A daily diary study of discrimination and distress in Mexican-origin adolescents: Testing mediating mechanisms

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.

Family-level moderators of daily associations between discrimination and distress among Mexican-origin youth

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.

Sociocultural Risk and Resilience in the Context of Adverse Childhood Experiences

Importance

Knowledge about childhood resilience factors relevant in circumstances of marginalization and high numbers of adverse childhood experiences (ACEs) can improve interventions.

Objective

To identify sociocultural resilience factors in childhood that are associated with better young adult mental health in the context of ACEs.

Design, Setting, and Participants

This cohort study examined 4 waves of data from the Boricua Youth Study, which included Puerto Rican children from the South Bronx, New York, and San Juan, Puerto Rico. Participants were aged 5 to 17 years at waves 1 through 3 (2000-2003) and aged 15 to 29 years at wave 4 (2013-2017). Linear and logistic regression models tested the associations of 7 childhood resilience factors and their interaction with ACEs on young adult mental health outcomes. Data were analyzed from June 2021 to October 2023.

Main Outcomes and Measures

Perceived stress, major depressive disorder and/or generalized anxiety disorder (MDD/GAD), and substance use disorder (SUD) in young adulthood.

Results

Among a total 2004 participants, the mean (SD) age at wave 4 was 22.4 (2.9) years; 1024 participants (51.1%) were female, and 980 (48.9%) were male. Positive parent-child relationships and nonparental adult support during childhood were associated with both lower perceived stress (β = -0.14; SE = 0.02; P < .001; β = -0.08; SE = 0.03; P = .003, respectively) and lower odds of MDD/GAD (adjusted odds ratio [aOR], 0.84; 95% CI, 0.73 to 0.97; aOR = 0.81; 95% CI, 0.69 to 0.95, respectively) in young adulthood. Maternal warmth reported during childhood was also associated with lower young adult perceived stress (β = -0.11; SE = 0.02; P < .001). None of the resilience factors were associated with SUD. The resilience factors familism, friendships, and family religiosity were not associated with any of the mental health outcomes. ACEs were associated with poorer mental health outcomes; however, none of the resilience factors exhibited interactions consistent with being protective for ACEs. Unexpectedly, higher family religiosity was associated with more perceived stress in the presence of higher ACEs.

Conclusions and Relevance

The results of this study suggest that promoting positive relationships with adults during childhood may reduce later young adulthood stress and MDD/GAD. However, there is still a need to identify sociocultural childhood protective factors for ACEs. Caution should be taken in assuming what resilience factors are relevant for a given group, as higher family religiosity (one postulated resilience factor) was unexpectedly associated with a stronger, rather than a weaker, association between ACEs and perceived stress in young adulthood.

Multiple Discrimination and Substance Use Intention in Late Childhood: Findings From the Adolescent Brain Cognitive Development (ABCD) Study

PURPOSE

The study aimed to investigate longitudinal, bidirectional associations between discrimination due to multiple reasons (race/ethnicity, sexual orientation, weight; termed multiple discrimination) and substance use (SU) intention in late childhood. These associations were compared across youth with no, single, and multiple (i.e., intersecting) marginalized identities based on race/ethnicity, sexual orientation, and overweight status.

METHODS

Data were drawn from a national sample of youth in the Adolescent Brain Cognitive Development study (N = 8,530; 9-12 years old). Youth reported both their experiences of multiple discrimination (the number of forms of discrimination youth experienced) and SU intention at one-year and two-year follow-ups. Theoretically relevant covariates were included.

RESULTS

Compared to non-marginalized youth (n = 2,689) and youth with single marginalized identities (n = 3,399), youth with intersecting marginalized identities (n = 2,442) reported the highest SU intention and multiple discrimination across waves. Only for this last group, multiple discrimination predicted stronger SU intention subsequently (β = 0.07, 95% confidence interval [0.02, 0.11]), whereas stronger SU intention predicted lower levels of multiple discrimination over time (β = -0.06, 95% confidence interval [-0.09, -0.02]). Sensitivity analyses yielded similar patterns with some nuances among subgroups of youth with varying intersecting marginalized identities.

DISCUSSION

Multiple discrimination predicted stronger SU intention over time in late childhood, particularly among youth with intersecting marginalized identities. Policies and practices should consider addressing multiple discrimination to reduce SU disparities among diverse youth.

Referrals to Community and State Agencies to Address Social Determinants of Health for Improving Mental Health, Functioning, and Quality of Care Outcomes for Diverse Adults

Objectives. To examine whether referral for social determinants of health (SDH) needs decreases psychological distress and posttraumatic stress disorder (PTSD) symptoms and improves level of functioning and quality of care among diverse adults. Methods. Data are from control participants (n = 503 adults) in a randomized controlled trial testing a mental health intervention in North Carolina and Massachusetts. We fitted multilevel mixed-effects models to repeated assessments (baseline, 3, 6, and 12 months) collected between September 2019 and January 2023. Results. After referral to services for trouble paying utility bills, participants reported lower PTSD symptoms. Participants reported better quality of care when receiving referrals to mental health care. After adjusting for income and employment status, we found that participants who were referred more often also had lower PTSD symptoms and better levels of functioning. Conclusions. Referrals for certain SDH needs might decrease PTSD symptoms and improve self-reported quality of care and functioning. However, referrals alone, without ensuring receipt of services, might be insufficient to affect other mental health outcomes. Research is needed on training and providing care managers time for offering interpersonal support, securing services, and understanding agencies' contexts for addressing high SDH needs. (Am J Public Health. 2024;114(S3):S278-S288. https://doi.org/10.2105/AJPH.2023.307442).

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

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.

A Learning Assessment to Increase Diversity in Academic Health Sciences

Importance

Strategies and innovations to advance racial and ethnic equity in recruitment, promotion, and retention at academic health science institutions are needed.

Objective

This learning assessment aims to isolate evidence-based strategies to advance racial equity in the academic health sciences, which have implications for policy and institution-level interventions.

