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Park IJK, Wang L, Li R, Yip T, Valentino K, Cruz-Gonzalez M, Giraldo-Santiago N, Lorenzo K, Zhen-Duan J, Alvarez K, Alegría M. A daily diary study of discrimination and distress in Mexican-origin adolescents: Testing mediating mechanisms. Child Dev 2024. [PMID: 38698702 DOI: 10.1111/cdev.14108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The present 21-day daily diary study (conducted 2021-2022) tested anger and racism-related vigilance as potential transdiagnostic mediators linking exposure to racial and ethnic discrimination (RED) to distress (negative affect and stress, respectively). The data analytic sample included N = 317 Mexican-origin adolescents (Mage = 13.5 years; 50.8% male, 46.7% female; 2.5% non-binary) from the Midwestern United States. Results from longitudinal mediation models revealed significant mediation effects through anger and racism-related vigilance, respectively, in the association between daily RED and daily distress, both within and across adolescents. Implications for theory, research, and practice are discussed so that future work can leverage these novel findings toward promoting the well-being of Mexican-origin adolescents, especially those who live in contexts of ethnoracial adversity.
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Affiliation(s)
- Irene J K Park
- Department of Psychiatry, Indiana University School of Medicine-South Bend, South Bend, Indiana, USA
| | - Lijuan Wang
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Ruoxuan Li
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Tiffany Yip
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Kristin Valentino
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Giraldo-Santiago
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle Lorenzo
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kiara Alvarez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Valentino K, Park IJK, Cruz-Gonzalez M, Zhen-Duan J, Wang L, Yip T, Lorenzo K, Dias D, Alvarez K, Alegría M. Family-level moderators of daily associations between discrimination and distress among Mexican-origin youth. Dev Psychopathol 2024:1-16. [PMID: 38584283 DOI: 10.1017/s0954579424000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The current study evaluated cultural values and family processes that may moderate associations between daily racial-ethnic discrimination and distress among Mexican-origin youth. Integrating micro-time (daily diary) and macro-time (longitudinal survey) research design features, we examined familism, family cohesion, and ethnic-racial socialization from youth-, mother-, and father- reports as potential buffers of daily associations between youth racial-ethnic discrimination and youth distress (negative affect and anger). The analytic sample, drawn from the Seguimos Avanzando study, included 317 Mexican-origin adolescents (Mage = 13.5 years) and their parents, recruited from the Midwestern United States. Results indicated that youth-reported familism and family cohesion significantly buffered daily associations between youth racial-ethnic discrimination and youth distress. In contrast, parent-reported familism and family cohesion and some aspects of ethnic-racial socialization exacerbated the discrimination to distress link. The implications of these results are discussed to inform efforts supporting the healthy development of Mexican-origin youth and their families.
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Affiliation(s)
| | - Irene J K Park
- Department of Psychiatry, Indiana University School of Medicine-South Bend, South Bend, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Lijuan Wang
- Department of Psychology, University of Notre Dame, Notre Dame, USA
| | - Tiffany Yip
- Department of Psychology, Fordham University, New York, USA
| | - Kyle Lorenzo
- Department of Psychology, Fordham University, New York, USA
| | - David Dias
- Department of Psychology, University of Notre Dame, Notre Dame, USA
| | - Kiara Alvarez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
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Platt R, Alvarez K, Vasquez MG, Bancalari P, Acosta J, Caicedo MR, Polk S, Wilcox H. Suicide prevention programming across ecological levels: Recommendations from Latinx immigrant origin youth and their parents. Fam Syst Health 2024; 42:101-115. [PMID: 37616106 PMCID: PMC10891300 DOI: 10.1037/fsh0000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Latinx immigrant-origin youth (IOY) have unique risks for suicidal thoughts and behaviors. It has been suggested that these risks should be addressed from an ecological perspective, addressing cultural and family context as well as structural and systemic barriers to prevention. This study sought to explore perspectives of immigrant-origin Latinx adolescents and their caregivers on suicide and its prevention, including the potential impact of stressors specific to immigrant status. METHOD Focus groups were conducted in 2018-2019 with Latinx immigrant-origin caregivers (N = 41, 97.5% female) and adolescents (ages = 14-19, N = 56, 50% female). Participants were recruited from community-based organizations in two different cities. A codebook approach to thematic analysis was used to identify themes, which were subsequently mapped onto levels of the Center for Disease Control's Social-Ecological Framework for Violence Prevention. RESULTS Participants identified both contributors to suicidal behavior and potential components of prevention programming across ecological levels. Specific recommendations for suicide prevention included engaging in recreation, parenting education and support, enhancing academic supports for adolescents, and enhancing school-family communication. Structural barriers (e.g., caregiver work schedules) to implementing recommendations were described. DISCUSSION Our results highlight the potential role of access to school and community-based supports as public health-oriented suicide prevention strategies and suggest a need to address barriers faced by immigrant families in accessing these supports alongside addressing barriers to mental health treatment. Policies impacting immigrant families' financial stability and increasing the availability of recreational and academic opportunities may promote mental health and prevent suicidal thoughts and behavior among IOY. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kiara Alvarez
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Pilar Bancalari
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- NYC Administration for Children’s Services, New York, NY
| | - Jennifer Acosta
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Maryland Department of Health, Baltimore, MD
| | - Mariana Rincon Caicedo
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Psychology, University of Kansas, Lawrence, KS
| | - Sarah Polk
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Holly Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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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:S0890-8567(24)00066-2. [PMID: 38367767 DOI: 10.1016/j.jaac.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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. 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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Zhen-Duan J, Alvarez K, Zhang L, Cruz-Gonzalez M, Kuo J, Falgas-Bagué I, Bird H, Canino G, Duarte CS, Alegría M. Parental psychopathology and posttraumatic stress in Puerto Ricans: the role of childhood adversity and parenting practices. J Child Psychol Psychiatry 2023:10.1111/jcpp.13902. [PMID: 37850715 PMCID: PMC11024057 DOI: 10.1111/jcpp.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Parental psychopathology is associated with their children's posttraumatic stress symptoms (PTSS). However, the mechanisms through which this occurs remain unclear. We hypothesized that exposure to childhood adversities is the mechanism linking parental psychopathology to child PTSS and that parenting practices moderated these associations. METHODS Participants (N = 1,402) with an average age of 24.03 years old (SD = 2.20), were all Puerto Ricans (50% Male and 50% Female) from the Boricua Youth Study, which is a four-wave longitudinal study spanning almost 20 years, following individuals from childhood (ages 5-13 at Wave 1) to young adulthood. Measured variables include parental psychopathology at Wave 1, childhood adversities and parenting practices at Waves 2-3, and PTSS at Wave 4. A traditional mediation model estimated the association between parental psychopathology and child PTSS via childhood adversities. A moderated mediation model was used to examine whether parenting practices moderated this mediation model. RESULTS Results showed that the total effect of parental psychopathology at Wave 1 on PTSS at Wave 4 was fully mediated by childhood adversities at Waves 2-3 (direct effect b = 1.72, 95% CI = [-0.09, 3.83]; indirect effect b = 0.40, 95% CI = [0.15, 0.81]). In addition, the magnitude of this pathway varied by levels of parenting practices (i.e. parental monitoring and parent-child relationship quality). Specifically, the indirect effect of additional adversities in the psychopathology-PTSS link was stronger with higher levels of parental monitoring but weaker with higher parent-child relationship quality scores. CONCLUSIONS Intergenerational continuity of psychopathology may be mitigated through the prevention of additional childhood adversities via upstream interventions, emphasizing providing parents with mental health needs with parenting tools. Family-based interventions focused on providing families with the tools to improve parent-child relationships may reduce the negative impact of childhood adversities on mental health across the life course.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kiara Alvarez
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Josephine Kuo
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Irene Falgas-Bagué
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Hector Bird
- Department of Psychiatry, Columbia University – New York State Psychiatric Institute, New York, NY, USA
| | - Glorisa Canino
- Department of Pediatrics, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Cristiane S. Duarte
- Department of Psychiatry, Columbia University – New York State Psychiatric Institute, New York, NY, USA
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Molock SD, Boyd RC, Alvarez K, Cha C, Denton EG, Glenn CR, Katz CC, Mueller AS, Meca A, Meza JI, Miranda R, Ortin-Peralta A, Polanco-Roman L, Singer JB, Zullo L, Miller AB. Culturally responsive assessment of suicidal thoughts and behaviors in youth of color. Am Psychol 2023; 78:842-855. [PMID: 36913280 PMCID: PMC10497725 DOI: 10.1037/amp0001140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The significance of youth suicide as a public health concern is underscored by the fact that it is the second-leading cause of death for youth globally. While suicide rates for White groups have declined, there has been a precipitous rise in suicide deaths and suicide-related phenomena in Black youth; rates remain high among Native American/Indigenous youth. Despite these alarming trends, there are very few culturally tailored suicide risk assessment measures or procedures for youth from communities of color. This article attempts to address this gap in the literature by examining the cultural relevancy of currently widely used suicide risk assessment instruments, research on suicide risk factors, and approaches to risk assessment for youth from communities of color. It also notes that researchers and clinicians should consider other, nontraditional but important factors in suicide risk assessment, including stigma, acculturation, and racial socialization, as well as environmental factors like health care infrastructure and exposure to racism and community violence. The article concludes with recommendations for factors that should be considered in suicide risk assessment for youth from communities of color. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sherry D Molock
- Department of Psychological and Brain Sciences, George Washington University
| | - Rhonda C Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
| | - Kiara Alvarez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Christine Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | - Ellen-Ge Denton
- Department of Psychology, College of Staten Island, City University of New York
| | | | - Colleen C Katz
- Silberman School of Social Work, Hunter College, City University of New York
| | | | - Alan Meca
- Department of Psychology, University of Texas at San Antonio
| | - Jocelyn I Meza
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Regina Miranda
- Department of Psychology, Hunter College, City University of New York
| | - Ana Ortin-Peralta
- Department of Psychology, Hunter College, City University of New York
| | | | | | - Lucas Zullo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Grieb SM, Platt R, Vazquez MG, Alvarez K, Polk S. Mental Health Stigma Among Spanish-Speaking Latinos in Baltimore, Maryland. J Immigr Minor Health 2023; 25:999-1007. [PMID: 37213041 PMCID: PMC10201042 DOI: 10.1007/s10903-023-01488-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
To assess mental health-related stigma in an emerging Latino immigrant community and explore demographic characteristics associated with stigma. We surveyed 367 Spanish-speaking Latino adults recruited at community-based venues in Baltimore, Maryland. The survey included sociodemographic questions, the Depression Knowledge Measure, Personal Stigma Scale, and the Stigma Concerns about Mental Health Care (SCMHC) assessment. Multiple regression models examining associations between personal stigma and stigma concerns about mental health care, respectively, were constructed using variables that were statistically significant in bivariate analyses. Being male, having less than high school education, reporting high importance of religion, and having lower depression knowledge contributed to higher personal stigma. When controlling for other variables, only depression knowledge contributed unique variance to the prediction of higher SCMHC. Efforts to improve access to and quality of mental health care must be paralleled by ongoing efforts to reduce depression stigma within emergent immigrant Latino communities.
