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.

A National Institutes of Health Approach for Advancing Research to Improve Youth Mental Health and Reduce Disparities

Even before the COVID-19 pandemic, mental health challenges were the leading cause of disability and poor health outcomes in youth. Challenges are even greater for youth from racially and ethnically minoritized groups in the United States. Racially and ethnically minoritized youth are more vulnerable to mental health problems than White adolescents, yet are less likely to use mental health services. In late 2021, the National Institutes of Health (NIH) sponsored a virtual conference to examine the state of the science around youth mental health disparities (YMHD), focusing on youth from racially and ethnically minoritized populations and the intersection of race and ethnicity with other drivers of mental health disparities. Key findings and feedback gleaned from the conference have informed strategic planning processes related to YMHD, which has included the development of a strategic framework and funding opportunities, designed to reduce YMHD. This commentary briefly describes the collaborative approach used to develop this framework and other strategies implemented across the NIH to address YMHD and serves as an urgent call to action.

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.

Majnūn or Mental Disorders: Between Cultural Traditions and Western Psychology in Jordan

Mental disorders or altered psychological states are prevalent in all populations, regardless of race or ethnic origin, while at the same time, culture also shapes the conceptions of mental disorders. Religion is deeply rooted in the daily life of the Muslim-majority countries, while Arab countries are affected by an ongoing modernization. Thus, how does the traditional religious conception of mental disorders interact with Western psychological conceptions in contemporary Arab-Muslim society? This study explores the conceptions of mental disorders and their causes among Muslims in contemporary Jordan. By employing cognitive anthropological method (free listing), forty participants were asked to provide three lists of (a) typical names of mental disorders, (b) causes of mental disorders and (c) determining features of mental disorders. Collected qualitative data have been quantitatively analysed and interpreted in the context of relevant ethnographic and interview data. While Western terms of mental disorders are well known among young and educated Jordanians, the study demonstrates that Jordanians employ cultural and religious notions alongside. This co-existence of different conceptions confirms an importance of Islamic notion in the modern rendering of mental health. As a result, despite rapid modernization, mental health is still highly stigmatized.

Latinx Youth's Mental Health Needs and Socioeconomic Factors Associated with Service Utilization

This study examined mental health needs and risk factors associated with service use among Latinx high school students in two cities in the United States. We explored how socioeconomic characteristics, school location, youth and parental nativity, and self-perceived clinical needs were associated with the odds of youths seeing a mental health provider. Data were collected from 306 Latinx youths during the 2018-19 school year. Most youths (78%) self-reported symptoms of anxiety, trauma, or depression above the clinical range. None of these clinical needs predicted service utilization. Youth experiencing less economic hardship and having a mother from South America were almost five times more likely to use services than their counterparts. Similarly, males and older respondents were more likely to be underserved than females and younger respondents. Implications to ensure equitable access to services among older, low-income Latinx youth, particularly those from Central America, the Caribbean, and Mexico, are discussed.

Co-occurring mental health and drug use experiences among Black and Hispanic/Latino sexual and gender diverse individuals

Black and Hispanic/Latino sexual and gender diverse individuals disproportionately experience overlapping health disparities, such as drug use and elevated depressive symptoms, which are often driven by minority stressors. We sought to better understand the interaction between drug use and mental health, as it may be fruitful in developing effective interventions to address co-occurring health disparities. In a longitudinal, 5-wave sample of 300 Black and Hispanic/Latino sexual and gender diverse (SGD) individuals collected between March 2020 and March 2022, we found a within-person association between greater than average levels of psychological distress (depression and anxiety) and more frequent extra-medical use of cannabis, inhalants, methamphetamines, and opioids over the span of two years. These associations held after adjusting for the direct, within-person association of internalized homonegativity with drug use frequency. These results suggest that psychological distress explains at least some variance in drug use among Black and Hispanic/Latino SGD individuals. This highlights the importance of interventions that focus on mental health among Black and Hispanic/Latino SGD individuals who report drug use.

Evaluation of the Mental Health Referral Process for African American Adolescent Patients Within a Primary Care Setting: A Quality Improvement Project

INTRODUCTION

Mental health disorders affect 18% of the U.S.

POPULATION

Problems with access to mental health care for the African American community are multifactorial. Provider and staff perceptions and opinions regarding factors attributing to problems with mental health access are explored.

METHOD

Providers and staff (N=10) completed a 26-item electronic questionnaire RESULTS: The primary barriers to screening, consultation, and follow-through were time constraints, location of services, and lack of parental support, respectively.

CONCLUSIONS

Integrating behavioral health into primary care is a promising way to address many reported barriers, such as time restraints, social stigma, and lack of resources.

Caregiver experiences of racism and child mental health outcomes: cross-sectional analysis from Aotearoa New Zealand

AIMS

This study aimed to estimate the prevalence of vicarious racism experienced by children (0-14 years) in Aotearoa New Zealand and investigate the association between vicarious racism and diagnosed child mental health conditions.

METHODS

Adult and child 2016/2017 New Zealand Health Survey data were merged to create child-caregiver dyads. Multivariable logistic regression models were used to investigate the association between the caregiver experiences of racism (exposure) and diagnosed child mental health conditions (outcome), adjusting for confounders and exploring potential pathway variables.

RESULTS

Looking at 2,989 dyads, the prevalence of "any" vicarious racism was higher for Māori (28.1%; 95% CI 24.2-31.9), Pacific (23.2%; 95% CI 17.9-28.5) and Asian (29%; 95% CI 23.6-34.5) children compared to European/Other children (12.5%; 95% CI 10.2-14.8). A statistically significant association was identified between >2 reports of vicarious racism and the outcome (OR= 2.53, 95% 1.18-5.43). Adding caregiver psychological distress reduced this association (OR= 1.92, 95% 0.91-4.08).

CONCLUSIONS

Children in Māori, Pacific and Asian ethnicity groupings experience higher exposure to vicarious racism than those in the European/Other grouping. Multiple experiences of vicarious racism are associated with increased odds of diagnosed child mental health conditions in a dose-response distribution.

Associations of Patient Race and Ethnicity With Emergency Department Disposition for Mental Health Visits in the United States

Objective: To describe associations between patient race and ethnicity with emergency department disposition for mental health visits in the United States.

Methods: We identified 674,821 visits for mental health in the 2019 National Emergency Department Sample and classified them by ICD-10 diagnostic group: schizophrenia-spectrum, bipolar, major depressive, anxiety, or other disorders. Racial and ethnic categories were White, Black, Hispanic, or other. Logistic regression models, adjusted for age, sex, insurance status, and medical comorbidities, were used to describe differences in odds of inpatient admission by race/ethnicity and diagnosis.

