The Impact of Ethnicity and Response Bias on the Self-Report of Negative Affect

Expanding the Trauma-Informed Care Measurement Toolkit: An Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC-45) Scale with SUD Workers in PIMH

Human service organizations (HSO) have increasingly recognized the value of employing trauma-informed care (TIC) in a variety of practice settings. Evidence suggests that effectively adopting TIC has shown client improvements. Organizational barriers to TIC implementation, however, exist. To improve TIC practice, the attitudes related to trauma-informed care (ARTIC) scale was developed to measure staff attitudes and beliefs towards TIC. The ARTIC has been widely adopted by researchers without evaluating its psychometric performance in diverse practice settings. The purpose of this study was to independently validate the ARTIC scale drawn from a sample of staff (n = 373) who provide services to substance-using parents. Psychometric tests were conducted to evaluate how the ARTIC performs with our HSO population. Results from a confirmatory factor analysis showed poor fit (X² = 2761.62, df = 2.96; RMSEA = 0.07 [0.07, 0.08]; CFI = 0.72). An exploratory factor analysis was conducted to analyze how the data fit with our specific population, yielding 10 factors. Finally, a qualitative inter-item analysis of these factors was conducted, resulting in nine factors. Our findings suggest that measuring TIC attitudes and beliefs may vary according to field of practice and ethno-racially diverse workers. Further refinement of the ARTIC may be necessary for various services domains.

Associations among migration risk factors, cultural identity conflict, and psychological symptoms among Syrian emerging adults with refugee backgrounds in the Netherlands

OBJECTIVES

In the present study, we examined relations between premigration, perimigration, and postmigration risk factors (i.e., potentially traumatic events [PTEs], postmigration living problems [PMLPs], stressful life events) and psychological symptoms (i.e., anxiety/depression, posttraumatic stress) in Syrian emerging adults with refugee backgrounds; we also tested cultural identity conflict as a possible mediator of these relations. We expected that greater exposure to migration risk factors was associated with more psychological symptoms and that higher cultural identity conflict would contribute to these associations.

METHODS

We used data from the first wave of Karakter, a longitudinal study of 158 Syrians with refugee backgrounds (69.0% men, age range 18-35). Participants completed a questionnaire assessing PTEs, PMLPs, stressful life events, cultural identity conflict, and symptoms of anxiety/depression and posttraumatic stress.

RESULTS

Correlational analyses indicated that more PTEs and stressful life events were related to higher levels of cultural identity conflict and more psychological symptoms. Furthermore, greater cultural identity conflict was associated with more psychological symptoms. We did not observe indirect effects of cultural identity conflict in the mediation analyses.

CONCLUSIONS

Results suggest that postmigration stressors and cultural identity conflict are associated with psychological symptoms among Syrian emerging adults who have resettled in the Netherlands.

Longitudinal Examination of an Ethnic Paradox of Stress and Mental Health in Older Black and Latinx Adults

OBJECTIVES

To explain the ethnic paradox of mental health in aging, we evaluated whether Black and Latinx older adults experience (1) fewer depressive symptoms (DepSx), but more physical problems, and (2) greater psychological resilience as a result of life stressors than White older adults.

METHODS

DepSx, physical health, and recent stress were obtained biennially from 25,893 older adults (77% White, 15% Black, 9% Latinx) in the U.S. Health and Retirement Study, across 16 years. Psychological resilience, lifetime stress, and discrimination experiences were available for 13,655 individuals. We conducted mixed-effects and linear regression analyses.

RESULTS

For Blacks and Latinxs, experiencing more-than-usual stress events was associated with less increase in DepSx compared to Whites, although on average Blacks and Latinxs experience more DepSx. Black adults showed worse physical health than White adults and weaker effects of stress on psychological resilience despite experiencing more stress of all types. Findings were mixed for Latinxs.

CONCLUSIONS

Studying effects of time-varying stress on changes in health and multiple stressors on psychological resilience by race/ethnicity elucidates mechanisms for later-age health disparities.

CLINICAL IMPLICATIONS

Cross-sectional evaluations of stress and psychological health in a clinical setting may provide incomplete appraisals of health risks for Black and Latinx older Americans.

Social context and loneliness in an epidemiological youth sample using the Experience Sampling Method

BACKGROUND

Previous research has shown the relationship between loneliness and affect, as well as the relationship between trait loneliness and state loneliness. However, none has investigated how social context affects the association between loneliness and affect. The current study aims to examine the association between trait loneliness, state loneliness and momentary affects in different social contexts.