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Affiliation(s)
- Suzanne M Grieb
- Department of Pediatrics Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building - Center Tower Suite 4200, Baltimore, MD, 21205, USA.
| | - Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Monica Guerrero Vazquez
- Department of Pediatrics Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building - Center Tower Suite 4200, Baltimore, MD, 21205, USA
- Center for Salud/Health and Opportunities for Latinos, Johns Hopkins University, Baltimore, MD, USA
| | - Kiara Alvarez
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah Polk
- Department of Pediatrics Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building - Center Tower Suite 4200, Baltimore, MD, 21205, USA
- Center for Salud/Health and Opportunities for Latinos, Johns Hopkins University, Baltimore, MD, USA
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8
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Fong HF, Alvarez K, Cruz-Gonzalez M, Canino G, Bird HR, Alegría M. A Longitudinal Study of Risk Factors for Sexual Victimization in Puerto Rican Youth. Acad Pediatr 2023; 23:1142-1150. [PMID: 36584936 PMCID: PMC10293476 DOI: 10.1016/j.acap.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine whether youth, family, and neighborhood factors and minoritized status are associated with youth-reported sexual victimization from childhood through young adulthood. METHODS We analyzed longitudinal data from 2 population-based samples of Puerto Rican youth living in the South Bronx (as a minoritized group) and Puerto Rico (as a nonminoritized group). Waves 1 to 3 were collected annually beginning in 2000 (youth age 5-13). Wave 4 was collected 2013 to 2017 (youth age 15-29). We estimated multivariable associations between youth, family, and neighborhood factors and minoritized status at Wave 1 (independent variables); and youth-reported sexual victimization at Waves 1 to 4 (dependent variables). RESULTS None of the factors was associated with youth-reported sexual victimization at Wave 1 (N = 1911). Among youth reporting no previous history of sexual victimization at Wave 1 (n = 1823), youth in the South Bronx vs Puerto Rico were more likely to report sexual victimization at Waves 2 or 3 (odds ratio (OR) [95% confidence interval (CI)] = 3.62 [1.46-8.97]). Older youth were less likely to report sexual victimization (OR [95% CI] = 0.77 [0.65-0.91]) (all P < .01). Among youth reporting no history of sexual victimization at Waves 1 to 3 (n = 1782), youth in the South Bronx (OR [95% CI] = 2.53 [1.52-4.22]), female youth (OR [95% CI] = 2.81 [1.83-4.30]), and youth whose parents had more than a high school degree (OR [95% CI] = 2.25 [1.38-3.67]) were more likely to report sexual victimization at Wave 4 than their counterparts (all P ≤ .001). CONCLUSIONS Future research should investigate how living as a minoritized youth may contribute to an increased risk of sexual victimization.
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Affiliation(s)
- Hiu-Fai Fong
- Division of General Pediatrics, Boston Children's Hospital (H-f Fong), Boston, Mass; Department of Pediatrics, Harvard Medical School (H-f Fong), Boston, Mass.
| | - Kiara Alvarez
- Department of Medicine, Harvard Medical School (K Alvarez, M Cruz-Gonzalez, and M Alegría), Boston, Mass; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital (K Alvarez, M Cruz-Gonzalez, and M Alegría), Boston, Mass
| | - Mario Cruz-Gonzalez
- Department of Medicine, Harvard Medical School (K Alvarez, M Cruz-Gonzalez, and M Alegría), Boston, Mass; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital (K Alvarez, M Cruz-Gonzalez, and M Alegría), Boston, Mass
| | - Glorisa Canino
- Department of Pediatrics, University of Puerto Rico School of Medicine, University of Puerto Rico Medical Science Campus (G Canino), San Juan, Puerto Rico
| | - Hector R Bird
- Department of Psychiatry, Columbia University (HR Bird), New York, NY
| | - Margarita Alegría
- Department of Medicine, Harvard Medical School (K Alvarez, M Cruz-Gonzalez, and M Alegría), Boston, Mass; Department of Psychiatry, Harvard Medical School (M Alegría), Boston, Mass; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital (K Alvarez, M Cruz-Gonzalez, and M Alegría), Boston, Mass
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9
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Falgas-Bague I, Cruz-Gonzalez M, Zhen-Duan J, Nagendra A, Alvarez K, Canino G, Duarte CS, Bird H, M. De-Salazar P, Alegría M. Association of sociocultural stressors with bipolar disorder onset in Puerto Rican youth growing up as members of a minoritized ethnic group: results from the Boricua Youth Longitudinal Study. Lancet Reg Health Am 2023; 24:100549. [PMID: 37485018 PMCID: PMC10362791 DOI: 10.1016/j.lana.2023.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/29/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023]
Abstract
Background The development of bipolar disorder is currently explained by a complex interaction of genetic and environmental factors. Less is known regarding the influence of sociocultural factors. This study aims to evaluate the incidence and impact of sociocultural factors on bipolar disorder onset in two comparable samples of youth growing up in different social settings. Methods We leveraged data from two urban population-based cohorts representative of Puerto Rican children growing up in either San Juan (Puerto Rico) or the South Bronx (NYC) and followed up for 17 years. Bipolar disorder diagnoses were based on retrospective self-reports on the World Health Organization Composite International Diagnostic Interview. We used a causal inference approach to estimate associations of sociocultural factors with bipolar disorder onset after adjusting for potential confounders. Findings We found that South Bronx children, who grew up as a minoritized group, had twice the risk of bipolar disorder onset as young adults, with an incidence rate of 2.22 new cases per 1000 person-years compared to 1.08 new cases in San Juan (incidence rate difference, 1.13; 95% CI, 0.09-1.20). After adjusting for potential confounders, South Bronx children had the same lifetime hazard of bipolar disorder onset compared to San Juan children. However, our analysis demonstrated that caregivers' exposure to societal cultural stress partially explained the increased risk of bipolar disorder onset in the South Bronx, in addition to the potential contribution of genetics. Interpretation Our results provide evidence that societal cultural stress can increase the risk of lifetime bipolar disorder onset in youth growing up as a minoritized group. Addressing stress in minoritized groups might reduce the risk of bipolar disorder onset. Funding The Boricua Youth Study has been supported by the National Institutes of HealthMH56401, MH098374, DA033172, and AA020191. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.
