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Garcia RS, Hollis T, Baratta J, King Z, Faulks M, Ricketts M, Brown-Johnson C, Shankar M, Guerin A, Wong HN, Zulman DM, Floyd BD. Building Trust and Partnership with Black Pediatric Patients and their Caregivers. Acad Pediatr 2024; 24:216-227. [PMID: 37659602 DOI: 10.1016/j.acap.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
Systemic racism embedded within the US health care system results in disproportionately worse health outcomes for Black pediatric patients and their caregivers. One meaningful mechanism through which these health disparities persist is through discriminatory treatment and anti-Black bias from clinicians. Strengthening care provided to Black pediatric patients and their caregivers requires that clinicians adopt culturally tailored communication strategies that promote health equity and counter racism. We conducted a scoping review of evidence-based communication practices in the medical literature that improve care for Black pediatric patients. We mapped the specific practices to the Presence 5 for Racial Justice framework and identified cross-cutting themes to describe practices across the five domains. There are three cross-cutting themes that underlie the recommended practices: 1) promote unbiased implementation of clinician communication strategies (eg, providing equitable recommendations for preventive care), 2) tailor care to Black pediatric patients (eg, explore the importance of the family unit), and 3) address racism experienced by Black pediatric patients and their caregivers (eg, acknowledge any previous negative experiences with the health care system). This review highlights communication practices that clinicians can adopt to build trusting relationships, empower Black families, and promote racial justice in clinical care. Future opportunities include expanding to system level change and validating these practices with patients and clinicians.
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Affiliation(s)
- Raquel S Garcia
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Department of Medicine (RS Garcia), Duke University School of Medicine, Durham, NC
| | - Taylor Hollis
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; University of Alabama at Birmingham Heersink School of Medicine (T Hollis)
| | - Juliana Baratta
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Massachusetts Institute of Technology Sloan School of Management (J Baratta), Cambridge, Mass
| | - Zoe King
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Stanford Prevention Research Center (Z King), Stanford University School of Medicine, Palo Alto, Calif
| | - Melvin Faulks
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Maya Ricketts
- Meharry Medical College School of Medicine (M Ricketts), Nashville, Tenn
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Megha Shankar
- Division of General Internal Medicine (M Shankar), Department of Medicine, University of California San Diego, La Jolla, Calif; Presence Center (M Shankar), Stanford University School of Medicine, Stanford, Calif
| | - Allison Guerin
- Department of Pediatrics (A Guerin), Office of Pediatric Education and Office of Diversity, Equity, Inclusion, and Justice in Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Hong-Nei Wong
- Lane Medical Library (HN Wong), Stanford University School of Medicine, Stanford, Calif
| | - Donna M Zulman
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Baraka D Floyd
- Department of Pediatrics (BD Floyd), Division of General Pediatrics and Office of Diversity Equity, Inclusion, and Justice in Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
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Sekhar DL, Hivner E, Molinari A, Allen K, Stuckey H. A qualitative analysis of participant experiences with universal school-based depression screening. Prev Med Rep 2022; 31:102073. [DOI: 10.1016/j.pmedr.2022.102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
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Romano I, Ferro MA, Patte KA, Leatherdale ST. Measurement Invariance of the GAD-7 and CESD-R-10 Among Adolescents in Canada. J Pediatr Psychol 2022; 47:585-594. [PMID: 35552429 PMCID: PMC9113328 DOI: 10.1093/jpepsy/jsab119] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The primary objective of our study was to assess measurement invariance (by grade and sex) of the 7-item Generalized Anxiety Disorder (GAD-7) and 10-item Center for Epidemiologic Studies Depression Revised (CESD-R-10) scales in a sample of adolescents in Canada. If measurement invariance was demonstrated, our secondary objective was to estimate differences in scale scores across these subgroups. METHODS We used data from 59,052 adolescents in Year 7 (2018-19) of the COMPASS school-based study. Measurement invariance was tested within a multigroup confirmatory factor analysis framework. Differences in scale scores were estimated using mixed linear regression which accounted for school-level clustering and adjusted for relevant confounders. RESULTS Both the GAD-7 and CESD-R-10 demonstrated strict measurement invariance by sex and grade in our sample. Mean scale scores were higher among adolescents in grade 12 compared to grade 9 (βGAD-7 = 0.91, p < .001; βCESD-R-10 = 0.99, p < .001) and among female adolescents compared to males (βGAD-7 = 3.36, p < .001; βCESD-R-10 = 2.58, p < .001). CONCLUSIONS Findings support the validity of the GAD-7 and CESD-R-10 for screening risk of generalized anxiety and depression among Canadian adolescents, and further indicate that differences observed in scale scores across subgroups reflect actual differences in risk for generalized anxiety and major depression, respectively.