METHODS

Participants aged 15-24 were randomly recruited from a Hong Kong epidemiological study to participate in an Experience Sampling Method (ESM) study. The group was divided in two based on the mean trait loneliness score (UCLA Loneliness Scale) at baseline. State loneliness, momentary positive (PA) and negative affect (NA) and social context were assessed using ESM. Multilevel logistic regression was used to analyze the association between momentary affect, state loneliness and trait loneliness in various social contexts.

RESULTS

HL (high lonely) and LL (low lonely) groups consisted of 79 participants (44.6%) and 98 participants (55.4%) respectively. HL group had lower PA and higher NA, as well as a higher state loneliness than LL group. HL group had a lower state loneliness when being with intimate company compared to alone. LL group only had a higher PA when being with intimate company compared to non-intimate company and alone respectively.

CONCLUSION

Adolescents with high level of trait loneliness experienced higher PA, momentary loneliness and lower NA compared to those with low level of trait loneliness. The quality of social company is crucial in allowing one to experience different degrees of PA and momentary loneliness.

The impact of depression and post-traumatic stress symptoms on physical health perceptions and functional impairment among sexual minority men living with HIV with histories of trauma

Mental health symptoms may compromise health-related quality of life (HRQOL), including among men who have sex with men (MSM) living with HIV, who experience high rates of trauma and other stressors. This study sought to examine the relative contributions of post-traumatic stress disorder (PTSD) symptoms, depression symptoms, and biological indices of HIV disease status on HRQOL in this population. Participants were 79 MSM with HIV (49% White; 35% Black; 8% Hispanic/Latinx) with trauma histories (52% met current PTSD diagnostic criteria). HRQOL outcomes were general perceptions of health (0-100 visual analog scale) and functional disability (WHODAS 2.0). Dominance analysis was applied to examine the relative share of variance in these outcomes accounted for by PTSD symptom severity, depression symptom severity, viral suppression status, and CD4 count. Depression symptom severity accounted for 70% and 92% of variance in perceived health, respectively, across models (p's < 0.05). Both PTSD symptom severity (45%) and depression symptom severity (43%) scores also accounted for significant variance in functional disability (p's < 0.05). Medical indices of HIV disease progression did not explain significant variance in HRQOL in any model. A trauma-informed approach may aid clinicians in interpreting reports of health and physical functioning in MSM with HIV.

Alignment Between Heart Rate Variability From Fitness Trackers and Perceived Stress: Perspectives From a Large-Scale In Situ Longitudinal Study of Information Workers

BACKGROUND

Stress can have adverse effects on health and well-being. Informed by laboratory findings that heart rate variability (HRV) decreases in response to an induced stress response, recent efforts to monitor perceived stress in the wild have focused on HRV measured using wearable devices. However, it is not clear that the well-established association between perceived stress and HRV replicates in naturalistic settings without explicit stress inductions and research-grade sensors.

OBJECTIVE

This study aims to quantify the strength of the associations between HRV and perceived daily stress using wearable devices in real-world settings.

METHODS

In the main study, 657 participants wore a fitness tracker and completed 14,695 ecological momentary assessments (EMAs) assessing perceived stress, anxiety, positive affect, and negative affect across 8 weeks. In the follow-up study, approximately a year later, 49.8% (327/657) of the same participants wore the same fitness tracker and completed 1373 EMAs assessing perceived stress at the most stressful time of the day over a 1-week period. We used mixed-effects generalized linear models to predict EMA responses from HRV features calculated over varying time windows from 5 minutes to 24 hours.

RESULTS

Across all time windows, the models explained an average of 1% (SD 0.5%; marginal R2) of the variance. Models using HRV features computed from an 8 AM to 6 PM time window (namely work hours) outperformed other time windows using HRV features calculated closer to the survey response time but still explained a small amount (2.2%) of the variance. HRV features that were associated with perceived stress were the low frequency to high frequency ratio, very low frequency power, triangular index, and SD of the averages of normal-to-normal intervals. In addition, we found that although HRV was also predictive of other related measures, namely, anxiety, negative affect, and positive affect, it was a significant predictor of stress after controlling for these other constructs. In the follow-up study, calculating HRV when participants reported their most stressful time of the day was less predictive and provided a worse fit (R2=0.022) than the work hours time window (R2=0.032).

CONCLUSIONS

A significant but small relationship between perceived stress and HRV was found. Thus, although HRV is associated with perceived stress in laboratory settings, the strength of that association diminishes in real-life settings. HRV might be more reflective of perceived stress in the presence of specific and isolated stressors and research-grade sensing. Relying on wearable-derived HRV alone might not be sufficient to detect stress in naturalistic settings and should not be considered a proxy for perceived stress but rather a component of a complex phenomenon.

