Historical trauma and social support as predictors of psychological stress responses in American Indian adults during the COVID-19 pandemic

Connected for life: How social connectedness can help prevent suicide in American Indian and Alaska Native communities

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

Pilot evaluation of a Psychological First Aid online training for COVID-19 frontline workers in American Indian/Alaska Native communities

Introduction

The COVID-19 pandemic exacerbated mental health concerns and stress among American Indians and Alaska Natives (AI/ANs) in the United States, as well as among frontline workers responding to the pandemic. Psychological First Aid (PFA) is a promising intervention to support mental wellbeing and coping skills during and after traumatic events, such as the COVID-19 pandemic. Since PFA is often implemented rapidly in the wake of a disaster or traumatic event, evidence evaluating its impact is lacking. This paper reports pilot evaluation results from a culturally adapted PFA training designed to support COVID-19 frontline workers and the AI/AN communities they serve during the pandemic.

Methods

This study was designed and implemented in partnership with a collaborative work group of public health experts and frontline workers in AI/AN communities. We conducted a pre-post, online pilot evaluation of a culturally adapted online PFA training with COVID-19 frontline workers serving AI/AN communities. Participants completed a baseline survey and two follow-up surveys 1 week and 3 months after completing the PFA training. Surveys included demographic questions and measures of anxiety, burnout, stress, positive mental health, communal mastery, coping skills, PFA knowledge, confidence in PFA skills, and satisfaction with the PFA training.

Results

Participants included N = 56 COVID-19 frontline workers in AI/AN communities, 75% were AI/AN, 87% were female, and most (82%) were between the ages of 30-59. Participants reported high satisfaction with the training and knowledge of PFA skills. Pilot results showed significant increases in positive mental health and social wellbeing and reductions in burnout from baseline to 3 months after completing the PFA training among frontline workers. There were no changes in communal mastery, coping skills, stress, or anxiety symptoms during the study period.

Discussion

To our knowledge, this is the first pilot evaluation of a PFA training designed and culturally adapted with and for AI/AN communities. Given that many AI/AN communities were disproportionately impacted by COVID-19 and prior mental health inequities, addressing acute and chronic stress is of crucial importance. Addressing traumatic stress through culturally adapted interventions, including Indigenous PFA, is crucial to advancing holistic wellbeing for AI/AN communities.

Continuum of Trauma: Fear and Mistrust of Institutions in Communities of Color During the COVID-19 Pandemic

Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions.

State-Federal Vocational Rehabilitation Services, Demographic Characteristics and Employment Outcomes for Native Americans with Mental Illnesses

There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9-11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed.

Trauma and mental health in Pacific Islanders

BACKGROUND

Little is known about trauma and its mental health impact on Native Hawaiians/Pacific Islanders (NH/PI), an understudied Indigenous-colonized population that endures severe mental health disparities.

AIMS

This novel investigation assessed trauma prevalence and its mental health and substance use correlates in NH/PIs in the U.S.

METHOD

Using community-based participatory research methods, survey data on NH/PI trauma, depression, anxiety, substance use, and treatment need were collected from 306 NH/PI adults using online, telephone, and in-person methods. Descriptive statistics and adjusted regression models were employed.

RESULTS

Sixty-nine percent of participants experienced lifetime trauma, reporting mean exposure to 2.5 different trauma types. Childhood physical and sexual abuse, and lifetime forced sexual assault rates were 34%, 25%, and 27%, respectively, exceeding general population rates. Women and men reported equivalent total mean exposure to different trauma types, as well as equal prevalence for every trauma type examined (e.g. sexual abuse/assault). Confirming hypotheses, after controlling for key demographic and mental health risk factors, increased exposure to multiple trauma types uniquely associated with greater depression, anxiety, alcohol symptomology, and greater likelihood for needing treatment and using illicit substances.

CONCLUSIONS

Trauma is prevalent in NH/PI populations and significantly impacts NH/PI mental health; serving as an important but overlooked contributor to NH/PI mental health disparities. Current findings fill critical gaps in our knowledge of NH/PI trauma and mental health while revealing the importance of screening and treating NH/PIs for trauma exposure to alleviate existing mental health disparities.

Factors Associated With Physical Restraint in an Urban Emergency Department

STUDY OBJECTIVE

To determine what patient characteristics were associated with the application of physical restraints in our emergency department (ED).

METHODS

This was a retrospective analysis of encounters in the ED of an urban, Level I academic trauma center. We included ED encounters of adult patients (aged ≥18 years) during a 5-year period starting in 2017. We evaluated the independent association of restraint application during an encounter using a generalized estimating equation model.

RESULTS

There were 464,031 ED encounters during the time period from 162,244 unique patients, including 34,798 (7.5%) with restraint application, comprising 18,166 unique patients. Several variables were associated with an increased likelihood of restraint use during an encounter. The variable with the highest odds ratio was intoxication with drugs or alcohol (adjusted odds ratio [aOR] 8.29; 95% confidence interval (CI) 7.94 to 8.65). American Indian race was associated with increased odds of restraint application (aOR 1.42; 95% CI 1.31 to 1.54) compared to the reference value of White race. Black race (aOR 0.58; 95% CI 0.55 to 0.61) and Hispanic ethnicity (aOR 0.42; 95% CI 0.37 to 0.48) were associated with lower odds of restraint application.