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Affiliation(s)
- Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 2 Kreutzstrasse, 4123, Allschwil, Switzerland
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA
| | - Arundati Nagendra
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Schizophrenia and Psychosis Action Alliance, Alexandria, VA 22301, USA
| | - Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico Medical School, Office A928 9th Floor, Rio Piedras, 00935, Puerto Rico
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Hector Bird
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Pablo M. De-Salazar
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 2 Kreutzstrasse, 4123, Allschwil, Switzerland
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Suite 506, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA
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10
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Alegría M, Alvarez K, Cheng M, Falgas-Bague I. Recent Advances on Social Determinants of Mental Health: Looking Fast Forward. Am J Psychiatry 2023; 180:473-482. [PMID: 37392038 DOI: 10.1176/appi.ajp.20230371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
The fields of psychiatry and mental health are increasingly recognizing the importance of social determinants of health (SDOH) and their impact on mental health outcomes. In this overview, the authors discuss the recent research, from the past 5 years, on advances made in SDOH work. SDOH frameworks and theories have expanded to include more social conditions, from traumas associated with immigration to psychosocial and community strengths, that impact mental health and well-being. Research has consistently shown the pervasive deleterious impacts of inequitable social conditions (e.g., food insecurity, housing instability) on minoritized populations' physical and mental health. Social systems of oppression (e.g., racism, minoritization) have also been shown to confer higher risk for psychiatric and mental disorders. The COVID-19 pandemic illuminated the inequitable impact of the social determinants of health outcomes. More efforts have been made in recent years to intervene on the social determinants through interventions at the individual, community, and policy levels, which have shown promise in improving mental health outcomes in marginalized populations. However, major gaps remain. Attention should be paid to developing guiding frameworks that incorporate equity and antiracism when designing SDOH interventions and improving methodological approaches for evaluating these interventions. In addition, structural-level and policy-level SDOH efforts are critical for making long-lasting and impactful advances toward mental health equity.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and the Mongan Institute, Boston (Alegría, Cheng, Falgas-Bague); Department of Medicine (Alegría, Falgas-Bague) and Department of Psychiatry (Alegría), Harvard Medical School, Boston; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Alvarez); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Allschwil, Basel, Switzerland (Falgas-Bague)
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and the Mongan Institute, Boston (Alegría, Cheng, Falgas-Bague); Department of Medicine (Alegría, Falgas-Bague) and Department of Psychiatry (Alegría), Harvard Medical School, Boston; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Alvarez); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Allschwil, Basel, Switzerland (Falgas-Bague)
| | - Michelle Cheng
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and the Mongan Institute, Boston (Alegría, Cheng, Falgas-Bague); Department of Medicine (Alegría, Falgas-Bague) and Department of Psychiatry (Alegría), Harvard Medical School, Boston; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Alvarez); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Allschwil, Basel, Switzerland (Falgas-Bague)
| | - Irene Falgas-Bague
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and the Mongan Institute, Boston (Alegría, Cheng, Falgas-Bague); Department of Medicine (Alegría, Falgas-Bague) and Department of Psychiatry (Alegría), Harvard Medical School, Boston; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Alvarez); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Allschwil, Basel, Switzerland (Falgas-Bague)
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11
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Liu RT, Anglin DM, Dyar C, Alvarez K. Intersectional approaches to risk, resilience, and mental health in marginalized populations: Introduction to the special section. J Psychopathol Clin Sci 2023; 132:527-530. [PMID: 37347907 DOI: 10.1037/abn0000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Although persistent health disparities affecting marginalized communities have long been recognized, marginalized populations (i.e., oppressed groups with stigmatized social identities) have remained significantly understudied in clinical science and allied disciplines. To reduce mental health disparities, it is critical to examine the experiences of Black, Indigenous, and people of color and sexual and gender minority populations within an intersectional framework (i.e., intersection of multiple marginalized identities) and to identify processes through which these experiences relate to risk and resilience for negative mental health outcomes. The goal of this special section is to highlight recent efforts to address this critical need by examining mental health among marginalized individuals impacted by multiple systems of oppression. These studies demonstrate the generative potential of intersectional approaches in clinical science. Our hope is that these studies will encourage future work in this field, with the ultimate aim of addressing disparities in underserved and understudied populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Richard T Liu
- Massachusetts General Hospital, Department of Psychiatry
| | - Deidre M Anglin
- City University of New York, The City College of New York, Department of Psychology
| | | | - Kiara Alvarez
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society
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12
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Zhen-Duan J, Colombo D, Alvarez K. Inclusion of Expanded Adverse Childhood Experiences in Research About Racial/Ethnic Substance Use Disparities. Am J Public Health 2023; 113:S129-S132. [PMID: 37339415 PMCID: PMC10282858 DOI: 10.2105/ajph.2023.307220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 06/22/2023]
Affiliation(s)
- Jenny Zhen-Duan
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniella Colombo
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kiara Alvarez
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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13
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Zhen-Duan J, Colombo D, Cruz-Gonzalez MA, Hoyos M, Alvarez K. Adverse childhood experiences and alcohol use and misuse: Testing the impact of traditional and expanded adverse childhood experiences among racially/ethnically diverse youth transitioning into adulthood. Psychol Trauma 2023; 15:S55-S64. [PMID: 37476532 PMCID: PMC10356013 DOI: 10.1037/tra0001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Objective Traditional Adverse Childhood Experiences (T-ACEs), such as abuse and neglect, have been associated with an increased risk of youth alcohol use and misuse. This study aims to compare associations of T-ACEs and Expanded ACEs (E-ACEs), an expanded set of ACEs that encompass community-level adversities, with alcohol use and misuse by race/ethnicity. Method Data came from a three-wave (1998-1999; 1999-2000; 2004-2005) community-based study in Houston, including youth transitioning into adulthood. We compared associations between ACEs at Wave 1 and past-year alcohol use, abuse, and dependence at Wave 3. Results Participants (n = 2,391) included White (n =908), Black (n = 898) and Latinx (n = 585) youth (M (SD) = 14.00 (2.04)) transitioning into young adulthood (M (SD) = 19.77 (2.34)). T-ACEs were associated with higher odds of alcohol use, abuse, and dependence (OR = 1.15, OR = 1.18, OR = 1.24, respectively) while E-ACEs increased the odds of alcohol dependence (OR = 1.23) in the total sample. No significant differences by race/ethnicity were found. Racial/ethnic differences in increased alcohol risk were observed for some ACE items, such as bullying and use for Latinx youth (OR = 2.13) and poverty and dependence for White youth (OR = 2.01). Conclusions T-ACES and E-ACEs increase the risk of alcohol use and misuse. Results highlight the importance of preventing ACEs exposure as a risk factor for youth alcohol use and misuse. Public policies must also focus on preventing ACEs through multi-level interventions aimed at reducing violence, bullying, and financial instability.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Mario A. Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mercedes Hoyos
- Department of Political Science, Boston College, Chestnut Hill, MA, USA
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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14
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Haroz EE, Sarapik LM, Adams LB, Nestadt PS, Athey A, Alvarez K, Slade EP, Cwik M, Berman AL, Wilcox HC. A Cascade of Care Model for Suicide Prevention. Am J Prev Med 2023; 64:599-603. [PMID: 36402646 PMCID: PMC10166000 DOI: 10.1016/j.amepre.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/31/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Emily E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Liina M Sarapik
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leslie B Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul S Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alison Athey
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kiara Alvarez
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric P Slade
- Johns Hopkins School of Nursing, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alan L Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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15
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Sandel C, Myers J, Alvarez K, Stavrakis S, Gaffney P, Cunningham M. Cd4+ T cell phenotypes, autoantibodies and transcriptional signatures overlap between myocarditis, ischemic and nonischemic heart failure, suggesting shared inflammatory pathogenic mechanisms. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocarditis may progress to heart failure (HF) often as a result of viral myocardial infection where cardiomyocyte damage exposes sequestered self-antigens including cardiac myosin (CM) leading to autoimmunity. CM acts as an adjuvant via activation of Toll-like receptor (TLR)2 and TLR8, and is a potent autoantigen promoting HF in myocarditis through elevated IL-6, IL-17A and Th17 differentiation concomitant with autoantibody responses against CM. Since cardiomyocyte damage also occurs in ischemic and nonischemic cardiomyopathies, we investigated the hypothesis that ischemic and nonischemic HF would have similar inflammatory phenotypes.
Purpose
We defined CD4+ T helper cell phenotypes, autoantibodies, and peripheral blood transcriptome of the inflammatory phenotypes in myocarditis, compared to ischemic, and nonischemic HF. The identification of immune phenotypes in myocarditis and HF are important for consideration of inflammatory interventions and immunotherapies in myocarditis and HF.
Methods
Peripheral blood was collected from myocarditis patients within 6 months of disease onset, and from clinically stable, chronic HF patients. CD4+ T helper cells (Th1, Th2, and Th17) were evaluated by flow cytometry after density gradient separation, and human CM autoantibody titers were determined by ELISA. Whole blood RNA sequencing, Ingenuity Pathway Analysis (IPA), as well as multi-contrast pathway enrichment were performed.
Results
(Fig. 1A) Significantly elevated human CM autoantibodies were observed in myocarditis, ischemic and nonischemic HF patients, and correlated with nonrecovered patients and poor outcomes. (Fig. 1B) Myocarditis and nonischemic HF patients had significantly elevated Th17 and Th2 frequencies. Ischemic HF patients had a trend toward elevated Th 17 and Th 2 CD4+ T cell frequencies. None of the cohorts demonstrated an elevation in Th1 (not shown) (Fig 2A), IPA canonical pathway enrichment for all cohorts together showed elevated pathways concordant with our proposed pathogenic mechanisms in myocarditis and HF, including TLR and inflammasome signaling and IL17A and IL13 pathways (Fig. 2B). Myocarditis and nonischemic HF shared more inflammatory pathway enrichment in common than ischemic HF (Fig. 2C) Multi contrast pathway enrichment demonstrated that males in each cohort shared TLR and IL1b signaling that was not observed in females.
Conclusion
Nonischemic HF patients have overlapping immunological features with myocarditis including elevated anti-CM autoantibodies, as well as Th17, and Th2 frequencies. Ischemic HF demonstrated elevated CM autoantibodies and fewer inflammatory genes and pathways. The transcriptome supported the immune phenotypes in myocarditis and heart failure suggesting pathogenic autoimmune and inflammatory mechanisms shared in myocarditis and ischemic HF. The results have implications for immunomodulatory therapies in myocarditis and HF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health
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Affiliation(s)
- C Sandel
- The University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - J Myers
- The University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - K Alvarez
- The University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - S Stavrakis
- The University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - P Gaffney
- The University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - M Cunningham
- The University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
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16
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Hoffmann JA, Alegría M, Alvarez K, Anosike A, Shah PP, Simon KM, Lee LK. Disparities in Pediatric Mental and Behavioral Health Conditions. Pediatrics 2022; 150:e2022058227. [PMID: 36106466 PMCID: PMC9800023 DOI: 10.1542/peds.2022-058227] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/31/2022] Open
Abstract
Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.
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Affiliation(s)
- Jennifer A. Hoffmann
- . Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Margarita Alegría
- . Disparities Research Unit, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kiara Alvarez
- . Disparities Research Unit, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA
| | - Amara Anosike
- . Office of Government Relations, Boston Children’s Hospital, Boston, MA
| | | | - Kevin M. Simon
- . Adolescent Substance use and Addiction Program, Boston Children’s Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- . Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
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17
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Alvarez K, Cervantes PE, Nelson KL, Seag DEM, Horwitz SM, Hoagwood KE. Review: Structural Racism, Children's Mental Health Service Systems, and Recommendations for Policy and Practice Change. J Am Acad Child Adolesc Psychiatry 2022; 61:1087-1105. [PMID: 34971730 PMCID: PMC9237180 DOI: 10.1016/j.jaac.2021.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Racism is a public health crisis that impacts on children's mental health, yet mental health service systems are insufficiently focused on addressing racism. Moreover, a focus on interpersonal racism and on individual coping with the impacts of racism has been prioritized over addressing structural racism at the level of the service system and associated institutions. In this paper, we examine strategies to address structural racism via policies affecting children's mental health services. METHOD First, we identify and analyze federal and state policies focused on racism and mental health equity. Second, we evaluate areas of focus in these policies and discuss the evidence base informing their implementation. Finally, we provide recommendations for what states, counties, cities, and mental health systems can do to promote antiracist evidence-based practices in children's mental health. RESULTS Our analysis highlights gaps and opportunities in the evidence base for policy implementation strategies, including the following: mental health services for youth of color, interventions addressing interpersonal racism and bias in the mental health service system, interventions addressing structural racism, changes to provider licensure and license renewal, and development of the community health workforce. CONCLUSION Recommendations are provided both within and across systems to catalyze broader systems transformation.