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Affiliation(s)
- Isabella Romano
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Karen A Patte
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Cruden G, Karmali R. Opioid misuse as a coping behavior for unmet mental health needs among U.S. adults. Drug Alcohol Depend 2021; 225:108805. [PMID: 34174774 DOI: 10.1016/j.drugalcdep.2021.108805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Self-medication theory posits that opioids may be misused to cope with mental or emotional distress, especially if distress is not treated. Opioid misuse may lead to opioid use disorder, overdose, and death. We estimated the risk of opioid misuse associated with unmet mental health treatment needs (UMHN). METHODS We used 2015-2018 data on U.S. adults from the National Survey of Drug Use and Health (n = 165,767). UMHN was the perceived need for mental health services in the past year without service receipt. The primary dependent variable was past year prescription opioid misuse (POM). Secondary analyses estimated POM and/or heroin misuse risk. Logistic regressions estimated the predicted probability for POM, controlling for demographics, social factors, a major depressive episode (MDE), and overall health. We also tested whether the association of UMHN on the predicted probability of POM varied by MDE. RESULTS UMHN was associated with a 4.6 percentage point higher predicted probability of POM (p < 0.001; 95 % CI 0.04-0.05) and a 4.9 percentage point higher predicted probability of POM and/or heroin (p < 0.001; 95 % CI 0.04-0.06) compared to adults who accessed mental health services. MDE was associated with a significantly greater risk of POM (p < 0.001). POM risk was greater for adults potentially experiencing social isolation. CONCLUSION Targeted mental health support strategies may reduce the likelihood of POM initiation and episodes. Future research should investigate the relationship between unmet mental health needs and initiation of POM episodes.
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Affiliation(s)
- Gracelyn Cruden
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR 97401, United States.
| | - Ruchir Karmali
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States.
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Zou P, Siu A, Wang X, Shao J, Hallowell SG, Yang LL, Zhang H. Influencing Factors of Depression among Adolescent Asians in North America: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9050537. [PMID: 34064345 PMCID: PMC8147770 DOI: 10.3390/healthcare9050537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Asian American adolescents experience rates of depression comparable to or greater than those of other ethnic minorities. The purpose of this systematic review is to summarize psychosocial factors related to depressive symptoms of Asian American adolescents between the ages of 10 to 19. Methods: Various electronic databases were systematically searched to identify research articles published from 2000 to 2021, and the psychosocial factors influencing depression among Asian adolescents in North America were examined. Results: A total of 81 studies were included in this systematic review. Consistent findings on relationships between depressive symptoms and influencing factors included (a) acculturative stress, (b) religious or spiritual significance for females, (c) parent–child cohesion, (d) harsh parenting style, (e) responsive parenting style, (f) racial or ethnic discrimination, (g) being bullied, (h) positive mentor presence, and (i) exposure to community violence. Collectively, the majority of included studies suggest that depressive symptoms were more likely found among Asian American adolescents who (a) are older, (b) are female, (c) have immigrant status, (d) exhibit coping behaviours, (e) face academic challenges, (f) face a poor socioeconomic situation, (g) perceive parent–child conflict, (h) perceive maternal disconnectedness, and (i) perceive negative peer relations. A number of conflictive findings also existed. Discussion/Conclusions: This systematic review provides a summary of the various psychosocial factors on individual, familial, and social levels, which influenced the depressive symptoms of Asian American adolescents. Such findings offer a starting point to examine what factors should be necessarily included in related depression-preventive intervention design and evaluation. Culturally sensitive care, strengthened family–school–community collaboration, and targeted research efforts are needed to meet the needs of Asian adolescents experiencing a range of depressive symptoms.
