Increasing mental health issues in college students from 2016-2019: Assessing the intersections of race/ethnicity, gender, and sexual orientation

BACKGROUND

This study aimed to evaluate how trends in mental health (e.g., diagnosis/treatment of depression, anxiety, suicidal ideation) varied across intersections of gender, race/ethnicity, and sexual orientation in a large, national sample of undergraduate students.

METHODS

Data from the American College Health Association, and National College Health Assessment II: 2016-2019 were analyzed (N = 228,640 undergraduate students from 442 campuses, ages 18-24; 67.8 % female, 40.4 % BIPOC, 3.0 % non-binary (trans/non-conforming), 19.4 % LGBQ+). We used logistic regression to predict each mental health indicator; covariates included year, gender, BIPOC, LGBQ+ status, and their interactions, as well as other covariate controls (e.g., region, year in school).

RESULTS

There were significant and steady increases in the odds of each mental health indicator by year (ORs = 1.12-1.13), which were significantly greater in magnitude for LGBQ+ students (ORs = 1.20-1.23). Increases did not vary by gender, race/ethnicity, or intersections between these groups and LGBQ+ status. There were significant interactions between identity groups that aligned with intersectional and minority stress theories (which did not vary by year). Non-Hispanic White students had significantly greater odds of past-year treatment/diagnosis of depression and anxiety compared to BIPOC students; however, BIPOC students had significantly greater odds of past-year suicidal ideation and this was pronounced for BIPOC women. Being non-binary x LGBQ+ was associated with significantly greater odds of each indicator.

DISCUSSION

Results affirm the importance of promoting mental health among college students, with a particular focus on how to better serve and support BIPOC, non-binary, and LGBQ+ students.

Family Functioning, Identity Commitments, and School Value among Ethnic Minority and Ethnic Majority Adolescents

Ethnic minority youth show worse school adjustment than their ethnic majority peers. Yet, it remains unclear whether this gap can be explained by differences in family functioning and consequent identity commitments. This study examined (1) whether family functioning relates to identity commitments over time and (2) whether identity commitments impact later school value (3) among minority and majority adolescents. Minority (N = 205, Mage = 16.25 years, 31.1% girls) and majority adolescents (N = 480, Mage = 15.73 years, 47.9% girls) participated in this preregistered three-wave longitudinal study (T1: March-April 2012; T2: October 2012; T3: March-April 2013). Dynamic Panel Models revealed that most within-person cross-lagged associations were not significant in the total sample. Yet, multigroup analyses revealed differences between groups: Stronger identity commitments related to lower school value among minority adolescents, but were unrelated to school value among majority adolescents over time. Additionally, higher school value increased identity commitments among minority youth, yet it decreased identity commitments among majority youth over time. The findings highlight the differential interplay between identity commitments and school adjustment for minority and majority adolescents, with important implications for their future life chances.

The impact of reduced routine community mental healthcare on people from minority ethnic groups during the COVID-19 pandemic: qualitative study of stakeholder perspectives

BACKGROUND

Enduring ethnic inequalities exist in mental healthcare. The COVID-19 pandemic has widened these.

AIMS

To explore stakeholder perspectives on how the COVID-19 pandemic has increased ethnic inequalities in mental healthcare.

METHOD

A qualitative interview study of four areas in England with 34 patients, 15 carers and 39 mental health professionals from National Health Service (NHS) and community organisations (July 2021 to July 2022). Framework analysis was used to develop a logic model of inter-relationships between pre-pandemic barriers and COVID-19 impacts.

RESULTS

Impacts were largely similar across sites, with some small variations (e.g. positive service impacts of higher ethnic diversity in area 2). Pre-pandemic barriers at individual level included mistrust and thus avoidance of services and at a service level included the dominance of a monocultural model, leading to poor communication, disengagement and alienation. During the pandemic remote service delivery, closure of community organisations and media scapegoating exacerbated existing barriers by worsening alienation and communication barriers, fuelling prejudice and division, and increasing mistrust in services. Some minority ethnic patients reported positive developments, experiencing empowerment through self-determination and creative activities.

CONCLUSIONS

During the COVID-19 pandemic some patients showed resilience and developed adaptations that could be nurtured by services. However, there has been a reduction in the availability of group-specific NHS and third-sector services in the community, exacerbating pre-existing barriers. As these developments are likely to have long-term consequences for minority ethnic groups' engagement with mental healthcare, they need to be addressed as a priority by the NHS and its partners.

Race, Rurality, and Suicidality in Children and Adolescents

INTRODUCTION

Suicide is among the leading causes of death in U.S. youth. Rural residency is a risk factor, but suicide variability by race/ethnicity is more nuanced. Early detection of suicidal ideation and intent are key components of prevention, but to the authors' knowledge, few prior studies have examined how rurality and race interact on youth suicidality. This study examined suicidality between White non-Hispanic versus non-White or Hispanic youth, as well as those who lived in rural versus non-rural areas.

METHODS

Cross-sectional analyses were conducted using data from youth age 5-17 years who had complete capture of their medical care in a Wisconsin healthcare system. Suicidality was extracted from medical records by screening for diagnoses indicative of suicidal attempt or ideation between 2017 and 2022. Race/ethnicity and rural residence were extracted from administrative records. Analyses were done in 2023.

RESULTS

The sample included 27,392 rural and 20,370 non-rural youth, with suicidality observed in 2% of participants. There was a significant interaction between rural residence and race/ethnicity (p=0.015). Non-White or Hispanic youth in rural areas had the highest risk of suicidality at 75 (CI: 57, 97) per 10,000. Non-White or Hispanic youth in non-rural areas had the lowest risk of suicidality at 38 (CI: 28, 52) per 10,000.

CONCLUSIONS

Racial/ethnic minority youth who lived in rural areas were more likely to experience suicidality as compared to their non-rural counterparts. Larger prospective studies are needed to identify causal elements of the rural environment that may hasten racial disparities in youth suicidality.

Disrupted family reunification: Mental health, race, and state-level factors

The children's mental health landscape is rapidly changing, and youth with mental health conditions (MHCs) are overrepresented in the child welfare system. Mental health is the largest unmet health need in child welfare, so MHCs may affect the likelihood of system reentry. Concerns regarding mental health contribute to calls for expanded supports, yet systems contact can also generate risk of continued child welfare involvement via surveillance. Still, we know little about how expanded supports at the state-level shape child welfare outcomes. Using the Adoption and Foster Care Analysis Reporting System (AFCARS), we examine the association between MHCs and system reentry within 36 months among youth who reunified with their families in 2016 (N = 41,860). We further examine whether this association varies across states and White, Black, and Latinx racial and ethnic groups via two- and three-way interactions. Results from multilevel models show that, net of individual and state-level factors, MHCs are associated with higher odds of reentry. This relationship is stronger for youth in states that expanded Medicaid by 2016 and with higher Medicaid/CHIP child participation rates. The results also show evidence of the moderating role of state-level factors, specifically student-to-school counselor ratio, diverging across racial and ethnic groups. Our results suggest a need for systems of care to better support youth mental health and counteract potential surveillance.

Exploring experiences with alcohol and how drinking has changed over time among minority ethnic groups with a diagnosed mental health problem

INTRODUCTION

Minority ethnic groups are more likely to experience poor mental health but less likely to seek formal support. Mental health problems and alcohol use (including non-drinking) co-occur, the reasons for this among minority ethnic groups are not well understood. This study explored i) alcohol use among minority ethnic individuals with a mental health problem,ii) how alcohol was used before individuals received support for their mental health,iii) how alcohol changed whilst and after individuals received treatment for their mental health.

METHODS

Participants were purposively sampled through community/online mental health organisations. Participants took part if they i)were not White British, ii) had a mental health diagnosis, iii) drank at hazardous and above levels or former drinkers. Telephone/online semi-structured interviews were conducted. Data were analysed using framework analysis with an intersectional lens.

RESULTS

25 participants took part. Four themes were developed; "drinking motivations", "mental health literacy and implications on drinking behaviour", "cultural expectations and its influence on mental health problems and drinking practices", and "reasons for changes in drinking". Themes reflect reasons for drinking and the role of understanding the range of mental health problems and implicit cultural expectations. An intersectional lens indicated gendered, ethnic and religious nuances in experiences with alcohol and seeking support. Engaging with formal support prompted changes in drinking which were facilitated through wider support.