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Affiliation(s)
- Kiara Alvarez
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | - Katherine L Nelson
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Merck & Co., Inc., Kenilworth, New Jersey
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18
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Alvarez K, Polanco-Roman L, Breslow AS, Molock S. Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. Am J Psychiatry 2022; 179:422-433. [PMID: 35599542 PMCID: PMC9765395 DOI: 10.1176/appi.ajp.21101001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Correspondence: Kiara Alvarez, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | | | - Aaron Samuel Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY,Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Sherry Molock
- Department of Psychological & Brain Sciences, The George Washington University, Washington, DC
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19
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NeMoyer A, Cruz-Gonzalez M, Alvarez K, Kessler RC, Sampson NA, Green JG, Alegría M. Reducing racial/ethnic disparities in mental health service use among emerging adults: community-level supply factors. Ethn Health 2022; 27:749-769. [PMID: 32877232 PMCID: PMC7921204 DOI: 10.1080/13557858.2020.1814999] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives: Emerging adulthood-spanning 18-29 years of age-is associated with the highest risk for onset of certain behavioral health disorders (e.g. major depression, bipolar disorder, psychosis, substance use disorders) and high prevalence of many behavioral health disorders. Yet, rates of mental health service use remain low in this age range. Racial/ethnic minorities are particularly impacted by individual, cultural/linguistic, and community-level barriers to mental health care. This study examined community-level factors associated with mental health service use and investigated whether these associations varied by race/ethnicity.Design: This study analyzed individual- and county-level data for emerging adults in the United States (N=3,294) from the nationally representative Collaborative Psychiatric Epidemiological Surveys (CPES). Using the Andersen Model of Health Care Utilization, analyses examined predisposing, enabling, and need factors utilized in prior studies with adult samples as well as novel community characteristics hypothesized to impact service use among emerging adults of diverse racial/ethnic backgrounds. Past-year use of both specialty and any mental health services were assessed, controlling for individual- and community-level variables, and adjusting for presence of past-year mental health disorder, overall health status, and functional impairment. Differences between racial/ethnic minority groups and Non-Latino Whites were tested through a multilevel model incorporating random intercepts logistic regression, with analysis focusing on the interaction between race/ethnicity and community-level supply variables.Results: For past-year use of specialty mental health services, density of hospitals with child wellness programs was linked to service use among Black emerging adults, whereas density of hospitals with linguistic/translation services was linked to service use among Latino emerging adults.Conclusions: This study expands on previous research in behavioral health disparities to examine ways to improve behavioral health services for an emerging adult population with unmet service needs and identifies specific community-level factors that can improve mental health for racial/ethnic minority emerging adults.
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Affiliation(s)
- Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States
- Department of Medicine, Harvard Medical School, 21 Shattuck Street, Boston, MA, 02115, United States
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States
- Department of Medicine, Harvard Medical School, 21 Shattuck Street, Boston, MA, 02115, United States
- Corresponding author: Kiara Alvarez, 50 Staniford Street Suite 830 Boston, MA 02114; telephone: +1-617-724-1237;
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States
| | - Jennifer Greif Green
- Wheelock College of Education and Human Development, Boston University, 2 Silber Way, Boston, MA 02215, United States
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States
- Department of Medicine, Harvard Medical School, 21 Shattuck Street, Boston, MA, 02115, United States
- Department of Psychiatry, Harvard Medical School, 21 Shattuck Street, Boston, MA, 02115, United States
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20
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Alegría M, Alvarez K, NeMoyer A, Zhen-Duan J, Marsico C, O'Malley IS, Mukthineni R, Porteny T, Herrera CN, Najarro Cermeño J, Kingston K, Sisay E, Trickett E. Development of a Youth Civic Engagement Program: Process and Pilot Testing with a Youth-Partnered Research Team. Am J Community Psychol 2022; 69:86-99. [PMID: 34350588 DOI: 10.1002/ajcp.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although research suggests neighborhood-level factors influence youth well-being, few studies include youth when creating interventions to address these factors. We describe our three-step process of collaborating with youth in low-income communities to develop an intervention focused on civic engagement as a means to address neighborhood-level problems impacting their well-being. In the first step, we analyzed qualitative interviews from a project in which youth shared perceptions about their neighborhoods (e.g., interpersonal relations with neighbors and institutions). Three major themes were identified: pride in youth's communities, desire for change, and perceptions of power and responsibility. Based on these themes, we completed the second step: developing a civic engagement and leadership program, called LEAP, aimed at helping youth take an active role in addressing neighborhood problems. In the third step, we collaborated with youth who completed a pilot version of the civic program and provided feedback to finalize it for large-scale testing. While discussing our process, we highlight the importance of including youth voices when developing programs that affect them. Furthermore, we note the need for more research exploring whether civic engagement serves as a mechanism for encouraging youth involvement in addressing neighborhood-level health disparities and identifying potential psychological costs of such involvement.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Amanda NeMoyer
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christine Marsico
- Wheelock College of Education & Human Development, Boston University, Boston, MA, USA
| | - Isabel Shaheen O'Malley
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ravali Mukthineni
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thalia Porteny
- Department of Community Health and Occupational Therapy, Tufts University, Medford, MA, USA
| | - Carolina-Nicole Herrera
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jesse Najarro Cermeño
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kyle Kingston
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emnet Sisay
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Edison Trickett
- School of Education and Human Development, University of Miami, Coral Gables, FL, USA
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NeMoyer A, Alvarez K, Mukthineni R, Tendulkar S, Alegría M. Addressing Youth-Focused Research Questions in a Community Context: Collecting and Integrating Mixed Methods Data at Multiple Ecological Levels with the PhotoStories Project. J Mix Methods Res 2021; 15:507-525. [PMID: 37771416 PMCID: PMC10538592 DOI: 10.1177/1558689820972916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Research seeking to understand and improve social conditions for marginalized youth would benefit from merging complex mixed methods research designs emphasizing multilevel data and participatory-social justice principles. We contribute to mixed methods research by introducing a multilevel, participatory-social justice mixed methods design that accomplishes this task and by illustrating its real-world application via PhotoStories, a multistage study aimed at understanding youths' community-based experiences and emotional well-being. During the project's three phases (preparation, training, and dissemination) we obtained and integrated quantitative and qualitative data at multiple ecological levels. Additionally, we examined youth perceptions about their participation, an important outcome given our participatory-social justice focus. We also provide lessons learned and recommendations for investigators seeking to use similar approaches for youth-focused research.
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Affiliation(s)
- Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston MA 02114
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston MA 02114
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114
| | - Ravali Mukthineni
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston MA 02114
| | - Shalini Tendulkar
- Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Avenue Suite 208, Medford, MA 02155
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston MA 02114
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
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22
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Polanco-Roman L, Alvarez K, Corbeil T, Scorza P, Wall M, Gould MS, Alegría M, Bird H, Canino GJ, Duarte CS. Association of Childhood Adversities With Suicide Ideation and Attempts in Puerto Rican Young Adults. JAMA Psychiatry 2021; 78:896-902. [PMID: 33950163 PMCID: PMC8100905 DOI: 10.1001/jamapsychiatry.2021.0480] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/25/2021] [Indexed: 12/14/2022]
Abstract
Importance Racial/ethnic and sex disparities in suicide ideation and attempts are well established, with higher risk of suicide ideation and attempt among US racial/ethnic minority school-aged youths (than their White peers) and girls and women (than boys and men). The suicide-related risk of racial/ethnic minority young adults, especially young women, may be strongly influenced by adverse childhood experiences, known early determinants of suicide ideation and attempts. Objectives To assess lifetime and past-year prevalence estimates of suicide ideation and suicide attempt and to examine sex differences in the role of adverse childhood experiences as a prospective risk factor for Puerto Rican young adults from 2 sociocultural contexts. Design, Setting, and Participants Data in this longitudinal cohort study are from 4 waves of the Boricua Youth Study, a population-based cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico, and the South Bronx, New York, 5 to 17 years of age (N = 2491; waves 1-3: 2000-2004) and 15 to 29 years of age (wave 4: 2013-2017). Data analysis was performed from February 26, 2019, to October 16, 2020. Exposures Adverse childhood experiences were assessed by interview in childhood and early adolescence (waves 1-3) and included child maltreatment (physical, sexual, and emotional abuse and neglect), exposure to violence, parental loss (separation, divorce, and death), and parental maladjustment (mental health problems, substance or alcohol abuse, intimate partner violence, and incarceration). Main Outcomes and Measures Lifetime and past-year suicide ideation and attempt were assessed in young adulthood (wave 4) using the World Health Organization Composite International Diagnostic Interview. Results Among 2004 Puerto Rican young adults (80.4% of the original cohort; mean [SD] age, 22.9 [2.8] years; 1019 [50.8%] male), young women compared with young men had a higher prevalence of lifetime suicide attempt (9.5% vs 3.6%) and lifetime suicide ideation (16.4% vs 11.5%), whereas past-year suicide ideation (4.4% vs 2.4%) was not statistically different. Logistic regression models, adjusting for demographics and lifetime psychiatric disorders, found that young women but not young men with more adverse childhood experiences had higher odds of suicide ideation (lifetime; odds ratio [OR], 2.44; 95% CI, 1.54-3.87; past year: OR, 2.56; 95% CI, 1.18-5.55). More adverse childhood experiences were also prospectively associated with lifetime suicide attempt (OR, 1.16; 95% CI, 1.04-1.29), irrespective of sex. Conclusions and Relevance The findings of this cohort study suggest that, among Puerto Rican young adults from 2 different sociocultural contexts, adverse childhood experiences were relevant to understanding suicide attempt and suicide ideation, the latter specifically among young women. The prevention of cumulative adverse childhood experiences could reduce later risk of suicide attempts and, among young women, for suicide ideation.