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Affiliation(s)
- Ping Zou
- School of Nursing, Nipissing University, Toronto, ON M5T 1V4, Canada
- Correspondence:
| | - Annisa Siu
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China;
| | - Jing Shao
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou 310058, China;
| | | | - Lihua Lydia Yang
- Wellness Counselling Centre for Youth Canada, Markham, ON L3R 6G2, Canada;
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, China;
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Rice AN, Harris SC. Issues of cultural competence in mental health care. J Am Pharm Assoc (2003) 2020; 61:e65-e68. [PMID: 33160868 DOI: 10.1016/j.japh.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
As the United States' population continues to grow in its diversity, health care providers, including pharmacists, need to be able to provide culturally competent care to their patients. Cultural competence allows patients to feel comfortable with their provider and leads to their continuing to seek out care. Mental health is one of the most underused services in health care, particularly in underrepresented minority communities. This review looks at different published literature that assessed the reasons why individuals from minority communities may avoid seeking mental health care, cultural competence in psychiatric care for underrepresented minority communities, strategies for implementation for training providers in cultural competency, and barriers to implementation in mental health services. Current ideas include providing cultural competency training to students in their respective professional school or residency, incorporating the cultural formulation interview into psychiatric sessions, or increasing minority representation in the psychiatric services. On the basis of the literature examined, research is still needed to identify the best approach to improve culturally competent care in psychiatric services in the United States.
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Abstract
OBJECTIVE South Asians (SAs), a rapidly growing minority group in the United States are underrepresented in mental health research. They represent a unique sub-group of Asian immigrants in that their journey to the United States in the last 50 years was driven by the pursuit of academic and career opportunities. Our goal is to provide a topical overview of factors contributing to the mental health challenges of South Asian American (SAA) youth and to describe culturally sensitive approaches that would provide effective treatment for SAA youth and their families. METHODS We conducted a review of published literature in PubMed and PsycInfo search engines using the key words South Asian immigrants, South Asian Americans, psychological, psychiatric, mental health treatment, therapy and interventions. RESULTS The challenges faced by these highly educated families are distinctive in that there is a struggle to maintain ethnic identity based on collectivism while embracing American ideals of individualism. These opposing values along with model minority expectations put SAs at high risk for mental health concerns and acculturative family distancing. Furthermore, mental health stigma impedes help-seeking. Mental health practitioners must navigate the different value systems of the parent-child dyad without ostracizing either generation and deliver effective care. Hence, culturally adapted family therapy and community-based approaches may be particularly relevant in SA youth. CONCLUSION Our article outlines common family attitudes and issues pertinent to mental health in youth and discusses useful clinical approaches to dealing with SAA youth and their families.
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Affiliation(s)
- Neha Sharma
- Division of Child and Adolescent Psychiatry, Tufts Medical Center, Boston, MA, USA
| | - Deepika Shaligram
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Grace H Yoon
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
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8
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Van Meter AR, Birnbaum ML, Rizvi A, Kane JM. Online help-seeking prior to diagnosis: Can web-based resources reduce the duration of untreated mood disorders in young people? J Affect Disord 2019; 252:130-134. [PMID: 30981056 PMCID: PMC6529208 DOI: 10.1016/j.jad.2019.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/26/2019] [Accepted: 04/07/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Mood and anxiety disorders typically begin in adolescence or early adulthood, but those at the age of highest risk are among those least likely to access mental health services. However, they may be more likely than other demographic groups to seek help online. The goal of the present study was to investigate the online help- and information-seeking activity of young people newly diagnosed with mood and anxiety disorders in order to better understand how digital resources might serve this population. METHOD Participants, aged 15 to 35, with a diagnosis of a mood or anxiety disorder were eligible if they had received their first mental health diagnosis within 24 months. Participants were interviewed with the Pathways to Care Questionnaire, which inquires about online activity prior to one's first interaction with mental healthcare providers. RESULTS Forty people participated (depression n = 30, bipolar disorder n = 5, generalized anxiety disorder n = 5); average age 21 years (SD=3.2), 60% female. Eighty-one percent reported seeking help and/or information about their symptoms online. The gap between symptom onset and in-person help seeking was 91.90 weeks (SD=133.7). Most participants (85%) reported they would be open to communicating with a mental health professional online. CONCLUSION A majority of young people experiencing clinically-significant symptoms seek help online. However, the gap between symptom onset and treatment initiation remains unacceptably long. Better strategies are needed to translate young people's interest in online resources into meaningful care, whether through web-based services or facilitated pathways to traditional treatment.