Results: After covariate adjustment, we did not find overall differences in the likelihood of admission between racial/ethnic groups. However, compared to White patients, admission rates were lower for visits by Black patients for bipolar disorder (OR = 0.71; 95% CI, 0.59-0.84) and major depressive disorder (OR = 0.70; 95% CI, 0.59-0.83) and lower for Hispanic patients (OR = 0.57; 95% CI, 0.47-0.68) for anxiety disorders. There were no significant racial/ethnic differences in admission rates for schizophrenia-spectrum disorders.

Conclusions: Overall admission rates were comparable for Black and White patients. After covariate adjustment, there were no differences across racial/ethnic groups, though some racial/ethnic differences persisted within diagnostic subsets of mood and anxiety disorders.

Conceptualising mental illness among University students of African, Caribbean and similar ethnic heritage in the United Kingdom

OBJECTIVE

Students of African, Caribbean and similar ethnicity (ACE) encounter unique mental health challenges within the Western higher education system, such as feeling constrained in social spaces and perceiving greater stigma about mental health. Students of ACE are also resilient to mental health problems, such as depression, when enduring social inequality. This study aimed to conceptualise mental illness and help-seeking behaviours among university students in the United Kingdom (UK) in the context of their identity as ACE.

DESIGN

Six university students of ACE in the UK were interviewed about the meaning of mental illness, the influence of ACE culture on mental health and help-seeking by ACE students. Thematic analysis was applied from a socio-constructionist theoretical lens to interpret the interview transcripts.

RESULTS

Five main themes emerged, namely 'Perceived meanings and attitudes toward mental health problems', 'Beliefs about the non-existence of mental health problem and its spiritual attributions', 'Family dynamics and the 'silencing' of mental health problems', 'Help-seeking for mental health among people of ACE' and 'Stigma and discriminatory responses to mental health issues'. Participants expressed that mental health is an imported concept that people from ACE communities tend to shy away from. A reluctance to discuss mental health problems arose over fear of rejection from families and fear of not being understood by a mental health professional from a different cultural background.

CONCLUSION

University students of ACE and their families struggle to adopt the Western conceptualisation of mental health. Consequently, there is poor awareness of mental health issues and stigma of mental illness among university students of ACE which pose a barrier to help-seeking for mental health. The limited sample size constrains the ability to draw sound conclusions. Nonetheless, a culturally sensitive conceptualisation of mental health is needed to address poor help-seeking for mental health among people of ACE.

La lutte continue: Louis Mars and the genesis of ethnopsychiatry

The scientific contributions of Western mental health professionals have been lauded and leveraged for global mental health responses to varying degrees of success. In recent years, the necessity of recognizing the inefficiencies of solely etic and Western-based psychological intervention has been reflected in certain decolonial scholars like Frantz Fanon gaining more recognition. Despite this urgent focus on decolonial psychology, there are still others whose work has historically and contemporarily not received a great deal of attention. There is no better example of such a scholar than Dr. Louis Mars, Haiti's first psychiatrist. Mars made a lasting impact on the communities of Haiti by shifting the conversation around Haitian culture and the practice of how people living with a mental illness were treated. Further, he influenced the global practice of psychiatry by coining "ethnopsychiatry" and asserting that non-Western culture should be intimately considered, rather than stigmatized, in treating people around the world. Unfortunately, the significance of his contributions to ethnopsychiatry, ethnodrama, and the subsequent field of psychology has effectively been erased from the disciplinary canon. Indeed, the weight of Mars' psychiatric and political work deserves focus. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Race and COVID-19 among Social Workers in Health Settings: Physical, Mental Health, Personal Protective Equipment, and Financial Stressors

Social work is an essential workforce integral to the United States' public health infrastructure and response to COVID-19. To understand stressors among frontline social workers during COVID-19, a cross-sectional study of U.S-based social workers (N = 1,407) in health settings was collected (in June through August 2020). Differences in outcome domains (health, mental health, personal protective equipment [PPE] access, financial stress) were examined by workers' demographics and setting. Ordinal logistic, multinomial, and linear regressions were conducted. Participants reported moderate or severe physical (57.3 percent) and mental (58.3 percent) health concerns; 39.3 percent expressed PPE access concerns. Social workers of color were more likely to report significantly higher levels of concern across all domains. Those identifying as Black, American Indian/Alaska Native (AIAN), Asian American/Pacific Islander (AAPI), multiracial, or Hispanic/Latinx were over 50 percent more likely to experience either moderate or severe physical health concerns, 60 percent more likely to report severe mental health concerns, and over 30 percent more likely to report moderate PPE access concerns. The linear regression model was significantly associated with higher levels of financial stress for social workers of color. COVID-19 has exposed racial and social injustices that that hold true for social workers in health settings. Improved social systems are critical not just for those impacted by COVID-19, but also for the protection and sustainability of the current and future workforce responding to COVID-19.

An Analysis of East Asian American Inpatient Psychiatric Data from the Hawai'i Health Information Corporation Database

Past research has examined the complex reasons for the apparent reluctance of East Asian Americans (ie, Chinese, Japanese, Koreans) to seek mental health services when needed. The current study analyzed East Asian American (EAA) mental health, utilizing inpatient hospitalization data from the Hawai'i Health Information Corporation (HHIC) database. Frequency of inpatient hospitalizations for specific mental health diagnoses (depression, bipolar disorder, schizophrenia, and suicide attempts/ideation) in EAA patients was examined. White, Native Hawaiian, and Filipino patients were included for comparative purposes. Retrospective data on adult (18 years and over) inpatient visits in Hawai'i from 2007 to 2017 were analyzed. Variables available for analysis were detailed race/ethnicity, age, sex, island, and insurance type as well as readmission rates, severity of illness (SOI), and initial length of stay (LOS). Overall, there were no significant differences between race/ethnicity groups in regards to readmission, SOI, or LOS for a majority of the diagnoses. However, for depression, even when adjusting for other demographics, Japanese and Chinese patients had significantly higher initial LOS and SOI than White patients, though the strength of this association was weak (R Squared model fits being less than .1 for both outcomes). The reason for these findings requires further examination, including whether EAAs may be reticent to seek help and/or whether healthcare providers are not recognizing the need for assistance.

Effects of ethnic density on the risk of compulsory psychiatric admission for individuals attending secondary care mental health services: evidence from a large-scale study in England

BACKGROUND

Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density - the so-called 'ethnic density' hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission.

METHODS

Data from the 2010-2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density.

RESULTS

Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95-0.99 and 0.94, 95% CI 0.93-0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11-1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission.

CONCLUSIONS

We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.