Difficulties in psychosocial functioning due to current depressive symptoms: What can C-Reactive protein tell us?

Background

Multiple empirical studies and meta-analyses have examined how inflammation may be associated with various aspects of major depression, with older adults being particularly at risk for the effects of inflammation-related depression. Despite this wide area of research, no study has examined how depression-related inflammation impacts psychosocial functioning.

Methods

Data from the National Health and Nutrition Examination Survey, years 2007–2008, were utilized to examine whether adults over the age of 40 experienced difficulty in their work, taking care of things at home, or getting along with other people due to current depressive symptoms through a logistic regression analysis. We selected C-reactive protein (CRP), a common marker of immune system activation, as our primary predictor of interest while controlling for relevant covariates.

Results

Greater CRP was positively associated with a greater risk for individuals experiencing difficulties in psychosocial functioning due to depressive symptoms. While current number and severity of depressive symptoms was also found to be significant in the model, comparison of effect sizes identified that CRP appears to be a more relevant marker for experiencing difficulty than a number of relevant biopsychosocial covariates.

Conclusion

Inflammation as measured by CRP may be a helpful tool in understanding how depressive symptoms are associated with an individual's ability to successfully navigate their social environment. Results here demonstrate the emerging utility of CRP in helping to assess the risk for negative outcomes in those experiencing depressive symptoms, especially as it pertains to older adults.

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Aimed to evaluate the role of CRP in psychosocial functioning of older adults experiencing current depressive symptoms.

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Higher CRP levels were positively associated with risk for experiencing psychosocial difficulty due to depressive symptoms.

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CRP levels above 10 mg/L were associated with a 13.7–55.6% increased risk for experiencing psychosocial difficulties.

A systematic review and psychometric evaluation of self-report measures for hoarding disorder

BACKGROUND

Hoarding disorder (HD) affects approximately 2.5% of the general population, leads to significant distress and impairment, and is notoriously difficult to treat. The crux of developing effective treatments for HD is our ability to reliably and validly measure relevant constructs in HD to better understand its presentation and, subsequently, formulate appropriate interventions.

METHODS

We identified measures specific to HD and evaluated their psychometric properties using rating criteria formulated by the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) group.

RESULTS

The 17 included measures were developed to assess adult and pediatric hoarding severity, functional impairment, and maladaptive processes (e.g., material scrupulosity). The Saving Inventory-Revised, the most widely used measure of HD severity showed the strongest psychometric properties. However, psychometric investigations were generally of poor quality across all measures and results indicated unsatisfactory performance of measures.

LIMITATIONS

The current review excluded non-English measures and ratings inherently contain some element of subjectivity despite use of predetermined criteria and two independent reviewers.

CONCLUSIONS

We suggest that clinical researchers continue to develop and modify measures used to conceptualize and, ultimately, improve treatment for HD.

Exploring the utility of RDoC in differentiating effectiveness amongst antidepressants: A systematic review using proposed psychometrics as the unit of analysis for the Negative Valence Systems domain

Background

RDoC conceptualises psychopathology as neurobiologically-rooted behavioural psychological “constructs” that span dimensionally from normality to pathology, but its clinical utility remains controversial.

Aim

To explore RDoC’s potential clinical utility by examining antidepressant effectiveness through Negative Valence Systems (NVS) domain constructs.

Method

A systematic review was conducted on Web of Science, MEDLINE, EMBASE and PsycINFO for antidepressant trials that included psychometric instruments assessed by Watson, Stanton & Clark (2017) to represent NVS constructs of Acute Threat, Potential Threat and Loss.

Results

221 citations were identified; 13 were included in qualitative synthesis, none for quantitative analysis. All suffered from significant bias risks. 9 antidepressants were investigated, most within 1 construct, and most were found to be effective. Paroxetine, citalopram and fluvoxamine were found to be effective for Acute Threat, fluoxetine, desvenlafaxine and sertraline for Potential Threat, and sertraline, fluvoxamine, fluoxetine and desvenlafaxine effective for Loss. Nefazodone was found to be ineffective for acute fear.

Conclusion

Preliminary evidence supports RDoC NVS constructs’ clinical utility in assessing antidepressant effectiveness, but lack of discriminant validity between Potential Threat and Loss supports their recombination into a single Distress construct. Finding of effectiveness within “normal” construct levels support the utility of a dimensional approach. Testable hypotheses were generated that can further test RDoC’s clinical utility.

Adolescents' Engagement with Crisis Hotline Risk-management Services: A Report from the Emergency Department Screen for Teen Suicide Risk (ED-STARS) Study

OBJECTIVE

This study examines the feasibility of a risk-management protocol for adolescent research participants at risk for suicide that relies on engagement with telephone crisis counselors. The study also examines whether engagement is moderated by adolescent demographics and clinical characteristics.