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Affiliation(s)
- Anna R. Van Meter
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA,Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Michael L. Birnbaum
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA,Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Asra Rizvi
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - John M. Kane
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA,Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
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Doumit R, Kazandjian C, Militello LK. COPE for Adolescent Syrian Refugees in Lebanon: A Brief Cognitive-Behavioral Skill-Building Intervention to Improve Quality of Life and Promote Positive Mental Health. Clin Nurs Res 2018; 29:226-234. [PMID: 30477312 DOI: 10.1177/1054773818808114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lebanon has the highest per-capita concentration of refugees worldwide. There is an urgent need to offer psychosocial interventions to vulnerable groups such as Syrian refugee adolescents. To assess the feasibility, acceptability, and preliminary effects of a cognitive-behavioral intervention (Creating Opportunities for Patient Empowerment [COPE]) on depression, anxiety, and quality of life (QOL) in a sample of adolescent refugees (13-17 years) living in Lebanon. A preexperimental study design was used. COPE 7-Session was delivered to 31 adolescent Syrian refugees. Participants were assessed for depression (Personal Health Questionnaire-9), anxiety (General Anxiety Disorders Scale), and QOL (Pediatric Quality of Life Inventory). Feasibility and acceptability findings indicated that the COPE program was a positive experience for teens. Significant decreases in depression and anxiety, and increases in QOL were also reported. COPE is an effective cognitive-behavioral intervention that can be delivered in an Arabic/Middle-Eastern setting for teen refugees to improve mental health and QOL.
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Affiliation(s)
- Rita Doumit
- Lebanese American University, Byblos, Lebanon.,Sigma Theta Tau International Chi Iota Chapter, American University of Beirut, Lebanon
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Recto P, Champion JD. "We Don't Want to be Judged": Perceptions about Professional Help and Attitudes Towards Help-Seeking among Pregnant and Postpartum Mexican-American Adolescents. J Pediatr Nurs 2018; 42:111-117. [PMID: 29709411 DOI: 10.1016/j.pedn.2018.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this qualitative study is to understand how depression is recognized, as well as perceptions of professional help and attitudes concerning perinatal depression among pregnant and postpartum (perinatal) Mexican-American adolescents. DESIGN AND METHODS This qualitative descriptive study used deductive and inductive content analysis to analyze data. Categories and subcategories describing the mental health literacy of perinatal Mexican-American adolescents concerning perinatal depression are presented. A convenience sample of 20 perinatal Mexican-American adolescents between the ages of 15 and 19 years were interviewed. Participants were recruited from parenting classes across urban high-schools in Southwestern United States. RESULTS Adolescents expressed difficulties in recognizing perinatal depression. Depressive symptoms were identified through self-appraisals or the appraisal of others. Establishing rapport with empathetic health care providers facilitated trust among adolescents. Fear of judgement was the most common response and prevented help-seeking. Lack of trust, normalization of depression, and reluctance with disclosing symptoms were also indicated by participants. CONCLUSIONS Stigma concerning perinatal depression was identified as a barrier for help-seeking among participants who were already experiencing criticism due to their pregnancy status. The quality of interactions with health providers may hinder or facilitate adolescents from professional help-seeking. PRACTICE IMPLICATIONS Active engagement and collaboration with Mexican-American adolescents are indicated in identification and treatment of perinatal depression. Integration of mental health services in primary care settings is suggested to facilitate help-seeking for perinatal depression. Mental Health First Aid may be utilized to improve knowledge and decrease stigma concerning perinatal depression among Mexican-American adolescents.
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Affiliation(s)
- Pamela Recto
- The University of Texas at Austin, School of Nursing, Austin, Texas, USA.
