Trauma, socioeconomic resources, and self-rated health in an ethnically diverse adult cohort

Disparity in Obesity and Hypertension Risks Observed Between Pacific Islander and Asian American Health Fair Attendees in Los Angeles, 2011-2019

INTRODUCTION

The Pacific Islander American population is understudied due to being aggregated with Asian Americans. In this study, we conduct a comparative analysis of directly measured body mass index (BMI), body fat percentage (%BF), and blood pressure (BP) between Pacific Islander Americans and Asian Americans from health screenings in Los Angeles, California. We hope to reveal intra-APIA health disparities masked by this data aggregation.

METHODS

We analyzed BMI, %BF, and BP that were objectively measured by trained personnel at health screenings in Los Angeles between January 2011 and December 2019. We performed multivariable multinomial logistic regression models with obesity and hypertensive categories as outcome variables and ethnicity as the primary independent variable of interest. Models controlled for year of visit, participant age, sex, income, education level, years living in the USA, employment status, English proficiency, regular doctor access, and health insurance status.

RESULTS

A total of 4,832 individuals were included in the analysis. Multivariable analyses revealed that Pacific Islander participants were at significantly higher risks for being classified as obese compared with all Asian American subgroups studied, including Chinese, Korean, Thai, Vietnamese, Filipino, and Japanese. Pacific Islanders also exhibited significantly lower predicted probability of having a normal blood pressure compared with Chinese and Thai participants. Some variation between Asian subgroups were also observed.

CONCLUSIONS

Pacific Islander participants had higher risk of several sentinel health problems compared to Asian American participants. Disaggregation of PI Americans from the APIA umbrella category in future studies is necessary to unmask the critical needs of this important community.

Assessing the Validity of Self-rated Health Across Ethnic Groups: Implications for Health Disparities Research

OBJECTIVES

This study examines the association between morbidity (i.e., chronic health conditions) and self-rated health (SRH) with the aim of testing the within-group and across-group validity of SRH across nine ethnic groups: non-Latinx White, Mexican, Puerto Rican, Cuban, African American, Afro-Caribbean, Chinese, Filipino, and Vietnamese Americans. In addition, we assess whether acculturation (i.e., nativity, years of US residency, language of interview) and health-related factors (e.g., mental disorder) account for ethnic distinctions in SRH.

DESIGN

Data are from the National Survey of American Life (NSAL) and the National Latino and Asian American Study (NLAAS) (N = 8338). Weighted proportions and means for SRH and chronic conditions are reported. Ordered logistic regression analysis is used to determine ethnic group patterns in SRH.

RESULTS

Despite evidence of within-group validity of SRH for each ethnic group, our results seriously challenge the across-group validity of SRH. For example, Chinese and Vietnamese respondents report lower SRH despite having fewer chronic conditions relative to non-Latinx Whites. Moreover, Mexican Americans report fewer chronic health problems but lower SRH compared to non-Latinx Whites. Acculturation factors (e.g., language of interview) partially explain the Mexican-White difference in SRH. Among Chinese Americans, completing an interview in English is associated with higher SRH relative to those who completed an interview in Chinese.

CONCLUSION

These findings have implications for health disparities research that uses SRH as the dependent measure. Studies that compare the health profiles of diverse ethnic groups should use the SRH measure with caution, as SRH does not align with ethnic patterns of morbidity.

Family Adversity and Relationship Quality for Pacific Islanders and the Mediating Role of Coming to Terms, Self-Esteem, and Depression

This study investigated the association between family of origin (FOO) adversities and relationship quality for Pacific Islanders as well as the potential intermediary role of coming to terms (CTT), depression, and self-esteem. The sample consisted of 226 self-identified Pacific Islanders who completed the RELATE assessment (see www.relate-institute.org). Results indicated that greater levels of FOO adversity predicted lower levels of CTT. However, higher levels of CTT in turn associated with higher self-esteem, and lower levels of depression. Results also indicated that greater FOO adversity associates with lower relationship quality indirectly. The clinical implications of these findings and directions for future research are discussed.