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Affiliation(s)
- Lillian Polanco-Roman
- Department of Psychology, The New School, New York, New York
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York
| | - Kiara Alvarez
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Thomas Corbeil
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, New York
| | - Pamela Scorza
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Melanie Wall
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, New York
| | - Madelyn S. Gould
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, New York
| | - Margarita Alegría
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Hector Bird
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York
| | - Glorisa J. Canino
- Behavioral Science Research Institute, University of Puerto Rico, San Juan
| | - Cristiane S. Duarte
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York
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23
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Spain AK, Monahan EK, Alvarez K, Finno-Velasquez M. Latinx Family Perspectives on Social Needs Screening and Referral during Well-Child Visits. MCN Am J Matern Child Nurs 2021; 46:143-149. [PMID: 38019058 DOI: 10.1097/nmc.0000000000000710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand Latinx parent perspectives on screening and referral approaches to identify social determinants of health and address social and material needs during well-child visits and to identify techniques that promote their engagement with these approaches. STUDY DESIGN We investigated parent perspectives and engagement with social needs screening and referral practices during well-child visits using focus group methodology. RESULTS We conducted 17 focus groups (n = 134 parents and other primary caregivers) with families receiving care at sites operated by eight pediatric primary care clinics. Adding social needs screening and referral shifted the social context of well-child visits for Latinx parents. Participants reported greater engagement with the practices where they perceived an emotional connection with nurses and other clinicians and cultural brokering to ensure their screening responses accurately reflected family needs and priorities. Participants highlighted the importance of having a personal patient-provider relationship as many preferred to discuss social needs outside of the exam room. CLINICAL IMPLICATIONS Nurses and other clinicians play a critical role in establishing systems needed to systematically screen and refer families for social needs. Future policy development should consider implications for nursing practice and leadership in adopting these approaches.
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Duarte CS, Canino GJ, Alegria M, Ramos-Olazagasti MA, Vila D, Miranda P, Ramjattan V, Alvarez K, Musa GJ, Elkington K, Wall M, Lapatin S, Bird H. Developmental Psychopathology and Ethnicity I: The Young Adulthood Assessment of the Boricua Youth Study. J Am Acad Child Adolesc Psychiatry 2021; 60:398-409. [PMID: 32171634 PMCID: PMC9044282 DOI: 10.1016/j.jaac.2020.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Developmental psychopathology processes pertinent to underserved ethnically diverse youths may not always coincide with those relevant to youths from nondisadvantaged groups. This article reports on the young adulthood assessment (fourth wave; April 2013 to August 2017) of the Boricua Youth Study, which includes 2 population-based samples of children of Puerto Rican background (N = 2,491) aged 5-13 years (recruited in 2000), in the South Bronx, New York, and San Juan, Puerto Rico. METHOD Study procedures included intensive participant tracking and in-person interviews of young adults and, when possible, their parents. Study participation rates, measures, and weights are described. RESULTS At Boricua Youth Study wave 4 (on average 11.3 years since last wave of participation), we reassessed 2,004 young adults (mean age = 22.9 years, range = 15-29 years; 51% women; retention rate adjusted for ineligibility = 82.7%) and available parents (n = 1,180). Nonparticipation was due to inability to locate/contact participants (8.6%); refusal (4.7%); and ineligible status (2.8%) owing to cognitive impairment, incarceration, or death. Among participants originally from Puerto Rico, 91% stayed in Puerto Rico during young adulthood. Of participants from the South Bronx, 52.4% remained in the area (85.8% within 100 miles). Most study measures had good internal consistency (Cronbach α ≥ .70). CONCLUSION Our results support the viability of retaining a population-based cohort of children from the same ethnic group across 2 contexts during a life stage when individuals are likely to move. Longitudinal samples that are generalizable to underserved populations can elucidate developmental processes of relevance for curtailing the risk of psychopathology in disadvantaged contexts.
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Affiliation(s)
- Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, New York.
| | - Glorisa J Canino
- Behavioral Sciences Research Institute, University of Puerto Rico School of Medicine, San Juan
| | | | | | - Doryliz Vila
- Behavioral Sciences Research Institute, University of Puerto Rico School of Medicine, San Juan
| | - Patricia Miranda
- New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Vijah Ramjattan
- New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Kiara Alvarez
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - George J Musa
- New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Katherine Elkington
- New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Melanie Wall
- New York State Psychiatric Institute, Columbia University Medical Center, New York
| | - Sheri Lapatin
- Massachusetts General Hospital, Harvard Medical School, Boston
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Cruz-Gonzalez M, Shrout PE, Alvarez K, Hostetter I, Alegría M. Measurement Invariance of Screening Measures of Anxiety, Depression, and Level of Functioning in a US Sample of Minority Older Adults Assessed in Four Languages. Front Psychiatry 2021; 12:579173. [PMID: 33658950 PMCID: PMC7917233 DOI: 10.3389/fpsyt.2021.579173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/25/2021] [Indexed: 01/21/2023] Open
Abstract
Population aging in the US and its increase in racial/ethnic diversity has resulted in a growing body of literature aimed at measuring health disparities among minority older adults. Disparities in health outcomes are often evaluated using self-reported measures and, to attend to linguistic diversity, these measures are increasingly being used in languages for which they were not originally developed and validated. However, observed differences in self-reported measures cannot be used to infer disparities in theoretical attributes, such as late-life depression, unless there is evidence that individuals from different groups responded similarly to the measures-a property known as measurement invariance. Using data from the Positive Minds-Strong Bodies randomized controlled trial, which delivered evidence-based mental health and disability prevention services to a racially/ethnically diverse sample of minority older adults, we applied invariance tests to two common measures of anxiety and depression (the GAD-7 and the HSCL-25) and two measures of level of functioning (the Late-Life FDI and the WHODAS 2.0) comparing four different languages: English, Spanish, Mandarin, and Cantonese. We found that these measures were conceptualized similarly across languages. However, at the item-level symptom burden, we identified a non-negligible number of symptoms with some degree of differential item functioning. Spanish speakers reported more worry symptoms and less somatic symptoms for reasons unrelated to their psychological distress. Mandarin speakers reported more feelings of restlessness, and both Mandarin and Cantonese speakers reported no interest in things more often for reasons unrelated to their psychological distress. Mandarin and Cantonese speakers were also found to consistently report more difficulties performing physical activities for reasons unrelated to their level of functioning. In general, invariance tests have been insufficiently applied within psychological research, but they are particularly relevant as a prerequisite to accurately measure health disparities. Our results highlight the importance of conducting invariance testing, as we singled out several items that may require careful examination before considering their use to compare symptoms of psychological distress and level of functioning among ethnically and linguistically diverse older adult populations.
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Affiliation(s)
- Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Patrick E Shrout
- Department of Psychology, New York University, New York, NY, United States
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Isaure Hostetter
- Department of Health Policy, Harvard School of Public Health, Boston, MA, United States
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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26
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Mujica C, Alvarez K, Tendulkar S, Cruz-Gonzalez M, Alegría M. Association between patient-provider racial and ethnic concordance and patient-centered communication in outpatient mental health clinics. Journal of Psychotherapy Integration 2020. [DOI: 10.1037/int0000195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
To date, little research has systematically considered the ways in which schools can better address the needs of immigrant-origin youth (IOY). Further, considering the increased negative attitudes toward and policies targeting IOY and families within the U.S., there is a need to go beyond targeting just IOY at risk for mental health concerns and promote a culture of inclusion throughout the school. The goal of this paper is to address ways in which schools can best attend to the mental health needs of IOY by systematically integrating prevention and intervention efforts across three tiers of support within the school setting. Specifically, we propose a three-tiered model of school based mental health services for IOY. Based on a thorough review of current literature, we propose universal, selective, and targeted programming to support the MH needs of IOY and families. We discuss implications for implementation as well as future directions for research.
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Affiliation(s)
- Prerna G Arora
- Department of Health and Behavioral Sciences, Columbia University, 525 W. 120th Street, New York, NY, 10027, USA.
| | - Kiara Alvarez
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Cindy Huang
- Department of Clinical and Counseling Psychology, Columbia University, New York, NY, USA
| | - Cixin Wang
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, MD, USA
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28
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Carmona R, Cook BL, Baca-García E, Chavez L, Alvarez K, Iza M, Alegría M. Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid. J Behav Health Serv Res 2020. [PMID: 29516339 DOI: 10.1007/s11414-018-9596-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Analyses of healthcare expenditures and adequacy are needed to identify cost-effective policies and practices that improve mental healthcare quality. Data are from 2010 to 2012 electronic health records from three hospital psychiatry departments in Madrid (n = 29,944 person-years) and three in Boston (n = 14,109 person-years). Two-part multivariate generalized linear regression and logistic regression models were estimated to identify site differences in mental healthcare expenditures and quality of care. Annual total average treatment expenditures were $4442.14 in Boston and $2277.48 in Madrid. Boston patients used inpatient services more frequently and had higher 30-day re-admission rates (23.7 vs. 8.7%) despite higher rates of minimally adequate care (49.5 vs. 34.8%). Patients in Madrid were more likely to receive psychotropic medication, had fewer inpatient stays and readmissions, and had lower expenditures, but had lower rates of minimally adequate care. Differences in insurance and healthcare system policies and mental health professional roles may explain these dissimilarities.
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Affiliation(s)
- Rodrigo Carmona
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, 01241, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Enrique Baca-García
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain.,Psychiatry Department, Autonoma University of Madrid, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Madrid, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Madrid, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Universidad Católica del Maule, Curico, Chile
| | - Ligia Chavez
- Behavioral Sciences Research Institute, University of Puerto Rico Medical Sciences Campus, Rio Piedras, 00935, Puerto Rico
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Miren Iza
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA.
