Moral injury, race-related stress and post-traumatic stress disorder in a trauma-exposed Black population

BACKGROUND

Race-related stress (RRS) is an unrecognized source of moral injury (MI)-or the emotional and/or spiritual suffering that may emerge after exposure to events that violate deeply held beliefs. Additionally, MI has not been explored as a mechanism of risk for post-traumatic stress disorder (PTSD) in trauma-exposed civilians. We examined relations among exposure to potentially morally injurious events (moral injury exposure, MIE), related distress (moral injury distress, MID), and RRS in Black Americans. Potential indirect associations between RRS and PTSD symptoms via MID were also examined.

METHODS

Black Americans (n = 228; 90.4% female; Mage = 31.6 years. SDage = 12.8 years) recruited from an ongoing study of trauma completed measures assessing civilian MIE and MID, RRS, and PTSD. Bivariate correlations were conducted with MIE and MID, and mediation analysis with MID, to examine the role of MI in the relationship between RRS and PTSD symptom severity.

RESULTS

MIE was significantly correlated with cultural (r = 0.27), individual (r = 0.29), and institutional (r = 0.25) RRS; MID also correlated with cultural (r = 0.31), individual (r = 0.31), and institutional (r = 0.26) RRS (ps < 0.001). We found an indirect effect of RRS on PTSD symptoms via MID (β = 0.10, p < 0.005).

CONCLUSIONS

All types of RRS were associated with facets of MI, which mediated the relationship between RRS and current PTSD symptoms. MI may be a potential mechanism through which RRS increases the risk for PTSD in Black individuals.

Black Moms Matter: A Qualitative Approach to Understanding Barriers to Service Utilization at a Children's Advocacy Center Following Childhood Abuse

Black families are significantly less likely to receive evidence-based trauma treatment services; however, little is known about factors impacting engagement, particularly at Children's Advocacy Centers (CACs). The goal of this study is to better understand barriers and facilitators of service utilization for Black caregivers of CAC referred youth. Participants (n = 15) were randomly selected Black maternal caregivers (ages 26-42) recruited from a pool of individuals who were referred to receive CAC services. Black maternal caregivers reported barriers to accessing services at CACs including a lack of assistance and information in the referral and onboarding process, transportation issues, childcare, employment hours, system mistrust, stigma associated with the service system, and outside stressors such as stressors related to parenting. Maternal caregivers also shared suggestions for improving services at CACs including increasing the length, breadth, and clarity of investigations conducted by child protection services and law enforcement (LE) agencies, providing case management services, and having more diverse staff and discussing racial stressors. We conclude by identifying specific barriers to the initiation and engagement in services for Black families, and we provide suggestions for CACs seeking to improve engagement of Black families referred for trauma-related mental health services.

Psychological distress links perceived neighborhood characteristics to longitudinal trajectories of cognitive health in older adulthood

RATIONALE

Perceived neighborhood characteristics have been linked to cognitive health in older adulthood. The pathways through which neighborhood characteristics could influence cognition in older adulthood, however, have not been fully explored. Poorer quality neighborhoods may negatively influence cognition through feelings of psychological distress.

OBJECTIVE

To examine whether perceived neighborhood physical disorder and social cohesion were associated with change in episodic memory and semantic verbal fluency through anxiety and depressive symptoms.

METHODS

Using the Health and Retirement Study (HRS; n = 13,919), mediation models were conducted. Change in cognition (episodic memory and semantic verbal fluency) were modeled using latent growth curve models.

RESULTS

Higher physical disorder was associated with worse initial episodic memory and verbal fluency through greater anxiety symptoms. Higher social cohesion was associated with better initial episodic memory and verbal fluency through both lower anxiety and fewer depressive symptoms. Further, individuals with higher social. cohesion reported lower anxiety and in turn, showed a slower rate of verbal fluency decline. A direct effect of physical disorder on initial episodic memory remained, after accounting for indirect effects and covariates.

CONCLUSIONS

Overall, individuals who live in neighborhoods with high physical disorder and low social cohesion may experience greater psychological distress. Symptoms of anxiety and depression may, in turn, interfere with cognitive functioning. Neighborhood characteristics may be an important, targetable area for intervention to improve not only mental health outcomes, but cognitive health outcomes in older adulthood.

ANXIETY AND DEPRESSIVE SYMPTOMS MEDIATE THE LINK BETWEEN PERCEIVED NEIGHBORHOOD CHARACTERISTICS AND COGNITION

Although prior research has linked perceived neighborhood characteristics to cognition, scant research has investigated underlying mechanisms regarding how neighborhood characteristics impact cognition. One pathway, in particular, may be through mental health outcomes. Poorer neighborhood characteristics have been independently linked to greater depressive and anxiety symptoms, which may, in turn, be risk factors for cognitive decline in later life. The current study examined direct and indirect effects of perceived neighborhood characteristics (social cohesion, physical disorder) on cognitive functioning (episodic memory, executive functioning) through anxiety and depressive symptoms using longitudinal data from the Health and Retirement Study (2010–2014). Results revealed that higher social cohesion was associated with better memory and executive functioning through lower anxiety and depressive symptoms. Physical disorder was associated with worse episodic memory and executive functioning through greater anxiety symptoms. These findings highlight the importance of neighborhood context for promoting both mental and cognitive health outcomes in older adulthood.

Recommendations for a culturally-responsive mindfulness-based intervention for African Americans

BACKGROUND

African Americans are at increased risk for stress-related disparities. Mindfulness-based interventions are effective in reducing adverse outcomes; yet, racial/ethnic minorities are underrepresented in these interventions. Also, the development of culturally-responsive interventions has been mostly non-existent.

MATERIALS AND METHODS

Focus group and interview data were acquired following a four-week mindfulness intervention with African American women.

RESULTS

Using Brigg's (2011) mental health utilization model to guide analysis, several recommended culturally-responsive modifications emerged. Recommended modifications internal to the intervention included using African American facilitators, incorporating cultural values, using culturally-familiar terminology, and providing cultural resources. Suggested modifications to the intervention's external factors included offering the intervention within culturally-familiar settings. Individual-level factors to address were religious concerns, perceived benefits, and holistic health goals.

CONCLUSIONS

Themes were used to propose a model toward the creation of a culturally-responsive mindfulness-based interventions to guide culturally-relevant treatment modifications and improve underserved communities' engagement in these interventions.