CONCLUSIONS

Drug and alcohol intoxication were most closely associated with restraint. Encounters in which the patient was American Indian had higher odds of restraint, but this study does not replicate prior findings regarding other racial disparities in restraint.

Profiles of historical loss and childhood trauma as predictors of mental and cardiometabolic health in American Indian adults

Cardiometabolic disease and mental health conditions are two major contributors to persistent inequities in health and life expectancy for American Indian adults. The atrocities associated with European colonization are linked to intergenerational psychological and emotional wounding (i.e., historical trauma) and high incidence of childhood trauma. Prior work has examined the independent relationships of childhood trauma and thoughts about historical loss with cardiometabolic and mental health in American Indians. In the current work, we used a data-driven approach to identify profiles of childhood trauma and frequency of thoughts about historical loss, and then examined how these profiles related to cardiometabolic and mental health in a sample of American Indian adults from across the United States (N = 727). We found that a profile characterized by high levels of childhood trauma and high frequency of thoughts about historical losses was associated with the greatest risk for mental health conditions. The profile characterized by the highest levels of childhood trauma and by moderate frequency of thoughts about historical losses was associated with the largest risk of cardiometabolic conditions. The findings represent an important first step towards understanding how childhood trauma and thoughts about historical loss may simultaneously inform enduring inequities in American Indian health.

An Updated Narrative Review on the Role of Alcohol Among Indigenous Communities

Purpose of Review

The role of alcohol varies considerably among Indigenous Peoples and is the backdrop of persistent stereotypes despite decades of research. This paper provides an updated narrative review on the alcohol literature among Indigenous communities, highlighting recent studies published since 2017.

Recent Findings

We examined published literature involving alcohol use rates, including abstinence; risk and protective factors; treatment; and recovery, as well as future directions for alcohol prevention and intervention efforts with Indigenous communities.

Summary

Evidence-based alcohol use prevention, intervention, and recovery strategies with Indigenous communities are outlined. Recommendations are provided for researchers, health providers, and public policy advocates to address and better understand alcohol use, treatment, prevention, and recovery among Indigenous Peoples. Specific recommendations include using community-based participatory research strategies and harm reduction approaches to prevent and treat alcohol use problems with Indigenous communities. Future research is needed to elucidate mechanisms of resilience and recovery from Alcohol Use Disorder and possible shifts in perceptions of alcohol use for Indigenous Peoples.

Resilience and health in American Indians and Alaska Natives: A scoping review of the literature

American Indians and Alaska Natives suffer from disproportionately high rates of chronic mental and physical health conditions. These health inequities are linked to colonization and its downstream consequences. Most of the American Indian and Alaska Native health inequities research uses a deficit framework, failing to acknowledge the resilience of American Indian and Alaska Native people despite challenging historical and current contexts. This scoping review is based on a conceptual model which acknowledges the context of colonization and its consequences (psychological and health risk factors). However, rather than focusing on health risk, we focus on protective factors across three identified domains (social, psychological, and cultural/spiritual), and summarize documented relationships between these resilience factors and health outcomes. Based on the scoping review of the literature, we note gaps in extant knowledge and recommend future directions. The findings summarized here can be used to inform and shape future interventions which aim to optimize health and well-being in American Indian and Alaska Native peoples.

Culturally Centered Implementation of Video Telehealth for Rural Native Veterans

Introduction: Native American Veterans are the most rural and experience heightened risk for mental health (MH) challenges while facing significant health care inequities and access barriers. Rural Native Veterans (RNVs) have experienced historical loss and racial discrimination, contributing to mistrust of Veterans Health Administration (VHA) and other Federal systems. Telemedicine, including video telehealth (VTH), can improve access to MH care for RNVs by addressing barriers. Understanding the cultural context and existing community resources can improve engagement and implementation efforts with RNVs. Objective: This article describes a model of culturally centered MH care and a flexible implementation approach, Personalized Implementation of Virtual Treatments for Rural Native Veterans (PIVOT-RNV), used to disseminate the model. Methods: Participants included four VHA sites serving large RNV populations where PIVOT-RNV was applied to expand the availability of virtual solutions, including VTH, for RNVs. A mixed methods formative evaluation tracked VTH utilization and used provider and RNV feedback to inform iterative process improvements. Results: Where PIVOT-RNV was used, number of providers using VTH with RNVs, number of unique RNVs receiving MH care through VTH, and number of VTH encounters with RNVs grew annually. Provider and RNV feedback highlighted the importance of addressing the unique barriers and cultural context of RNVs. Conclusions: PIVOT-RNV demonstrates promise for improving implementation of virtual treatments and access to MH care for RNVs. The integration of implementation science within a cultural safety framework helps address specific barriers to adoption of virtual treatments for RNVs. Next steps include expanding PIVOT-RNV efforts at additional sites.

COVID-19 pandemic effects on emotional health and substance use among urban American Indian and Alaska Native people

OBJECTIVE

The COVID-19 pandemic has disproportionately affected American Indian and Alaska Native (AI/AN) people, who experience a 3.2 times higher age-adjusted rate of hospitalization and nearly double the attributed deaths compared to non-Hispanic Whites. We examined pandemic effects on emotional health and substance use in urban AI/AN people.