Evidence Review

This learning assessment used a mixed-methods approach, including a quantitative survey, qualitative in-depth interviews, and a scoping literature review. Survey respondents were recruited from outreach lists that included researchers working with racial and ethnic minoritized populations. In-depth interviews were conducted among 60 university administrators, faculty/staff, scholars, students, and individuals affiliated with governmental, nongovernmental, and identity-based professional associations. A search of the literature in PsycINFO, MEDLINE, ERIC, Education Source, Academic Search Ultimate, and CINAHL was conducted for the scoping review. The scoping review included 366 primary articles of studies evaluating strategies to advance racial and ethnic equity at academic health science institutions.

Findings

The survey yielded analyzable results from 328 individuals, including faculty, students, administrators, or staff, and individuals not currently employed at or enrolled full time at a university or college. The interviews included 60 participants with a mean (SD) age of 49.3 (16.5) years, and 39 (65%) were female. The scoping review included 366 primary research articles that met inclusion criteria for analysis. Data were analyzed individually across the survey, interviews, and scoping review, and findings were triangulated. While each of the 3 assessments yielded unique findings, 13 common themes emerged across all project components. Results revealed strategies implemented and evaluated successfully, as well as challenges and barriers to advancing equity in the academic health sciences.

Conclusions and Relevance

In this study, 13 meaningful strategies emerged across the survey, in-depth interviews, and scoping review. Through triangulation of findings, recommendations of actionable steps were made.

Resilience of racial and ethnic minority older adults during the COVID-19 pandemic: The role of a prior disability prevention intervention

Older adults from racially and ethnically diverse backgrounds and with preexisting mental illness have been disproportionately vulnerable to severe illness, disability, and death due to the adverse impacts of the COVID-19 pandemic. This study used a sample of older adults (60 +; N = 307) from a randomized clinical trial (Positive Minds-Strong Bodies [PMSB]) conducted between May 25, 2015, and March 5, 2019. Participants were recontacted to assess symptoms of anxiety, depression, general distress, and physical functioning during the COVID-19 pandemic between March 2, 2021, and July 18, 2022 (62.7% recontacting rate excluding ineligible participants; N = 165). We estimated an analysis of covariance model to evaluate whether or not prior differences between the PMSB intervention and enhanced usual care (EUC) groups continued to be observed at the COVID-19 follow-up. Results showed that, compared to EUC, participants who received the PMSB intervention reported fewer depression symptoms (Geriatric Depression Scale-15 scores) and greater physical functioning (Late-Life Functioning and Disability Instrument scores) at the COVID-19 follow-up. No significant differences were observed between the PMSB intervention and EUC groups on anxiety symptoms (Generalized Anxiety Disorder-7 scores) during the pandemic. Last, findings suggested that the lower depression symptoms and greater physical functioning observed after treatment completion were sustained, though not further improved, over time. These findings provide evidence that the PMSB intervention is a powerful intervention to promote resilience and prevent disability associated with major life stressors, such as the COVID-19 pandemic. Future research is needed to examine the underlying mechanisms of psychosocial and exercise training interventions that lead to lasting resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Late life anxiety and depression symptoms, and suicidal behaviors in racial/ethnic minority older adults in community-based organizations and community clinics in the U.S

OBJECTIVE

Late life anxiety and depression represent a significant source of disability, with racial/ethnic minority older adults in the U.S. showing marked disparities in healthy aging. Community-based organizations (CBOs) and community clinics serve these populations for preventive care, yet few identify their mental health service needs. We examine the association between race/ethnicity and risk of mild-to-severe symptoms of anxiety and depression, and suicidal behaviors in minority older adults.

METHOD

Data come from the multisite randomized controlled trial Building Community Capacity for Disability Prevention for Minority Elders, which screened 1,057 adults (45.5% Asian, 26.8% Latinx, 15.0% non-Latinx Black, 8.5% non-Latinx White, and 4.2% American Indian) aged 60 + years at CBOs and clinics in Massachusetts, New York, Florida, and Puerto Rico. Screened participants completed the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, the Geriatric Depression Scale-15 (GDS-15) for depression symptoms, and the Paykel Suicide Risk Questionnaire for suicidal behaviors.

RESULTS

28.1% of older adults reported mild-to-severe anxiety symptoms, 30.1% reported mild-to-severe depression symptoms, and 4.3% reported at least one suicidal behavior. Compared to non-Latinx Whites, Latinxs had higher odds of mild-to-severe anxiety and depression symptoms and one or more suicidal behaviors, and Asians had higher odds of mild-to-severe depression symptoms only.

CONCLUSIONS

There is an urgent need to improve outreach for screening and preventive mental health care for minority older adults. Expanding outreach and community-based capacity to identify and treat minority older adults with mental health conditions represents an opportunity to prevent disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attitudes and perceptions toward the COVID-19 risk-mitigation strategies among racially and ethnically diverse older adults in the United States and Puerto Rico: a qualitative study

OBJECTIVES

There is limited qualitative research investigating how risk-mitigation strategies during the COVID-19 pandemic impacted the lives of diverse older adults, who met criteria for mild to severe generalized anxiety or depression and minor to moderate disability. This study aims to address this gap by examining how racially and ethnically diverse older adults with at least mild mental health symptoms and minor physical disability in the United States and Puerto Rico adapted to guidelines during COVID-19. It aims to inform the medical community and policymakers of potential threats to these older adults' well-being given the COVID-19 burden.

DESIGN

Based on descriptive qualitative inquiry and phenomenological perspectives, we conducted semi-structured interviews over the phone with a racially and ethnically diverse sample of older (age 60+), predominantly minoritized adults (N = 100) in four states and territories across the United States and Puerto Rico in 2021. Interviews were recorded, coded, and analyzed using a thematic analysis approach.

RESULTS

Findings centered on five themes: (1) Previous experiences with the healthcare system and cultural beliefs related to trust and distrust led to mixed attitudes toward COVID-19 risk-mitigation strategies; (2) Compliance with COVID-19 mitigation strategies ensured safety and addressed fear of illness; (3) Compliance led to isolation due to interrupted social relations; (4) Isolation and disrupted social networks negatively impacted mental health and finances, and (5) Coping strategies and embracing support reduced the effects of social isolation.