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NeMoyer A, Wang Y, Alvarez K, Canino G, Duarte CS, Bird H, Alegría M. Parental incarceration during childhood and later delinquent outcomes among Puerto Rican adolescents and young adults in two contexts. Law Hum Behav 2020; 44:143-156. [PMID: 31750677 PMCID: PMC7125033 DOI: 10.1037/lhb0000354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Childhood parental incarceration has been linked to increased rates of delinquency and arrest during adolescence and young adulthood; however, previous research has focused on White and/or Black samples rather than Latinx youth. We examined relationships between childhood parental incarceration and later delinquency and arrest among Puerto Rican youth living in Puerto Rico (majority context) and the mainland United States (minority context). HYPOTHESES We expected that childhood parental incarceration would be significantly linked to delinquent behavior and arrest. In line with acculturation theory, we hypothesized that residence (proxy for minority status) would be significantly related to delinquent outcomes and that an interaction effect would emerge between parental incarceration and residence. METHOD Longitudinal data from the Boricua Youth Study were examined for 1,294 Puerto Rican youth from the South Bronx, NY (minority context) and greater San Juan, PR (majority context). We conducted a series of negative binomial and logistic regressions to determine the effects of parental incarceration and residence in childhood on self-reported delinquent behavior and arrest in adolescence and young adulthood, while also examining factors previously linked to delinquency in Puerto Rican youth. RESULTS Childhood parental incarceration and South Bronx residence were both linked to delinquent behavior but not arrest, even when simultaneously examining several individual, diagnostic, environment/social, and family factors reported in childhood. However, we did not observe an interaction effect between parental incarceration and residence for either outcome. CONCLUSIONS Findings suggest that Puerto Rican youth with histories of parental incarceration could benefit from targeted programs aimed at preventing future delinquency. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston MA 02114, USA
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, USA
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston MA 02114, USA
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston MA 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, Medical Sciences Campus, Office A928 9 Floor, Rio Piedras, Puerto Rico 00935
| | - Cristiane S. Duarte
- Department of Psychiatry, Columbia University Irving Medical Center-New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Hector Bird
- Department of Psychiatry, Columbia University Irving Medical Center-New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston MA 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
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30
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Chen R, Kessler RC, Sadikova E, NeMoyer A, Sampson NA, Alvarez K, Vilsaint CL, Green JG, McLaughlin KA, Jackson JS, Alegría M, Williams DR. Racial and ethnic differences in individual-level and area-based socioeconomic status and 12-month DSM-IV mental disorders. J Psychiatr Res 2019; 119:48-59. [PMID: 31563857 PMCID: PMC7255491 DOI: 10.1016/j.jpsychires.2019.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/09/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to: (1) examine the associations of individual-level objective socioeconomic status (OSS), subjective socioeconomic status (SSS), and area-based indicators of socioeconomic status, with 12-month DSM-IV mood, anxiety, alcohol use, and drug use disorders; and, (2) determine the extent of racial/ethnic differences in these associations across non-Latino White, non-Latino Black, Latino, and Asian participants. Data are from the Collaborative Psychiatric Epidemiology Studies dataset, a collection of three population-based surveys of mental disorders among U.S. residents aged 18 and older (n = 13,775). Among all indicators of socioeconomic status, SSS was most consistently associated with 12-month mental disorders. Income was negatively associated with mood and anxiety disorders; education was negatively associated with alcohol use and drug use disorders. Significant interactions with race/ethnicity were found for the associations of socioeconomic indicators with anxiety, alcohol use, and drug use disorders but not with mood disorders. SSS was not associated with any of the 12-month mental disorders among Blacks. Education had stronger associations with 12-month anxiety and alcohol use disorders among Whites than among other racial/ethnic groups. Among Asians, low income compared to high income was associated with a lower risk of anxiety disorders and less than high school completion compared to college or more was associated with a lower risk of alcohol use disorders. Finally, tract-level income inequality was associated with a greater risk of drug use disorders only among Blacks. The patterns and magnitudes of the associations of individual-level and area-based socioeconomic indicators differed by type of disorder and race/ethnicity.
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Affiliation(s)
- Ruijia Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States.
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States.
| | - Ekaterina Sadikova
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States.
| | - Amanda NeMoyer
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, United States.
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States.
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, United States; Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, United States.
| | - Corrie L Vilsaint
- Recovery Research Institute, Massachusetts General Hospital Center for Addiction Medicine, 151 Merrimac Street, Boston, MA, 02114, United States.
| | - Jennifer Greif Green
- Wheelock College of Education & Human Development, Boston University, 2 Silber Way, Boston, MA, 02215, United States.
| | - Katie A McLaughlin
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, United States.
| | - James S Jackson
- Institute for Social Research, 5057 ISR, 426 Thompson St., Ann Arbor, MI, 48104, United States.
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, United States; Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, 02215, United States.
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States.
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Alegria M, Shrout PE, Canino G, Alvarez K, Wang Y, Bird H, Markle SL, Ramos-Olazagasti M, Rivera DV, Cook BL, Musa GJ, Falgas-Bague I, NeMoyer A, Dominique G, Duarte C. The effect of minority status and social context on the development of depression and anxiety: a longitudinal study of Puerto Rican descent youth. World Psychiatry 2019; 18:298-307. [PMID: 31496076 PMCID: PMC6732673 DOI: 10.1002/wps.20671] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Few longitudinal studies have explored to date whether minority status in disadvantaged neighborhoods conveys risk for negative mental health outcomes, and the mechanisms possibly leading to such risk. We investigated how minority status influences four developmental mental health outcomes in an ethnically homogeneous sample of Puerto Rican youth. We tested models of risk for major depressive disorder (MDD) and generalized anxiety disorder (GAD), depressive and anxiety symptoms (DAS), and psychological distress, as Puerto Rican youth (aged 5-13 years) transitioned to early adulthood (15-29 years) in two sites, one where they grew up as a majority (the island of Puerto Rico), and another where they were part of a minority group (South Bronx, New York). At baseline, a stratified sample of 2,491 Puerto Rican youth participated from the two sites. After baseline assessment (Wave 1), each youth participant and one caregiver were assessed annually for two years, for a total of three time points (Waves 1-3). From April 2013 to August 2017, participants were contacted for a Wave 4 interview, and a total of 2,004 young people aged 15 to 29 years participated in the assessment (response rate adjusted for eligibility = 82.8%). Using a quasi-experimental design, we assessed impacts of minority status on MDD, GAD, DAS and psychological distress. Via mediation analyses, we explored potential mechanisms underlying the observed relationships. Data from 1,863 Puerto Rican youth (after exclusion of those with MDD or GAD during Waves 1-3) indicated links between minority status and higher rates of lifetime and past-year GAD, DAS and past 30-day psychological distress at Wave 4, and a marginal trend for MDD, even after adjustments. Childhood social support and peer relationships partially explained the differences, as did intercultural conflict, neighborhood discrimination, and unfair treatment in young adulthood. The experience of growing up as a minority, as defined by context, seemingly elevates psychiatric risks, with differences in social relationships and increased social stress as mediators of this relationship. Our findings suggest that interventions at the neighborhood context rather than at the individual level might be important levers to reduce risks for the development of mood disorders in minority youth.
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Affiliation(s)
- Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Patrick E Shrout
- Department of Psychology, New York University, New York, NY, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico Medical School, San Juan, Puerto Rico
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Hector Bird
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Doryliz Vila Rivera
- Behavioral Sciences Research Institute, University of Puerto Rico Medical School, San Juan, Puerto Rico
| | - Benjamin Lê Cook
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - George J Musa
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Irene Falgas-Bague
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Georgina Dominique
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Cristiane Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
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McLaughlin KA, Alvarez K, Fillbrunn M, Green JG, Jackson JS, Kessler RC, Sadikova E, Sampson NA, Vilsaint C, Williams DR, Alegría M. Racial/ethnic variation in trauma-related psychopathology in the United States: a population-based study. Psychol Med 2019; 49:2215-2226. [PMID: 30378513 PMCID: PMC6494744 DOI: 10.1017/s0033291718003082] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prevalence of mental disorders among Black, Latino, and Asian adults is lower than among Whites. Factors that explain these differences are largely unknown. We examined whether racial/ethnic differences in exposure to traumatic events (TEs) or vulnerability to trauma-related psychopathology explained the lower rates of psychopathology among racial/ethnic minorities. METHODS We estimated the prevalence of TE exposure and associations with onset of DSM-IV depression, anxiety and substance disorders and with lifetime post-traumatic stress disorder (PTSD) in the Collaborative Psychiatric Epidemiology Surveys, a national sample (N = 13 775) with substantial proportions of Black (35.9%), Latino (18.9%), and Asian Americans (14.9%). RESULTS TE exposure varied across racial/ethnic groups. Asians were most likely to experience organized violence - particularly being a refugee - but had the lowest exposure to all other TEs. Blacks had the greatest exposure to participation in organized violence, sexual violence, and other TEs, Latinos had the highest exposure to physical violence, and Whites were most likely to experience accidents/injuries. Racial/ethnic minorities had lower odds ratios of depression, anxiety, and substance disorder onset relative to Whites. Neither variation in TE exposure nor vulnerability to psychopathology following TEs across racial/ethnic groups explained these differences. Vulnerability to PTSD did vary across groups, however, such that Asians were less likely and Blacks more likely to develop PTSD following TEs than Whites. CONCLUSIONS Lower prevalence of mental disorders among racial/ethnic minorities does not appear to reflect reduced vulnerability to TEs, with the exception of PTSD among Asians. This highlights the importance of investigating other potential mechanisms underlying racial/ethnic differences in psychopathology.
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Affiliation(s)
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Mirko Fillbrunn
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | | | | | | | | | | | - Corrie Vilsaint
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - David R. Williams
- Department of Social and Behavioral Sciences; Harvard School of Public Health
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
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Myers J, Sandel C, Alvarez K, Garman L, White K, Wiley G, Montgomery CG, Gaffney P, Stavrakis S, Cooper LT, Cunningham MW. P6288Autoantibodies in heart failure associate with disease severity and differentially expressed genes in apoptotic, fibrotic, and hypoxia pathways in cardiomyocytes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous studies suggest that autoantibodies against cardiac myosin lead to dilated cardiomyopathy (DCM). Anti-cardiac myosin antibodies cross-react with the beta adrenergic receptor (βAR) and signal cAMP-dependent protein kinase A (PKA) in cardiomyocytes leading to apoptosis, fibrosis, dilated cardiomyopathy and arrhythmias.
Purpose
To determine if cross-reactive anti-cardiac myosin/anti-βAR autoantibodies which signal cardiomyocytes through PKA might play a role to establish DCM by promoting remodeling, apoptosis, and fibrosis.