Caring for Refugees with Mental Health Problems: Difficulties Encountered by Providers Requesting Exemptions from United States Citizenship Examinations

Mental health providers caring for refugees should be aware that obtaining citizenship is critical to stability and safety for their patients. In the United States (U.S.), obtaining citizenship requires applicants to pass an examination exhibiting working knowledge of English and foundational knowledge of U.S. civics. For refugees with mental health disorders that impair cognition, this may present insurmountable barriers. The United States Customs and Immigration Services (USCIS) offers form N-648 to request exemption from these requirements. However, the form can be difficult to complete in a manner acceptable to USCIS. In this paper, the authors present preliminary data on citizenship-related mental health evaluations and subsequent applications for 40 patients seen in a university-based refugee mental health clinic. We simplify the process into three phases, and present three cases highlighting specific complexities involved. Our experiences and recommendations may help other mental health providers prepare to advocate for their refugee patients.

School Disengagement Predicts Accelerated Aging among Black American Youth: Mediation by Psychological Maladjustment and Moderation by Supportive Parenting

Early experiences of school disengagement may serve as a warning sign for later young adult adjustment difficulties and eventually contribute to accelerated aging among Black American youth. At the same time, supportive parenting may play a protective role. Using longitudinal data from the Family and Community Health Study (FACHS), we examined psychological maladjustment (comprising depression, lack of self-regulation, and low self-esteem) as a mediator of the relationship between school disengagement and accelerated aging. We also examined the effect of supportive parenting in buffering the impact of school disengagement on adulthood outcomes by controlling for covariates. Hypotheses were examined in a sample of 386 (Mean age = 28.68; Females = 62.7%; Males = 37.3%) Black American youth who were followed into young adulthood. Path modeling was used to test hypothesized relationships. We found school disengagement, i.e., problems with school attendance, performance, and engagement, reported across ages 10-18, predicted psychological maladjustment, which, in turn, predicted accelerated aging at age 29. We also found a buffering effect for supportive parenting. No significant gender difference in the indirect effect or buffering effect was found. This study highlights the potential importance of greater attention to school disengagement to identify and potentially influence long-term health trajectories and adult outcomes for Black American youth.

Does "Susto" Really Exist? Indigenous Knowledge and Fright Disorders Among Q'eqchi' Maya in Belize

Susto is one of the most common disorders referenced in the medical anthropological and cultural psychiatric literature. This article questions if "susto" as understood in cultural psychiatric terms, especially in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM), is in fact a single "cultural concept of distress." There is extensive cross-cultural and intracultural variability regarding fright-related disorders in the ethnographic literature. What is often labeled "susto" may be in reality a variety of distinct disorders, or lacking in the two signature components found in the cultural psychiatric literature: the existence of a "fright," and subsequent soul loss. There has been significant polysemic and geographical drift in the idiom label, the result of colonialism in Mesoamerica, which has overlayed but not necessarily supplanted local knowledge. Using data from fifteen years of research with Q'eqchi' (Maya) healers and their patients, we demonstrate how important variability in signs, symptoms, diagnosis, treatment, and prognosis of fright-related disorders renders any simple declaration that this is a singular "susto" problematic. We argue for a careful consideration of the knowledge of Indigenous medical specialists charged with treating fright-related disorders and against the inclination to view variability as insignificant. Such consideration suggests that Indigenous forms of fright-related disorder are not susto as presented commonly in the DSM and cultural psychiatric literature.

Prevalence, Comorbidity, and Continuity of Psychiatric Disorders in a 15-Year Longitudinal Study of Youths Involved in the Juvenile Justice System

Importance

Previous studies have found that one-half to three-quarters of youths detained in juvenile justice facilities have 1 or more psychiatric disorders. Little is known about the course of their disorders as they age.

Objective

To examine the prevalence, comorbidity, and continuity of 13 psychiatric disorders among youths detained in a juvenile justice facility during the 15 years after detention up to a median age of 31 years, with a focus on sex and racial/ethnic differences.

Design, Setting, and Participants

The Northwestern Juvenile Project is a longitudinal cohort study of health needs and outcomes of 1829 randomly selected youths in a temporary juvenile detention center in Cook County, Illinois. Youths aged 10 to 18 years were interviewed in detention from November 20, 1995, through June 14, 1998. Participants were reinterviewed up to 12 times during the 15-year study period through February 2015, for a total of 16 372 interviews. The sample was stratified by sex, race/ethnicity (Black, Hispanic, and non-Hispanic White), age (10-13 years or 14-18 years), and legal status (processed in juvenile or adult court). Data analysis was conducted from February 2014, when data preparation began, to March 2020.

Exposures

Detention in a juvenile justice facility.

Main Outcomes and Measures

Psychiatric disorders, assessed by the Diagnostic Interview Schedule for Children, version 2.3 at the baseline interviews. Follow-up interviews were conducted using the Diagnostic Interview Schedule for Children, version IV; the Diagnostic Interview Schedule, version IV; and the World Mental Health Composite International Diagnostic Interview (beginning at the 6-year follow-up interview).

Results

The study included 1829 youths sampled at baseline (1172 males and 657 females; mean [SD] age, 14.9 [1.4] years). Although prevalence and comorbidity of psychiatric disorders decreased as the 1829 participants aged, 52.3% of males and 30.9% of females had at least 1 or more psychiatric disorders 15 years postdetention. Among participants with a disorder at baseline, 64.3% of males and 34.8% of females had a disorder 15 years later. Compared with females, males had 3.37 times the odds of persisting with a psychiatric disorder 15 years after baseline (95% CI, 1.79-6.35). Compared with Black participants and Hispanic participants, non-Hispanic White participants had 1.6 times the odds of behavioral disorders (odds ratio, 1.56; 95% CI, 1.27-1.91 and odds ratio, 1.59; 95% CI, 1.23-2.05, respectively) and greater than 1.3 times the odds of substance use disorders (odds ratio, 1.90; 95% CI, 1.55-2.33 and odds ratio, 1.39; 95% CI, 1.11-1.73, respectively) throughout the follow-up period. Behavioral disorders and substance use disorders were the most prevalent 15 years after detention.

Conclusions and Relevance

This study's findings suggest that persistent psychiatric disorders may complicate the transition from adolescence to adulthood, which is already challenging for youths involved in the juvenile justice system, many of whom are from racial/ethnic minority groups and low-income backgrounds. The pediatric health community should advocate for early identification and treatment of disorders among youths in the justice system.

A Rapid Assessment of the Impact of COVID-19 on Asian Americans: Cross-sectional Survey Study

BACKGROUND

The diverse Asian American population has been impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities experienced by this population are hidden.