CONCLUSION

This study underscores the importance of increasing support and social connectedness during a pandemic and beyond to ensure the well-being of older adults in racially and ethnically diverse communities. It highlights the resiliency of older adults in identifying strategies to cope with negative impacts. We recommend safeguarding economic security through policy efforts toward financial safety nets during health crises and collaborative approaches with community-based organizations to mitigate social isolation.

Mexican-origin parent and child reported neighborhood factors and youth substance use

Background

Structural oppression affects health behaviors through residence in suboptimal neighborhoods and exposure to community violence. Youth and parents report perceptions of neighborhood factors that can affect youth substance use behaviors. Given that Latinx youth report higher levels of perceived community violence than other racial and ethnic groups, it is imperative to examine how youth- and parent-perceived neighborhood-level factors may relate to youth substance use.

Methods

Data were collected using clinical interviews with family triads (fathers, mothers, and youth) and parent-child dyads (father or mother and youth) enrolled in the Seguimos Avanzando study of 344 Mexican-origin families in Indiana. Neighborhood measures, including perceptions of exposure to violence, neighborhood characteristics, and neighborhood collective efficacy, were included in parent and youth surveys. Self-report measures for past year alcohol and drug use were included in the youth survey only. T-tests were conducted to estimate differences in neighborhood reports among the sample triads. A series of linear regression models were used to estimate the associations between youth-, mother-, and father-reported perceptions of neighborhood factors and youth substance use.

Results

Preliminary results indicate that fathers reported higher levels of exposure to violence than mothers [t(163) = 2.33, p = 0.02] and youth [t(173) = 3.61, p < 0.001]. Youth reported lower negative neighborhood characteristics than mothers [t(329) = 6.43, p < 0.001] and fathers [t(169) = 3.73, p < 0.001]. Youth reported significantly better neighborhood collective efficacy than mothers [t(296) = 3.14, p = 0.002], but not statistically different from fathers. Results from the primary analysis showed that youth exposure to violence was positively associated with youth substance use (b = 0.24, SE = 0.06, p < 0.0001), but the youth's neighborhood characteristics and collective efficacy were not significantly associated with youth substance use. None of the parent-reported neighborhood variables were associated with youth substance use.

Conclusion

The discrepant findings between parent and youth reports of perceived neighborhood characteristics and substance use have important implications for researchers and community stakeholders, and for developing targeted interventions and prevention strategies. Our study highlights the need to address youth experience of community violence and to prioritize creating safe and inclusive neighborhood environments. Potential strategies include improving community resources, strengthening social support networks, promoting open communication about neighborhood risks, and fostering collaborative efforts to address substance use behaviors.

Clinical significance of psychotic-like experiences across U.S. ethnoracial groups

BACKGROUND

Prevalence of psychotic-like experiences (PLEs) - reports of hallucinations and delusional thinking not meeting criteria for psychotic disorder - varies substantially across ethnoracial groups. What explains this range of PLE prevalence? Despite extensive research, the clinical significance of PLEs remains unclear. Are PLE prevalence and clinical severity differentially associated across ethnoracial groups?

METHODS

We examined the lifetime prevalence and clinical significance of PLEs across ethnoracial groups in the Collaborative Psychiatric Epidemiology Surveys (N = 11 139) using the Composite International Diagnostic Interview (CIDI) psychosis symptom screener. Outcomes included mental healthcare use (inpatient, outpatient), mental health morbidity (self-perceived poor/fair mental health, suicidal ideation or attempts), and impairment (role interference). Individuals with outcome onsets prior to PLE onset were excluded. We also examined associations of PLEs with CIDI diagnoses. Cox proportional-hazards regression and logistic regression modeling identified associations of interest.

RESULTS

Contrary to previous reports, only Asian Americans differed significantly from other U.S. ethnoracial groups, reporting lower lifetime prevalence (6.7% v. 8.0-11.9%) and mean number (0.09 v. 0.11-0.18) of PLEs. In multivariate analyses, PLE clinical significance showed limited ethnoracial variation among Asian Americans, non-Caribbean Latinos, and Afro-Caribbeans. In other groups, mental health outcomes showed significant ethnoracial clustering by outcome (e.g. hospitalization and role interference with Caribbean-Latino origin), possibly due to underlying differences in psychiatric disorder chronicity or treatment barriers.

CONCLUSIONS

While there is limited ethnoracial variation in U.S. PLE prevalence, PLE clinical significance varies across U.S. ethnoracial groups. Clinicians should consider this variation when assessing PLEs to avoid exaggerating their clinical significance, contributing to mental healthcare disparities.

Uncovering Barriers to Engagement in Substance Use Disorder Care for Medicaid Enrollees

OBJECTIVE

The authors aimed to uncover factors that affect engagement in substance use disorder treatment among Medicaid beneficiaries in New York State.

METHODS

The authors conducted 40 semistructured interviews with clients, plan administrators, health care providers, and policy leaders directly involved with substance use care in New York State. Data were analyzed with thematic analysis.

RESULTS

Main themes resulting from analysis of the 40 interviews showed that most stakeholders agreed that a need exists to better integrate psychosocial services into behavioral health care systems; that systemic stigma, stigma from providers, and lack of cultural responsiveness in the substance use care system hinder engagement in and provision of high-quality care; and that rural health care networks with coordinated models benefit clients' engagement in care.

CONCLUSIONS

Stakeholders involved in care for substance use disorder perceived a lack of integration of resources to meet clients' social needs, the presence of stigma, and low levels of cultural and linguistic capacity as key factors contributing to low engagement in and low quality of care for substance use disorder. Future interventions should address social needs within the therapeutic regimen and modify curricula in clinical training to reduce stigma and increase cultural competence.

Mitigating Multiple Sources of Bias in a Quasi-Experimental Integrative Data Analysis: Does Treating Childhood Anxiety Prevent Substance Use Disorders in Late Adolescence/Young Adulthood?