CONCLUSION

There were specific reasons to cope among minority ethnic individuals who have a mental health problem. Applying an intersectional lens provided an insight into the role of cultural and gendered expectations on mental health and drinking practices. Mental health literacy and implicit cultural expectations within specific minority ethnic groups can affect both mental health and drinking practices. Healthcare professionals and wider community play an important role in prompting changes in drinking among minority ethnic groups who have a mental health problem.

Factors Associated with Opting Out of an Unrelated Hematopoietic Stem Cell Donor Registry: Differences and Similarities across Five Key Groups of Young Race/Ethnically Diverse Potential Donors in the United States

Young adults from underserved racial/ethnic groups are critically needed as unrelated hematopoietic stem cell (HSC) donors, yet they are more likely than other groups to opt out of donation after having matched a patient. Understanding which factors are most strongly associated with opting out among young underserved racial/ ethnic registered donors compared with their White counterparts will provide the basis for specific interventions to improve donor retention. We sought to determine the key, modifiable psychosocial, registry-related, and donation-related characteristics that are uniquely associated with opting out across 5 key racial/ethnic groups of young HSC donor registry members who had been contacted as a potential match for a patient. This study examines data from a large cross-sectional survey of young (age 18 to 30) registry members shortly after they preliminarily matched a patient (CT-stage) and continued toward or opted out of donation (CT-C and CT-NI), stratified by racial/ethnic group and sex. We assessed psychosocial, registry-related, and donation-related characteristics for all participants. We used chi-squared and F tests to assess differences between racial/ethnic groups. A separate logistic regression analysis for each racial/ethnic group was conducted to quantify adjusted associations between each variable and opting out. Then, we compared these associations across the racial/ethnic groups by evaluating the interaction effect between each variable and racial/ethnic group, with the same outcome (CT-C versus CT-NI) in question. Nine hundred thirty-five participants were surveyed, including 284 White, 165 Hispanic, 191 Black, 192 Asian/Pacific Islander, and 103 Multiracial/multiethnic participants. There were significant differences across racial/ethnic groups in values/goals, religious objections to donation, HSC-related medical mistrust, and parental involvement in donation decisions. Adjusted logistic regression subgroup analyses indicated that ambivalence was strongly associated with opting out across all racial/ethnic groups. Greater focus on intrinsic life goals (e.g., raising a family, becoming a community leader, influencing social values) was associated with opting out in the Multiracial/multiethnic, Hispanic, and Asian/Pacific Islander groups. Healthcare mistrust and insufficient registry contact was a significant factor for Hispanic participants. Protective factors against opting out included remembering joining the registry (Black participants), and parental support for donation decision (Asian/Pacific Islander participants). The performance of each logistic regression model was strong, with area-under-the curve ≥.88, CT-stage outcome classification accuracy ≥89%, and good fit between expected and observed opt-out probabilities. In the analysis across different racial/ethnic groups, the only significant interaction was race/ethnicity by whether more contact with the registry would have changed the decision at CT-stage; this variable was significant only for the Hispanic group. In the within-group analysis for Hispanic participants, the "more registry contact" variable was strongly associated with opting out (odds ratio 5.8, P = .03). Consistent with a growing body of HSC donor research, ambivalence was a key factor associated with opting-out for all racial/ethnic groups. Other key variables were differentially associated with opting-out depending on racial/ethnic group. Our study highlights key variables that registries should focus on as they develop targeted and tailored strategies to enhance commitment and reduce attrition of potential donors.

Ethnic differences in treatment outcome for children and young people accessing mental health support

Children and Young People (CYP) from minoritized ethnic backgrounds experience structural inequalities in Children and Young People's Mental Health Settings (CYPMHS). This mixed methods study explores whether CYP's ethnicity is associated with their treatment outcomes (operationalised as 'measurable change') from CYPMHS. A multilevel multi-nominal regression analysis, controlling for age, gender, referral source, presenting difficulty, case closure reason, suggests that CYP from Asian backgrounds (OR = 0.82, CI [0.70, 0.96]) and Mixed-race (odds ratio (OR) = 0.80; 95% CI [0.69, 0.92]) are less likely to report measurable improvement in mental health difficulties compared to White British CYP. Three themes from a thematic analysis of semi-structured interviews with 15 CYP from minoritized ethnic backgrounds focused on views and experiences of ending mental health support are also presented. CYP view personalised support and the right therapist as conducive to good endings and valued a range of outcomes pertaining to empowerment. Experiences of stigma and inequalities may begin to explain the less positive outcomes experienced by Asian and Mixed-race CYP found in the regression analysis. The implications of these findings and future areas of research are suggested.

American Muslim Engagement With Advance Care Planning: Insights From a Community Survey

Background and Objectives: Advance Care Planning (ACP) is a critical tool in advancing patient self-determination in health care delivery. Despite increasing research into racial/ethnic minorities' engagement with ACP in the US, studies on Muslim Americans are relatively scarce. We aimed to examine levels of ACP engagement among Muslim adults and measure associations between socio-demographic and religiosity characteristics and ACP engagement. Methodology: This was a survey study among Muslims attending mosque seminars in Chicago and Washington DC. Religiosity characteristics were assessed using a modified version of the Duke University Religion Index (DUREL) and the Psychological Measure of Islamic Religiousness (PMIR). ACP engagement was measured by the 4-item ACP Engagement Survey (4-ACPES) and 2 additional items covering ACP religious dimensions. Statistical analyses were performed using SPSS 28.0. Results: Out of 152 respondents, 56.2% to 72.6% were in the pre-contemplation stage of ACP across the 6 ACP items. Bivariate analyses showed that ACP engagement was correlated with participant age, ethnicity, duration of stay in the US and country of birth. Multivariable analyses demonstrated no association between religiosity characteristics and ACP engagement; independent predictors of ACP engagement were race/ethnicity (being South Asian), country of birth (born outside the US) and duration of stay in the US (longer years). Discussion/Conclusion: Our study suggests that American Muslims are largely unprepared to engage with ACP. Moreover, religiosity does not predict ACP engagement. We call for greater community outreach and educational programs that instill awareness and knowledge on the importance of ACP, and provide resources for tailored religiously-oriented conversations that assist individuals with ACP.

Understanding African American help-seeking for romantic relationships: Advocacy, barriers, and considerations

African American couples experience greater levels of relationship distress than other racial/ethnic groups, but they are less likely to seek formal couple counseling. Existing literature highlights the importance of community support in the form of church, family, and friends. While the literature suggests that African Americans encounter unique barriers, we do not know how racism and discrimination impact the couple help-seeking process. This study seeks to address this gap and better understand unique barriers in the African American couple help-seeking (AACHS) process via a grounded theory-informed qualitative study. Findings from interviews with 11 African American individuals in committed relationships highlighted mistrust as a significant barrier to AACHS, while community supports are frequently sought out. Our findings add to current understandings about AACHS and highlight important areas for future research. In the clinical implications section, the authors outline tangible steps that clinicians can take based on the findings from this study.