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Recto P, Champion JD. Assessment of Mental Health Literacy among Perinatal Hispanic Adolescents. Issues Ment Health Nurs 2017; 38:1030-1038. [PMID: 28766973 DOI: 10.1080/01612840.2017.1349224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
According to the United States (U.S.) Census Bureau, Hispanics are the fastest growing ethnic minority in the U.S. As such, Hispanic females have the highest birth rate (35 per 1000) among adolescents between the ages of 15 and 19 years. Despite high fertility rates, there is limited mental health information among Hispanic adolescents during the perinatal period. Perinatal depression is a major concern as it poses health risks for both the mother and infant. Adverse outcomes such as preterm birth, low infant birth weight, and poor maternal-infant attachment may result from perinatal depression. However, less than half of Hispanic adolescent mothers who experience perinatal depression receive treatment. Previous research identified low mental health literacy (MHL) as one of the primary reasons for the limited use of mental health services among ethnic minorities. This study assessed the MHL of pregnant and postpartum Hispanic adolescents (n = 30) using a modified MHL scale. Implications for nursing practice are discussed to help improve mental health outcomes among pregnant and postpartum Hispanic adolescents.
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Affiliation(s)
- Pamela Recto
- a School of Nursing , The University of Texas at Austin , Austin , Texas , USA
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Guo Y, Rousseau J, Renno P, Kehoe P, Daviss M, Flores S, Saunders K, Phillips S, Chin M, Evangelista LS. Feasibility of an emotional health curriculum for elementary school students in an underserved Hispanic community. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 30:133-141. [PMID: 29504643 PMCID: PMC6198665 DOI: 10.1111/jcap.12185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/15/2017] [Accepted: 12/17/2017] [Indexed: 01/24/2023]
Abstract
PROBLEM Hispanic children have greater mental health challenges but fewer received mental health services than other ethnic groups. A classroom-based Emotional Health Curriculum (EHC) was developed to address mental health disparities in an underserved Hispanic community. METHODS A quasi-experimental design with one group pre- and post-intervention was used to test the feasibility of an 8-week EHC for one hundred 3rd and 4th grade children in a dual-immersion Spanish-English elementary school. Limited efficacy was measured by changes in depression and anxiety scores reported by children and teachers. Acceptance was evaluated by a child-reported satisfaction survey and a focus group in which the four teachers shared their experiences. Implementation was measured by participation, retention, and fidelity rates. FINDINGS The child-reported depression and anxiety and teacher-reported depression were significantly decreased in at-risk children with the effect size ranging from 0.60 to 1.16 (ps < 0.05). The majority of children (89.7%) enjoyed the EHC and teachers observed that children had acquired skills to manage their emotional distress. The participation, retention, and fidelity rates were 98%, 94%, and 99.13%, respectively. CONCLUSIONS The results provide promising evidence that the EHC has the potential to improve depression and anxiety symptoms in at-risk children.
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Affiliation(s)
- Yuqing Guo
- Sue & Bill Gross School of Nursing, University of California, Irvine, 299D, Berk Hall, Irvine, CA, 92697-3959, Phone: 949-824-9057, Fax: 949-824-0470,
| | - Julie Rousseau
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine CA, 92697-3959,
| | - Patricia Renno
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Semel Institute for Neuroscience & Human Behavior, Rm. 68-229, 760 Westwood Plaza, Los Angeles, CA 90095-1759,
| | - Priscilla Kehoe
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA 92697-3959,
| | - Monique Daviss
- El Sol Science and Arts Academy of Santa Ana, 1010 N. Broadway Street, Santa Ana, CA 92701, Phone: 714-543-0023,
| | - Sara Flores
- El Sol Science and Arts Academy of Santa Ana, 1010 N. Broadway Street, Santa Ana, CA 92701, Phone: 714-543-0023,
| | - Kathleen Saunders
- Sue & Bill Gross School of Nursing, University of California, Irvine, 209, Berk Hall, Irvine, CA, 92697-3959, Phone: 949-824-9694,
| | - Susanne Phillips
- Sue & Bill Gross School of Nursing, University of California, Irvine, 252E Berk Hall, Irvine, CA, 92697-3959, Phone: 949-824-4274,
| | - Mindy Chin
- Sue & Bill Gross School of Nursing, University of California, Irvine, 299C, Berk Hall, Irvine, CA, 92697-3959,
| | - Lorraine S. Evangelista