Psychiatric epidemiologists, developmental psychopathologists, prevention scientists, and treatment researchers have long speculated that treating child anxiety disorders could prevent alcohol and other drug use disorders in young adulthood. A primary challenge in examining long-term effects of anxiety disorder treatment from randomized controlled trials is that all participants receive an immediate or delayed study-related treatment prior to long-term follow-up assessment. Thus, if a long-term follow-up is conducted, a comparison condition no longer exists within the trial. Quasi-experimental designs (QEDs) pairing such clinical samples with comparable untreated epidemiological samples offer a method of addressing this challenge. Selection bias, often a concern in QEDs, can be mitigated by propensity score weighting. A second challenge may arise because the clinical and epidemiological studies may not have used identical measures, necessitating Integrative Data Analysis (IDA) for measure harmonization and scale score estimation. The present study uses a combination of propensity score weighting, zero-inflated mixture moderated nonlinear factor analysis (ZIM-MNLFA), and potential outcomes mediation in a child anxiety treatment QED/IDA (n = 396). Under propensity score-weighted potential outcomes mediation, CBT led to reductions in substance use disorder severity, the effects of which were mediated by reductions in anxiety severity in young adulthood. Sensitivity analyses highlighted the importance of attending to multiple types of bias. This study illustrates how hybrid QED/IDAs can be used in secondary prevention contexts for improved measurement and causal inference, particularly when control participants in clinical trials receive study-related treatment prior to long-term assessment.

Parental psychopathology and posttraumatic stress in Puerto Ricans: the role of childhood adversity and parenting practices

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.

Shared decision making between community therapists and Latinx caregivers during evidence-based practice delivery in publicly-funded children's mental health services

OBJECTIVES

This observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. Study aims were to (1) Characterize therapist use of SDM strategies and (2) Describe the types of treatment decisions that were the focus of therapist use of SDM.

METHODS

The OPTION instrument was used to measure SDM in 210 audio-recorded therapy sessions with 62 community therapists and 109 Latinx caregivers; frequency and mean ratings of OPTION items were examined. Qualitative analysis on the descriptions of treatment decisions being deliberated was also conducted.

RESULTS

Results revealed that therapists used at least one SDM step in most sessions (N = 192; 91.43%) with a mean composite score of 32.78 (SD=17.79; range: 6.25-81.25). Four superordinate categories of decisions were: (1) Treatment planning, (2) Evidence-based Parenting Strategies, (3) Addressing Youth Functioning, and (4) Addressing Family Psychosocial Needs.

CONCLUSIONS

Findings suggest that community therapists serving Latinx families are naturalistically engaging in SDM steps about a variety of decisions during most EBP sessions, but only at modest levels.

Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness

BACKGROUND

Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness.

METHODS

PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences.

RESULTS

Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences.

CONCLUSION

Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.

A Longitudinal Study of Risk Factors for Sexual Victimization in Puerto Rican Youth

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.

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

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.

Intersectional approaches are essential to identify the multiple sources of oppression

Intersectional and multilevel approaches are required to tackle mental health disparities for marginalized populations. Intersectionality offers a guiding framework to study how social structures and systems work at multiple socioecological levels to influence the health and well-being of minoritized communities. This special section showcases research using intersectional approaches elucidating mental health and psychopathology outcomes among diverse populations. This commentary briefly summarizes five articles in this special section and discusses their contributions to health disparities research. These articles apply multilevel approaches to investigating how institutional and systemic marginalization impact mental health burden among understudied populations, including sexual and gender minority populations of color and Indigenous people. The studies also highlight future directions for research on the explanatory mechanisms of intersectionality that open the door to designing preventive interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Recent Advances on Social Determinants of Mental Health: Looking Fast Forward

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.

Maintenance Psychotherapies for Older Adults: A Scoping Review

BACKGROUND/OBJECTIVE

Given the chronicity of depression and anxiety disorders in late life, maintenance treatments may have a role in preserving healthy functioning. This study aims to understand the state of the science on maintenance psychotherapies for Black, Asian, and Latinx older adults.

DESIGN

Scoping review.

METHODS

A priori protocol was prospectively published. Four databases were searched up to December 1, 2021. Eligible studies were conducted in the United States or Puerto Rico and focused on maintenance psychotherapies treating depression, anxiety, or both in adults 60+. Due to the underrepresentation of Black, Asian, and Latinx participants, studies were included irrespective of the participant's racial or ethnic background.

RESULTS

A total of 3,623 unique studies were retrieved, and eight studies were included. Two studies represented randomized clinical trials, and six were studies of post hoc analyses. All studies were from the same research team, had similar maintenance treatments, and focused on depression. Studies included racially homogenous samples (94-98% White). The primary outcome was the recurrence of a major depressive episode. Across studies, maintenance psychotherapy shows promise in preventing the recurrence of depression in some older adults.

CONCLUSION

Expanding the scope of knowledge from achieving optimal functioning to sustaining those changes in older adults is a significant public health challenge given symptom recurrence. The small body of knowledge on maintenance psychotherapies shows a promising direction in maintaining healthy functioning following recovery from depression. However, opportunities remain to expand the evidence of maintenance psychotherapies with a more significant commitment to the inclusion of diverse populations.

Head Trauma in Refugees and Asylum Seekers: A Systematic Review

BACKGROUND AND OBJECTIVES

Refugees and asylum seekers are at risk of head trauma. They endure blows to the head due to exigent circumstances necessitating resettlement (e.g., torture, war, interpersonal violence) and during their dangerous journeys to refuge. Our objective was to assess the global prevalence of head trauma in refugees and asylum seekers and describe its clinical characteristics in this population.

METHODS

The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42020173534). PubMed/MEDLINE, PsycInfo, Web of Science, Embase, and Google Scholar databases were searched for relevant studies. We included all studies in English that comprised refugees or asylum seekers of any age and examined the prevalence or characteristics of head trauma. We excluded studies that were not peer-reviewed original research. Information was recorded on the prevalence of head trauma, method of ascertaining head trauma, severity, mechanism of injury, other trauma exposures, and comorbidities. Descriptive analyses and narrative syntheses were performed.