METHOD

Participants were 234 adolescents (83% female; 63% White) ages 12-18 (M = 15.3 years) drawn from the national study, Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) Study One sample of adolescents randomized for 3-month telephone follow-up (n = 2,850). This study's sample was comprised of adolescents who completed the follow-up (69% retention), met study risk criteria, and were transferred to a crisis hotline for risk management. Engagement with a counselor was assessed by successful call connection, call duration, and information sharing.

RESULTS

Ninety-four percent of calls resulted in a successful call transfer, and the majority of youth (84%) shared information with counselor about one or more coping strategies. Average call length was 12.6 min (SD = 9.9). Engagement did not vary by gender, race, age, ethnicity, or clinical characteristics.

CONCLUSIONS

Adolescents' engagement with telephone risk-management services was strong, suggesting that this strategy can address safety. Further, findings suggest telephone risk-management services effectively engage youth across demographic and clinical subgroups.

Comparison of the utility of the PHQ and CES-D for depression screening among youth with HIV in an integrated care setting

BACKGROUND

Depressive symptoms are well documented among people living with HIV and some evidence suggests that youth living with HIV (YLWH) are more affected than their adult counterparts. Therefore, screening for depression is imperative among YLWH to ensure optimal health. The objective of this study is to compare the utility of the Center for Epidemiological Studies-Depression (CES-D) and the Patient Health Questionnaire (PHQ) as depression screeners in an integrated care setting serving YLWH in the southeastern United States.

METHODS

As a part of standard care, the CES-D and the PHQ were administered to YLWH. A Retrospective review of patient records was conducted. Using receiver operating characteristic (ROC) curve analysis and reports from mental health providers, researchers compared the utility of the screeners.

RESULTS

The sample consisted of 121 cases from 2017. Youth ranged in age from 12-25 (M = 20.68, SD = 2.75). Most were Black/African American (59.5%) males (56.2%) who acquired HIV behaviorally (51.2%). Sexual orientation was nearly evenly split between heterosexual (37.2%) and homosexual (34.7%). The CES-D demonstrated higher specificity and sensitivity for identifying clinical depression, yet, this was not significantly different from the PHQ, p = .09.

LIMITATIONS

Generalizability of findings may be limited as the study sample included youth from a single integrated care setting.

CONCLUSION

Both the PHQ and the CES-D demonstrate utility for depression screening among YLWH. However, the PHQ may be preferable for use within a clinical setting.

Racial/ethnic disparities in cortisol diurnal patterns and affect in adolescence

Racial/ethnic minorities are more vulnerable to mental and physical health problems, but we know little about the psychobiological underpinnings of these disparities. In this study, we examined racial/ethnic differences in cortisol diurnal patterns and affect as initial steps toward elucidating long-term health disparities. A racially/ethnically diverse (39.5% White, 60.5% minority) sample of 370 adolescents (57.3% female) between the ages of 11.9 and 18 years (M = 14.65 years, SD = 1.39) participated in this study. These adolescents provided 16 cortisol samples (4 samples per day across 4 days), allowing the computation of diurnal cortisol slopes, the cortisol awakening response, and diurnal cortisol output (area under the curve), as well as daily diary ratings of high-arousal and low-arousal positive and negative affect. Consistent with prior research, we found that racial/ethnic minorities (particularly African American and Latino youth) exhibited flatter diurnal cortisol slopes compared to White youth, F (1, 344.7) = 5.26, p = .02, effect size g = 0.25. Furthermore, African American and Asian American youth reported lower levels of positive affect (both high arousal and low arousal) compared to White youth. Racial/ethnic differences in affect did not explain differences in cortisol patterns, suggesting a need to refine our models of relations between affect and hypothalamic-pituitary-adrenocortical activity. We conclude by proposing that a deeper understanding of cultural development may help elucidate the complex associations between affect and hypothalamic-pituitary-adrenocortical functioning and how they explain racial/ethnic differences in both affect and stress biology.