METHODS

From January-May 2021 we collected cross-sectional data from 642 patients seen at five health organizations serving primarily AI/AN people in urban settings. The outcomes are self-reported, cross-sectional changes in emotional health and substance use since pandemic onset. Exposures of interest include infection history, COVID-19 risk perception, pandemic-related life disruption, and feared effects on AI/AN culture. Poisson regression was used to model adjusted multivariate associations.

RESULTS

Since pandemic onset, 46% of participants reported worsened emotional health; 20% reported increased substance use. Very or extremely disruptive pandemic experiences and increasing reported feared pandemic effects on culture were associated with worse pandemic emotional health [adjusted Prevalence Ratio 1.84; 95% CI 1.44, 2.35 and 1.11; 95% CI 1.03, 1.19], respectively. COVID-19 infection and risk perception were not associated with emotional health after adjustment for other factors. The primary exposures were not associated with change in substance use.

CONCLUSIONS

The COVID-19 pandemic has impacted the emotional health of urban AI/AN people. The finding that poor emotional health is associated with pandemic-related threats to AI/AN culture may signal a protective role for community and cultural resources. This warrants further study as exploratory analysis did not find hypothesized effect modification according to strength of affiliation with AI/AN culture.

Challenges in Accessing Mental Health Care during Pregnancy and Postpartum in Rural Montana

PURPOSE

Postpartum depression is a well-known maternal health care concern. For women using substances or experiencing underlying mental health conditions, incidence of postpartum depression is higher than that of the general population. The purpose of this study was to identify barriers and facilitators associated with seeking mental health care among women with substance use disorder or mental health concerns.

STUDY DESIGN AND METHODS

Qualitative methods using interviews were conducted via the narrative inquiry approach. Women receiving care at a clinic in rural Montana and reporting substance use or mental health concerns were referred to the research team by the care manager. Participants were at least 18 years of age, English speaking, and pregnant or within 12 months postpartum at time of referral.

RESULTS

Twenty-five women met inclusion criteria and were referred for potential study participation. Seven women were interviewed. Four themes on family history, stigmatization, lack of postpartum depression awareness, and isolation were identified.

CLINICAL IMPLICATIONS

Our findings provide a better understanding of barriers and facilitators to seeking mental health care during pregnancy and postpartum among women living in rural areas with mental health concerns or perinatal substance use. An environment where opportunities for women to receive mental health care in a location that is free of stigma and judgment, while understanding the effects of familial trauma and limited or inconsistent social support, is essential to promote optimal outcomes.

Disproportionate impact of COVID-19 severity and mortality on hospitalized American Indian/Alaska Native patients

Epidemiological data across the United States of America illustrate health disparities in COVID-19 infection, hospitalization, and mortality by race/ethnicity. However, limited information is available from prospective observational studies in hospitalized patients, particularly for American Indian or Alaska Native (AI/AN) populations. Here, we present risk factors associated with severe COVID-19 and mortality in patients (4/2020-12/2021, n = 475) at the University of New Mexico Hospital. Data were collected on patient demographics, infection duration, laboratory measures, comorbidities, treatment(s), major clinical events, and in-hospital mortality. Severe disease was defined by COVID-related intensive care unit requirements and/or death. The cohort was stratified by self-reported race/ethnicity: AI/AN (30.7%), Hispanic (47.0%), non-Hispanic White (NHW, 18.5%), and Other (4.0%, not included in statistical comparisons). Despite similar timing of infection and comparable comorbidities, admission characteristics for AI/AN patients included younger age (P = 0.02), higher invasive mechanical ventilation requirements (P = 0.0001), and laboratory values indicative of more severe disease. Throughout hospitalization, the AI/AN group also experienced elevated invasive mechanical ventilation (P < 0.0001), shock (P = 0.01), encephalopathy (P = 0.02), and severe COVID-19 (P = 0.0002), consistent with longer hospitalization (P < 0.0001). Self-reported AI/AN race/ethnicity emerged as the highest risk factor for severe COVID-19 (OR = 3.19; 95% CI = 1.70-6.01; P = 0.0003) and was a predictor of in-hospital mortality (OR = 2.35; 95% CI = 1.12-4.92; P = 0.02). Results from this study highlight the disproportionate impact of COVID-19 on hospitalized AI/AN patients, who experienced more severe illness and associated mortality, compared to Hispanic and NHW patients, even when accounting for symptom onset and comorbid conditions. These findings underscore the need for interventions and resources to address health disparities in the COVID-19 pandemic.

Determinants of Life Satisfaction and Quality of Life Among American Indian Women Cancer Survivors: The Role of Psychosocial Resources

PURPOSE

This study assessed the relationship of spirituality, social support, and sense of mastery to life satisfaction and quality of life to identify viable psychosocial coping resources among American Indian (AI) women cancer survivors.

METHOD

We conducted a cross-sectional survey of 73 AI women cancer survivors residing in South Dakota. A series of multivariate hierarchical regression analyses was conducted.

RESULTS

Findings indicated that lower self-rated physical health was consistently associated with lower levels of life satisfaction and quality of life. Spirituality was found to be the most influential predictor for life satisfaction, while social support and sense of mastery were two significant predictors for quality of life.

DISCUSSION

Our data underscored the importance of spirituality, social support, and sense of mastery to the well-being of AI women cancer survivors and as effective coping strategies to mitigate life stressors. Implications of this evidence for the design of cancer preventions and interventions are discussed.

