of incidence. The most consistent factors across disorders involved indicators of stress. The role of adverse family context was particularly noteworthy, predicting incidence of every disorder examined. Personal resources such as mastery consistently enhanced resilience to onset of first episodes. The presence of multiple risk factors, cumulative burden, substantially increased risk of first incidence of all disorders examined. CONCLUSIONS The incidence of any disorder of 7.5% was similar to two earlier studies using DSM-III-R criteria (8.9 and 10.6, respectively). This is the first study to estimate incidence of DSM-IV disorders for a range of diagnostic categories, and with the exception of substance use disorders, the rates are quite different from one earlier study using DSM-II-R criteria. A clear pattern emerged from the analyses. That is, psychiatric disorders, like other chronic diseases, are the product of multiple factors and these factors in turn have effects on multiple disorders.
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Affiliation(s)
- Robert E Roberts
- Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, Texas 77030, USA.
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Abstract
BACKGROUND There is little consensus on the extent to which psychiatric disorders or syndromes are universal or the extent to which they differ on their core definitions and constellation of symptoms as a result of cultural or contextual factors. This controversy continues due to the lack of biological markers, imprecise measurement and the lack of a gold standard for validating most psychiatric conditions. METHOD Empirical studies were used to present evidence in favor of or against a universalist or relativistic view of child psychiatric disorders using a model developed by Robins and Guze to determine the validity of psychiatric disorders. RESULTS The prevalence of some of the most common specific disorders and syndromes as well as its risk and protective factors vary across cultures, yet comorbid patterns and response to treatments vary little across cultures. Cross-cultural longitudinal data on outcomes is equivocal. CONCLUSIONS The cross-cultural validity of child disorders may vary drastically depending on the disorder, but empirical evidence that attests for the cross-cultural validity of diagnostic criteria for each child disorder is lacking. There is a need for studies that investigate the extent to which gene-environment interactions are related to specific disorders across cultures. Clinicians are urged to consider culture and context in determining the way in which children's psychopathology may be manifested independent of their views. Recommendations for the upcoming classificatory system are provided so that practical or theoretical considerations are addressed about how culture and ethnic issues affect the assessment or treatment of specific disorders in children.
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Affiliation(s)
- Glorisa Canino
- University of Puerto Rico Medical School, Medical Sciences Campus, Behavioral Research Institute, San Juan, Puerto Rico 00936-5067, USA.
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Abstract
The rate and predictors of parental detection of youth self-harm behavior and relationship with help-seeking were examined in 7,036 parent-child dyads from the 1999 and 2004 surveys of Mental Health of Children and Young People in Great Britain. Youth self-harm behavior was reported by 463 (6.6%) children and adolescents but only 190 (2.7%) of the parents (kappa=0.30). Reports were more accurate if parents were from majority White ethnicity, were mothers of girls, experienced psychological distress themselves, or if children were older or had emotional/behavioral problems. Parental detection of youth self-harm was associated with increased likelihood of professional help-seeking.
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Affiliation(s)
- Ramin Mojtabai
- Department of Psychiatry, Beth Israel Medical Center, New York, NY 10010, USA.
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Abstract
OBJECTIVE Social risk factors such as growing up in poverty, racial/ethnic minority status, and maternal depression have been associated with poorer health outcomes for children. This study examined the strength of association of 8 social risk factors, both individually and as part of a cumulative social risk index, on parent-reported child health status. METHODS We performed an analysis of cross-sectional data from the 2003 National Survey of Children's Health, a telephone survey of 102,353 parents of children aged 0 to 17 years. In bivariate and multivariate logistic regression models, 8 social risk factors were tested as independent predictors of 4 parent-reported child health outcomes: global health status, dental health, socioemotional health, and overweight. These risk factors were combined into a categorical "social risk index" ranging from low risk (0 risk factors) to very high risk (> or = 6 risk factors), and risk gradients were examined using linear polynomial testing and multivariate logistic regression. RESULTS The percentage of children in poorer health increased with the number of social risk factors across all health outcomes. More than half of children had > or = 2 risk factors, and 24% had > or = 4. Low maternal mental health, black or Hispanic race/ethnicity, < 200% of the federal poverty level, low household education, unsafe neighborhoods, and lack of health insurance increased the odds for less than very good child health in adjusted models. CONCLUSIONS Multiple social risk factors have a cumulative effect on parent-reported child health status across physical and socioemotional domains, demonstrating a very strong risk gradient effect. These findings emphasize the importance of addressing multiple levels of social risk to achieve improvements in child health.
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Affiliation(s)
- Kandyce Larson
- UCLA Center for Healthier Children, Families, and Communities, 1100 Glendon Ave, Suite 850, Los Angeles, CA 90024, USA.