OBJECTIVE

This study aims to describe the Asian American community's experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center's (FQHC) health care services and response to challenges faced by the community.

METHODS

We conducted a cross-sectional survey between May 20 and June 23, 2020, using a multipronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey question topics included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges.

RESULTS

Among 1297 Asian American respondents, only 3.1% (39/1273) had previously been tested for COVID-19, and 46.6% (392/841) stated that they could not find a place to get tested. In addition, about two-thirds of respondents (477/707) reported feeling stressed, and 22.6% (160/707) reported feeling depressed. Furthermore, 5.6% (72/1275) of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32.2% (246/763) had lost their regular jobs and 22.5% (172/763) had reduced hours or reduced income. Additionally, 70.1% (890/1269) of respondents shared that they avoid leaving their home to go to public places (eg, grocery stores, church, and school).

CONCLUSIONS

We found that Asian Americans had lower levels of COVID-19 testing and limited access to testing, a high prevalence of mental health issues and economic impacts, and a high prevalence of risk-avoidant behaviors (eg, not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the impact of the COVID-19 pandemic on Asian American communities served by an FQHC and underscore the longstanding need for culturally and linguistically appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multilingual and multicultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccination programs.

Predisplacement Abuse and Postdisplacement Factors Associated With Mental Health Symptoms After Forced Migration Among Rohingya Refugees in Bangladesh

IMPORTANCE

At the end of August 2017, violence and persecution in Myanmar's Rakhine state forced nearly 1 million Rohingyas to flee to Bangladesh for their lives and seek shelter. Many refugees, after their traumatic experiences leaving Myanmar, experience mental health problems.

OBJECTIVES

To identify the prevalence of posttraumatic stress symptoms (PTSSs) among displaced Rohingya adults and investigate the association of predisplacement abuse and postdisplacement factors with PTSSs.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional analysis from a household survey of 1184 Rohingya adults aged 18 years or older was conducted in 8 refugee camps within Cox's Bazar, Bangladesh, from September 17, 2019, to January 11, 2020.

MAIN OUTCOMES AND MEASURES

The Impact of Event Scale-Revised was used to assess PTSSs. The possible range of scores was 0 to 88; moderate PTSSs were classified using a score cutoff of 33 to 38 and severe PTSSs were classified using a score cutoff of 39 and above. Adjusted prevalence ratios (aPRs) were estimated using a multivariable logistic regression model adjusted for potential confounders.

RESULTS

Of 1184 participants (625 men [52.8%]; mean [SD] age, 35.1 [13.4] years), 552 (46.6%) had severe PTSSs, and 274 (23.1%) had moderate PTSSs. In Bangladesh, refugees are not legally permitted to work in refugees camps, but 276 of 1165 respondents (23.7%) had temporary paid jobs. Moreover, 113 of the 276 working participants (40.9%) and 430 of the 889 nonworking participants (48.4%) reported severe PTSSs. A total of 496 respondents (41.9%) reported inadequate humanitarian aid for their families, and among them, 281 (56.7%) reported severe PTSSs. A total of 136 of 1177 respondents (11.6%) experienced both physical and sexual abuse in Myanmar, and 87 (64.0%) of them had severe PTSSs. The multivariable analysis showed a reduced risk of PTSSs with appropriate humanitarian assistance (aPR, 0.50; CI, 0.38-0.65). Experiencing both physical and sexual abuse before displacement had a significant association with PTSSs (aPR, 2.09; CI, 1.41-3.07). Opportunities for paid employment in refugee camps also reduced the risks of PTSSs (aPR, 0.69; CI, 0.52-0.91).

CONCLUSIONS AND RELEVANCE

The high prevalence of self-reported severe PTSSs in Rohingya refugees suggests that the trauma of displacement and the violent consequences of military crackdowns still exist. In the Rohingya camp settings of Bangladesh, employment opportunity and sufficient humanitarian aid hold promise as potential interventions to reduce the high prevalence of severe PTSSs. Mental health symptoms were more prevalent in adults who experienced physical abuse or physical and sexual abuse before displacement.

Mental Health and Psychosocial Risk and Protective Factors Among Black and Latinx Transgender Youth Compared With Peers

IMPORTANCE

Black and Latinx transgender youth experience stigma that may increase their susceptibility to mental health symptoms.

OBJECTIVE

To compare past-year mental health symptoms and psychosocial factors among Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth.

DESIGN, SETTING, AND PARTICIPANTS

This survey study used data from the 2015-2017 Biennial California Healthy Kids Survey with a weighted sample (N = 45 269) representative of California's secondary school population. The analytic sample (n = 19 780) included Black and Latinx transgender youth, White transgender youth, and Black and Latinx cisgender youth in the 9th and 11th grades. Data analysis was conducted from July 2020 to February 2021.

MAIN OUTCOMES AND MEASURES

Outcomes include past-year depressive symptoms and suicidality. Psychosocial risk factors include school-based victimization, gender-based harassment, sexuality-based harassment, and race-based harassment; protective factors include school connectedness and caring adult relationships.

RESULTS

The analytic sample of 19 780 participants (in 9th grade: weighted percentage, 51% [95% CI, 50% to 52%]; female participants: weighted percentage, 50% [95% CI, 49% to 51%]) included 252 Black and Latinx transgender youth (weighted percentage, 1.3% [95% CI, 1.1% to 1.5%]), 104 White transgender youth (weighted percentage, 0.7% [95% CI, 0.6% to 0.8%]), and 19 424 Black and Latinx cisgender youth (weighted percentage, 98.0% [95% CI, 97.8% to 98.2%]). For Black and Latinx transgender youth, estimated prevalence of depressive symptoms and suicidality were 50% (95% CI, 44% to 57%) and 46% (95% CI, 39% to 52%), respectively. Logistic regression models adjusted for grade, living arrangement, and reported sex indicated that compared with White transgender youth, Black and Latinx transgender youth had similar odds of depressive symptoms (adjusted odds ratio, 0.6; 95% CI, 0.4 to 1.1) and suicidality (adjusted odds ratio, 1.1; 95% CI, 0.6 to 1.8) and similar odds of all forms of harassment (eg, race-based harassment: adjusted odds ratio, 1.5; 95% CI, 0.8 to 2.6). Regression models indicated that compared with White transgender youth, Black and Latinx transgender youth had similar levels of victimization (adjusted linear regression coefficient, 0.5; 95% CI, -0.3 to 1.3) and caring adult relationships (adjusted linear regression coefficient, -0.6; 95% CI, -1.4 to 0.09) but lower levels of school connectedness (adjusted linear regression coefficient, -1.6; 95% CI, -2.9 to -0.4). With similar analyses, compared with Black and Latinx cisgender youth, Black and Latinx transgender youth had higher odds of depressive symptoms (adjusted odds ratio, 2.7; 95% CI, 2.0 to 3.7) and suicidality (adjusted odds ratio, 5.9; 95% CI, 4.3 to 8.0), higher odds and levels of all forms of harassment and victimization (eg, race-based harassment: adjusted odds ratio, 3.2; 95% CI, 2.4 to 4.5), and lower levels of school connectedness (adjusted linear regression coefficient, -2.6; 95% CI -3.3 to -1.8) and caring adult relationships (adjusted linear regression coefficient, -0.9; 95% CI -1.3 to -0.5).