Screening for depression among youth with HIV in an integrated care setting

Youth living with HIV (YLWH) are at risk for depression. Depressive symptoms can impact treatment engagement, health outcomes, and quality of life. Early identification of symptoms can guide treatment planning. This study aimed to identify trends in depressive symptoms for YLWH in a specialty-care clinic and follow-up clinical treatment procedures. An archival review of a clinical database provided depression screening information for a sample of 130 YLWH between 11 and 25 years old in the southeastern United States. Findings indicated that approximately 24% of the sample screened positive for depression-risk. Most commonly endorsed symptoms included fatigue (54.3%) and sleep difficulties (48.5%). Depressive symptoms did not differ significantly by age, gender, race, ethnicity, or sexual orientation. Youth who acquired HIV behaviorally were more likely to endorse the critical item (i.e., self-harm and/or suicidal ideation) than youth who acquired HIV perinatally. Forty-percent of the sample (i.e., 51 youth) had a follow-up treatment plan. YLWH who endorsed the critical item were more likely to receive follow-up action when compared to those who did not endorse the item. Despite limitations of the study, findings have important implications for clinical care and future research.

Trans fatty acid intake and emotion regulation

We examined whether there is a relationship between trans fatty acid intakes and emotion regulation, mediated by positive or negative affect. Archival data on 1699 men and 3293 women were used to measure trans fatty acid intake at baseline, positive, and negative affects and emotion regulation at follow-up. Higher trans fatty acid intake related to subsequent difficulties with emotional awareness (p = 0.045), clarity (p = 0.012), and regulation strategies (p = 0.009). Affect mediated these relationships. Lower trans fatty acid intake associated with increased positive and decreased negative affects which, in turn, associated with improved emotion regulation. Trans fatty acid intakes may be associated with subsequent ability to regulate emotions.

Delinquent and Aggressive Behavior and Social Desirability Among Roma and Non-Roma Adolescents in Slovakia: A Cross-Sectional Study

Rates of aggression and delinquency are assumed to be higher among Roma and other minorities, but sound evidence of this is lacking. Our aim was to assess delinquent and aggressive behavior among Roma and non-Roma adolescents and the effects on ethnic differences of parental education and social desirability. We conducted a cross-sectional study among Roma from separated and segregated settlements in the eastern part of Slovakia (N = 330; Mage = 14.50; interview) and non-Roma adolescents (N = 722; Mage = 14.86; questionnaire). The effect of ethnicity on antisocial behaviors was analyzed using linear regression (crude) and adjusted for gender, parental education, and social desirability. Adjustment for social desirability diminished the ethnic differences in delinquency (B = 1.08; 95% confidence interval [CI] = [2.12, -0.04]), led to an increase in the differences in hostility (B = 2.43; 95% CI = [0.87, 3.99]), and led to the disappearance of differences in physical aggression (B = 0.45; 95% CI = [1.14, 2.07]). Parental education did not affect the associations in an important way. Our findings indicate that Roma are not that much different from non-Roma, in terms of antisocial behavior, which contradicts the general perception of Roma. Our findings should be confirmed in other settings.

The mediating effect of discrimination, social support and hopelessness on self-rated health of Roma adolescents in Slovakia

Background

According to the EU-MIDIS report on discrimination, Roma are the most discriminated against group in Europe. Research suggests that experiencing discrimination may itself be detrimental to health. The aim of this paper is to investigate whether discrimination, hopelessness and social support mediate differences in self-rated health (SRH) between Roma and non-Roma adolescents.

Methods

We conducted a cross-sectional study among Roma from separated and segregated settlements in the eastern part of Slovakia (N = 330; mean age = 14.50; interview) and non-Roma adolescents (N = 722; mean age = 14.86; questionnaire); only non-missing data were used for analyses (n = 759). The effect of perceived discrimination, mother and father social support, and hopelessness on SRH was analysed as crude and adjusted for ethnicity, age, gender, parental education and social desirability. Mediating effects were separately assessed using the Sobel test and structural equation modelling.

Results

Roma adolescents reported poorer SRH and more discrimination, mother and father social support, hopelessness and social desirability. Roma ethnicity (Odds ratio/95 %-Confidence interval 3.27/2.40–4.47), discrimination (2.66/1.82–3.88), hopelessness (1.35/1.20–1.51) and mother (0.92/0.88–0.97) and father social support (0.96/0.93 – 0.997) were statistically significant predictors of poor SRH. Perceived discrimination, social support and hopelessness mediated the ethnicity-health association, with adjustment for social support increasing its strength and the other two variables decreasing it.

Conclusions

Perceived discrimination, social support and hopelessness mediate a part of the association between Roma ethnicity and poor SRH, with discrimination and hopelessness being risk factors and social support a protective factor.