- Sue & Bill Gross School of Nursing, University of California, Irvine, 299E, Berk Hall, Irvine, CA, 92697-3959, Phone: 949-824-9057,
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Acceptance and Commitment Therapy for adolescent depression: Application with a diverse and predominantly socioeconomically disadvantaged sample. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2017.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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“Why Should I Tell My Business?”: An Emerging Theory of Coping and Disclosure in Teens. Res Theory Nurs Pract 2016; 30:124-42. [DOI: 10.1891/1541-6577.30.2.124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disclosing predepression feelings of sadness is difficult for teens. Primary care providers are a potential avenue for teens to disclose these feelings and a bridge to mental health care before becoming more seriously ill. To explore how to more effectively recruit teens into a primary care-based, online depression prevention study, we held 5 focus groups with African American and Latino teens (n = 43) from a large Midwestern city. We conducted constant comparative analysis of the data and a theoretical conceptualization of coping and disclosure emerged. Our analysis revealed an internal coping continuum in reaction to sadness and pivotal elements of trust and judgment that either lead teens to disclose or not disclose these feelings. The teens’ perspectives show the necessary characteristics of a relationship and comfortable community and virtual settings that can best allow for teens to take the step of disclosing to receive mental health care services.
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Minority Primary Care Patients With Depression: Outcome Disparities Improve With Collaborative Care Management. Med Care 2015; 53:32-7. [PMID: 25464162 DOI: 10.1097/mlr.0000000000000280] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/OBJECTIVES Racial and ethnic disparities in depression incidence, prevalence, treatment, and outcomes still persist. The hypothesis of this study was that use of collaborative care management (CCM) in treating depressed primary care patients would decrease racial disparities in 6-month clinical outcomes compared with those patients treated with usual primary care (UC). RESEARCH DESIGN/SUBJECTS In a retrospective chart review analysis, 3588 (51.2%) patients received UC and 3422 (48.8%) patients were enrolled in CCM. Logistic regression analyses were used to examine disparities in 6-month outcomes. RESULTS Minority patients enrolled in CCM were more likely to be participating in depression care at 6 months than minority patients in UC (61.8% vs. 14.4%; P≤0.001). After adjustment for demographic and clinical covariates, this difference remained statistically significant (odds ratio=9.929; 95% CI, 6.539-15.077, P≤0.001).The 568 minority UC patients with 6-month follow-up PHQ-9 data demonstrated a much lower odds ratio of a PHQ-9 score of <5 (0.220; 95% CI, 0.085-0.570; P=0.002) and a much higher odds ratio of PHQ-9 score of ≥10 (3.068; 95% CI, 1.622-5.804; P<0.001) when compared with the white, non-Hispanic patients. In contrast, the 2329 patients treated with CCM, the odds ratio for a PHQ-9 score of <5 or ≥10 after 6 months, demonstrated no significance of minority status. CONCLUSIONS Utilization of CCM for depression was associated with a significant reduction of the disparities for outcomes of compliance, remission, or persistence of depressive symptoms for minority patients with depression versus those treated with UC.
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Huang CY, Zane N. Cultural influences in mental health treatment. Curr Opin Psychol 2015; 8:131-136. [PMID: 29506788 DOI: 10.1016/j.copsyc.2015.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/26/2015] [Accepted: 10/03/2015] [Indexed: 12/15/2022]
Abstract
Research on mental health treatments from 2010 to 2015 has continued to highlight the critical role of culture on treatment services, processes, and outcomes for racial/ethnic minority groups. Studies showed that factors such as acculturation and phenotypic appearance were associated with risk for psychopathology. Issues such as face concern and acculturation level were associated with the quality of client-therapist relationships and the amount of information clients disclosed in sessions. While racial/ethnic minority clients generally preferred same-ethnicity therapists, findings showed relatively small effects for racial/ethnic match and positive treatment outcomes. Several studies provided additional evidence for the effectiveness of culturally-adapted, evidence-based treatments compared to non-adapted treatments for minority clients, and more researchers are beginning to delineate the processes involved in making these successful adaptations.