CONCLUSIONS AND RELEVANCE

In this study, Black and Latinx transgender youth had high rates of mental health symptoms, with rates comparable with White transgender youth but higher than Black and Latinx cisgender youth. Their unique pattern of psychosocial risk and protective factors for these mental health symptoms should be factored in clinical preventive services and school-based interventions to support them.

Black and unarmed: statistical interaction between age, perceived mental illness, and geographic region among males fatally shot by police using case-only design

PURPOSE

We examine whether the race and armed status interact to modify the risk of being fatally shot by police within categories of civilian age and mental illness status, and U.S. region.

METHODS

Data are from The Washington Post online public-use database of all U.S. police-involved shooting deaths. The sample includes black and white males with known armed status who were killed from 1/1/2015 through 12/31/2019 (n = 3090). A case-only design is used to assess multiplicative interaction using adjusted logistic regression.

RESULTS

The fully adjusted interaction estimate is null (SOR = 0.75; 95% confidence interval [CI] = 0.55-1.04). However, adjusted estimates within strata show that the risk of being armed versus unarmed when fatally shot is smaller for black than white males older than 54 years (SOR = 0.18; 95% CI = 0.06-0.65), those showing mental illness signs (SOR = 0.50; 95% CI = 0.26-0.98), and those killed in the South (SOR = 0.52; 95% CI = 0.33-0.83), and that the risk is greater in the Midwest (SOR = 2.42; 95% CI = 1.11-5.26). Notably, there is no black-white difference in armed status among younger age groups (SOR≈0.89).

CONCLUSION

The race and armed status may interact leaving black males at a higher risk of being unarmed than white males when fatally shot by police among those older than 54 years, mentally impaired, and residing in the South. Causal interaction suggests a lower risk for unarmed blacks in the Midwest. Researchers should further explore the utility of the case-only design to study social-environmental interaction.

Mortality and major disease risk among migrants of the 1991-2001 Balkan wars to Sweden: A register-based cohort study

BACKGROUND

In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991-2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period.

METHODS AND FINDINGS

We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991-2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34-1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29-1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08-1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15-1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14-1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96-10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48-0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51-0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration.

CONCLUSIONS

Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.

Trauma Exposure and Mental Health Symptoms in Rural Latinx Adolescents: The Role of Family Processes

Previous research suggests that rural Latinx youth are more likely to experience traumatic events and are at higher risk for developing subsequent psychopathology compared to non-Latinx white youth. The aim of this study is to understand how family processes and values affect risk for internalizing and externalizing symptoms among rural Latinx youth (N = 648, m_age = 15.7 (SD = 1.2)) who are exposed to trauma. Multiple mediation analyses were performed to understand if family variables such as familism and family conflict explain the relationship between trauma exposure and psychopathology. Results suggest that familism partially mediates the relationship between trauma exposure and internalizing and externalizing symptoms, whereas family conflict partially mediates the relationship between trauma exposure and externalizing symptoms. These findings show that family variables are differentially impacted by trauma and have a separate and unique impact on mental health outcomes among rural Latinx youth. Specifically, our findings suggest that familial support or closeness may constitute a nonspecific protective factor for psychopathology among Latinx youth, whereas family conflict creates a stressful home environment that may deter adolescent trauma recovery and lead specifically to externalizing symptoms.

Relationships between parent and adolescent/young adult mental health among Hispanic and non-Hispanic childhood cancer survivors

PURPOSE

To examine associations between parents and adolescent and young adult (AYA) childhood cancer survivors' (CCS) mental health, and differences by Hispanic ethnicity.

SAMPLE

Participants were 129 CCS (Mage = 19.5 yrs.; 49.9% female) and their parents (Mage = 49.0 yrs.; 87.6% female); 52.7% identified as Hispanic.

METHODS

CCS completed assessments of Depressive Symptoms (CES-D), Posttraumatic Growth (PTG) and Pediatric Quality of Life (PedsQL), while parents completed CES-D, Perceived Stress (PSS) and Posttraumatic Stress Disorder (PTSD) measures.

RESULTS

After controlling for covariates, all three negative parental mental health measures (Parent CES-D, PSS, and PTSD), were positively associated with CCS CES-D indicating that higher depressive symptoms and stress in parents was associated with higher depressive symptoms in CCS. Parent CES-D was negatively associated with CCS PedsQL and parent PSS was negatively associated with CCS PTG. Moderation analysis revealed parent PSS to be negatively associated with PedsQL and positively related to CES-D among Hispanic families only.

CONCLUSION

Higher parental negative mental health measures may adversely affect CCS levels of depression, while lower values for parental negative health measures were associated with positive CCS mental health outcomes in AYA. Hispanic parents experience more associations with stress than non-Hispanics.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Long-term survivorship follow-up care guidelines should address the mental health needs of both parents and CCS, paying particular attention to perceived stress in Hispanic families.

An epidemiological cross-sectional study of prevalence of mental disorders in Dulong nationality of Southwest China

The Dulong nationality is one of the 5 smallest ethnic minorities in China. The suicide rate among people of the Dulong nationality is very serious. To address this issue, we conducted cross-sectional epidemiological studies on the prevalence of mental disorders in ethnic groups. Studying the unique situation of ethnic minorities can help us better understand their mental state and improve their quality of life.We conducted a cross-sectional epidemiological survey on a minority group in Southwest China. We used the cluster sampling method, and 2129 people were included in the study.The highest 1-month disorder prevalence was for alcohol dependence/abuse (4.16%), and the prevalence of lifelong mood disorders was 9.82%. The results of multivariate analysis showed that women faced a higher risk of mood disorders and anxiety disorders.This epidemiological survey of the prevalence of mental disorders in ethnic minorities in Southwest China provides a significant reference for mental health interventions for other ethnic minorities around the world.