Methods
Forty-one adults with DCM were enrolled <6 months from symptom onset and followed for 12 months. Serum and myocarditis/DCM-derived human mAb were analyzed by ELISA for autoantibodies, and a PKA assay measured anti-HCM/βAR antibody-mediated signaling of cardiomyocytes (ATCC primary heart cell line H9c2). The top 50 genes differentially expressed in the cardiomyocytes treated with sera or human mAb were identified and compared to genes differentially expressed in blood of DCM patients to identify shared disease-specific genes.
Results
Anti-HCM autoantibodies including autoantibody responses against 32 overlapping synthetic peptides of the S2 fragment of HCM were significantly elevated in patients whose ejection fraction did not improve over 1-year compared to those with improved ejection fraction. The human mAb confirmed our results with HCM, βAR, specific HCM peptides, and PKA signaling. RNA sequencing revealed differentially expressed genes in serum/mAb-treated cardiomyocytes compared to genes identified after RNA sequencing of peripheral blood of patients (n=10) with DCM for >1 year from onset. A primary heart cell line (H9c2-ATCC) treated with myocarditis/DCM patient sera or human mAb revealed differentially expressed genes associated with cardiac hypertrophy and heart failure, and included inflammasome component NLRP3 and complement factor H. Ingenuity Pathway Analyses revealed 27, 7, and 1 differentially expressed genes related to apoptosis, fibrosis, and hypoxia, respectively. Gene expression of CASZ1, a transcription factor important in protection against DCM, was strongly correlated with PKA signaling (r=0.89). The KDM6B gene for lysine demethylase associated with hypoxia and apoptosis pathways and was shared between cardiomyocyte and peripheral blood analysis of DCM patients. Overall, 5 genes were shared in heart failure vs in vitro Ab-treated cardiomyocyte RNA sequencing analysis: CYP4F3, KDM6B, MBOAT7, SMAP2, and DDIT4, which affects phosphorylation of mTOR to promote autophagy and cell death, cardiac hypertrophy and dysfunction.
Conclusions
Significantly higher responses to cardiac myosin in patients with DCM were related to lack of left ventricular function improvement and to differential expression of genes promoting apoptosis, fibrosis and disease severity. These studies identify autoantibody-directed gene signaling as a potential novel therapeutic target in DCM.
Acknowledgement/Funding
National Heart, Lung, and Blood Institute, Bethesda, MD, USA
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Affiliation(s)
- J Myers
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - C Sandel
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - K Alvarez
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - L Garman
- Oklahoma Medical Research Foundation, Oklahoma City, United States of America
| | - K White
- Oklahoma Medical Research Foundation, Oklahoma City, United States of America
| | - G Wiley
- Oklahoma Medical Research Foundation, Oklahoma City, United States of America
| | - C G Montgomery
- Oklahoma Medical Research Foundation, Oklahoma City, United States of America
| | - P Gaffney
- Oklahoma Medical Research Foundation, Oklahoma City, United States of America
| | - S Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - L T Cooper
- Mayo Clinic, Jacksonville, United States of America
| | - M W Cunningham
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
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Rosenbloom JM, Jackson J, Alegria M, Alvarez K. Healthcare provider perceptions of disparities in perioperative care. J Natl Med Assoc 2019; 111:616-624. [PMID: 31431287 DOI: 10.1016/j.jnma.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Many strategies to alleviate racial/ethnic disparities in surgical care target healthcare providers. Yet limited data exists about the perception of disparities among the range of clinical staff who work in perioperative settings. Such information could help initiate conversations about disparities in perioperative care and, if necessary, implement interventions to alleviate them. Our aim was to evaluate the association between sociodemographic characteristics, clinical position (physicians and non-physicians) and perception of perioperative disparities at a large tertiary care center. METHODS We surveyed perioperative staff at the institution using an anonymous online survey. Primary outcome was respondents' perception of disparities in perioperative care at the institution due to patients' insurance status/type, ability to speak English, education, and racial/ethnic minority status. The association between clinical position (physician vs. non-physician) and perception of disparities was assessed in bivariate and then multivariable analysis, adjusting for respondents' race, sex, age, and years at the institution. Secondary outcomes included perception of disparities in perioperative care in the United States due to patients' insurance status/type, ability to speak English, education, and racial/ethnic minority status. RESULTS 217 completed questions that could be analyzed. Among these responders, 101 were physicians (46.5%), 165 (76.0%) were white, and 144 (66.4.%) were female. Bivariate and multivariate analysis revealed that physicians had higher perception of disparities in perioperative care at the institution based on patients' ability to speak English, education, and racial/ethnic minority status. Physicians also had higher perceptions of disparities in perioperative care in the United States than non-physicians. CONCLUSIONS Physicians reported higher perceptions of disparities in perioperative care than non-physicians, potentially explained by differences in training or contact with patients. Such findings serve as a first step at examining and discussing disparities in perioperative care and warrant further study.
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Affiliation(s)
- Julia M Rosenbloom
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02115, USA.
| | - Jaleesa Jackson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02115, USA
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St. Suite 830, Boston, MA 02114, USA; Departments of Medicine and Psychiatry, Harvard Medical School, Boston, MA 02114, USA
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St. Suite 830, Boston, MA 02114, USA
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Alvarez K, Fillbrunn M, Greif Green J, Jackson JS, Kessler RC, McLaughlin KA, Sadikova E, Sampson NA, Alegría M. Race/ethnicity, nativity, and lifetime risk of mental disorders in US adults. Soc Psychiatry Psychiatr Epidemiol 2019; 54:553-565. [PMID: 30547212 PMCID: PMC6586416 DOI: 10.1007/s00127-018-1644-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE There has been no comprehensive examination of how race/ethnicity and nativity intersect in explaining differences in lifetime prevalence of mental disorders among Asian, Black, Latino, and White adults. This study aims to estimate racial/ethnic differences in lifetime risk of mental disorders and examine how group differences vary by nativity. METHODS Survival models were used to estimate racial/ethnic and nativity differences in lifetime risk of DSM-IV anxiety, mood, and substance use disorders in a nationally representative sample of over 20,000 respondents to four US surveys. RESULTS Asians had the lowest lifetime prevalence of mental disorders (23.5%), followed by Blacks (37.0%), Latinos (38.8%), and Whites (45.6%). Asians and Blacks had lower lifetime risk than Whites for all disorders even after adjusting for nativity; Latinos and Whites had similar risk after adjusting for nativity. Risk of disorder onset was lowest for foreign-born respondents in years before migration. There were significant race/ethnicity and nativity interactions for mood and substance use disorders. Odds of mood disorder onset were higher for Whites with at least one US-born parent. Odds of substance use disorder onset among Asians were higher for US-born respondents; for Latinos, they were higher for those with at least one US-born parent. CONCLUSIONS Parental foreign-born nativity is associated with a low risk of mental disorders, but not uniformly across racial/ethnic groups or disorders. Exposure to the US context may be associated with greater mental disorder risk for Latinos and Whites particularly. Investigations of cultural processes, including among Whites, are needed to understand group differences.
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Mirko Fillbrunn
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Jennifer Greif Green
- Boston University, School of Education, Two Silber Way, Boston, MA 02215, United States
| | - James S. Jackson
- University of Michigan, Institute for Social Research, 5057 ISR, 426 Thompson St., Ann Arbor, MI 48104, United States
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States
| | - Katie A. McLaughlin
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, United States
| | - Ekaterina Sadikova
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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NeMoyer A, Rodriguez T, Alvarez K. Psychological Practice with Unaccompanied Immigrant Minors: Clinical and Legal Considerations. Transl Issues Psychol Sci 2019; 5:4-16. [PMID: 30882017 DOI: 10.1037/tps0000175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Among youth who migrate to the United States from Latin America, unaccompanied immigrant minors (UIMs)-traveling without a parent or caregiver-are a unique subpopulation facing substantial challenges before, during, and after migration. UIMs often migrate as a result of traumatic experiences in their home countries, but are also vulnerable to experiencing trauma pre and post-migration. These experiences are compounded by the impact of prolonged separation from caregivers who migrated earlier (pre-migration) and caregivers who were left behind (post-migration). Once in the US, UIMs are typically considered undocumented and often do not have the legal representation necessary to successfully navigate immigration proceedings in a system designed for adults. Further, they often live in areas with increased rates of poverty and community violence and can face stigmatization and exclusion from important protective activities. UIMs are therefore at risk for psychological distress, including depression, anxiety, and posttraumatic stress. This article provides an overview of typical experiences for UIMs, discusses the accompanying legal and clinical implications, and offers recommendations for psychological practice at the level of providers, training programs, and child-serving systems. For example, providers might incorporate family-based and trauma-focused interventions to enhance resilience and psychological well-being, in addition to support in navigating interactions with the legal system. Clinical training programs can provide education about the experiences of UIMs, while clinicians can advocate at the systems level to promote social integration of UIMs into school systems and a more humane immigration system focused on meeting the needs of these vulnerable children.
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Affiliation(s)
- Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Department of Health Care Policy, Harvard Medical School
| | - Trinidad Rodriguez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Department of Medicine, Harvard Medical School
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Mazorra Z, Saavedra D, Popa X, Martínez L, Fuentes K, Huerta V, Alvarez K, Viada C, Neninger E, Ibañez E, Rodríguez C, Hernández M, González Z, González A, García B, Crombet T. EGF-based vaccine: Recent immunological results in advanced lung cancer and non-invasive bladder cancer patients. Eur J Cancer 2019. [DOI: 10.1016/j.ejca.2019.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vilsaint CL, NeMoyer A, Fillbrunn M, Sadikova E, Kessler RC, Sampson NA, Alvarez K, Green JG, McLaughlin KA, Chen R, Williams DR, Jackson JS, Alegría M. Racial/ethnic differences in 12-month prevalence and persistence of mood, anxiety, and substance use disorders: Variation by nativity and socioeconomic status. Compr Psychiatry 2019; 89:52-60. [PMID: 30594752 PMCID: PMC6421861 DOI: 10.1016/j.comppsych.2018.12.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/20/2018] [Accepted: 12/15/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. METHOD Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. RESULTS Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels. CONCLUSION Nativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.