Gender, Ethnicity, and Their Intersectionality in the Prediction of Smoking Outcome Expectancies in Regular Cigarette Smokers

The current study utilized the intersectionality framework to explore whether smoking outcome expectancies (i.e., cognitions about the anticipated effects of smoking) were predicted by gender and ethnicity, and the gender-by-ethnicity interaction. In a cross-sectional design, daily smokers from the general community (32.2% women; non-Hispanic African American [n = 175], non-Hispanic White [n = 109], or Hispanic [n = 26]) completed self-report measures on smoking expectancies and other co-factors. Results showed that women reported greater negative reinforcement (i.e., anticipated smoking-induced negative affect reduction) and weight control (i.e., anticipated smoking-induced appetite/weight suppression) expectancies than men. Hispanic (vs. African American or White) smokers endorsed greater negative reinforcement expectancies. A gender-by-ethnicity interaction was found for weight control expectancies, such that White women reported greater weight control expectancies than White men, but no gender differences among African American and Hispanic smokers were found. These findings suggest that gender, ethnicity, and their intersectionality should be considered in research on cognitive mechanisms that may contribute to tobacco-related health disparities.

Mother and father socially desirable responding in nine countries: Two kinds of agreement and relations to parenting self-reports

We assessed 2 forms of agreement between mothers' and fathers' socially desirable responding in China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand and the United States (N = 1110 families). Mothers and fathers in all 9 countries reported socially desirable responding in the upper half of the distribution, and countries varied minimally (but China was higher than the cross-country grand mean and Sweden lower). Mothers and fathers did not differ in reported levels of socially desirable responding, and mothers' and fathers' socially desirable responding were largely uncorrelated. With one exception, mothers' and fathers' socially desirable responding were similarly correlated with self-perceptions of parenting, and correlations varied somewhat across countries. These findings are set in a discussion of socially desirable responding, cultural psychology and family systems.

Negative affectivity, emotion regulation, and coping in migraine and probable migraine: a New Zealand case-control study

BACKGROUND

Migraine is a prevalent and disabling health condition. While there have been some suggestions that personality may be linked to migraine incidence, dose-response links to disability or impact are yet to be conducted and multivariate analyses are uncommon.

PURPOSE

The purposes of this study are to evaluate the personality characteristics differentiating migraine and probable migraine sufferers from matched controls in multivariate models and assess the possibility of a dose-response relationship.

METHODS

Fifty migraine sufferers and 50 age-, sex-, and ethnicity-matched controls in New Zealand completed personality measures including negative affectivity, coping, and monitoring-blunting.

RESULTS

Logistic regressions indicated that migraine status was concurrently predicted by Type D negative affectivity, more frequent venting and planning coping, and lower monitoring. There was little evidence to suggest a consistent dose-response type effect of personality on migraine; lower impact and disability were associated with greater openness to experiences, acceptance, and behavioural disengagement.

CONCLUSIONS

A personality profile characterised by moderate levels of negative emotion and irritability together with failures in inhibitory self-regulation may be associated with an increased risk of strict and probable migraine.

Perceived parental reactions to adolescent distress: development and validation of a brief measure

Although adolescence is a time of individuation with increased reliance on peers, research indicates that, despite a deliberate distancing from parents, adolescents continue to seek the support and console of parental attachment figures in times of distress. The Perceived Parental Reactions to Adolescent Distress (PRAD) is a brief self-report measure developed to examine adolescents' perception of parental response under conditions of distress as measured by four conceptually and empirically distinct parental reactions to distress: Comfort, Self-Focus, Avoidance and Harshness. Across two studies involving a total of 738 high school students, we developed the PRAD and substantiated its robust psychometric properties, including evidence for reliability as well as internal and criterion validity. Sources of individual differences in the test-scores were also explored. Empirical as well as practical importance of assessing parental reactions to adolescent distress is discussed with regard to both the attachment and adolescent development literature.

Social support, hopelessness and life satisfaction among Roma and non-Roma adolescents in Slovakia

OBJECTIVES

Evidence on the psychosocial determinants of health among Roma adolescents is completely lacking. Our aim was to compare social support, life satisfaction and hopelessness of Slovak Roma and non-Roma adolescents and to assess the impact of parental education and social desirability on these differences.

METHODS

We conducted a cross-sectional study among Roma from settlements in the eastern part of Slovakia (N = 330; mean age = 14.50; interview) and non-Roma adolescents (N = 722; mean age = 14.86; questionnaire). The effect of ethnicity on social support, life satisfaction and hopelessness was analysed using linear regression, adjusted for gender, parental education and social desirability.

RESULTS

Roma adolescents reported higher social support from parents, higher life satisfaction and higher hopelessness rates. Parental education explained part of the ethnic differences, as did social desirability. After adjustment for the aforementioned factors, differences by ethnicity remained statistically significant.

CONCLUSIONS

Roma adolescents experience higher levels of social support, life satisfaction and hopelessness than non-Roma adolescents. Reduction of hopelessness feelings while maintaining levels of social support and life satisfaction among Roma adolescents should be a topic for both intervention and further research.