Seeking sanctuary: rethinking asylum and mental health

Forced migrants are at an increased risk of mental disorder compared to host country populations. To effectively address this, programmatic and policy responses need to be underpinned by rigorous evidence. Drawing on our experience conducting a systematic review of post-migration risk factors for mental disorder among asylum seekers and our appraisal of related systematic reviews, this paper discusses four challenges facing the field: (1)The reliance on Western conceptions of mental health.(2)The investigation, to date, of a relatively narrow range of potential risk factors.(3)The lack of consistency in the measurement and reporting of risk factor variables.(4)The use of the legal term 'asylum seeker' to define study populations.We suggest potential ways forward, including using mental health measures developed in collaboration with communities affected by forced migration, the examination of key risk factors around homelessness and workers' rights, the development of a core set of risk factors to be investigated in each study, and defining study populations using the conceptual category of 'sanctuary seekers' - people who have fled their country and are asking another country for safety and residence.

Mental health and COVID-19: is the virus racist?

COVID-19 has changed our lives and it appears to be especially harmful for some groups more than others. Black and Asian ethnic minorities are at particular risk and have reported greater mortality and intensive care needs. Mental illnesses are more common among Black and ethnic minorities, as are crisis care pathways including compulsory admission. This editorial sets out what might underlie these two phenomena, explaining how societal structures and disadvantage generate and can escalate inequalities in crises.

Cross-Sectional Study of Homeless High Service Utilizers in Los Angeles County Jails: Race, Marginalization and Opportunities for Diversion

Objective

To describe the demographic, legal, and clinical characteristics of a cross-section of incarcerated homeless individuals with the highest utilization of Los Angeles (LA) County public services in order to increase opportunities for focused jail diversion.

Methods

The "5% list" (N=5,905 in February 2018), LA County's list of homeless individuals with the highest 5% utilization of public services, was cross-matched with the total jail population to obtain a sample of 333 homeless high-utilizing individuals. This sample was compared with the overall jail population (N=17,121) from publicly available aggregate data by Chi-square testing.

Results

84% of the high-utilizing sample were male, 38% Black, 37% Hispanic, 21% White. 67% were prescribed psychiatric medication. Compared with the overall jail population, the sample was significantly older, with a greater proportion of Black and White persons, and a lesser proportion of Hispanic individuals relative to the overall jail population. A significantly greater proportion of high-utilizing individuals faced misdemeanor charges.

Conclusion

These data highlight the compounding effects of homelessness, race, and mental illness on carceral and social vulnerability. Findings suggest homeless high utilizers in jail with mental illness are likely to benefit from court-based diversion efforts aimed at housing and treatment.

Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

Substance Use, Mental Health, and Child Welfare Profiles of Juvenile Justice-Involved Commercially Sexually Exploited Youth

Objectives: To describe the substance use profiles of youth impacted by commercial sexual exploitation (CSE) and explore associations between substance use with mental health diagnoses and child welfare involvement. Methods: Data were systematically extracted from the court files of 364 youth who participated between 2012 and 2016 in Los Angeles County's Succeeding Through Achievement and Resilience (STAR) Court, a juvenile delinquency specialty court for youth impacted by CSE. Descriptive statistics and multivariate regression analyses were conducted to quantify associations between youths' substance use with mental health diagnoses and child welfare involvement. Results: Of the 364 youth impacted by CSE involved in the STAR Court, 265 youth had documented contact with a psychiatrist while in court-of whom, 73% were diagnosed with at least one mental health challenge. Before STAR Court participation, 74% of youth were the subject of one or more child welfare referral; of these youth, 75% had prior out-of-home care. Eighty-eight percent of youth reported substance use, the most prevalent illicit substances were marijuana (87%), alcohol (54%), and methamphetamine (33%). Controlling for age and race, youth impacted by CSE with a diagnosed general mood disorder had more than five times the odds of reporting substance use compared with those without a mood disorder diagnosis (adjusted odds ratio [AOR]: 5.80; 95% confidence interval CI: 2.22-18.52; p < 0.001); and youth impacted by CSE with prior child welfare placements had more than two times the odds of reporting substance use (AOR: 2.24; 95% CI: 1.04-4.86; p = 0.039) compared with youth without prior placements. The association between substance use and general mood disorder was significant and positive for all substance use types (AOR = 3.3, p = 0.033 marijuana; AOR = 4.01, p = 0.011 concurrent alcohol and marijuana; AOR = 9.2, p < 0.001, polysubstance use). Conclusions: High prevalence of substance use among juvenile justice-involved youth impacted by CSE combined with strong associations between substance use with both mental health diagnoses and child welfare system history underscores the need for comprehensive, specialized substance use treatment. Findings suggest an important opportunity for multidisciplinary collaboration among mental health providers, child welfare professionals, juvenile justice practitioners, and other care providers for these youth.

Media language preferences and mental illness stigma among Latinx adolescents

PURPOSE

Media-a powerful influence on mental illness stigma-varies by language and culture. Nevertheless, recent meta-analyses have demonstrated scant attention to Spanish language media as well as historically low Latinx participation in mental illness anti-stigma intervention. To better inform how to improve equity in mental health service utilization, this study assessed how language preferences in mass media influence stigma among Latinx adolescents, compared to family language and social preferences.

METHODS

Sixth-graders self-identifying as Latinx self-completed assessments of mental illness knowledge/positive attitudes and desired separation from peers and adolescent vignette characters experiencing mental illness (N = 179; Texas, U.S., 2011-2012). Participants also responded to measures of language preferences (any Spanish versus only English) for consuming media (film/television, music/radio) and speaking with family (parents/grandparents), and social preferences for parties or social gatherings (Latinx versus Anglo persons). Linear regression models adjusting for student and household factors examined the associations between media and family language and social preferences on mental illness stigma.

RESULTS

Latinx adolescents preferring any Spanish versus English-only media reported less mental illness knowledge/positive attitudes and greater social separation from peers and vignette characters with a mental illness, net of all covariates. Family language and social preferences were not associated with any mental illness stigma outcomes.

CONCLUSIONS

Spanish media preference is associated with greater stigma suggesting more stigmatization may exist in Spanish- versus English-media. Ensuring anti-stigma messaging in Spanish media may reduce disparities in mental illness stigma among Latinx adolescents. These findings have implications for populations with other non-English media preferences.

Health and Healthcare Utilization among Asylum-Seekers from Berlin's LGBTIQ Shelter: Preliminary Results of a Survey

BACKGROUND

LGBTIQ asylum-seekers face multiple health risks. Yet, little is known about their healthcare needs. In 2016, Berlin opened the only major shelter for LGBTIQ asylum-seekers in Germany. This preliminary study describes health and healthcare utilization by asylum-seekers living in Berlin's LGBTIQ shelter. To identify particular healthcare needs, we compared our results to asylum-seekers from other shelters.