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Affiliation(s)
- Cindy Y Huang
- Asian American Center on Disparities Research, University of California, Davis One Shields Avenue, Davis, CA 95616, USA.
| | - Nolan Zane
- Asian American Center on Disparities Research, University of California, Davis One Shields Avenue, Davis, CA 95616, USA
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Sarkin A, Lale R, Sklar M, Center KC, Gilmer T, Fowler C, Heller R, Ojeda VD. Stigma experienced by people using mental health services in San Diego County. Soc Psychiatry Psychiatr Epidemiol 2015; 50:747-56. [PMID: 25406401 DOI: 10.1007/s00127-014-0979-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 11/10/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This paper describes how individuals struggling with severe mental illness experience stigma along multiple dimensions including their experiences of discrimination by others, their unwillingness to disclose information about their mental health, and their internalization or rejection of the negative and positive aspects of having mental health problems. METHODS This cross-sectional study employs descriptive analyses and linear regression to assess the relationship between demographics, mental health diagnoses and self-reported stigma among people receiving mental health services in a large and ethnically diverse county public mental health system (n = 1,237) in 2009. We used the King Stigma Scale to measure three factors related to stigma: discrimination, disclosure, and positive aspects of mental illness. RESULTS Most people (89.7 %) reported experiencing some discrimination from having mental health problems. Regression analyses revealed that younger people in treatment experienced more stigma related to mental health problems. Women reported experiencing more stigma than men, but men were less likely to endorse the potentially positive aspects of facing mental health challenges than women. Although people with mood disorders reported more discomfort with disclosing mental illness than people with schizophrenia, they did not report experiencing more discrimination than people with schizophrenia. CONCLUSIONS Study findings suggest that the multidimensional experiences of stigma differ as a function of age, gender, and diagnosis. Importantly, these findings should inform anti-stigma efforts by describing different potential treatment barriers due to experiences of stigma among people using mental health services, especially among younger people and women who may be more susceptible to stigma.
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Affiliation(s)
- Andrew Sarkin
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, 92093, USA,
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Sandler L, Sommerfeld E, Shoval G, Tsafrir S, Chemny A, Laor N, Zalsman G. Effects of ethnicity on sub-clinical PTSD and depressive symptoms, following exposure to missile attacks in Israel--a pilot study. Int J Psychiatry Clin Pract 2015; 19:51-5. [PMID: 25356662 DOI: 10.3109/13651501.2014.980829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this pilot study was to compare the occurrence of post-traumatic stress disorder (PTSD) symptoms, major depression disorder (MDD)-related symptoms, and negative mood regulation capacities among Israeli Jewish and Arab children and their parents, all of whom had been exposed to recurrent missiles attacks during the Second Lebanon War. METHODS Participants consisted of 28 Jewish and 14 Arab children (aged 4-18 years) and their parents. They were assessed by self-report instruments and a semi-structured interview (K-SADS-PL). RESULTS Among children, PTSD and depressive symptoms were found to be interrelated. Parents' depression and mood regulation were found to be related to their children's PTSD and depressive responses. Both children's and parents' negative mood regulation capacities were inversely related to children's depressive and PTSD symptoms. Both Jewish and Arab children's scores on the Children Depression Inventory (CDI) and on the PTSD Scale Symptoms Interview (PSS-I) showed significant levels of emotional distress following the missile attacks. However, Arab children reported significantly higher levels of PTSD and depressive symptoms in comparison to Jewish children. CONCLUSION Ethnicity seems to be an important factor in children's responses to war-related events.