RESULTS

A total of 22 studies were included, of which 13 with 6,038 refugees and asylum seekers reported head trauma prevalence. Prevalence estimates ranged from 9% to 78%. Heterogeneity among studies precluded meta-analysis. Most studies were US based (n = 9, 41%), followed by the Middle East (n = 5, 23%). Most refugees or asylum seekers were from the Middle East (n = 9, 41%), with those from Latin America least represented (n = 3, 14%). Studies disproportionately involved younger (pooled mean age = 29 years) adult samples composed of men. Recruitment settings were predominantly hospitals/clinics (n = 14, 64%), followed by refugee camps (n = 3, 14%). The most common mechanism of injury was direct impact through a beating or blow to the head. Studies varied greatly in how head trauma was defined and ascertained; no study used a validated traumatic brain injury (TBI)-specific screening tool. Similarly, TBI severity was not uniformly assessed, although hospital-based samples captured more moderate-to-severe head injuries. Mental health comorbidities were more frequently documented rather than physical health ones. Only 2 studies included a comparison with local populations.

DISCUSSION

Refugees and asylum seekers are vulnerable to head trauma, but studies using systematic approaches to screening are lacking. Increased attention to head trauma in displaced populations will allow for optimizing equitable care for this growing vulnerable population.

How psychologists can help achieve equity in health care-advancing innovative partnerships and models of care delivery: Introduction to the special issue

For as long as the United States has been a country, the distribution of good health has been unequal. In this special issue, we consider what psychology can do to understand and ameliorate these inequalities. The introduction sets the context for why psychologists are well positioned, well trained, and needed to champion health equity via innovative partnerships and models of care delivery. A guide is provided for engaging and maintaining a health equity lens in advocacy, research, education/training, and practice efforts for psychologists, and readers are invited to apply a health equity lens to reimagine their existing and forthcoming work. More broadly, the special issue brings together a collection of 14 articles across three core themes: (a) integration of care, (b) intersections between social drivers/determinants of health, and (c) intersecting social systems. The articles collectively highlight the need for new conceptual models to guide research, education, and practice, the importance of engaging in transdisciplinary partnerships, and the urgency of collaborating with community members in cross-system alliances to tackle social drivers of health, structural racism, and contextual risks, all of which are fundamental drivers of health inequity. Although psychologists are uniquely positioned to investigate causes of inequality, develop health equity interventions, and advocate for policy changes, our voice and vision have been missing from broader national dialogues around these issues. This issue is poised to provide examples of existing equity work and inspire ALL psychologists to engage for the first time or deepen existing health equity work with renewed vigor and reimagined possibilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Addressing health inequities for children in immigrant families: Psychologists as leaders and links across systems

What can psychologists do to address social determinants of health and promote health equity among America's approximately 20 million children in immigrant families (CIF)? This article identifies gaps in current research and argues for a stronger role for psychologists. Psychologists can advocate for and enact changes in institutional systems that contribute to inequities in social determinants of health and promote resources and services necessary for CIF to flourish. We consider systemic exclusionary and discriminatory barriers faced by CIF, including a heightened anti-immigrant political climate, continued threat of immigration enforcement, restricted access to the social safety net, and the disproportionate health, economic, and educational burden of the COVID-19 pandemic. We highlight the potential role of psychologists in (a) leading prevention that addresses stressors such as poverty and trauma; (b) changing systems to mitigate risk factors for CIF; (c) expanding workforce development across multiple disciplines to better serve their needs; (d) identifying mechanisms, such as racial profiling, that contribute to health inequity, and viewing them as public health harms; and (e) guiding advocacy for resources at local, state, and federal levels, including by linking discriminatory policies or practices with health inequity. A key recommendation to increase psychologists' impact is for academic and professional institutions to strengthen relationships with policymakers to effectively convey these findings in spaces where decisions about policies and practices are made. We conclude that psychologists are well positioned to promote systemic change across multiple societal levels and disciplines to improve the well-being of CIF and offer them a better future. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Attitudes toward COVID-19 Vaccine Uptake: A Qualitative Study of Mostly Immigrant Racial/Ethnic Minority Older Adults

(1) Background: Few qualitative studies address diverse older adults' perceptions of COVID-19 vaccination in the United States, including non-English speakers and immigrant populations. This study aims to understand the attitudes of diverse, primarily immigrant older adults in the U.S. toward the COVID-19 vaccine and its influences on their vaccination decision-making. (2) Methods: The research team conducted semi-structured interviews (N = 100) in 2021 focused on understanding ethnically/racially diverse older adults' perceptions of the COVID-19 vaccine. Interviews were recorded, coded, and analyzed using a thematic analysis approach. (3) Results: Thematic analyses identified three themes. (1) Older adults showed mixed attitudes toward the COVID-19 vaccine associated with information consumed and trust in healthcare systems; (2) health concerns and underlying medical conditions were the most influential factors of vaccine uptake; and (3) systemic barriers and trusted figures impacted vaccination decision-making of older adults. (4) Conclusions: Accessible information in diverse languages tailored to the community's fears is needed to combat vaccine mistrust. Vaccine rollout programs need to tackle the fear of vaccine side effects. Attitudes of religious leaders, family members, and physicians considerably influenced vaccine uptake, suggesting their role as trusted members for vaccine messaging for older, primarily immigrant adults. Systemic barriers, namely lack of transportation and inaccessible vaccination sites, contributed to vaccine deterrence.

Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City: The Role of Plan and Geography

OBJECTIVE

The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC).

DATA SOURCE

Medicaid claims and managed care plan enrollment files for 2015-2017 in NYC.

RESEARCH DESIGN

We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015-2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities.

RESULTS

We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures.

CONCLUSIONS

Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.