Lived Experiences of Persons with Chronic Schizophrenia Living in the Community

Background

Each individual with schizophrenia experiences life uniquely, despite the sameness in their diagnosis. Understanding their experiences is vital for their better community integration and social work practice.

Method

We used the interpretative phenomenological approach. Persons with schizophrenia seeking outpatient services at a tertiary care institute in Bengaluru, India, were recruited through purposive sampling. In-depth interviews were conducted with six participants.

Results

Some of the meta-themes and subthemes identified were as follows: (a) perception about self (struggling with the sense of self, desire for normalcy, wanting to be in control of self and desire to live independently), (b) relationship with others (feeling supported by others and feeling rejected by others), (c) coping with consequences of illness (coping with disruptions in personal life and coping with disruptions in family life), and (d) experience of seeking treatment (reasons for seeking treatment, being on medication, and behavior of mental health professionals). The participants tried to find meaning in their lives by making sense of their illness. Family and community can have a significant impact on how persons with schizophrenia perceive their lives.

Conclusion

Mental health professionals need to encourage persons' and their families' greater participation in treatment planning and clinical interventions, which will enhance persons integration within the community and will help decrease the feeling of isolation commonly experienced when one lives with chronic mental illnesses.

Indigenous peoples and the COVID-19 pandemic: a systematic scoping review

Past influenza pandemics including the Spanish flu and H1N1 have disproportionately affected Indigenous Peoples. We conducted a systematic scoping review to provide an overview of the state of understanding of the experience of Indigenous peoples during the first 18 months of the COVID-19 pandemic, in doing so we capture the state of knowledge available to governments and decision makers for addressing the needs of Indigenous peoples in these early months of the pandemic. We addressed three questions: (a) How is COVID-19 impacting the health and livelihoods of Indigenous peoples, (b) What system level challenges are Indigenous peoples experiencing, (c) How are Indigenous peoples responding? We searched Web of Science, Scopus, and PubMed databases and UN organization websites for publications about Indigenous peoples and COVID-19. Results were analyzed using descriptive statistics and content analysis. A total of 153 publications were included: 140 peer-reviewed articles and 13 from UN organizations. Editorial/commentaries were the most (43%) frequent type of publication. Analysis identified Indigenous peoples from 19 different countries, although 56% of publications were centered upon those in Brazil, United States, and Canada. The majority (90%) of articles focused upon the general adult population, few (<2%) used a gender lens. A small number of articles documented COVID-19 testing (0.04%), incidence (18%), or mortality (16%). Five themes of system level challenges affecting exposure and livelihoods evolved: ecological, poverty, communication, education and health care services. Responses were formal and informal strategies from governments, Indigenous organizations and communities. A lack of ethnically disaggregated health data and a gender lens are constraining our knowledge, which is clustered around a limited number of Indigenous peoples in mostly high-income countries. Many Indigenous peoples have autonomously implemented their own coping strategies while government responses have been largely reactive and inadequate. To 'build back better' we must address these knowledge gaps.

Improving the representativeness of the tribal behavioral risk factor surveillance system through data integration

BACKGROUND

Previous literature showed significant health disparities between Native American population and other populations such as Non-Hispanic White. Most existing studies for Native American Health were based on non-probability samples which suffer with selection bias. In this paper, we are the first to evaluate the effectiveness of data integration methods, including calibration and sequential mass imputation, to improve the representativeness of the Tribal Behavioral Risk Factor Surveillance System (TBRFSS) in terms of reducing the biases of the raw estimates.

METHODS

We evaluated the benefits of our proposed data integration methods, including calibration and sequential mass imputation, by using the 2019 TBRFSS and the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). We combined the data from the 2018 and 2019 BRFSS by composite weighting. Demographic variables and general health variables were used as predictors for data integration. The following health-related variables were used for evaluation in terms of biases: Smoking status, Arthritis status, Cardiovascular Disease status, Chronic Obstructive Pulmonary Disease status, Asthma status, Cancer status, Stroke status, Diabetes status, and Health Coverage status.

RESULTS

For most health-related variables, data integration methods showed smaller biases compared with unadjusted TBRFSS estimates. After calibration, the demographic and general health variables benchmarked with those for the BRFSS.

CONCLUSION

Data integration procedures, including calibration and sequential mass imputation methods, hold promise for improving the representativeness of the TBRFSS.

Smoking Cessation Interventions in Indigenous North Americans: A Meta-Narrative Systematic Review

INTRODUCTION

Indigenous North Americans have the highest cigarette smoking prevalence among all racial and ethnic groups in the United States. We seek to identify effective components of smoking cessation interventions in Indigenous people in the United States associated with favorable cessation outcomes.

METHODS

A review of literature studying smoking cessation interventions in Indigenous North Americans (American Indians and Alaska Natives) from January 2010 through August 2021 was completed. The primary objective of this study was to identify components of interventions associated with positive smoking cessation outcomes in Indigenous people. The studies identified were synthesized in a meta-narrative approach.

RESULTS

Ten studies out of 608 titles were included (6 randomized trials, 2 single-arm studies, 1 cohort study, and 1 prospective observational study). Five categories of smoking cessation interventions were identified; phone or web-based tools, culturally-tailored interventions, the inclusion of Indigenous study personnel, pharmaceutical cessation aids, and behavioral health interventions. Phone and web tools, cultural tailoring, and inclusion of Indigenous personnel conditions inconsistently influenced smoking cessation. Pharmaceutical aids were viewed favorably among participants. Individualized behavioral counseling sessions were effective at promoting smoking cessation, as was input from local communities in the planning and implementation phases of study.