Improving our understanding of predictive bias in testing

Predictive bias (i.e., differential prediction) means that regression equations predicting performance differ across groups based on protected status (e.g., ethnicity, sexual orientation, sexual identity, pregnancy, disability, and religion). Thus, making prescreening, admissions, and selection decisions when predictive bias exists violates principles of fairness based on equal treatment and opportunity. First, we conducted a two-part study showing that different types of predictive bias exist. Specifically, we conducted a Monte Carlo simulation showing that out-of-sample predictions provide a more precise understanding of the nature of predictive bias-whether it is based on intercept and/or slope differences across groups. Then, we conducted a college admissions study based on 29,734 Black and 304,372 White students, and 35,681 Latinx and 308,818 White students and provided evidence about the existence of both intercept- and slope-based predictive bias. Third, we discuss the nature and different types of predictive bias and offer analytical work to explain why each type exists, thereby providing insights into the causes of different types of predictive bias. We also map the statistical causes of predictive bias onto the existing literature on likely underlying psychological and contextual mechanisms. Overall, we hope our article will help reorient future predictive bias research from whether it exists to the why of different types of predictive bias. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reevaluating the "deaths of despair" narrative: Racial/ethnic heterogeneity in the trend of psychological distress-related death

Despite the significant scientific advancement in deciphering the "deaths of despair" narrative, most relevant studies have focused on drug-, alcohol-, and suicide-related (DAS) deaths. This study directly investigated despair as a determinant of death and the temporal variation and racial heterogeneity among individuals. We used psychological distress (PD) as a proxy for despair and drew data from the US National Health Interview Survey-Linked Mortality Files 1997 to 2014, CDC (Centers for Disease Control and Prevention) Multiple Cause of Death database 1997 to 2014, CDC bridged-race population files 1997 to 2014, Current Population Survey 1997 to 1999, and the American Community Survey 2000 to 2014. We used Cox proportional hazards models to estimate mortality hazard ratios of PD and compared age-standardized PD- and DAS-related mortality rates by race/ethnicity and over time. We found that while Whites had a lower prevalence of PD than Blacks and Hispanics throughout the whole period, they underwent distinctive increases in PD-related death and have had a higher PD-related mortality rate than Blacks and Hispanics since the early 2000s. This was predominantly due to Whites' relatively high and increasing vulnerability to PD less the prevalence of PD. Furthermore, PD induced a more pervasive mortality consequence than DAS combined for Whites and Blacks. In addition, PD- and DAS-related deaths displayed a concordant trend among Whites but divergent patterns for Blacks and Hispanics. These findings suggest that 1) DAS-related deaths underestimated the mortality consequence of despair for Whites and Blacks but overestimated it for Hispanics; and 2) despair partially contributed to the DAS trend among Whites but probably not for Blacks and Hispanics.

The Psychosocial Impact of the COVID-19 Pandemic on Families of Youth of Color: A Prospective Cohort Study

OBJECTIVE

Prospectively examine racial and ethnic disparities in exposure to COVID-19-related stressors and their impact on families.

METHODS

A racially, ethnically, and socioeconomically diverse cohort of caregivers of youth (n = 1,581) representative of the population served by a pediatric healthcare system completed the COVID-19 Exposure and Family Impact Scales in Oct/Nov 2020 and March/April 2021. Linear mixed-effects models were used to examine exposure to COVID-19-related events (Exposure), impact of the pandemic on family functioning and well-being (Impact), and child and parent distress (Distress) across time and as a function of race and ethnicity, adjusting for other sociodemographic variables.

RESULTS

Exposure and Distress increased over time for all participants. After adjusting for sociodemographic factors, caregivers of Black and Hispanic youth reported greater Exposure than caregivers of White youth and caregivers of Black youth had a greater increase in Exposure over time than caregivers of White youth. Caregivers of White youth reported greater Impact than caregivers of Black and Other race youth.

CONCLUSIONS

Exposure to and impact of the COVID-19 pandemic on family psychosocial functioning varied by race and ethnicity. Although exposure to COVID-19-related events was greater among Hispanic and non-Hispanic Black families, those of marginalized races reported less family impact than non-Hispanic White families, suggesting resiliency to the pandemic. Research should examine such responses to public health crises in communities of color, with a focus on understanding protective factors. These findings suggest the importance of culturally tailored interventions and policies that support universal psychosocial screenings during times of public health crises.

Cognitive behavioral therapy versus general health education for smoking cessation: A randomized controlled trial among diverse treatment seekers

OBJECTIVE

Racial and ethnic disparities in smoking cessation persist. This randomized controlled trial compared the efficacy of group cognitive behavioral therapy (CBT) for cessation among African American/Black, Latino/Hispanic, and White adults.

METHOD

African American/Black (39%), Latino/Hispanic (29%), and White (32%) adults (N = 347) were randomly assigned to eight group sessions of CBT or general health education (GHE), both including nicotine patch therapy. Biochemically confirmed 7-day point prevalence abstinence (7-day ppa) was measured at the end-of-therapy, and at 3-, 6-, and 12-month follow-ups. Generalized linear mixed models and logistic regressions tested abstinence rates by condition, stratified by race and ethnicity, and interaction effects.

RESULTS

CBT led to greater abstinence than GHE across 12-months of follow-up (AOR = 1.84, 95% CI [1.59, 2.13]) overall [12-month follow-up: CBT = 54% vs. GHE = 38%] and within racial and ethnic groups [12-months: African American/Black (CBT = 52%, GHE = 29%), Latino/Hispanic (CBT = 57%, GHE = 47%), and White (CBT = 54%, GHE = 41%)]. African American participants were less likely than White participants to quit irrespective of condition, as were persons with lower education and income. Socioeconomic status indicators positively predicted abstinence among racial and ethnic minority participants, but not White participants.

CONCLUSIONS

Group CBT was efficacious compared with GHE. However, cessation patterns suggested that intensive group interventions were less beneficial over the longer term among lower socioeconomic African American and Latino individuals, compared with White participants. Tobacco interventions should target racial and ethnic and socioeconomic differences, via culturally specific approaches and other means. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cultural Identity and the Academic, Social, and Psychological Adjustment of Adolescents with Immigration Background

As Western societies become more ethnically and culturally diverse, understanding the acculturation of immigrant youth is essential for fostering social cohesion. How the cultural identity formation of ethnic minority adolescents relates to their academic, social, and psychological adjustment is an important and as yet unresolved research question. This study examined to what extent identifying with the heritage and/or host culture is an individual resource or risk factor for the adjustment of immigrant youth in Germany. A random sample of 15-17-year-olds (N = 1992; Mage_w1 = 15.3 years, SD = 0.64; 44.5% girls; 44.7% students with immigrant background) was assessed twice: at the end of 9th and 10th grade. Academic performance and three dimensions of social/psychological adjustment (school attachment, self-esteem, and life satisfaction) were examined. Results showed that biculturalism was the modal identification pattern. Contrary to expectations, cultural identification did not differ systematically with perceived distance from the majority culture. Multivariate structural equation modeling revealed that both heritage and host identification can be developmental resources, but that their effects are dependent on the dimension of adjustment; biculturalism only proved to be a cumulative resource for school attachment. The domain specificity of the findings challenges the generalization claims of predominant acculturation theories.

A retrospective analysis of the ethnicity of individuals referred to a tertiary neuropsychology service in the United Kingdom

Objective: Ethnic minorities comprise approximately 18% of the UK population and are at high risk of developing neurological conditions. Despite this, there is little information regarding their access to neuropsychology services. This study evaluated whether ethnic minorities were proportionally represented in a tertiary neuropsychology department in the UK in accordance with census data for the region. We also aimed to highlight which ethnic groups were over- and underrepresented. Method: Anonymised demographic data of 3429 outpatient and 3304 inpatient referrals to an adult UK neuropsychology department was collected. These data were compared to the 2021 UK census data for the region. Results: Ethnicities in both the outpatient referrals (χ2(15) = 24066.55, p < .001) and inpatient referrals (χ2(15) = 35940924.75, p < .001) are significantly different from the Census. All ethnic minorities were underrepresented in adult neuropsychology referral data for both outpatient settings (-0.06% to -4.66%) and inpatient settings (-0.01% to -4.99%). Pakistani individuals were the most underrepresented across all settings, followed by individuals from an African background. Conversely, individuals of White British ethnicity were overrepresented in both outpatient settings (+10.73%) and inpatient settings (+15.68%). Conclusions: The UK ethnic minorities were not referred to a neuropsychology service relative to regional population prevalence. This contradicts their increased susceptibility for risk of neurological conditions but may also indicate the inaccessibility of neuroscience services for ethnic minorities. Replicating this study across different regions and gathering data on prevalence rates for different neurological conditions across ethnicity is recommended. Additionally, improving accessibility of neuropsychology services for British ethnic minorities should be prioritised.

Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot

Inequality in treatment access is a pressing issue in most healthcare systems across many medical disciplines. In mental healthcare, reduced treatment access for minorities is ubiquitous but remedies are sparse. Here we demonstrate that digital tools can reduce the accessibility gap by addressing several key barriers. In a multisite observational study of 129,400 patients within England's NHS services, we evaluated the impact of a personalized artificial intelligence-enabled self-referral chatbot on patient referral volume and diversity in ethnicity, gender and sexual orientation. We found that services that used this digital solution identified substantially increased referrals (15% increase versus 6% increase in control services). Critically, this increase was particularly pronounced in minorities, such as nonbinary (179% increase) and ethnic minority individuals (29% increase). Using natural language processing to analyze qualitative feedback from 42,332 individuals, we found that the chatbot's human-free nature and the patients' self-realization of their need for treatment were potential drivers for the observed improvement in the diversity of access. This provides strong evidence that digital tools may help overcome the pervasive inequality in mental healthcare.

Mental health and access to care among the Roma population in Europe: A scoping review

The Roma are Europe's largest ethnic minority group, and often face discrimination and social exclusion. Social strife and lack of access to healthcare are associated with increased symptoms of psychopathology. We aimed to review evidence on mental health outcomes and on access to mental healthcare among the Roma population in Europe. We systematically searched five databases (PsycINFO, Global Health, Social Policy and Practice, Web of Science and PubMed) and conducted a grey literature search in August 2020. We identified 133 studies, 26 of which were included for final analysis. We present the results using a narrative synthesis. The available literature indicates a relatively high prevalence of anxiety, depression and substance abuse among Roma, and females seem to be more affected than males. Roma children exhibit more externalizing and internalizing disorders when compared with non-Roma children. Mental health and perceived well-being among the Roma population are strongly linked to social determinants of health such as housing or economic income. Access to mental healthcare is limited for Roma people because of several barriers pertaining to language, lack of information regarding available services, and the insurance and economic status of Roma people. Roma people report mainly negative experiences with mental health services, including a lack of understanding from healthcare providers, and instances of racism and discrimination. There is a need for more research on mental health and access to healthcare in Roma people. Future studies should be participatory in order to provide guidelines for mental healthcare that addresses the needs of the Roma population.

Experience of discrimination reported during pregnancy and infant's emerging effortful control

Discrimination reported during pregnancy is associated with poorer offspring emotional outcomes. Links with effortful control have yet to be examined. This study investigated whether pregnant individuals' reports of lifetime racial/ethnic discrimination and everyday discrimination (including but not specific to race/ethnicity) reported during pregnancy were associated with offspring emerging effortful control at 6 months of age. Pregnant individuals (N = 174) and their offspring (93 female infants) participated. During pregnancy, participants completed two discrimination measures: (1) lifetime experience of racial/ethnic discrimination, and (2) everyday discrimination (not specific to race/ethnicity). Parents completed the Infant Behavior Questionnaire-Revised when infants were 6 months old to assess orienting/regulation, a measure of emerging effortful control. Analyses were conducted in a subsample with racially/ethnically marginalized participants and then everyday discrimination analyses were repeated in the full sample. For racially/ethnically marginalized participants, greater everyday discrimination (β = -.27, p = .01) but not greater lifetime experience of racial/ethnic discrimination (β = -.21, p = .06) was associated with poorer infant emerging effortful control. In the full sample, greater everyday discrimination was associated with poorer infant emerging effortful control (β = -.24, p = .002). Greater perceived stress, but not depressive symptoms, at 2 months postnatal mediated the association between everyday discrimination and emerging effortful control. Further research should examine additional biological and behavioral mechanisms by which discrimination reported during pregnancy may affect offspring emerging effortful control.

Satisfaction with Care and Attention to Age-Specific Concerns by Race and Ethnicity in a National Sample of Young Women with Breast Cancer

Purpose: In light of disparities in breast cancer care and outcomes, we explored whether attention to fertility, genetic, and emotional health concerns, as well as satisfaction with care, differs by race/ethnicity among young breast cancer patients. Methods: The Young and Strong Study was a cluster randomized trial of an intervention for patients and providers at 54 U.S. oncology practices enrolling women diagnosed with breast cancer at ≤45 years of age. Provider attention to fertility, genetics, and emotional health was evaluated by medical record review. The proportions of patients with attention to these concerns were compared by race/ethnicity (Hispanic, non-Hispanic Black [NHB], Asian, non-Hispanic White [NHW], or multiracial/other). Satisfaction with care was assessed with the Patient Satisfaction Questionnaire-18 (PSQ-18) at 3 months, with median scores for each of 7 PSQ-18 subscales (general satisfaction, interpersonal manner, communication, financial, time spent with doctor, accessibility, and technical quality) compared by race/ethnicity. Results: Among 465 patients, median age at diagnosis was 40; 6% were Hispanic, 11% NHB, 4% were Asian, 75% NHW, and 3% multiracial/other. Provider attention to genetics, emotional health, and fertility did not differ by race/ethnicity. Median PSQ-18 scores did not differ by race/ethnicity, with median subscale scores ranging from 3.0 to 4.5 across groups, indicating high levels of satisfaction. Conclusion: Satisfaction with care and provider attention to age-specific concerns were similar across racial/ethnic groups among young patients enrolled in an educational and supportive care intervention study. These data suggest that high-quality, equitable care is feasible. Further care delivery research is warranted in more diverse patient and practice settings. Clinical Trial Registration number: NCT01647607.

Pushed Out and Drawn In: Exclusionary Discipline, Mental Health, and Protective Factors Among Youth in Public Schools

BACKGROUND

Exclusionary discipline (ED) has long been an educational equity concern, but its relationship with student health and protective factors is less understood.

METHODS

Using population-based public school student data (N = 82,216), we examined associations between past-month ED and positive depression and anxiety screening instrument results. We also assessed whether each of 9 potential protective factors moderated the ED-mental health relationship by testing interaction effects.

RESULTS

Over 1 in 10 youth experienced past-month ED, with variation by sex, gender identity, special education status, poverty, region, race/ethnicity, and adverse childhood experiences. Net of sociodemographic factors, youth who experienced ED had higher likelihood for current depression (adjusted odds ratio [AOR]: 1.64, 95% confidence interval [CI]: 1.55, 1.73) and anxiety (AOR: 1.49, 95% CI: 1.41, 1.58) symptoms. Significant associations were robust across 5 racial/ethnic groups, except for anxiety among American Indian/Alaska Native youth. Individual, interpersonal, and school-level protective factors appeared to mitigate depression and anxiety regardless of disciplinary experience.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Our findings document ED disproportionality and possible ramifications for emotional well-being.

CONCLUSIONS

In concert with structural efforts to reduce reliance on ED, strategies that bolster protective factors may support youth already impacted by ED and/or mental health problems.

Psychological Consequences of Chronic Ethnic Discrimination in Male Turkish Immigrants Living in Austria: A 30-Day Ambulatory Assessment Study

BACKGROUND

Chronic ethnic discrimination may be associated with negative psychological consequences in ethnic minority groups. However, little is known about the impact of acute discriminatory events on people who experience chronic ethnic discrimination.

PURPOSE

We examined the impact of chronic and acute ethnic discrimination on the daily lives of Turkish immigrants in Austria, a population often overlooked in discrimination research.

METHODS

Ninety male Turkish immigrants living in Austria (60 experiencing chronic and 30 infrequent ethnic discrimination) reported discriminatory events in real time for 30 days. Additionally, subjective stress, reactivity to daily hassles, affect, and maladaptive coping were assessed daily.

RESULTS

Participants experiencing chronic ethnic discrimination indicated higher daily values for stress, negative affect, reactivity to daily hassles, and anticipation and avoidance coping. Negative psychological states increased for all participants on days when discriminatory events occurred, but participants with chronic ethnic discrimination showed significantly stronger increases in maladaptive coping and reactivity to daily hassles, with the latter effect persisting until the next day.

CONCLUSIONS

Our study is the first to demonstrate interaction effects of chronic and acute ethnic discrimination on psychological factors in daily life. The results may advance the understanding of the mechanisms that lead to health disparities in ethnic minority populations and may inform the development of targeted interventions.

Racial/ethnic and nativity differences in adversity profiles among middle-aged and older adults

OBJECTIVES

Focusing on the nexus of race/ethnicity and nativity, this study examined profiles of adversity and their mental health implications in five groups of middle-aged and older adults: native-born whites, native-born blacks, native-born Hispanics, foreign-born whites, and foreign-born Hispanics.