Adolescent suicide risk screening: the effect of communication about type of follow-up on adolescents' screening responses

This experimental study examined the effect of communication about type of screening follow-up (in-person follow-up vs. no in-person follow-up) on adolescents' responses to a self-report suicide risk screen. Participants were 245 adolescents (131 girls, 114 boys; ages 13-17; 80% White, 21.6% Black, 9.8% American Indian, 2.9% Asian) seeking medical emergency services. They were randomized to a screening follow-up condition. Screening measures assessed primary risk factors for suicidal behavior, including suicidal thoughts, depressive symptoms, alcohol use, and aggressive/delinquent behavior. There was no main effect of follow-up condition on adolescents' screening scores; however, significant interactions between follow-up condition and public assistance status were evident. Adolescents whose families received public assistance were less likely to report aggressive-delinquent behavior if assigned to in-person follow-up. Adolescents whose families did not receive public assistance reported significantly higher levels of suicidal ideation if assigned to in-person follow-up. Findings suggest that response biases impact some adolescents' responses to suicide risk screenings. Because national policy strongly recommends suicide risk screening in emergency settings, and because screening scores are used to make critical decisions regarding risk management and treatment recommendations, findings indicate the importance of improving the reliability and validity of suicide risk screening for adolescents.

A prospective cohort study of modifiable risk factors for gestational diabetes among Hispanic women: design and baseline characteristics

OBJECTIVES

Women diagnosed with gestational diabetes mellitus (GDM) are at high risk for future diabetes, with rates of GDM consistently higher in Hispanic than non-Hispanic white women. Currently recognized risk factors for GDM are absent in up to half of affected women, and studies addressing modifiable risk factors for GDM in Hispanic women are sparse.

METHODS

Proyecto Buena Salud is an ongoing prospective cohort study of Hispanic women in Massachusetts designed to assess physical activity, psychosocial stress, and GDM risk. Bilingual interviewers recruit prenatal care patients early in pregnancy and assess activity, trait anxiety, perceived stress, and depressive symptoms using validated questionnaires.

RESULTS

Baseline characteristics of the first 632 participants are presented. Women were predominantly young (69% <24 years), were unmarried (87%), and had low levels of education (48% had less than high school). Women with high acculturation were less likely to live with a partner (OR: 0.6, 95% CI 0.4-0.8) than women with low acculturation. Few participants met physical activity guidelines during pregnancy (5.2%). Levels of perceived stress (mean 26.9 +/- 7.1), trait anxiety (mean 41.6 +/- 10.4), and depressive symptoms (33.2%) were high.

CONCLUSIONS

Proyecto Buena Salud represents a high-risk population of pregnant Hispanic women who are predominantly inactive, with higher levels of perceived stress, trait anxiety, and depressive symptoms compared to predominantly non-Hispanic white cohorts studied earlier. Therefore, Proyecto Buena Salud provides a unique opportunity to prospectively evaluate modifiable risk factors for GDM. Findings will inform prenatal behavioral intervention programs designed to address modifiable GDM risk factors.

Risk factors for prenatal depressive symptoms among Hispanic women

Prior studies of risk factors for depressive symptoms during pregnancy are sparse and the majority have focused on non-Hispanic white women. Hispanics are the largest minority group in the US and have the highest birth rates. We examined associations between pre and early pregnancy factors and depressive symptoms in early pregnancy among 921 participants in Proyecto Buena Salud, an ongoing cohort of pregnant Puerto Rican and Dominican women in Western Massachusetts. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (mean=13 weeks gestation) by bilingual interviewers who also collected data on sociodemographic, acculturation, behavioral, and psychosocial factors. A total of 30% of participants were classified as having depressive symptoms (EPDS scores>12) with mean+SD scores of 9.28+5.99. Higher levels of education (college/graduate school vs. <high school: RR=0.60, 95% CI 0.41-0.86), household income (Ptrend=0.02), and living with a spouse/partner (0.80; 95% CI 0.63-1.00) were independently associated with lower risk of depressive symptoms. There was the suggestion that failure to discontinue cigarette smoking with the onset of pregnancy (RR=1.32; 95% CI 0.97-1.71) and English language preference (RR=1.33; 95% CI 0.96-1.70) were associated with higher risk. Single marital status, second generation in the U.S., and higher levels of alcohol consumption were associated with higher risk of depressive symptoms in univariate analyses, but were attenuated after adjustment for other risk factors. Findings in the largest, fastest-growing ethnic minority group can inform intervention studies targeting Hispanic women at risk of depression in pregnancy.