Resilience, Trauma, and Cultural Norms Regarding Disclosure of Mental Health Problems among Foreign-Born and US-Born Filipino American Women

Resilience refers to a set of personal qualities and abilities that allow an individual to confront challenges, risks, or traumatic experiences in an integrated manner and to thrive in the face of significant adversities. This cross-sectional study explores resilience, posttraumatic stress disorder (PTSD), and family norms with disclosure of mental health problems (FNAD) in a sample of 182 Filipino American women (FAW). Participants completed survey measures of resilience, PTSD, and FNAD and open-ended questions about beliefs and reasons for (not) disclosing mental health problems outside the family. Previous research found that the rates of psychological trauma and depression among FAW are higher than those in other Asian ethnic groups, which makes it necessary to investigate the protective characteristic of resilience among FAW. According to our results, foreign-born FAW had a significantly lower PTSD and greater resilience as compared to their US-born counterparts. A significant negative relationship between PTSD and resilience was observed only among foreign-born FAW. We also found a conditional moderating effect of FNAD on the negative relationship between resilience and PTSD. The results of our qualitative analysis of the participants' responses to the open-ended questions of the survey showed that FAW's family norms of nondisclosure are related to the cultural value of "saving face," a salient cultural construct among Asian family members. Results suggest that protective properties of resilience against PTSD are influenced by cultural factors, such as FNAD. Taken together, our findings underscore the importance of considering the impact of collectivistic cultural values (e.g., FNAD) in future research on resilience among Asian Americans.

Resilience and psychological trauma among Filipino American women

AIMS

To explore the types of traumatic exposure, prevalence of posttraumatic stress disorder (PTSD), and level of resilience in a community sample of Filipino American women (FAW), as well as to investigate the relationships between their PTSD symptoms, history of traumatic exposure, and resilience.

METHOD

A cross-sectional study with a total of 188 adult FAW.

RESULTS

We observed high levels of resilience and low levels of PTSD symptom severity. The most common form of traumatic exposure was non-interpersonal trauma occurring after the age of 18 years old. We also found a significant correlation between history of traumatic exposure and PTSD and between resilience and PTSD. Resilience was found to have a significant moderating effect on the relationship between traumatic exposure and PTSD.

CONCLUSIONS

The results provide preliminary evidence on the buffering and protective properties of FAW's resilience to PTSD despite traumatic exposure.

Assessing the special need for protection of vulnerable refugees: testing the applicability of a screening method (RHS-15) to detect traumatic disorders in a refugee sample in Germany

Objectives: Although EU member states are obligated to take special account of the situation of particularly vulnerable refugees, appropriate and specific measures to detect affected asylum seekers are not yet available. This study tries to pave the way for the implementation of an adequate instrument which at the same time assesses these needs of suffering people whilst responding to the need for mental health assessments specifically designed for refugees. This was done by testing the implementation of a screening method (Refugee Health Screener RHS-15) for trauma related mental health problems in refugees. Design: Two refugee samples in Germany (differing in arrival time: 126 applicants for asylum residing in the initial reception center and 116 living in long term communal accommodations) were assessed with the culturally sensitive Refugee Health Screener (RHS-15) to detect the incidence of mental health problems amongst them. Test fairness, reasonableness, susceptibility, transparency, acceptance, external design, utility and economy of the instrument were examined to check the applicability of the RHS-15 standardization test. Results: The RHS-15 indicates a good practical feasibility as the examination of the focused psychometric characteristics suggests. It became apparent, that implementing a screening procedure depends on political, legal and medical context factors that need to be considered. 2/3 of the participants had a positive screening result, which needs further diagnostic clarification in a second step. Conclusion: The RHS-15 seems to be practicable, economical, and rapidly deployable for the widespread detection of traumatic disorders in refugees living in Europe. The tool proved useful to aid diagnostic assessments and provide treatment to individuals in need, however the time of examination (resp. the duration of staying in the target land) influences the results.

Presentation of psychogenic nonepileptic seizures in Hawaii's ethnoracially diverse population

PURPOSE

This exploratory study compared the semiology of psychogenic nonepileptic seizures (PNES) between a diverse group of patients in the state of Hawaii. This study may expand understanding of PNES across different ethnocultural and gender groups.

METHODS

A retrospective chart review of patients admitted to our Epilepsy Monitoring Unit (EMU) over a 4-year period was performed to compare semiology in different ethnic groups and gender.

RESULTS

A total of 139 patients were included in this study, 37% (n = 51) with PNES, 34% (n = 47) with epilepsy only, and 29% (n = 41) with other non-PNES, nonepilepsy diagnosis. The number of Asians with PNES were found to differ when compared with the patients with epilepsy and the patients with non-PNES, nonepilepsy diagnosis. A positive trend was found in the number of Native Hawaiians and Caucasians with PNES in comparison with patients with non-PNES, nonepilepsy diagnosis. In addition, three semiology of PNES in Native Hawaiians were found to differ in comparison with other ethnic groups with PNES: rhythmic motor, mixed semiology, and nonepileptic aura. There is a significant difference in all motor manifestation between males and females in Native Hawaiians. Between patients with PNES, patients with epilepsy, and patients with non-PNES, nonepilepsy diagnosis, significant correlation was found in psychiatric disorders including posttraumatic stress disorder (PTSD), anxiety, and any psychiatric disorder.