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Roberts RE, Roberts CR, Xing Y. Comorbidity of substance use disorders and other psychiatric disorders among adolescents: evidence from an epidemiologic survey. Drug Alcohol Depend 2007; 88 Suppl 1:S4-13. [PMID: 17275212 PMCID: PMC1935413 DOI: 10.1016/j.drugalcdep.2006.12.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 12/20/2006] [Indexed: 11/18/2022]
Abstract
This paper extends our knowledge of comorbidity of substance use disorders (SUDs) and other psychiatric disorders by examining comorbidity of specific types of SUDs and risk of comorbidity separately for abuse and dependence. The research question is whether there is specificity of risk for comorbidity for different SUDs and whether greater comorbidity is associated with dependence. Data are presented from a probability sample of 4175 youths aged 11-17 assessed with the NIMH DISC-IV and self-administered questionnaires. SUDs outcomes are alcohol, marijuana and other substances in past year. Mean number of other comorbid disorders ranged from 1.9 for marijuana abuse to 2.2 for other substance abuse and 1.9 for marijuana dependence to 2.8 for other substance dependence. None of the abuse SUDs does not increase risk of anxiety disorders, but dependence does. Both abuse and dependence increased risk of comorbid mood disorders. Similar results were observed for disruptive disorders. Patterns of comorbidity varied by substance, by abuse versus dependence, and by category of other psychiatric disorders. In general, there was greater association of comorbidity with other disorders for dependence versus abuse. Marijuana is somewhat less associated with other disorders than alcohol or other substances. The strongest association is for comorbid disruptive disorders, regardless of SUDs category. Having SUDs and comorbid other psychiatric disorders was associated with substantial functional impairment. Females with SUDs tended to have higher rates of comorbid disorders, as did older youths. There were no differences observed among ethnic groups. When comorbidity of SUDs with other disorders was examined, controlling for other non-SUDs disorders for each specific disorder examined, the greater odds for dependence versus abuse essentially disappeared for all disorders except disruptive disorders, suggesting larger number of comorbid non-SUDs in part account for the observed effects for dependence.
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Affiliation(s)
- Robert E Roberts
- Division of Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, P.O. Box 20186, 1200 Herman Pressler Dr., Houston, TX 77030, USA.
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Roberts RE, Roberts CR, Xing Y. Are Mexican American adolescents at greater risk of suicidal behaviors? Suicide Life Threat Behav 2007; 37:10-21. [PMID: 17397276 DOI: 10.1521/suli.2007.37.1.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A reexamination of ethnicity as a risk factor for adolescent suicidal behavior, focusing on whether Mexican American youths are at increased risk, was undertaken. Data from a sample of 4,175 African, European, and Mexican Americans, aged 11-17, are presented. We examined lifetime attempts and past year attempts, thoughts, and plans. Odds ratios, adjusting for covariates, indicate no differences between European and Mexican Americans on past year thoughts, plans, or attempts or lifetime attempts. Although some studies have reported Mexican American youths are at increased risk, we did not find any differences. Possible explanations for disparate results across studies are discussed, in particular methods effects.
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Affiliation(s)
- Robert E Roberts
- Division of Health Promotion and Behavioral Sciences in the School of Public Health, University of Texas Health Science Center at Houston, USA
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Roberts RE, Roberts CR, Xing Y. Prevalence of youth-reported DSM-IV psychiatric disorders among African, European, and Mexican American adolescents. J Am Acad Child Adolesc Psychiatry 2006; 45:1329-1337. [PMID: 17075355 DOI: 10.1097/01.chi.0000235076.25038.81] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The authors present prevalence data for adolescents in a large metropolitan area and examine the association of DSM-IV diagnoses with functional impairment and selected demographic correlates among European Americans (EA), African Americans (AA), and Mexican (MA) Americans. METHOD The authors sampled 4,175 youths ages 11 to 17 years whose households were enrolled in large health maintenance organizations. Data were collected using questionnaires, the Diagnostic Interview Schedule for Children-IV and the Children's Global Assessment Scale. The data were collected in the Houston Metropolitan area in 1998-2000. Data on psychiatric disorders were derived from interviews with youths only. RESULTS AA had a lower prevalence of mood disorders, substance use disorders, and any disorders adjusted for Diagnostic Interview Schedule for Children-IV impairment or Children's Global Assessment Scale score than did others. EA had greatest prevalence of substance use disorders, whereas AA were lowest. After adjusting for covariates, EA had a higher risk for some disorders than AA. Effects of gender, age, parent education, family income, and marital status were not consistent across groups. Family income was protective only for EA. CONCLUSIONS There appear to be few systematic differences between majority and minority adolescents at risk for psychiatric disorders. MA are not at increased risk contrasted to EA. AA had lower risk for some disorders, but adjusting for impairment and covariates eliminated most differences. Thus, multivariate analyses support the hypothesis that initial ethnic differences appear to be a function of factors associated with disadvantaged minority status rather than to distinctive ethnic culture. A noteworthy finding was that disadvantaged social status did not appear to increase the risk for disorders among minority youths.
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Affiliation(s)
- Robert E Roberts
- Dr. R.E. Roberts is with the Division of Health Promotion and Behavioral Sciences and Ms. Xing is with the Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston; and Dr. C.R. Roberts is with the Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston..
| | - Catherine Ramsay Roberts
- Dr. R.E. Roberts is with the Division of Health Promotion and Behavioral Sciences and Ms. Xing is with the Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston; and Dr. C.R. Roberts is with the Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston
| | - Yun Xing
- Dr. R.E. Roberts is with the Division of Health Promotion and Behavioral Sciences and Ms. Xing is with the Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston; and Dr. C.R. Roberts is with the Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston
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