Association of everyday discrimination with health outcomes among Asian and non-Asian US older adults before and during the COVID-19 pandemic

Increases in anti-Asian COVID-19 related discriminatory behaviors have been observed, many of which targeted older adults. Studies demonstrate that racial discrimination is associated with worse health outcomes, including anxiety, depression, and sleep difficulties. No previous studies have examined the impact of day-to-day experiences of discrimination before and during COVID-19 on both Asian and non-Asian older adults within the same sample. We examined whether everyday discrimination was associated with increased anxiety and depression symptoms, decreased levels of functioning, and increased sleep difficulties among Asian and non-Asian US older adults before and during the pandemic. Data came from the Positive Minds-Strong Bodies randomized clinical trial, an evidence-based mental health and disability prevention intervention for racially and ethnically diverse older adults with elevated depression or anxiety symptoms and minor to moderate disability. We conducted secondary data analyses in a cohort of 165 older adults (56 Asian and 109 non-Asian) assessed before COVID-19 (May 2015-May 2018) and during COVID-19 (March 2021-July 2022). Regression models examined whether everyday discrimination impacted health outcomes differently before and during COVID-19, and whether this effect was stronger among Asian compared to non-Asian older adults. Non-Asian older adults reported the same levels of everyday discrimination before and during COVID-19. Consistent with literature suggesting that social distancing has inadvertently kept US Asian populations from experiencing discrimination, Asian older adults reported marginally lower levels of everyday discrimination during the pandemic compared with pre-pandemic. We found that everyday discrimination was not associated with health outcomes before COVID-19. In contrast, during the pandemic, everyday discrimination was associated with worse anxiety and depression symptoms and worse levels of functioning, although only the impact on depression was significantly stronger compared with before the pandemic. This negative impact of everyday discrimination on health outcomes during the pandemic appeared to affect both Asian and non-Asian older adults similarly. Social support and social cohesion buffered against the negative effect of everyday discrimination on depression and level of functioning during the pandemic. Results suggest that public health interventions aimed at reducing everyday discrimination and emphasizing social support and cohesion can potentially improve health outcomes for all US older adult populations.

Clinical trial registration

www.ClinicalTrials.gov; identifier: NCT02317432.

Disparities in Pediatric Mental and Behavioral Health Conditions

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.

Using a structural vulnerability framework to understand the impact of COVID-19 on the lives of Medicaid beneficiaries receiving substance use treatment in New York City

OBJECTIVE

To investigate how the COVID-19 pandemic impacted low-income individuals with substance use disorder (SUD) in New York City (NYC) during the beginning of the pandemic, using a structural competency and structural vulnerability theoretical framework and a qualitative research approach.

DATA SOURCES

Primary qualitative data were collected from racial/ethnic minority adults enrolled in Medicaid receiving outpatient substance use treatment (e.g., medication, counseling) in NYC.

STUDY DESIGN

Semi-structured in-depth qualitative interviews (N = 20) were conducted during "stay-at-home" orders in NYC, the first epicenter of the COVID-19 pandemic in the United States. Interviews were conducted over the phone during the earlier stages of the pandemic, between April 2020 and June 2020.

DATA COLLECTION/EXTRACTION METHODS

Semi-structured in-depth interviews were conducted and audio recorded, transcribed, and analyzed using a thematic analysis approach.

PRINCIPAL FINDINGS

Three themes were yielded from our thematic analysis: (1) COVID-19 heightened food insecurity and housing conditions increased risks of infection; (2) stay-at-home orders limited access to resources but had positive impacts in strengthening social relationships and reducing substance use triggers; and (3) although COVID-19 created challenges for treatment, most described that SUD care improved during the pandemic.

CONCLUSIONS

While COVID-19 exacerbated numerous structural vulnerabilities among low-income individuals with SUD, programmatic adaptations to COVID-19 SUD care, including telehealth and loosening restrictions around medications for opioid use disorders mitigated past difficulties that patients had faced. Reducing structural vulnerabilities for Medicaid patients will require continuation of telehealth treatment delivery, retaining flexible medication regulations, and mobilizing community resources to mitigate economic disparities.

Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York

Importance

There is limited evaluation of the performance of Medicaid managed care (MMC) private plans in covering substance use disorder (SUD) treatment.

Objective

To compare the performance of MMC plans across 19 indicators of access, quality, and outcomes of SUD treatment.

Design Setting and Participants

This cross-sectional study used administrative claims and mandatory assignment to plans of up to 159 016 adult Medicaid recipients residing in 1 of the 5 counties (boroughs) of New York, New York, from January 2009 to December 2017 to identify differences in SUD treatment access, patterns, and outcomes among different types of MMC plans. Data from the latest years were received from the New York State Department of Health in October 2019, and analysis began soon thereafter. Approximately 17% did not make an active choice of plan, and a subset of these (approximately 4%) can be regarded as randomly assigned.

Exposures

Plan assignment.

Main Outcomes and Measures

Percentage of the enrollees achieving performance measures across 19 indicators of access, process, and outcomes of SUD treatment.

Results

Medicaid claims data from 159 016 adults (mean [SD] age, 35.9 [12.7] years; 74 261 women [46.7%]; 8746 [5.5%] Asian, 73 783 [46.4%] Black, and 40 549 [25.5%] White individuals) who were auto assigned to an MMC plan were analyzed. Consistent with national patterns, all plans achieved less than 50% (range, 0%-62.1%) on most performance measures. Across all plans, there were low levels of treatment engagement for alcohol (range, 0%-0.4%) and tobacco treatment (range, 0.8%-7.2%), except for engagement for opioid disorder treatment (range, 41.5%-61.4%). For access measures, 4 of the 9 plans performed significantly higher than the mean on recognition of an SUD diagnosis, any service use for the first time, and tobacco use screening. Of the process measures, total monthly expenditures on SUD treatment was the only measure for which plans differed significantly from the mean. Outcome measures differed little across plans.

Conclusions and Relevance

The results of this cross-sectional study suggest the need for progress in engaging patients in SUD treatment and improvement in the low performance of SUD care and limited variation in MMC plans in New York, New York. Improvement in the overall performance of SUD treatment in Medicaid potentially depends on general program improvements, not moving recipients among plans.

A New Agenda for Optimizing Investments in Community Mental Health and Reducing Disparities

The Biden-Harris Administration's FY22 budget includes $1.6 billion for the Community Mental Health Services Block Grant program, more than double the FY21 allocation, given the rising mental health crises observed across the nation. This is timely since there have been two interrelated paradigm shifts: one giving attention to the role of the environmental context as central in mental health outcomes, the other moving upstream to earlier mental health interventions at the community level rather than only at the individual level. An opportunity to reimagine and redesign the agenda of mental health research and service delivery with marginalized communities opens the door to more community-based care interventions. This involves establishing multisector partnerships to address the social and psychological needs that can be addressed at the community level rather than the clinical level. This will require a shift in training, delivery systems, and reimbursement models. The authors describe the scientific evidence justifying these programs and elaborate on opportunities to target investments in community mental health that can reduce disparities and improve well-being for all. They select levers where there is some evidence that such approaches matter substantially, are modifiable, and advance the science and public policy practice. They conclude with specific recommendations and the logistical steps needed to support this transformational shift.