METHODS

We surveyed residents of the LGBTIQ shelter and 21 randomly selected shelters in Berlin, using a validated questionnaire in nine languages (n = 309 respondents, including 32 respondents from the LGBTIQ shelter). Bivariate tests and generalized linear mixed models were applied to examine differences in health and healthcare utilization between the two groups.

RESULTS

Residents of the LGBTIQ shelter show high rates of chronic and mental illness. They use ambulatory and mental health services more frequently than asylum-seekers from other shelters, including a significantly higher chance of obtaining psychotherapy/psychiatric care in case of need. Emergency room utilization is also higher in the LGBTIQ group.

CONCLUSIONS

Asylum-seekers from the LGBTIQ shelter face high chronic and mental health burdens. Tailored services in the LGBTIQ shelter help obtain adequate healthcare; they should be scaled up to maximize their potential. Yet, unmet needs remain and warrant further research.

Clinician Perceptions of Implementing the Cultural Formulation Interview on a Mixed Forensic Unit

The use of the Cultural Formulation Interview (CFI), a 16-item, semistructured, patient cultural assessment, in a forensic mental health setting has not been examined. Using a mixed-methods approach, we performed a pilot test of the CFI in an inpatient service that treats both forensic and nonforensic adult patients. Clinicians' attitudes toward adoption of the CFI was assessed quantitatively with the Evidence-Based Practices Attitudes Scale, which is used to measure provider attitudes toward adopting new treatments, and qualitatively with a semistructured interview. Assessments occurred up to five times to analyze changes with increasing CFI use. In the quantitative measures we observed a general openness to implementing the CFI throughout the implementation period. Compared with clinicians on civil units, forensic clinicians indicated they were less likely to implement the CFI over time if it were required rather than voluntary. Interviews with clinicians revealed concerns about the skills, ability, and confidence needed to implement the CFI, external requirements, and the ease of integrating the CFI into their practice. Based on our findings, forensic units could encourage CFI use after the clinician has determined that the patient is clinically stable, rather than at admission. Units could also incorporate information obtained from the CFI into current documentation to reduce administrative burden.

Ethnic Disparities in Trauma-Related Mental Illness: Is Ethnic Identity a Buffer?

Despite evidence that racial and ethnic characteristics influence the impact of traumatic exposure on psychological health, little is known about how race and ethnic identity can alter, and possibly protect against, the effects of trauma on the psychiatric diagnoses of women. Therefore, the present study examined the moderating role of race/ethnicity and ethnic identity in the link between trauma exposure and psychiatric diagnosis for African American and Caucasian college women. Participants were a sample of 242 women from the Mid-Atlantic region of the United States who self-identified as African American or Black (31%) and European American or Caucasian (69%; M age = 19.5 years). Interviews were conducted over the phone to screen for trauma, followed by longer in-person interviews. Each of the interviewers was supervised, and interviews were reviewed to control for quality. Regression analyses revealed that the number of traumatic events was a stronger predictor of lifetime psychiatric diagnoses for Caucasian women. In addition, ethnic identity served as a protective factor against trauma exposure among participants. The findings suggest that ethnic identity is a relevant buffer against potential psychiatric diagnoses as result of exposure to traumatic events for both Caucasian and African American women.

Correlates of Mental Health Treatment Receipt Among Asian Americans with Perceived Mental Health Problems

Compared with other ethnic groups, Asian Americans report the lowest rates of mental health treatment and service utilization. This is true even among Asian Americans with mental illness, which indicates that the underutilization of mental health services is not due to the low prevalence of mental health disorders in this population. This study examined which sociodemographic factors, types of mental health problems, and barriers to treatment were associated with the treatment receipt among 126 Asian Americans who reported perceived mental health problems. Among sociodemographic factors, Chinese ethnicity and advanced English proficiency were associated with increased treatment receipt. Controlling for demographic variables, mental health problems such as psychosis, depression, and a history of abuse or trauma significantly increased the likelihood of receiving treatment, whereas addiction showed a tendency of decreased treatment receipt. Among reported barriers, difficulty finding a culturally appropriate therapist appeared to be an important barrier among Asian Americans with perceived mental health problems.

Country of birth and hospital admission rates for mental disorders: a cohort study of 4.5 million men and women in Sweden

This study analysed the association between country of birth and psychotic, affective, and neurotic disorders in seven immigrant categories, after adjustment for demographic and socioeconomic factors. A 2-year national cohort study of 4.5 million individuals in the age group 25–64 years was performed. Swedish national registers including individual demographic and socioeconomic data were linked to the hospital discharge register. Cox regression was used in the analysis. Several groups of immigrants, both men and women, had risks of hospital admission for psychotic, affective, or neurotic disorders compared to the Swedish-born reference group. The impact of demographic and socioeconomic factors on these risks seemed to be larger for men than for women. For foreign-born men, several of the risks no longer remained significant after adjustment for income and marital status. In contrast, most of the risks for foreign-born women remained significant after adjustment for income and marital status. Low income and being single were associated with an increased risk of psychiatric hospital admission. These results represent important knowledge for clinicians and public health planners who are involved in treatment and prevention of mental disorders among certain groups of immigrants, and among low income men and women irrespective of immigrant status.

Posttraumatic stress disorder and psychiatric co-morbidity: symptoms in a random sample of female Bosnian refugees

Objectives

This study investigated psychological symptoms in Bosnian women 3–4 years after their arrival in Sweden.

Methods

A simple random sample of 163 Bosnian women aged 19–59 was drawn from the Swedish populations register in 1996. The control group consisted of 392 Swedish-born women. Data were collected in face-to-face interviews. The Hopkins Symptom Checklist 25 (HSCL-25) and the Posttraumatic Symptom Scale (PTSS-10) were used to measure psychological symptoms of depression, anxiety, psychological distress, and posttraumatic stress disorder (PTSD). Unconditional logistic regression was used to estimate odds ratios (OR) for psychological symptoms after adjustment for age, country of birth, education, marital status, economic difficulties, social network, and feeling secure.

Results

The prevalence of symptoms of PTSD was 28.3% among the Bosnian women. Bosnian women had significantly higher risks of symptoms of depression, anxiety, and psychological distress than Swedish-born women. For depression the odds ratio was 9.50 among Bosnian women.

Conclusions

Psychiatric community interventions need to target Bosnian refugee women. Awareness among health-care workers who encounter these women in a clinical setting should be improved.

Moroccan colloquial Arabic version of the Mini International Neuropsychiatric Interview (MINI): qualitative and quantitative validation

The validation of mini international neuropsychiatric interview (MINI) into Moroccan Colloquial Arabic language demonstrated good psychometric properties. The concordance between translated MINI’s and expert diagnoses was good with kappa values greater than 0.80. The reliability inter-rater and test–retest were excellent with kappa values above 0.80 and 0.90, respectively.