CONCLUSION

A successful smoking cessation intervention in Indigenous North Americans includes Tribal or community input in intervention design and implementation; should provide individualized counseling sessions for participants, and offer access to validated smoking cessation tools including pharmacotherapy.

IMPLICATIONS

This study identifies a paucity of smoking interventions utilizing standard of care interventions in Indigenous North Americans. Standard of care interventions including individualized cessation counseling and pharmacotherapy were effective at promoting cessation. The use of novel culturally tailored cessation interventions was not more effective than existing evidence-based care with the exception of including Tribal and local community input in intervention implementation. Future smoking cessation interventions in Indigenous North Americans should prioritize the use of standard of care cessation interventions.

Exploring links between Chinese military recruits' psychological stress and coping style from the person-environment fit perspective: The chain mediating effect of self-efficacy and social support

The choice of coping style of recruits under psychological stress in the process of military task execution has been an important topic in the promotion of military operations and cohesion of military forces. Taking a positive coping style under psychological stress can help recruits overcome the negative effects of stress and improve military morale and group combat effectiveness. Although soldiers' psychological stress in the process of military mission execution having an impact on coping style has been studied by a large body of literature, very little literature has focused on the mechanism of self-efficacy and social support between recruits' psychological stress and coping style from the person-environment fit perspective. Therefore, this study was conducted to analyze the impact of recruits' psychological stress on coping style through a chain mediation model and to discuss the role of self-efficacy and social support in this relationship. Two waves of survey data were utilized to test the research hypotheses on a sample of 1028 Chinese recruits performing military tasks. The results indicated that recruits' psychological stress negatively impacted positive coping styles and positively correlated with negative ones. In addition, self-efficacy and social support mediated the relationship between psychological stress and positive coping style, and self-efficacy mediated the relationship between psychological stress and negative coping style. More importantly, self-efficacy and social support play the chain mediating effect between psychological stress and positive coping style.

The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans

OBJECTIVES

American Indian and Alaska Native (AI/AN) communities have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. This study examines whether neighborhood characteristics mediate AI/AN versus White-non-Hispanic Veteran COVID-19 infection disparities, and whether mediation differs based on proximity to reservations.

METHODS

Using Veteran Health Administration's (VHA) national database of VHA users evaluated for COVID-19 infection (3/1/2020-8/25/2020), we examined whether census tract neighborhood characteristics (percent households overcrowded, without complete plumbing, without kitchen plumbing, and neighborhood socioeconomic status [n-SES]) mediated racial disparities in COVID-19 infection, using inverse odds-weighted logistic models controlling for individual-level characteristics. Using moderated mediation analyses, we assessed whether neighborhood mediating effects on disparities differed for those residing in counties containing/near federally recognized tribal lands (i.e., Contract Health Service Delivery Area [CHSDA] counties) versus not.

RESULTS

The percent of households without complete plumbing, percent without kitchen plumbing, and n-SES partially mediated AI/AN-White-non-Hispanic COVID-19 infection disparities (accounting for 17-35% of disparity) to a similar extent in CHSDA and non-CHSDA counties. The percent of households without kitchen plumbing had stronger mediating effects for CHSDA than non-CHSDA residents.

CONCLUSIONS

Neighborhood-level social determinants of health may contribute to the disproportionate COVID-19 infection burden on AI/ANs; differences are exacerbated among AI/ANs living near reservations.

Getting Connected: a Retrospective Cohort Investigation of Video-to-Home Telehealth for Mental Health Care Utilization Among Women Veterans

BACKGROUND

Increasingly, women are serving in the military and seeking care at the Veterans Health Administration (VHA). Women veterans face unique challenges and barriers in seeking mental health (MH) care within VHA. VA Video Connect (VVC), which facilitates video-based teleconferencing between patients and providers, can reduce barriers while maintaining clinical effectiveness.

OBJECTIVE

Primary aims were to examine gender differences in VVC use, describe changes in VVC use over time (including pre-COVID and 6 months following the beginning of COVID), and determine whether changes over time differed by gender.

DESIGN

A retrospective cohort investigation of video-to-home telehealth for MH care utilization among veterans having at least 1 MH visit from October 2019 to September 2020.

PARTICIPANTS

Veterans (236,268 women; 1,318,024 men).

INTERVENTIONS (IF APPLICABLE)

VVC involves face-to-face, synchronous, video-based teleconferencing between patients and providers, enabling care at home or another private location.

MAIN MEASURES

Percentage of MH encounters delivered via VA Video Connect.

KEY RESULTS

Women veterans were more likely than men to have at least 1 VVC encounter and had a greater percentage of MH care delivered via VVC in FY20. There was an increase in the percentage of MH encounters that were VVC over FY20, and this increase was greater for women than men. Women veterans who were younger than 55 (compared to those 55 and older), lived in urban areas (compared to those in rural areas), or were Asian (compared to other races) had a greater percentage of MH encounters that were VVC since the start of the pandemic, controlling for the mean percentage of VVC MH encounters in the 6 months pre-pandemic.