Reducing racial/ethnic disparities in mental health service use among emerging adults: community-level supply factors

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.

Framework for Understanding and Addressing Racial and Ethnic Disparities in Children's Mental Health

In this framework, we synthesize the results of studies addressing racial/ethnic disparities in children's mental health through 4 domains hypothesized to impact minoritized children and their families: (1) policies, (2) institutional systems, (3) neighborhoods/community system, and (4) individual/family-level factors. We focus on children and adolescents, presenting findings that may impact mental health outcomes for major racial/ethnic groups in North America: Black/African American, Latinx, Asian, and American Indian youth. We conclude by suggesting areas for needed research, including whether certain domains of influence demonstrate differential impact for inequities reduction depending on the youth's race/ethnicity.

Key stakeholder perspectives on the use of research about supported employment for racially and ethnically diverse patients with mental illness in the United States

OBJECTIVE

To explore how stakeholders responded to research evidence regarding supported employment (e.g., vocational rehabilitation), and ways evidence could be incorporated into policy and action.

DATA SOURCES

Qualitative data were collected from three stakeholder groups-people with lived experience of mental health challenges, community health advocates, and state health policy makers.

STUDY DESIGN

This study consisted of two sequential steps. First, three focus groups were conducted after presenting stakeholder groups (inclusive of 22 participants) with simulation data showing that improvement in employment status had a stronger impact on mental health than improvement in education or income for racially/ethnically diverse groups. Second, with guidance from focus group findings, researchers conducted additional in-depth interviews (n = 19) to gain a deeper understanding of the opportunities and challenges related to incorporating these findings into policy and practice.

DATA COLLECTION/EXTRACTION METHODS

Focus groups and in-depth interviews were conducted, audio recorded, transcribed, and analyzed using a thematic analysis approach.

PRINCIPAL FINDINGS

People with lived experience described the positive effect of employment in their own life while highlighting the need to increase workplace accommodations and social supports for those with mental health challenges. Across stakeholder groups, participants emphasized the need for linguistic and cultural competence to promote equity in delivery of supported employment programs. Stakeholders also underscored that centralizing existing resources and using evidence-based approaches are crucial for successful implementation.

CONCLUSION

Implementing effective supported employment programs should focus on meeting the specific needs of target individuals, as many of those needs are not considered in current employment-related programming. Collecting information from diverse users of research demonstrates what other aspects of supported employment are required for the likelihood of successful uptake. Implementation and dissemination efforts need to fortify collaborations and knowledge transfer between stakeholders to optimize supported employment and mental health resources.

Development of a Youth Civic Engagement Program: Process and Pilot Testing with a Youth-Partnered Research Team

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.

Addressing Youth-Focused Research Questions in a Community Context: Collecting and Integrating Mixed Methods Data at Multiple Ecological Levels with the PhotoStories Project

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.

The association between patient-provider racial/ethnic concordance, working alliance, and length of treatment in behavioral health settings

Racial/ethnic concordance between patients and providers concerning the quality of care has received interest over past decades yielding mixed results. Patients seem to prefer clinicians of their own race/ethnicity, but empirical studies have found small or inconsistent effects on the quality of care. Research on the impact of racial/ethnic concordance and treatment duration appears to suggest that racial/ethnic concordance is associated with retention and completion; however, exactly why racial/ethnic concordance improves treatment length remains unexplored. On the other side, the quality of working alliance is a well-established common factor underlying effective treatments. In this study, we examined the interaction between patient-provider racial/ethnic concordance, length of treatment in the therapeutic dyad, and working alliance as evaluated by both patients themselves and objective raters. The study included 312 patients and 74 providers from 13 community and hospital-based outpatient mental health clinics in Massachusetts. Results indicated that among racial/ethnic concordant therapeutic dyads, longer length of treatment was associated with better quality of working alliance as evaluated by objective raters. Implications for clinical practice and future research on racial/ethnic concordance studies linked to the length of treatment are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association of Childhood Adversities With Suicide Ideation and Attempts in Puerto Rican Young Adults

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.

Centering the Voice of the Client: On Becoming a Collaborative Practitioner with Low-Income Individuals and Families

Despite current interest in collaborative practices, few investigations document the ways practitioners can facilitate collaboration during in-session interactions. This investigation explores verbatim psychotherapy transcripts to describe and illustrate therapist's communications that facilitate or hinder centering client's voice in work with socioeconomically disadvantaged populations. Four exemplar cases were selected from a large intervention trial aimed at improving shared decision making (SDM) skills of psychotherapists working with low-income clients. The exemplar cases were selected because they showed therapist's different degrees of success in facilitating SDM. Therapist's verbalizations were grouped into five distinct communicative practices that centered or de-centered the voice of clients. Communication practices were examined through the lens of collaborative approaches in family therapy. The analysis suggests that cross-fertilization between SDM and family-oriented collaborative and critical approaches shows promise to illuminate and enhance the challenging road from clinician-led to client-led interactions. This paper also stresses the importance of incorporating relational intersectionality with individuals and families who may not feel entitled to express their expectations or raise questions when interacting with authority figures.

Factors Associated With Mental Health Service Use Among Black, Latinx, and Asian Older Adults in Community-Based Organizations

OBJECTIVE

Older adults of color face systemic obstacles in seeking mental health care. Unaddressed late-life mental health issues can challenge independent living and increase disability and mortality risk. This study examined factors associated with mental health service use among community-dwelling older adults.

METHOD

This cross-sectional analysis used data from the Positive Minds-Strong Bodies trial (N= 1,013).

RESULTS

Higher anxiety, depressive, and posttraumatic stress disorder (PTSD) symptoms increased odds of service use (odds ratio [OR] = 1.05-2.11). Asian and Latinx, but not Black, older adults had lower odds of service use than Whites (OR = 0.15-0.35). Yet Asian and Latinx older adults with higher anxiety and depression symptoms and Asians with at least one PTSD symptom had higher odds of service use than Whites with the same symptomatology (OR = 1.16-2.88).