Immigration background and adolescent mental health problems: the role of family affluence, adolescent educational level and gender

PURPOSE

European studies demonstrated that immigrant adolescents are at a higher risk for mental health problems than native adolescents, but little is known about the role of socioeconomic status (SES) and gender in this association. This study examined to what extent differences in the mental health problems of non-western immigrant and native Dutch adolescents were explained by adolescents' family affluence and educational level and differed with the adolescents' family affluence, educational level, and gender.

METHODS

Adolescents in a Dutch nationally representative sample of 11-16-year old native Dutch (n = 5283) and non-western immigrants (n = 1054) reported on their family affluence, own educational level, conduct problems, emotional symptoms, peer relationship problems, and hyperactivity-inattention problems.

RESULTS

Non-western immigrant adolescents were at a higher risk for conduct problems and peer relationship problems than native Dutch adolescents, but family affluence and educational level explained only a very small proportion of these differences. With two exceptions, differences in the mental health problems of non-western immigrants and natives were highly comparable for different family affluence levels, educational levels, and for boys and girls. Only for natives, a higher family SES was related to less conduct problems. Furthermore, only for non-western immigrants a high family SES related to more hyperactivity-inattention problems.

CONCLUSIONS

Our findings illustrate that the association between immigration background and adolescent mental health problems is largely independent of SES and gender. Future studies should include other factors to facilitate our understanding of the association between immigration background and adolescent mental health problems.

Dual mental health diagnoses predict the receipt of medication-assisted opioid treatment: Associations moderated by state Medicaid expansion status, race/ethnicity and gender, and year

BACKGROUND

Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups.

METHODS

MAT treatment discharges were identified using the Treatment Episodes Dataset-Discharges (TEDS-D; 2014-2017) (n = 1,400,808). We used multivariate logistic regression to model MAT receipt using interactions and adjusted for several potential confounders.

RESULTS

Nearly one-third of OUD treatment discharges received MAT. Dual MHDs in both expansion and non-expansion states were positively associated with MAT uptake over time. Dual MHDs were negatively associated with MAT receipt only among American Indian/Alaska Native women residing in Medicaid expansion states (aOR = 0.58, 95 % CI = 0.52-0.66, p < 0.0001).

CONCLUSION

Disparities in MAT utilization are nuanced and vary widely depending on dual MHD status, Medicaid expansion, and race/ethnicity/gender. Medicaid is beneficial but not a universal treatment panacea. Clinical decisions to initiate MAT are dependent on multiple factors and should be tailored to meet the needs of high-risk, historically disadvantaged clients.

Immigrants' mental health service use compared to that of native Finns: a register study

PURPOSE

Many aspects related to migration might predispose immigrants to mental health problems. Yet immigrants have been shown to underuse mental health services. The aim of this study was to compare the intensity of psychiatric care, as an indicator of treatment adequacy, between natives and immigrants living in Finland.

METHODS

We used nationwide register data that included all the immigrants living in Finland at the end of 2010 (n = 185,605) and their matched controls. Only those who had used mental health services were included in the analyses (n = 14,285). We used multinomial logistic regression to predict the categorized treatment intensity by immigrant status, region and country of origin, length of residence, and other background variables.

RESULTS

Immigrants used mental health services less than Finnish controls and with lower intensity. The length of residence in Finland increased the probability of higher treatment intensity. Immigrants from Eastern Europe, sub-Saharan Africa, the Middle East, and Northern Africa were at the highest risk of receiving low-intensity treatment.

CONCLUSIONS

Some immigrant groups seem to persistently receive less psychiatric treatment than Finnish-born controls. Identification of these groups is important and future research is needed to determine the mechanisms behind these patterns.

Seeking Help for Mental Health Problems in Hong Kong: The Role of Family

Family members, rather than mental health professionals, are often the first responders for emotional or mental problems, particularly in Chinese societies where family is regarded as the primary care unit. Using data from the third wave of a representative sample of Chinese adults in the Hong Kong Panel Study of Social Dynamics, we investigate how family, and particularly family functioning, is associated with individual mental health help seeking and perceived barriers to professional service use, and how the associations vary across different generations of immigrants and between individuals with high versus low psychological distress. Our results demonstrate that family is still the primary source of help sought for mental health problems. Stronger family functioning is particularly significant for second-generation immigrants when they consider seeking help from immediate family members. Seeking professional help is uncommon, and stronger family functioning is associated with a lower probability of seeking help from general health professionals and alternative services. A well-functioning family is related to certain structural and cultural barriers to seeking professional help, yet trust in professional mental health services does not diminish along with stronger family functioning, even among the high psychological distress subgroup. The findings indicate that family can facilitate mental illness prevention and service integration. It is recommended that appropriate family support and services be incorporated into mental health treatment according to clients' differential family circumstances.

Perceptions Toward Mental Illness and Seeking Psychological Help among Bhutanese Refugees Resettled in the U.S

This study examined perceptions toward mental health and seeking psychological care among Bhutanese refugees in a large Midwestern U.S. city. Bhutanese adults (n = 201) completed a community health needs assessment. Survey questions addressed beliefs toward mental health and seeking psychological care. Perceptions toward mental illness and receiving psychological help were generally negative among participants. Over 71% believed others would look unfavorably on a person who sought out a counselor. Participants who had less than a high school education, were 35 years and older, and lived in refugee camps for more than 20 years had significantly greater negative beliefs toward mental illness. Over one-third (34.8%) of participants reported access to counseling services as being somewhat of a problem or a serious problem. These findings may inform future research and interventions aimed at improving mental health among Bhutanese refugees.

Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism

In this article we use the example of race/ethnic inequalities in severe mental illness to demonstrate the utility of a novel integrative approach to theorising the role of racism in generating inequality. Ethnic minority people in the UK are at much greater risk than White British people of being diagnosed with a severe - psychosis related - mental illness, and this is particularly the case for those with Black Caribbean or Black African origins. There is entrenched dispute about how we might understand the drivers of this inequality. To address this dispute we build on, and to a certain extent refine, established approaches to theorising structural and institutional racism, and integrate this within a theoretical framework that also incorporates racist/discriminatory interactions (interpersonal racism). We argue that this provides a conceptually robust and thorough analysis of the role of inter-related dimensions of racism in shaping risks of severe mental illness, access to care, and policy and practice responses. This analysis carries implications for a broader, but integrated, understanding of the fundamental drives of race/ethnic inequalities in health and for an anti-racism public health agenda.