METHODS

Data were from the 2018 psychosocial assessment of the HRS (N = 5,223). Latent class analysis (LCA) was employed to identify patterns of eleven adversity indicators and to compare the latent structures and class prevalence across the race/ethnicity and nativity groups. Regressions were used to examine the associations between adversity profiles and depression and life satisfaction, respectively.

RESULTS

Four adversity profiles emerged: low adversity (59.84%), low human capital (15.27%), socially marginalized (15.26%), and neighborhood adversity (9.63%). Regardless of nativity status, white older adults were most likely to have the low adversity profile (74 ∼ 75%). In contrast, all the racial/ethnic minority groups were more likely to have the other three adversity profiles. The adversity experienced by racial/ethnic minorities was further cofounded by their immigration status. Overall, having low adversity was associated with the best mental health outcomes and socially marginalized had the poorest outcomes. Even with the low adversity profile, native-born blacks had significantly more depressive symptoms than native-born whites.

CONCLUSION

Findings revealed heterogeneity in adversity profiles and their mental health implications in disadvantaged aging populations. Tailored programs are needed to address unique needs of different minority populations.

Negative emotional reactivity to minority stress: measure development and testing

The purpose of the present investigation was to develop and test a measure of negative emotional reactivity to racial/ethnic minoritized stress. In Study 1, we developed item content for a measure of negative emotional reactivity to racial/ethnic minoritized stress. We then evaluated item performance and produced a refined 15-item scale among a large sample of racial/ethnic minority adults (N = 1,343). Results supported a unidimensional construct and high levels of internal consistency. The factor structure and internal consistency were replicated and extended to a sample of Latinx persons who smoke (N = 338) in Study 2. There was evidence of convergent validity of the Emotional Reactivity to Minoritized Stress (ERMS) total score in terms of theoretically consistent and statistically significant relations with indices of mental health problems, social determinants of health, and substance use processes. There was also evidence that the ERMS demonstrated divergent validity in that it was negatively associated with psychological well-being, health literacy, subjective social status in Study 1, and positive abstinence expectancies in Study 2. Overall, the present study establishes the reliability and validity of measuring individual differences in negative emotional reactivity to racial/ethnic minority stress with the ERMS and that such responsivity is associated with behavioral health problems.

Sociodemographic and clinical predictors of delay to and length of stay with early intervention for psychosis service: findings from the CRIS-FEP study

PURPOSE

We investigated the influence of sociodemographic and clinical characteristics on delay to early intervention service (EIS) and the length of stay (LOS) with EIS.

METHODS

We used incidence data linked to the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study. We followed the patients from May 2010 to March 2016. We performed multivariable Cox regression to estimate hazard ratios of delay to EIS. Negative binomial regression was used to determine LOS with EIS by sociodemographic and clinical characteristics, controlling for confounders.

RESULTS

343 patients were eligible for an EIS, 34.1% of whom did not receive the service. Overall, the median delay to EIS was 120 days (IQR; 15-1668); and the median LOS was 130.5 days (IQR 0-663). We found that women (adj.HR 0.58; 95%C I 0.42-0.78), living alone (adj.HR: 0.63; 95% CI 0.43-0.92) and ethnicity ('Other': adj.HR 0.47; 95% CI 0.23-0.98) were associated with prolonged delay to EIS. However, family involvement in help-seeking for psychosis (adj.HR 1.37; 95% CI 1.01-1.85) was strongly associated with a shorter delay to EIS. Patients who have used mental health services previously also experienced long delays to EIS.

CONCLUSIONS

Our analyses highlight the link between sociodemographic status, help-seeking behaviours, and delay to EIS. Our findings also show the vulnerability faced by those with a previous mental health problem who later develop psychosis in receiving specialist treatment for psychosis. Initiatives that ameliorate indicators of social disadvantage are urgently needed to reduce health inequalities and improve clinical outcomes.

The longitudinal effect of the quality of participation experiences in a voluntary organization on youth psychological empowerment

Research shows its limitations by not capturing the specificities of individual experiences, which result either from the participation of or interaction among different people in a given context across time. This study explores the effect that the quality of youth participation experiences in a Portuguese voluntary organization can have on the development of their psychological empowerment (PE). This study adopted a longitudinal, quantitative design where the same cohort of 481 participants (62.4% female; Mage  = 17.26 years) was followed across three time points. Latent growth curve modeling was performed to examine the effect of the quality of participation experiences (QPE) on the developmental trajectories of PE components. Findings show that the QPE had the most powerful effect on developmental trajectories in PE. The study shows how youth perceptions of opportunities for reflection and action in interaction in a climate of openness to dialogue and the emergence of different ways of thinking and doing affect their PE.

Investigating the Relationship Between Marital Status and Ethnicity on Neurocognitive Functioning in a Rural Older Population: A Project FRONTIER Study

OBJECTIVES

Research indicates being married is related to better physical and psychological health. Little is known regarding the relationship between marital status and neurocognitive functioning and whether it differs based on ethnicity (Hispanic vs non-Hispanic). This is the first study to examine this relationship in a sample of aging adults in rural Texas.

METHODS

Data from 1,864 participants (Mage = 59.68, standard deviation [SD]age = 12.21), who were mostly Hispanic (n = 1,053), women (n = 1,295), and married (n = 1,125) from Project Facing Rural Obstacles to Healthcare Now Through Intervention, Education, & Research were analyzed. Neuropsychological testing comprised Repeatable Battery for the Assessment of Neuropsychological Status, Trails Making Test, and Clock Drawing. Participants were dichotomized, married, and unmarried.

RESULTS

There was a significant interaction between Hispanic identity and marital status on overall neurocognitive functioning (F(1, 1,480) = 4.79, p < .05, ηp2 = 0.003). For non-Hispanic individuals, married individuals had higher overall neurocognitive functioning compared to unmarried individuals, whereas neurocognitive functioning for Hispanic individuals did not significantly differ between married and unmarried individuals. There were significant main effects as married individuals (M = 84.95, SD = 15.56) had greater overall neurocognitive functioning than unmarried individuals (M = 83.47, SD = 15.86; F(1, 1,480) = 14.67, p < .001, ηp2 = 0.01), Hispanic individuals (M = 78.02, SD = 14.25) had lower overall neurocognitive functioning than non-Hispanic individuals (M = 91.43, SD = 15.07; F(1, 1,480) = 284.99, p < .001, ηp2 = 0.16).

DISCUSSION

Hispanics living in rural areas experience additional stressors that could lead to worse neurocognitive functioning, which is supported by the Lifespan Biopsychosocial Model of Cumulative Vulnerability and Minority Health, which postulates that race/ethnicity/socioeconomic-status-related stressors exacerbate the impact of other life stressors. Reduction of stress on rural Hispanics should be a priority as it could positively affect their neurocognitive functioning.

Identifying profiles of school climate in high schools

This cross-sectional study analyzed data from 364,143 students in 492 high schools who completed the Georgia School Climate Survey during the 2017-2018 school year. Through latent profile analysis, we identified that student perceptions of school climate could be classified into three distinct profiles, including positive, moderate, and negative climate. Using multinomial logistic regression, we then identified school and student characteristics that predicted student classification in the student profiles using the total sample and subsamples by race/ethnicity. Among the key results, we found that most of the school characteristics (e.g., percent of students receiving free or reduced lunch, schools with higher percentages of minoritized students) predicting classification in the negative and positive school climate profiles were different for White students compared to minoritized students. For example, Black students in primarily non-White schools were more likely to view school climate positively, whereas the opposite was the case for White students. We also found that Black and Other (e.g., multiracial) students were more likely to be classified in the negative school climate profile and less likely to be classified in the positive school climate profile compared to White students. In contrast, Latino/a/e students were more likely to be classified in the positive school climate profile and less likely to be classified in the negative school climate profile. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ethnic differences in receipt of psychological interventions in Early Intervention in Psychosis services in England - a cross-sectional study

There is some evidence of differences in psychosis care provision by ethnicity. We investigated variations in the receipt of Cognitive Behavioural Therapy for psychosis (CBTp) and family intervention across ethnic groups in Early Intervention in Psychosis (EIP) teams throughout England, where national policy mandates offering these interventions to all. We included data on 29,610 service users from the National Clinical Audit of Psychosis (NCAP), collected between 2018 and 2021. We conducted mixed effects logistic regression analyses to examine odds ratios of receiving an intervention (CBTp, family intervention, either intervention) across 17 ethnic groups while accounting for the effect of years and variance between teams and adjusting for individual- (age, gender, occupational status) and team-level covariates (care-coordinator caseload, inequalities strategies). Compared with White British people, every minoritized ethnic group, except those of mixed Asian-White and mixed Black African-White ethnicities, had significantly lower adjusted odds of receiving CBTp. People of Black African, Black Caribbean, non-African/Caribbean Black, non-British/Irish White, and of "any other" ethnicity also experienced significantly lower adjusted odds of receiving family intervention. Pervasive inequalities in receiving CBTp for first episode psychosis exist for almost all minoritized ethnic groups, and family intervention for many groups. Investigating how these inequalities arise should be a research priority.