CONCLUSION

White older adults might be more likely to seek mental health care at lower levels of need, while Asian and Latinx older adults might seek services when they perceive greater need.

Similarities in client-clinician perceptions of subjective social status and its association to similarities in the quality of working alliance and client anxiety symptoms

Subjective social status (SSS) has largely been ignored within psychotherapy literature. We investigated the association between similarities in client-clinician perceptions of SSS, similarities in their report of the quality of working alliance, and resultant anxiety symptoms.

Participants represented a primarily low-income, culturally diverse sample of 312 clients receiving care from 68 clinicians at 13 outpatient mental health clinics in the Northeastern United States between September 2013 and August 2016. As part of a larger randomized controlled trial, clients and clinicians completed the MacArthur Scale of subjective social status and the Working Alliance Inventory (WAI), and clients completed the Generalized Anxiety Disorder 7-item Scale (GAD-7).

At the within-clinician level, client-clinician dyads with less similar perceptions of the client's SSS were characterized by less similar perceptions of their alliance, which in turn resulted in worsening anxiety symptoms.

Clinicians' correct perception of their clients' social status might be important for sharing a similar view of the client-clinician level of alliance, which can, in turn, contribute to lowering the client's anxiety symptoms.

Substance use, mental health and dual disorders on pregnancy: results of prevalence and treatment rates in a developed country

Smoking and substance use during pregnancy are major preventable causes of mortality and morbidity, having a bidirectional and deleterious relationship with the mental health of the mother and child. As part of the WOMAP (Woman Mental Health and Addictions on Pregnancy) initiative, our study aimed to describe the prevalence of co-occurring mental illness and substance use problems, diagnoses and severity of those considered at risk and rates of treatment.A screening of 2,014 pregnant women was done using the AC-OK scale and they were asked about their smoking habits and services use for mental health/substance abuse. Of these, 170 women were considered at risk of co-occurring mental illness and substance use problems (≥ 2 positive responses to the AC-OK-Mental Health subscale, ≥ 1 positive response to the AC-OK-Substance Abuse subscale and/or smoking more than once a month and no use of specialized services) and were assessed with a more extensive battery of measures (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Posttraumatic stress disorder [PTSD] Checklist for DSM-5 [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] and Fagerström).In the last year, 614 women (30.5%) smoked tobacco (42.5% daily) and 9.8% were positive for both substance use and mental illness per the AC-OK. Only 11.1% of them received specific treatment in the previous three months while another 13.6% were scheduled to attend services in the following month. From the subsample assessed in depth, 62(36.5%) endorsed at least moderate depression, 35(20.6%) endorsed at least moderate anxiety, 32(18.8%) endorsed PTSD on the PCL, and 37 out of 88 alcohol users scored above the threshold in AUDIT (≥ 3).In conclusion, high prevalence and low treatment rates suggest that effective detection mechanisms should be integrated into usual care, allowing for early interventions.

Adaptation of an Evidence-Based Intervention for Disability Prevention, Implemented by Community Health Workers Serving Ethnic Minority Elders

INTRODUCTION

Changing demographics have created substantial unmet needs for mental health and physical disability services for immigrant and racial/ethnic minority elders. Workforce shortages can be reduced by task-shifting to community health workers (CHWs) who speak the same language and share the culture of these elders. Yet, implementation of interventions offered by CHWs requires adaptations of content and delivery, ideally under clinical supervision.

OBJECTIVE

To culturally adapt two evidence-based interventions, offered in community settings, to address mental health and physical disability prevention for diverse minority elders.

METHODS

We followed the Castro-Barrera stepped model for cultural adaptation of two evidence-based interventions into one combined program of disability management and prevention delivered by CHWs. We used feedback from key stakeholders, including four clinical supervisors, 16 CHWs, 17 exercise trainers, and 153 participants, collected at three time points to further adapt the intervention to a diverse population of elders.

RESULTS

Adaptations for administration by CHWs/exercise trainers included: systematization of supervision process, increased flexibility in sessions offered per participants' needs, inclusion of self-care content, modification of materials to better reflect elders' daily life experiences, and greater focus on patient engagement in care. Areas for additional adaptation included enhancing examples with culturally relevant metaphors, incorporating visual aids, and training CHWs in the importance of building trust.

CONCLUSION

This study identifies key aspects of the cultural adaptation process that facilitates broader cultural sensitivity of service delivery by CHWs to diverse elders in community settings.

Treating immigrant patients in psychiatric emergency rooms

We examine whether patient variables (geographic origin, gender, Spanish language proficiency) and subjective clinician aspects in emergency department psychiatric encounters (diagnostic certainty, clinician's comfort level with patient) are associated with diagnosis and the use of coercive measures. Using a descriptive cross-sectional design, we recorded 467 visits (400 foreign-born and 67 native-born patients) in hospital psychiatry emergency rooms (ERs) in Barcelona between 2007 and 2015. We first assessed the association of patient variables and subjective clinician aspects of psychiatric encounters with service use outcomes and with mental illness diagnosis. Fitted logistic models predicted the likelihood of service use outcomes and estimated the propensity of receiving each diagnosis. The null model evaluated the role of patient's geographical origin, while the full model evaluated the additional roles of patient's gender and language, the clinician's assessment of the influence of culture in diagnosis, and clinician comfort with two outcomes: patient's diagnosis and use of coercive measures in the ER. Women were less likely to receive coercive measures or intramuscular medications compared to men. Significant ethnic/racial and gender differences were found in receiving certain diagnoses. Additionally, a patient's lower Spanish proficiency was correlated with a higher probability of receiving a psychosis diagnosis. The clinician's level of diagnostic certainty was also positively correlated with increasing clinician-reported comfort with patient. Overall, ethnic factors and the subjective aspects of psychiatric encounters were found to influence diagnosis and the use of coercive measures. Cultural competency programs and interpreter services within psychiatric ER settings should thus be required.

Measurement Invariance of Screening Measures of Anxiety, Depression, and Level of Functioning in a US Sample of Minority Older Adults Assessed in Four Languages

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.