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Aggarwal NK, Glass A, Tirado A, Boiler M, Nicasio A, Alegría M, Wall M, Lewis-Fernández R. The development of the DSM-5 Cultural Formulation Interview-Fidelity Instrument (CFI-FI): a pilot study. J Health Care Poor Underserved 2014; 25:1397-417. [PMID: 25130248 PMCID: PMC4306341 DOI: 10.1353/hpu.2014.0132] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper reports on the development of the Cultural Formulation Interview-Fidelity Instrument (CFI-FI) which assesses clinician fidelity to the DSM-5 Cultural Formulation Interview (CFI). The CFI consists of a manualized set of standard questions that can precede every psychiatric evaluation. It is based on the DSM-IV Outline for Cultural Formulation, the cross-cultural assessment with the most evidence in psychiatric training. Using the New York sample of the DSM-5 CFI field trial, two independent raters created and finalized items for the CFI-FI based on six audio-taped and transcribed interviews. The raters then used the final CFI-FI to rate the remaining 23 interviews. Inter-rater reliability ranged from .73 to 1 for adherence items and .52 to 1 for competence items. The development of the CFI-FI can help researchers and administrators determine whether the CFI has been implemented with fidelity, permitting future intervention research.
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Leiner M, Peinado J, Villanos MTM, Jimenez P. Assessment Disparities among Pediatric Patients: Advantages of Pictorial Descriptions. Front Pediatr 2013; 1:28. [PMID: 24400274 PMCID: PMC3864193 DOI: 10.3389/fped.2013.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/02/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marie Leiner
- Department of Pediatrics, Texas Tech University Health Sciences El Paso, TX, USA ; Department of Social Sciences and Administration, Universidad Autonoma de Ciudad Juarez, Ciudad Juarez Chihuahua, Mexico
| | - Jesus Peinado
- Department of Pediatrics, Texas Tech University Health Sciences El Paso, TX, USA
| | | | - Patricia Jimenez
- Department of Social Sciences and Administration, Universidad Autonoma de Ciudad Juarez, Ciudad Juarez Chihuahua, Mexico
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Banta JE, James S, Haviland MG, Andersen RM. Race/ethnicity, parent-identified emotional difficulties, and mental health visits among California children. J Behav Health Serv Res 2013; 40:5-19. [PMID: 23070565 DOI: 10.1007/s11414-012-9298-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Variability in mental health services utilization by race/ethnicity was evaluated with a Behavioral Model approach. Subjects were 17,705 children 5 to 11 years of age in the 2005, 2007, and 2009 California Health Interview Surveys. Parents identified minor emotional difficulties in 18.7% of these children (ranging from 14.8% in Asians to 24.4% in African Americans) and definite or severe difficulties in 7.4% (5.5% in Asians to 9.7% in "other race"). Overall, 7.6% of children had at least one mental health visit in the prior year (2.3% in Asians to 11.2% in African Americans). Parent-identified need was the most salient predictor of mental health visits for all racial/ethnic groups. Beyond need, no consistent patterns could be determined across racial/ethnic groups with regard to the relationship between contextual, predisposing, and enabling measures and mental health service utilization. Different factors operated for each racial/ethnic group, suggesting the need for studies to examine mental health need, mental health service use, and determinants by racial/ethnic subgroup. These findings suggest that a "one-size-fits-all approach" with regard to policies and practices aimed at reducing mental health disparities will not be effective for all racial/ethnic groups.
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Affiliation(s)
- Jim E Banta
- Department of Health Policy and Management, Loma Linda University School of Public Health, Loma Linda, CA 92350, USA.
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Abstract
The Working with Culture seminar is offered as a course during the month long Annual McGill Summer Program for Social and Transcultural Psychiatry, attended by local and international participants each May since 1994. The article outlines some of the premises and pedagogical approaches of this clinically oriented biweekly seminar series with discussions and didactic teaching on cultural dimensions of mental health care. The course readings, seminar topics and invited speakers focus mainly on therapist client encounters constructed by the multiple voices with dimensions of psychiatric, social, historical, legal, ethical, political, systemic and intra-psychic domains. The dual leadership emphasizes the gaps and complementarity amongst voices, and it invites and supports a destabilizing decentering process and the creation of solidarities amongst participants. Applying a bio-psychosocial case study method, each 3-h seminar engages the participants in a critical dialogue on apprehending the enmeshment of social suffering with psychiatric disorders whilst examining the usefulness and the limits of cultural formulation models. The seminar working group and teaching approach acknowledges cultural hybridity as a dynamic process marked by continuous therapist attunement to uncertainty or 'not knowing' which implies a dethroning of an expert position.
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Affiliation(s)
- Graham J. Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
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