CONCLUSIONS

VVC use for MH care is greater in women veterans compared to male veterans and may reduce gender-specific access barriers. Future research and VVC implementation efforts should emphasize maximizing patient choice and satisfaction.

Unpacking determinants and consequences of food insecurity for insulin resistance among people living with HIV: Conceptual framework and protocol for the NOURISH-OK study

Background:

Over the past four decades, advances in HIV treatment have contributed to a longer life expectancy for people living with HIV (PLWH). With these gains, the prevention and management of chronic co-morbidities, such as diabetes, are now central medical care goals for this population. In the United States, food insecurity disproportionately impacts PLWH and may play a role in the development of insulin resistance through direct and indirect pathways. The Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in HIV for Oklahoma (NOURISH-OK) will use a novel, multi-level, integrated framework to explore how food insecurity contributes to insulin resistance among PLWH. Specifically, it will explore how food insecurity may operate as an intermediary risk factor for insulin resistance, including potential linkages between upstream determinants of health and downstream consequences of poor diet, other behavioral risk factors, and chronic inflammation.

Methods/design:

This paper summarizes the protocol for the first aim of the NOURISH-OK study, which involves purposeful cross-sectional sampling of PLWH (n=500) across four levels of food insecurity to test our conceptual framework. Developed in collaboration with community stakeholders, this initial phase involves the collection of anthropometrics, fasting blood samples, non-blood biomarkers, 24-hour food recall to estimate the Dietary Inflammatory Index (DII^®) score, and survey data. A 1-month, prospective observational sub-study (total n=100; n=25 for each food security group) involves weekly 24-hour food recalls and stool samples to identify temporal associations between food insecurity, diet, and gut microbiome composition. Using structural equation modeling, we will explore how upstream risk factors, including early life events, current discrimination, and community food access, may influence food insecurity and its potential downstream impacts, including diet, other lifestyle risk behaviors, and chronic inflammation, with insulin resistance as the ultimate outcome variable. Findings from these analyses of observational data will inform the subsequent study aims, which involve qualitative exploration of significant pathways, followed by development and testing of a low-DII^® food as medicine intervention to reverse insulin resistance among PLWH (ClinicalTrials.gov Identifier: NCT05208671).

Discussion:

The NOURISH-OK study will address important research gaps to inform the development of food as medicine interventions to support healthy aging for PLWH.

Future Directions on BIPOC Youth Mental Health: The Importance of Cultural Rituals in the COVID-19 Pandemic

Culture plays an important role in the development of mental health, especially during childhood and adolescence. However, less is known about how participation in cultural rituals is related to the wellbeing of youth who are Black, Indigenous, and People of Color (BIPOC), and part of the Global Majority. This is crucial amid the COVID-19 pandemic, a global event that has disproportionally affected BIPOC youth and disrupted participation in rituals. The goal of this paper is to promote advances in clinical child and adolescent psychology focused on rituals. We begin by defining culture and rituals and examining their role on development. We illustrate these issues with the Lunar New Year in China, Maya rituals in México, Ramadan in Turkey, and Black graduations and Latinx funerals in the United States. We discuss how the pandemic has affected participation in these rituals and their potential impact on BIPOC children and adolescents' mental health. We propose future directions and recommendations for research.

Associations between gender, torture, and health: A 5-year retrospective cohort analysis

Our purpose was to identify longitudinal associations between torture exposure, physical and mental health outcomes, and gender in a cohort of 143 war-affected Karen adults five years post resettlement. Results showed that participants who self-reported primary torture experiences had higher rates of certain mental and physical health diagnoses. We observed gender differences in health over time in the cohort. Findings have implications for how primary care and public health providers implement war trauma screening tools and timelines, targeted healthcare services, and community resources to promote health and prevent disease in populations that have trauma from torture or war.

Depression and anxiety symptoms and perceived stress in health professionals in the context of COVID-19: Do adverse childhood experiences have a modulating effect?

BACKGROUND

Adverse childhood experiences (ACE) have a great impact on mental health outcomes of adults. However, little is known whether ACE may act as modulators of the mental health of health professionals caring for patients with COVID-19.

METHODS

Data were collected through an online cross-sectional survey administered to health professionals in Lima (Peru) between May and July 2020. The survey included standardized self-assessment instruments for anxiety, depression, acute stress (AS) and history of ACE.

RESULTS

A total of 542 health professionals completed the survey. Caring for patients with COVID-19 was significantly associated with depression and anxiety and when caring for patients with COVID-19 was combined with a history of early sexual abuse, its effect on the risk of anxiety increased (OR = 7.71, p = .010). Mental health problems were associated with female gender in almost all the analyses and with the majority of ACEs.

CONCLUSIONS

Health workers in the context of the COVID-19 pandemic presented a high risk of mental health disorders. Antecedents of sexual abuse acted as a potentiating factor of anxiety in professionals providing COVID-19 care. These findings suggest that the burden of ACE modulates mental health problems in health professionals during the pandemic.

Trauma and US Minority Children and Youth

PURPOSE OF REVIEW

This paper reviews the literature on the prevalence, risk factors, and effects of traumatic experiences on the mental health outcomes of minority youth in the USA.