CONCLUSION

This cross-cultural study found significant differences in the expression of PNES across key ethnoracial groups for the Islands of Hawaii. These findings have implications to the diagnosis and treatment of PNES for Native Hawaiians and other Pacific Islanders in the United States.

Lifetime trauma, personality traits, and health: A pathway to midlife health status

OBJECTIVE

This study investigated whether lifetime experience of trauma is related to personality through instrumental and reactive trait processes, and whether lifetime trauma is a mechanism underlying the association between childhood conscientiousness and objectively assessed adult physical health.

METHOD

Participants (N = 831) were 442 women and 389 men from the Hawaii longitudinal study of personality and health. Teacher assessments of personality were obtained when the participants were in elementary school. Self-reported adult personality assessments, lifetime histories of trauma experience, and objectively assessed physiological dysregulation were obtained between ages 45-55.

RESULTS

Women tended to report more high-betrayal trauma than men, whereas men reported more low-betrayal trauma than women. Women who were judged by their teachers to be less agreeable and less conscientious in childhood reported more lifetime trauma, suggesting instrumental trait processes. For both genders, neuroticism and openness/intellect/imagination in adulthood, but not in childhood, were associated with lifetime trauma, suggesting reactive trait processes. For both genders, trauma experience was correlated with dysregulation and with Body Mass Index (BMI). The indirect paths from childhood conscientiousness to adult dysregulation and BMI through total teen and adult trauma were significant for women, but not for men (indirect effect for women's dysregulation = -.025, p = .040, 95% confidence interval [CI] = -.048, -.001; indirect effect for women's BMI = -.037, p = .009, 95% CI = -.067, -.008).

CONCLUSION

Teen and adult trauma experience appears to be a hitherto unidentified mechanism in women underlying the association between conscientiousness and health. (PsycINFO Database Record

Native Hawaiian and Pacific Islander Elders: What Gerontologists Should Know

Native Hawaiian and other Pacific Islanders (NHOPI) experience significant health disparities compared with other racial groups in the United States. Lower life expectancy has resulted in small proportions of elders in the population distribution of NHOPI, yet the number of NHOPI elders is growing. This article presents data on NHOPI elders and discusses possible reasons for continuing health disparities, including historical trauma, discrimination, changing lifestyle, and cultural values. We outline promising interventions with NHOPI and make suggestions for future research.

Are Single-Item Global Ratings Useful for Assessing Health Status?

The research performance of the single-item self-rating In general, would you say your health is: excellent, very good, good, fair, or poor? was evaluated relative to the SF-36 General Health Scale that contains this item, using data for a sample of psychiatric outpatients who had co-occurring chronic physical conditions (N = 177). The scale was more robust than the single-item in cross-sectional validity tests and for predicting 2-year outcomes, but the single-item had stronger discriminant validity as a measure of physical health, especially in post-baseline analyses. Single-item and scale were both sensitive enough to detect change in perceived health over 2 years and a conditional experimental effect on health self-perceptions in a randomized trial. These findings demonstrate that a global single-item can be as valid, reliable, and sensitive as a multi-item scale for longitudinal research purposes, even if the scale performs better in cross-sectional surveys or as a screening measure.

Are Single-Item Global Ratings Useful for Assessing Health Status?

The research performance of the single-item self-rating In general, would you say your health is: excellent, very good, good, fair, or poor? was evaluated relative to the SF-36 General Health Scale that contains this item, using data for a sample of psychiatric outpatients who had co-occurring chronic physical conditions (N = 177). The scale was more robust than the single-item in cross-sectional validity tests and for predicting 2-year outcomes, but the single-item had stronger discriminant validity as a measure of physical health, especially in post-baseline analyses. Single-item and scale were both sensitive enough to detect change in perceived health over 2 years and a conditional experimental effect on health self-perceptions in a randomized trial. These findings demonstrate that a global single-item can be as valid, reliable, and sensitive as a multi-item scale for longitudinal research purposes, even if the scale performs better in cross-sectional surveys or as a screening measure.