Context dependent cognitive development in Bhutanese children

We assessed risk/protective factors for cognitive development of Bhutanese children (504 3-5 year-olds, 49% girls, major ethnicities Ngalop 26%, Tshangla 30%, Lhotsampa 34%) using a non-verbal test of cognitive capacity (SON-R) and primary caregiver interviews. Cognitive capacity was related to the family's SES and whether the family belonged to the primary Buddhist majority ethnic groups (Ngalop or Tshangla) or primarily Hindu minorities (Lhotsampa). In majority families more engagement in Buddhist practices was associated with higher cognitive capacity in children. Minority children were more impacted by parents autonomous-relatedness values. Results demonstrate that cognitive development is dependent on the financial and educational context of the family, societal events, and culture specific risk/protective factors that differ across sub-groups (majority/minority, culture/religion).

Health-Risk Behaviors and Experiences Among Asian American and Native Hawaiian/Pacific Islander Adolescents in the United States, 2011-2019

OBJECTIVES

Understanding the health-risk behaviors of racial and ethnic groups when disaggregated is an important step in improving the health outcomes of racial and ethnic minority groups. We compared national prevalence estimates for selected health-risk behaviors and experiences of Asian American and Native Hawaiian/Pacific Islander (NHPI) students with those of non-Hispanic White, non-Hispanic Black, and Hispanic students.

METHODS

We analyzed data from the Youth Risk Behavior Survey, a nationally representative survey of US high school students. To generate a sufficient sample of Asian American and NHPI students for analyses, we combined data from 5 survey administrations, conducted in 2011, 2013, 2015, 2017, and 2019 (N = 73 074). We calculated the prevalence and 95% CIs; we analyzed data on Asian American and NHPI adolescents separately to unmask important differences.

RESULTS

Compared with students of other races and ethnicities, Asian American students had the lowest prevalence of alcohol use (16.7%) and marijuana use (10.3%). In contrast, NHPI students were more likely than Asian American students to participate in several health-risk behaviors and experiences, such as substance use (ranging from 4.8% for ever injecting an illegal drug to 31.5% for current alcohol use), having been in a physical fight (15.4%), and having been threatened or injured with a weapon (11.6%). Differential patterns in the prevalence of ever having missed school due to feeling unsafe among NHPI and Asian American students were observed among male and female students.

CONCLUSION

Further disaggregating racial subgroups within broad categories of Asian American and NHPI populations may reveal differences from overall group prevalence, and additional strategies to identify these differences should be investigated.

The Role of Ethnic-Racial Identity and Self-Esteem in Intergroup Contact Attitudes

Adolescents' ethnic-racial identity (ERI) exploration, resolution, and affirmation inform their approach and avoidance attitudes toward intergroup contact, but the potential mechanisms through which this occurs have been underexplored. Given the evidence that adolescents with higher ERI exploration, resolution, and affirmation also report higher self-esteem, and self-esteem is theorized to facilitate openness to intergroup contact, the current study explored the role of self-esteem as a mediator of the relation between adolescents' ERI and their intergroup contact attitudes. Participants were 4606 adolescents (Mage = 16.35, SD = 1.16; 37.5% White, 27.1% Black, 20.7% Latinx, 11.7% Asian American, 3% Native American) from the U.S. Southwest and Midwest. The three waves of data were collected between March 2017 and March 2018. Results from longitudinal multigroup path models indicated that across all ethnic-racial groups there were positive direct relations between Wave 1 (W1) ERI resolution and W2 self-esteem (7 months later). In turn, W2 self-esteem was positively related to W3 approach attitudes (12 months later) and negatively related to W3 avoidance attitudes. The relations between ERI resolution and both approach and avoidance attitudes were fully mediated by self-esteem across all ethnic-racial groups. Notably the baseline values (W1) of all mediation and outcome variables (W2, W3) were included, suggesting that ERI resolution at baseline predicted increases in self-esteem, which predicted subsequent increases in approach attitudes and decreases in avoidance attitudes. ERI exploration and affirmation were not significant predictors of later self-esteem or contact attitudes. These findings suggest that of the three dimensions of ERI examined, resolution is the primary driver of the increases in self-esteem that inform adolescents' attitudes towards interaction with ethnic-racial outgroup members.

Differences of biopsychosocial distress and requests for psychological assistance between Asian American and non-Hispanic White oncology patients

OBJECTIVE

The purpose of this study was to compare Asian American (AA) to non-Hispanic White (NHW) cancer patients regarding biopsychosocial distress and requests for psychological assistance.

METHODS

This retrospective study included 5627 eligible patients, newly diagnosed with cancer, who completed the 30-item SupportScreen® survey of biopsychosocial distress. The top 10 sources of high distress were assessed. Distress domains (Emotional, Physical/Functional, and Practical) were examined by race/ethnicity. Requests for psychological assistance were also explored by ethnic groups.

RESULTS

Overall, the top 10 sources of high distress were similar between groups and approximately half consisted of concerns regarding physical symptoms. All patients preferred "talking" as their method of receiving assistance for these items. Ratings of emotional, practical, and physical/functional distress were similar between AA and NHW patients. However, AAs (vs. NHWs) requested more assistance regarding physical/functional and practical distress. No difference was observed between these two groups regarding requests for emotional support.

CONCLUSIONS

Overall, our study suggests that healthcare providers should be aware of the physical and practical needs of AA cancer patients and provide culturally sensitive care that addresses these needs.

Race, everyday discrimination, and cognitive function in later life

Discrimination is pernicious in many ways, but there are inconsistent findings regarding whether it is harmful to cognitive function in later life. To address the inconsistency, we use two closely related concepts of everyday discrimination to predict cognitive trajectories in a diverse sample. Using data from the Health and Retirement Study (HRS), we examine whether the frequency of discrimination, measured at baseline with six questions, is related to poorer cognitive function and change in function over time (2008-2016). Age at baseline ranged from 53 to 100. Growth curve models of initial cognitive function and change in function were estimated. Everyday global discrimination was associated with poorer initial cognition and slower declines over time, and these relationships were not moderated by race and ethnicity. By contrast, the relationship between everyday racial discrimination and cognition was moderated by race: more frequent everyday racial discrimination was associated with better initial cognitive function among Black adults but not among Hispanic and White adults. Discrimination is a multifaceted concept, and specific types of discrimination manifest lower or higher cognitive function during later life for White, Black, and Hispanic adults.

A co-produced service evaluation of ethnic minority community service user experiences of a specialist mental health service during the COVID-19 pandemic

BACKGROUND

For ethnic minority communities in the UK, the COVID-19 pandemic amplified existing health inequalities and created other consequential disadvantages like increased vulnerability to COVID-19, higher rates of hospital admissions, increased mortality and poorer mental health outcomes. While longer-term impacts of COVID-19 are considered, it is crucial for NHS mental health services to understand the specific barriers and needs of ethnic minority communities to provide consistent and equitable access to mental health services. These aspects were the focus of a service evaluation of a Sussex-wide mental health service conducted in co-production with experts-by-experience, public members, health professionals and researchers from ethnic minority communities.