RECENT FINDINGS

The USA has an increasing number of children and youth from minority backgrounds. Research reveals that traumatic experiences disproportionately affect minority youth. These experiences include historical/generational trauma, immigration and acculturation stressors, natural and manmade disasters, experiences of discrimination, family violence, and community violence. The COVID-19 pandemic has also disproportionately affected minority youth resulting in illness and hospitalizations. Despite the higher incidence of trauma exposure, minority youth are less likely to access medical and mental health care. These disparities are resulting in increasing rates of depression, anxiety, post-traumatic stress, substance use disorders, and suicide in minority youth. Recognizing and understanding the impact of trauma is critical to the healthy development and successful functioning of minority youth, and to the success of our nation.

The COVID-19 Pandemic and Its Impact on Families' Mental Health: The Role Played by Parenting Stress, Parents' Past Trauma, and Resilience

International research has evidenced the psychological impact of the COVID-19 pandemic on families, and the key role played by parenting stress levels. Although significant associations with parents' past trauma and resilience have been shown, this study aimed to explore their complex interplay on the relationship between parents' peritraumatic distress due to COVID-19, parenting stress, and children's psychopathological difficulties. We recruited 353 parents with children aged two to 16 years via an online survey during the Italian second wave of COVID-19. Parents' peritraumatic distress due to COVID-19, parenting stress, past trauma and resilience, and children's psychological difficulties were assessed through self-report and report-form questionnaires. Parents' past traumas significantly predicted peritraumatic distress due to COVID-19 and children's psychological difficulties. The relationship between past traumas and children's psychological difficulties was serial mediated by parents' peritraumatic distress and parenting stress. Direct and total effects of parent's resilience on parent's peritraumatic distress were not significant, but there were significant indirect effects via parenting stress and via parents' peritraumatic distress and parenting stress, indicating inconsistent mediation. This study evidenced the key risk and protective role played by, respectively, parents' past traumas exposure and resilience on the relationship between parents' psychological difficulties due to COVID-19, parenting stress, and children's psychological difficulties, with important clinical implications.

Coming Out is Part of the Life Cycle: A Qualitative Study using Two-Eyed Seeing to Understand A Two-Spirits Coming Out Process

In two co-related studies about Two-spirit people in Atlantic Canada, the coming out stories share critical cultural perspectives about gender identity and sexuality from a L'nuwey (Mi'kmaw) perspective. This qualitative research implemented Etuaptmumk or Two-Eyed Seeing, a co-learning methodology using Indigenous and western perspectives for data collection and analysis. The findings surface stories about resiliency among Two-spirit people who face distress and anxiety, with supports mainly coming from family and community. According to their narratives, coming out is part of their cultural awakening process. The paper shares that Two-spirited people come out in intervals or phases, especially trans people. Sexuality and gender identity development are in flux until they reach a balanced and spiritual state. The Two-spirit identity process is non-linear that may evolve in a life cycle. The study captures the ongoing resurgence of regional Indigenous perspectives of gender identity and sexuality. The narratives share the physical, emotional, mental, and spiritual states of Two-spirit people during their coming out process. The stories are a source of hope and empowerment for the Two-spirit community relating to gender and sexuality. This study is the only current community-based evidence about coming out experiences of Two-spirit people in Atlantic Canada.

COVID-19 and psychological distress: Lessons for India

Purpose

The COVID-19 pandemic has undoubtedly altered the routine of life and caused unanticipated changes resulting in severe psychological responses and mental health crisis. The study aimed to identify psycho-social factors that predicted distress among Indian population during the spread of novel Coronavirus.

Method

An online survey was conducted to assess the predictors of distress. A global logistic regression model was built, by identifying significant factors from individual logistic regression models built on various groups of independent variables. The prediction capability of the model was compared with the random forest classifier.

Results

The respondents (N = 1060) who are more likely to be distressed, are in the age group of 21-35 years, are females (OR = 1.425), those working on site (OR = 1.592), have pre-existing medical conditions (OR = 1.682), do not have health insurance policy covering COVID-19 (OR = 1.884), have perceived seriousness of COVID-19 (OR = 1.239), have lack of trust in government (OR = 1.246) and whose basic needs’ fulfillment are unsatisfactory (OR = 1.592). The ones who are less likely to be distressed, have higher social support and psychological capital. Random forest classifier correctly classified 2.3% and 17.1% of people under lower and higher distress respectively, with respect to logistic regression.

Conclusions

This study confirms the prevalence of high distress experienced by Indians at the time of COVID-19 and provides pragmatic implications for psychological health at macro and micro levels during an epidemiological crisis.

Historical trauma and substance use among American Indian people with current substance use problems

OBJECTIVE

In the United States, American Indian and Alaska Native (AI/AN) people suffer health inequities associated with alcohol and other drug use and also experience historical trauma symptoms resulting from colonization. Research suggests that historical trauma may be associated with substance use among AI/ANs.

METHOD

As part of a Community-Based Participatory Research project with tribal partners from a rural AI reservation, our team collected cross-sectional survey data from 198 tribal members who self-identified as having substance use problems. We examined associations between historical trauma thoughts, historical trauma symptoms, and substance use outcomes. We also examined historical trauma symptoms, current trauma symptoms, awareness of systemic discrimination, and ethnic identity as moderators of the associations between historical trauma thoughts and substance use variables.