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Affiliation(s)
- Corrie L Vilsaint
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, 151 Merrimac Street 6th Floor, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, United States.
| | - Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA 02114, United States; Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States.
| | - Mirko Fillbrunn
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA 02114, United States; Department of Medicine, Harvard Medical School, 55 Fruit Street Boston, MA 02114, United States.
| | - Ekaterina Sadikova
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States.
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States.
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, United States.
| | - Kiara Alvarez
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, United States; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA 02114, United States; Department of Medicine, Harvard Medical School, 55 Fruit Street Boston, MA 02114, United States.
| | - Jennifer Greif Green
- Boston University, Wheelock College of Educaion & Human Development, Two Silber Way, Boston, MA 02215, United States..
| | - Katie A McLaughlin
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, United States.
| | - Ruijia Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building Room 615, Boston, MA 02115, United States.
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building Room 615, Boston, MA 02115, United States; Department of African and African American Studies, Harvard University, Barker Center, 12 Quincy St., Cambridge, MA 02138, United States.
| | - James S Jackson
- Institute for Social Research, 5057 ISR, 426 Thompson St., Ann Arbor, MI 48104, United States.
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, United States; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA 02114, United States; Department of Medicine, Harvard Medical School, 55 Fruit Street Boston, MA 02114, United States.
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Abstract
PURPOSE OF REVIEW The present review synthesizes recent literature on social determinants and mental health outcomes and provides recommendations for how to advance the field. We summarize current studies related to changes in the conceptualization of social determinants, how social determinants impact mental health, what we have learned from social determinant interventions, and new methods to collect, use, and analyze social determinant data. RECENT FINDINGS Recent research has increasingly focused on interactions between multiple social determinants, interventions to address upstream causes of mental health challenges, and use of simulation models to represent complex systems. However, methodological challenges and inconsistent findings prevent a definitive understanding of which social determinants should be addressed to improve mental health, and within what populations these interventions may be most effective. Recent advances in strategies to collect, evaluate, and analyze social determinants suggest the potential to better appraise their impact and to implement relevant interventions.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital,Department of Health Care Policy, Harvard Medical School
| | - Irene Falgas
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School
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Vidal C, Polo R, Alvarez K, Falgas-Bague I, Wang Y, Lê Cook B, Alegría M. Co-Occurrence of Posttraumatic Stress Disorder and Cardiovascular Disease Among Ethnic/Racial Groups in the United States. Psychosom Med 2018; 80:680-688. [PMID: 29781946 PMCID: PMC6113076 DOI: 10.1097/psy.0000000000000601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trauma and/or symptoms of posttraumatic stress disorder (PTSD) have been linked to the onset of cardiovascular disease (CVD), but the exact mechanism has not been determined. We examine whether the risk of CVD is different among those who have a history of trauma without PTSD symptoms, those who have experienced trauma and developed any symptoms of PTSD, and those with a PTSD diagnosis. Furthermore, we examine whether this association varies across ethnic/racial groups. METHODS We used two data sets that form part of the Collaborative Psychiatric Epidemiology Surveys - the National Latino and Asian American Study and the National Comorbidity Survey Replication. RESULTS We found an increased likelihood of cardiovascular events for those with a diagnosis of PTSD (odds ratio [OR] = 2.10, 95% CI = 1.32-3.33) when compared with those who had not experienced trauma. We did not find an increased risk for those who had experienced trauma without symptoms or with subclinical symptoms of PTSD. The higher likelihood of having a cardiovascular event in those with PTSD was significant for non-Latino whites (OR = 1.86, 95% CI = 1.08-3.11), Latinos (OR = 1.94, 95% CI = 1.04-3.62), and non-Latino blacks (OR = 3.73, 95% CI = 1.76-7.91), but not for Asian respondents. CONCLUSIONS The constellation of symptoms defining PTSD diagnosis reflect adverse reactions to traumatic events and indicate that complex responses to traumatic events may be a risk factor for CVD.
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Affiliation(s)
- Carmen Vidal
- From the Fundación Jiménez Díaz, Avda, Reyes Católicos, Madrid, Spain (Vidal, Polo); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Alvarez, Falgas-Bague, Wang, Alegría); Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Lê Cook); and Department of Psychiatry, Harvard Medical School (Lê Cook), Departments of Medicine and Psychiatry, Harvard Medical School, Boston, Massachusetts (Alegría)
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Alegría M, Alvarez K, Ishikawa RZ, DiMarzio K, McPeck S. Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care. Health Aff (Millwood) 2018; 35:991-9. [PMID: 27269014 PMCID: PMC5027758 DOI: 10.1377/hlthaff.2016.0029] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite decades of research, racial and ethnic disparities in behavioral health care persist. The Affordable Care Act expanded access to behavioral health care, but many reform initiatives fail to consider research about racial/ethnic minorities. Mistaken assumptions that underlie the expansion of behavioral health care run the risk of replicating existing service disparities. Based on a review of relevant literature and numerous observational and field studies with minority populations, we identified the following three mistaken assumptions: Improvement in health care access alone will reduce disparities, current service planning addresses minority patients' preferences, and evidence-based interventions are readily available for diverse populations. We propose tailoring the provision of care to remove obstacles that minority patients face in accessing treatment, promoting innovative services that respond to patients' needs and preferences, and allowing flexibility in evidence-based practice and the expansion of the behavioral health workforce. These proposals should help meet the health care needs of a growing racial/ethnic minority population.
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Affiliation(s)
- Margarita Alegría
- Margarita Alegría is a professor of psychology in the Department of Psychiatry at Harvard Medical School and chief of the Disparities Research Unit, Department of Medicine, at Massachusetts General Hospital (MGH), both in Boston
| | - Kiara Alvarez
- Kiara Alvarez is a postdoctoral research fellow in the Disparities Research Unit, Department of Medicine, at MGH
| | - Rachel Zack Ishikawa
- Rachel Zack Ishikawa is project director in the Disparities Research Unit, Department of Medicine, at MGH
| | - Karissa DiMarzio
- Karissa DiMarzio is a research assistant in the Disparities Research Unit, Department of Medicine, at MGH
| | - Samantha McPeck
- Samantha McPeck is a research assistant in the Disparities Research Unit, Department of Medicine, at MGH
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Affiliation(s)
- Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 USA,Department of Psychiatry, Harvard Medical School
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 USA
| | - Irene Falgas-Bague
- Vall d’Hebrón University Hospital, Department of Psychiatry and Forensic Medicine Universitat Autonoma de Barcelona, Barcelona, Spain
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Alvarez K, Wang Y, Alegria M, Ault-Brutus A, Ramanayake N, Yeh YH, Jeffries JR, Shrout PE. Psychometrics of shared decision making and communication as patient centered measures for two language groups. Psychol Assess 2017; 28:1074-86. [PMID: 27537002 DOI: 10.1037/pas0000344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Shared decision making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient's perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of 2 patient-centered outcome measures, the Shared Decision-Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the 2 language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the 2 groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. (PsycINFO Database Record
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | | | - Natasha Ramanayake
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Yi-Hui Yeh
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
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Klimek V, Coleman M, Alvarez K, Sen F, Pichardo J, Kashyap T, Klebanov B. Phase 2 Study of Selinexor in Patients with Myelodysplastic Syndromes Refractory to Hypomethylating Agents: Interim Report. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chen J, Tarver S, Alvarez K, Khan D. P026 Effects of proactive penicillin allergy testing on inpatient antibiotic utilization. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Castiglioni C, Cassandrini D, Fattori F, Bellacchio E, Alvarez K, D’Amico A, Gejman R, Díaz J, Santorelli F, Bevilacqua J, Bertini E. P.9.9 A novel de novo mutation in ACTA1 causes a congenital myopathy with misleading type 1 fiber predominance and a peculiar MRI. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Orellana P, López-Köstner F, Heine C, Suazo C, Pinto E, Church J, Carvallo P, Alvarez K. Large deletions and splicing-site mutations in the STK11 gene in Peutz-Jeghers Chilean families. Clin Genet 2012; 83:365-9. [PMID: 22775437 DOI: 10.1111/j.1399-0004.2012.01928.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 12/19/2022]
Abstract
Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by mucocutaneous melanocytic macules, gastrointestinal hamartomatous polyposis and an increased risk of various neoplasms. Germline mutations in the serine/threonine kinase 11 (STK11) gene have been identified as a cause for PJS. The aim of this study was to characterize the genotype of Chilean PJS patients. Mutation screening of 13 patients from eight PJS families was performed using a single strand conformation polymorphism analysis, DNA sequencing and multiplex ligation-dependent probe amplification assay. The breakpoints of the genomic rearrangements were assessed by a long-range polymerase chain reaction and sequencing. The results revealed the existence of seven different pathogenic mutations in STK11 gene in seven unrelated families, including three point mutations and four large genomic deletions. Three of these point mutations (43%, 3/7) may be considered as novel. Our results showed that a germline mutation is present in STK11 in 88% of probands fulfilling the diagnostic criteria of PJS. In this study, the combination of two different experimental approaches in the screening of the STK11 in PJS, led to a higher percentage of mutation detection.
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Affiliation(s)
- P Orellana
- Laboratorio de Oncología y Genética Molecular, Unidad de Coloproctología, Clínica Las Condes, Santiago, Chile
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Sauma D, Ramirez A, Alvarez K, Rosemblatt M, Bono MR. Notch Signalling Regulates Cytokine Production by CD8+ and CD4+ T Cells. Scand J Immunol 2012; 75:389-400. [DOI: 10.1111/j.1365-3083.2012.02673.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Priet S, Zlatev I, Barvik I, Neyts J, Dutartre H, Canard B, Morvan F, Alvarez K. Phosphoramidate Dinucleosides as Inhibitors of Hepatitis C Virus Subgenomic Replicon and NS5B Polymerase Activity. Antiviral Res 2011. [DOI: 10.1016/j.antiviral.2011.03.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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