METHODS

Co-designed creative workshops (n = 13) and semi-structured qualitative interviews (n = 13) were used to explore experiences of accessing specialist mental health services during the COVID-19 pandemic. Participants were: Sussex Partnership NHS Foundation Trust (SPFT) service users recruited between October 2021 and January 2022; aged 16+; from ethnic minority community backgrounds. Data was analysed using Thematic Analysis.

RESULTS

The analysis yielded five overarching themes contextualising service users' experiences: (1) limited awareness of SPFT mental health services; (2) effects of COVID-19 in gaining access to SPFT; (3) SPFT reaching out to ethnic minorities; (4) being supported, 4a) hiding my mental health status from friends and families, 4b) lack of ethnic diversity in services, and 4c) better provision of information and support services, (5) relationship between childhood experiences and current mental health. These findings led to seven key recommendations for future service developments within SPFT.

CONCLUSIONS

Although this evaluation was set in the context of COVID-19, findings have highlighted specific mental health service needs for ethnic minorities that are applicable beyond the confines of the pandemic. Many benefited from online sessions seen as more inclusive. Mental health advocates, outreach and joint working with communities could help further reduce stigmatising attitudes and improve engagement with mental health services. Improved service awareness of the impact of childhood or historical traumas experienced by ethnic minority communities on current mental health, the role of cultural awareness training and availability of culturally adapted therapies is also needed. Many service improvement recommendations provided could impact all service users.

COVID-19-Induced Inequalities and Mental Health: Testing the Moderating Roles of Self-rated Health and Race/Ethnicity

This study examines the relationship among COVID-19-induced social, economic, and educational inequalities on mental health (i.e., anxiety and depression). This study also examines if levels of self-rated health (SRH) moderate the relationship (i.e., COVID-induced inequalities [CII] and mental health), as well as examines the racial/ethnic group differences among 567 young adults in the mid-Atlantic region. Using a moderation model, results indicate that CII were significantly related to depression (b = .221, t(554) = 4.59, p = .000) and anxiety (b = .140, t(555) = 3.23, p = .001). SRH and race/ethnicity also moderated both relationships. At above-average SRH (i.e., moderator), higher CII were also significantly related to lower anxiety (Asian young adults only) and lower depression (Asian and White young adults only). Overall, SRH and race/ethnicity are important factors in the mental health impact of COVID-19 on young adults.

Racial/ethnic discrimination and suicide-related risk in a treatment-seeking group of ethnoracially minoritized adolescents

INTRODUCTION AND AIMS

Despite growing evidence demonstrating the negative mental health effects of racism-related experiences, racial/ethnic discrimination is seldom examined in youth suicide risk. The present study tested the association between racial/ethnic discrimination and well-supported correlates of suicide-related risk including emotion reactivity and dysregulation, and severity of psychiatric symptoms in a sample of ethnoracially minoritized adolescents receiving outpatient psychiatric services.

METHODS

Participants were adolescents (N = 46; 80.4% female; 65.2% Latinx) who ranged in age from 13-20 years old (M=15.42; SD=1.83) recruited from a child outpatient psychiatry clinic in a low-resourced community in Northeast US. Youth completed a clinical interview and a battery of surveys.

RESULTS

Findings from separate linear regression models show that increases in frequency of racial/ethnic discrimination were associated with increases in severity of suicidal ideation (SI), independent of emotion reactivity and dysregulation, and symptoms of PTSD and depression. Discriminatory experiences involving personal insults, witnessing family being discriminated, and school-based contexts were uniquely associated with SI.

DISCUSSION AND CONCLUSION

Preliminary findings support the association between racial/ethnic discrimination and increased severity of suicide-related risk in ethnoracially minoritized adolescents. Accounting for racial/ethnic discrimination may improve the cultural responsiveness of youth suicide prevention strategies within outpatient psychiatric care.

Internalizing problems before and during the COVID-19 pandemic in independent samples of Dutch children and adolescents with and without pre-existing mental health problems

The aim of the study was to assess internalizing problems before and during the pandemic with data from Dutch consortium Child and adolescent mental health and wellbeing in times of the COVID-19 pandemic, consisting of two Dutch general population samples (GS) and two clinical samples (CS) referred to youth/psychiatric care. Measures of internalizing problems were obtained from ongoing data collections pre-pandemic (NGS = 35,357; NCS = 4487) and twice during the pandemic, in Apr-May 2020 (NGS = 3938; clinical: NCS = 1008) and in Nov-Dec 2020 (NGS = 1489; NCS = 1536), in children and adolescents (8-18 years) with parent (Brief Problem Monitor) and/or child reports (Patient-Reported Outcomes Measurement Information System®). Results show that, in the general population, internalizing problems were higher during the first peak of the pandemic compared to pre-pandemic based on both child and parent reports. Yet, over the course of the pandemic, on both child and parent reports, similar or lower levels of internalizing problems were observed. Children in the clinical population reported more internalizing symptoms over the course of the pandemic while parents did not report differences in internalizing symptoms from pre-pandemic to the first peak of the pandemic nor over the course of the pandemic. Overall, the findings indicate that children and adolescents of both the general and clinical population were affected negatively by the pandemic in terms of their internalizing problems. Attention is therefore warranted to investigate long-term effects and to monitor if internalizing problems return to pre-pandemic levels or if they remain elevated post-pandemic.

Understanding the Process of Family Cancer History Collection and Health Information Seeking

PROBLEM ADDRESSED

To better understand the factors associated with family cancer history (FCH) information and cancer information seeking, we model the process an individual undergoes when assessing whether to gather FCH and seek cancer information and compare models by sociodemographics and family history of cancer. We used cross-sectional data from the Health Information National Trends Survey (HINTS 5, Cycle 2) and variables (e.g., emotion and self-efficacy) associated with the Theory of Motivated Information Management to assess the process of FCH gathering and information seeking. We completed path analysis to assess the process of FCH gathering and stratified path models.

RESULTS

Those who felt they could lower their chances of getting cancer (emotion) were more confident in their ability to complete FCH on a medical form (self-efficacy; B = 0.11, p < .0001) and more likely to have discussed FCH with family members (B = 0.07, p < .0001). Those who were more confident in their ability to complete a summary of their family history on a medical form were more likely to have discussed FCH with family members (B = 0.34, p < .0001) and seek other health information (B = 0.24, p < .0001). Stratified models showed differences in this process by age, race/ethnicity, and family history of cancer.

IMPLICATIONS FOR PUBLIC HEALTH RESEARCH AND PRACTICE

Tailoring outreach and education strategies to address differences in perceived ability to lower chances of getting cancer (emotion) and confidence in the ability to complete FCH (self-efficacy) could help encourage less engaged individuals to learn about their FCH and gather cancer information.

"You're Tearing Me Apart!" Racial/Ethnic Discrimination, Bicultural Identity, and Mental Health

Drawing from the rejection-identification and rejection-disidentification models (RIM/RDIM), we proposed a model of the association between racial/ethnic discrimination and symptoms of depression and anxiety among racially/ethnically minoritized immigrant individuals. We hypothesized that this relation would be sequentially mediated by discordance in ethnic and national cultural identities and bicultural identity conflict. First- and second-generation racially/ethnically minoritized immigrant college students in the United States (N = 877) completed a battery of self-report measures. We tested two models, one each for depression and anxiety symptoms. Racial/ethnic discrimination was positively associated with discordance in ethnic and national identity, which was positively associated with bicultural identity conflict. These were in turn, positively related to depression and anxiety symptoms. Immigrant individuals who experience racial/ethnic discrimination may perceive higher conflict between their ethnic and national identities. This conflict can in turn be associated with poor mental health. Clinicians should address cultural identity processes when working with racial/ethnic minoritized immigrant clients.