RESULTS

Historical trauma thoughts, controlling for symptoms, were associated with greater abstinent days, fewer heavy alcohol use days, fewer drinks per drinking day, and fewer drug use days; historical trauma symptoms, controlling for thoughts, were associated only with fewer abstinent days. Moderation analyses showed that historical trauma thoughts were associated with better substance use outcomes when historical trauma symptoms were low, current trauma symptoms were low, awareness of systemic discrimination was high, and ethnic identity was high.

CONCLUSION

When distressing trauma symptoms are low, historical trauma thoughts may act as a protective factor or as a marker for other factors associated with better substance use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceptions and Experiences of Frontline Urban Indian Organization Healthcare Workers With Infection Prevention and Control During the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) has created significant challenges for outpatient healthcare providers and patients across the United States (U.S.). Forty-one Urban Indian Organizations (UIOs), who provide a wide spectrum of health services for American Indian and Alaska Native (AI/AN) populations and other underinsured and uninsured populations in urban areas across the country, are no exception. The National Council of Urban Indian Health (NCUIH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), set out to understand the needs, challenges, and opportunities for improvement in infection prevention and control (IPC) training and systems from the perspective of UIO frontline healthcare workers. As part of the CDC's Project Firstline, NCUIH was chosen as a partner in a national collaborative. The first task was to conduct listening sessions with frontline UIO staff to learn more about IPC practices in the context of the COVID-19 pandemic. Thirty staff from 16 UIOs, representing full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential treatment programs participated in virtual video focus groups in July of 2020. Thematic and content analysis protocols guided data analysis and coding. Analysis of findings generated four major themes: staff adaptation in the context of resilience; responsibility and duty to protect patients, families, and coworkers; mental and emotional issues for UIO staff; and IPC challenges in the context of COVID-19. Participants' challenges ranged from lack of access to personal protective equipment (PPE) to the absence of standardized training. Significant disparities in social determinants of health experienced by Native American and non-Native populations served by UIOs create additional challenges to the delivery of and access to care during the pandemic. The diverse array of tribal cultural values and contexts of the people and communities served by UIOs reportedly serve as both facilitators and barriers to care, awareness, and uptake of infectious disease public health practices.

The impact of COVID-19 on the learning and achievement of vulnerable Canadian children and youth

Many children and youth in Canada are identified as vulnerable due to educational, environmental, and social factors. They are more likely to be negatively affected by events that cause significant upheaval in daily life. The changes imposed by COVID-19, such as physical distancing, school closures, and reductions in community-based services all have the potential to weaken the systems of support necessary for these children to learn and develop. Existing inequities in educational outcomes experienced by vulnerable children prior to the pandemic have been greatly exacerbated as cracks in our support structures are revealed. Many children and youth have experienced disengagement, chronic attendance problems, declines in academic achievement, and decreased credit attainment during the pandemic, with the impact far deeper for those already at-risk. This chapter examines what is known to date regarding the impact of COVID-19 on vulnerable children and youth and provides recommendations to guide postpandemic planning. Vulnerable children, youth, and their families require access to reliable high-speed internet, effective and inclusive learning spaces, and a range of coordinated social services. All stakeholders need to develop and fund initiatives that address these critical areas to ensure that educational opportunities for all children and youth can be realized.

Childhood Trauma and Mental Health Status in General Population: A Series Mediation Examination of Psychological Distress in COVID-19 Pandemic and Global Sleep Quality

Background: Coronavirus-2019 (COVID-19) has been coexisting with humans for almost 2 years, consistently impacting people's daily life, medical environment, and mental health. This study aimed to test the series mediation model triggered by childhood trauma, in which perceived psychological impact of COVID-19 pandemic and sleep quality mediated the path sequentially and led to adverse mental health outcomes. Methods: A cross-sectional design involving 817 participants were enrolled via WeChat online survey. Participants completed questionnaires, including demographic features, the Childhood Trauma Questionnaire, Impact of Event Scale-Revised (IES-R) questionnaire, Pittsburgh Sleep Quality Index (PSQI) questionnaire, and Depression, Anxiety, and Stress Scale (DASS-21). Pearson correlations and hierarchical multiple linear regression were employed to examine the association of childhood trauma and psychological stress of COVID-19, sleep quality, and mental health status. In addition, a series mediate analysis was carried out to examine sequence mediating effects of psychological impact of COVID-19 and sleep quality between childhood trauma and mental health status. Results: The results showed that childhood trauma is positively and significantly related to psychological distress of COVID-19 pandemic, sleep quality, and mental health status (p < 0.05). Hierarchical multiple linear regression analysis shown that demographic features explained 4.4, 2.1, and 4.0% of the total variance in DASS-21, IES-R, and PSQI total scale scores, respectively. Adding childhood trauma significantly increased the model variance of DASS-21 (ΔR ² = 0.129, F = 126.092, p = 0.000), IES-R (ΔR ² = 0.062, F = 54.771, p = 0.000), and PSQI total scale scores (ΔR ² = 0.055, F = 48.733, p = 0.000), respectively. Moreover, the series mediation model showed that the perceived impact of the COVID-19 pandemic and sleep quality were sequential mediators between childhood trauma and mental health status (proportion explained: 49.17%, p < 0.05). Conclusion: Amid the ravages of COVID-19, childhood trauma predicts poor mental health status, in part because of greater psychological impact related to COVID-19 and poorer global sleep quality. In order to improve mental health, future researchers should pay more attention to individuals with childhood trauma, for its association with greater stress related to life events and poorer sleep quality.