Examining Racial/Ethnic Disparities in Coping and Stress Within an Environmental Riskscape

Existing research on racial/ethnic differences in stress and coping is limited by small samples, single-item measures, and lack of inclusion of Mexican Americans. We address these gaps by analyzing data from the Texas City Stress and Health Study, a cross-sectional sample of Black (N = 257), White (N = 304), US-born (N = 689), and foreign-born (N = 749) Mexican Americans residing in proximity to a petrochemical complex. We compared active and avoidant coping by race/ethnicity and explored multivariable associations between coping and perceived stress. Black and foreign-born Mexican American respondents had the highest stressor exposure yet displayed different patterns of coping and perceived stress patterns. Active coping may be particularly effective for African Americans but may not offset extreme stress disparities. For Mexican Americans, the lack of association between coping and stress underscores the need for more work focused on the culturally diverse coping experiences.

Linguistic, affective, parental, and educational contributions to the bicultural identity development of Balkan minority adolescents

This study investigated linguistic, affective, parental, and educational contributions to bicultural identity, in two samples of younger (13- to 14-year-old; N = 95) and older (16- to 17-year-old; N = 67) bilingual adolescents, who were immigrants or belonged to ethnic minority communities in the Balkans. While bicultural identity level was not differentiated as a function of age group, there was an age-related shift in its predictors. Bicultural identity level was significantly predicted by perceived educators' attitudes toward linguistic/cultural diversity in the younger adolescent group, but by personal affective states (motivation and attitudes) toward the mainstream language in the older adolescent group. Implications of the findings are discussed regarding educational and family practices that would facilitate biculturalism in minority adolescents.

Cultural Framing and the Impact On Acute Pain and Pain Services

PURPOSE OF REVIEW

Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management.

RECENT FINDINGS

The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training.

Dismantling the monolith: ethnic origin, racial identity, and major depression among US-born Black Americans

PURPOSE

Numerous investigations have sought to understand why Black Americans have a lower prevalence of major depressive disorder (MDD) than white Americans, yet fewer have explored within-racial group variation or its causes. Limited extant evidence indicates that US-born Caribbeans have higher levels of MDD relative to African Americans. Among African Americans, racial identity is considered protective against depression, yet it is unclear how it functions among Black Americans with recent immigrant origins. We examined the extent to which differential effects of racial identity on MDD by ethnic origin explain the elevated prevalence among US-born Caribbeans relative to all other US-born Black Americans.

METHODS

With data from the largest nationally representative study of Black mental health, log-binomial models assessed effect modification of ethnic origin (Caribbean, non-Caribbean) on the relationship between racial identity and MDD. Separate models evaluated four indicators of racial identity-"closeness to Black people," "importance of race to one's identity," "belief that one's fate is shared with other Black people," and "Black group evaluation."

RESULTS

Belief in "shared fate" was positively associated with MDD for US-born Caribbeans alone (PR = 3.43, 95% CI 1.87, 6.27). Models suggested that "importance of race" and "Black group evaluation" were detrimental for Caribbeans, yet protective for non-Caribbeans. "Closeness" appeared protective for both groups.

CONCLUSION

Findings suggest that the protective effect of racial identity against MDD among US-born Black Americans may depend on both ethnic origin and the operationalization of racial identity. Results provide new insight into the role of racial identity on depression and suggest promising directions for future research.

Racial/Ethnic Disparities in Mental Healthcare in Youth With Incarcerated Parents

INTRODUCTION

Youth with incarcerated parents experience more adverse childhood experiences than other youth, placing them at higher risk for mental health and substance use disorders. Despite their increased risk, these youth may be less likely to access mental health services, particularly given their racial and ethnic makeup. Therefore, this study aimed to assess racial and ethnic disparities in access to mental health services for youth with incarcerated parents.

METHODS

This secondary data analysis used longitudinal data from 2016 to 2019 from the Adolescent Brain Cognitive Development Study. Logistic regression models assessed the relationships among incarceration, cumulative childhood experiences, DSM-5 diagnoses, and mental health services. Additional analyses stratified these models by race and ethnicity. All analyses were performed in 2022.

RESULTS

Youth with incarcerated parents were more likely to report 4 or more childhood experiences (51% vs 14%; AOR=3.92; 95% CI=3.3, 4.65; p<0.001) and to have received mental health services (25% vs 15%; AOR=1.89; 95% CI=1.6, 2.21; p<0.001) than unexposed youth. However, Black youth with incarcerated parents (19% vs 34%; AOR=0.38; 95% CI=0.27, 0.52; p<0.001) and Latinx youth with incarcerated parents (10% vs 17%; AOR=0.5; 95% CI=0.33, 0.76; p<0.001) were significantly less likely to report receiving mental health services than White youth with incarcerated parents and non-Latinx youth with incarcerated parents, respectively.

CONCLUSIONS

Youth with incarcerated parents were more likely to report utilization of mental health services, but significant racial and ethnic disparities exist between Black and Latinx youth with incarcerated parents compared with that among White and non-Latinx youth with incarcerated parents. There is a continued need to expand mental health services to youth with incarcerated parents and to address racial and ethnic disparities in access to care.

Emotional distress in cancer survivors from various ethnic backgrounds: Analysis of the multi-ethnic HELIUS study

PURPOSE

Insight into emotional distress of cancer survivors from ethnic minority groups in Europe is scarce. We aimed to compare distress levels of survivors from ethnic minorities to that of the majority population, determine whether the association between having cancer (yes vs. no) and distress differs among ethnic groups and investigate sociocultural correlates of distress.

METHODS

Cross-sectional data were derived from HELIUS, a multi-ethnic cohort study conducted in the Netherlands. Of 19,147 participants, 351 were diagnosed with cancer (n = 130 Dutch, n = 75 African Surinamese, n = 53 South-Asian Surinamese, n = 43 Moroccan, n = 28 Turkish, n = 22 Ghanaian). Distress (PHQ-9, MCS-12) and correlates were assessed by self-report. Cancer-related variables were derived from the Netherlands Cancer Registry.

RESULTS

Survivors were on average 7 years post-diagnosis. Survivors from South-Asian Surinamese, Moroccan, Turkish and Ghanaian origin reported more distress than survivors from Dutch origin (effect sizerange : 0.44-1.17; adjusted models). The association between having cancer or not with distress differed in direction between Dutch and the non-Dutch ethnic groups: Non-Dutch cancer patients tended to have more distress than their cancer-free peers, whereas Dutch cancer patients tended to have less distress than their cancer-free peers. For Moroccan and Turkish patients, the acculturation style of separation/marginalization, compared to integration/assimilation, was associated with higher depressive symptoms. In analyses pooling data from all ethnic minorities, lower health literacy, lower emotional support satisfaction and younger age at the time of migration were associated with higher depressive symptoms. Lower health literacy, fewer emotional support transactions, and more frequent attendance at religious services were associated with worse mental health.

CONCLUSION

Cancer survivors from ethnic minorities experience more distress than those from the majority population. Culturally sensitive supportive care should be considered.

Assessing parenting in racially and ethnically diverse families: A lack of measurement equivalence

The present study explored measurement invariance of the Multidimensional Assessment of Parenting Scale (MAPS; Parent & Forehand, 2017) across White, Hispanic, Black, and Asian American parents. Participants included 2,734 parents, 58% of whom were mothers. On average, parents were 36.32 years old (SD = 9.54); the parent sample was 66.9% White non-Hispanic, 10.1% Black, 5.3% Asian, and 17.7% Hispanic regardless of race. Child ages ranged from 3 to 17 years (M = 9.84, SD = 3.71), and 58% were identified as male. Parents completed a demographics questionnaire about themselves and their target child, and the 34-item MAPS. We explored measurement equivalence of the MAPS Broadband Positive and Negative parenting scales using item response theory to identify differential item functioning (DIF). Univariate analyses for Positive and Negative Parenting showed reliability was excellent. Twelve items assessing negative aspects of parenting exhibited bias by race/ethnicity. Specifically, when comparing racial and ethnic groups, three items had nonuniform DIF comparing Black and Asian participants, two items had nonuniform DIF comparing Black and Hispanic participants, and one item showed nonuniform DIF comparing Asian and Hispanic participants. When looking at Positive Parenting, no items showed evidence of DIF. Results from the present study suggest broadband Positive Parenting can be compared across ethnoracial groups, while findings raise concern about assessing Negative Parenting items when examining invariance across race and ethnicity. Findings from the present study imply that racial and ethnic comparisons are potentially invalid. These findings offer guidance for improving parenting assessment for racially/ethnically diverse populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).