The Affective Paradox

Despite generally more challenging developmental, environmental, economic, health, and social contexts, minority populations in the United States often report a lower frequency of many negative affects. In some views, such findings reflect a reporting or response bias among minority groups. However, an alternate view suggests that reports of negative emotion differ because minorities do not consciously experience certain discrete emotions as frequently. A study of 1,364 women from six ethnic subpopulations tested this thesis using trait anger as an exemplar. As expected, linear regressions demonstrated that while social desirability explained some ethnic variance in anger reports, a measure of repressive coping explained additional variance in trait anger and eliminated ethnic effects; social desirability no longer predicted trait anger once repressive coping was controlled. Results are discussed in terms how of how developmentally oriented, emotion regulation theories may supplement reporting bias conceptualizations of affective differences across ethnic groups. Implications and directions for future research are given.

The many faeces of colorectal cancer screening embarrassment: preliminary psychometric development and links to screening outcome

OBJECTIVES

Although embarrassment may be among the most easily modified discrete emotional barriers to patients seeking health care or testing, work in the area of colorectal cancer (CRC) has been restricted by the absence of suitable instrumentation. The current report describes the development and validation of a self-report instrument assessing two specific aspects of CRC screening embarrassment and their links to screening outcomes.

DESIGN

Convenience sampling was used to recruit 245 European American, African-American, and immigrant Caribbean community-dwelling men and women (aged 45-75 years) living in Brooklyn, New York.

METHODS

Participants completed the measure of CRC screening embarrassment, an array of convergent and divergent validity measures including dispositional embarrassment, general medical embarrassment, neuroticism, trait emotion, social desirability, previous treatment avoidance because of embarrassment, relevant health characteristics, and a brief CRC screening history.

RESULTS

As expected, CRC screening embarrassment was not unidimensional and had two reliable and distinct components, one concentrated on faecal/rectal embarrassment and the other on embarrassment arising from unwanted intimacy during examinations. In addition to demonstrating patterns of convergent and divergent validity consistent with their separation, multivariate analyses indicated that faecal/rectal embarrassment (but not intimacy concerns) predicted CRC screening frequency.

CONCLUSIONS

The current report extends current understanding by identifying the specific sources of embarrassment that may contribute to patients' avoidance of CRC screening. Directions for future study and implications for clinical practice and interventions are discussed.

Endothelial function: the impact of objective and subjective socioeconomic status on flow-mediated dilation

BACKGROUND

Although objective and subjective indicators of socioeconomic status (SES) are linked to cardiovascular disease (CVD), little is known about their relationship to endothelial dysfunction, which often precedes CVD.

PURPOSE

This study examined how objective and subjective SES relate to brachial artery flow-mediated dilation (FMD).

METHODS

FMD was assessed in 72 healthy adults (mean age 36 years). The MacArthur Scale of Subjective Social Status assessed perceived social standing in the USA (SSS-USA) and local community (SSS-Community). Objective SES measures included income and the Hollingshead Two-Factor Index of Social Position (education, occupation).

RESULTS

Adjusted regressions revealed that SSS-Community positively correlated with FMD (p < 0.05) and explained 8% of the variance. No other SES measures were significant for FMD. The association between FMD and SSS-Community remained significant (p < 0.01) after adjustment for objective SES and other covariates.

CONCLUSIONS

Lower subjective social status in one's community may be linked to CVD via impaired vasodilation.

Sleep health in U.S. Hispanic population

The importance of sleep on health has only been recently recognized, and the general public and the medical community are not yet fully knowledgeable about this issue. The great majority of sleep research has been performed in whites of European descent and to a lesser extent in African Americans, making generalization of the findings to other ethnic and racial groups difficult. Very little sleep research has been done in U.S. Hispanics. However, based on the available literature and the high prevalence of risk factors in Hispanics, such as obesity, diabetes, living in the inner city, and use of alcohol, the prevalence of such important sleep disorders such as obstructive sleep apnea and sleep habits such as poor sleep hygiene are suspected to be high. There is also some evidence that acculturation to the U.S. life style may lead to worse sleep habits in Hispanics, including fewer hours of sleep. Two current large NIH sponsored studies of sleep in U.S. Hispanics promise to significantly add to the literature on various sleep disorders such as sleep disordered breathing, insomnia, restless legs syndrome, periodic limb movement disorder, and sleep habits such as short sleep duration and sleep hygiene.

Everyday discrimination and nocturnal blood pressure dipping in black and white americans

OBJECTIVE

To investigate whether an association exists between experiences of everyday discrimination and blood pressure (BP) dipping in a biracial sample of black and white adults. Attenuated nocturnal BP dipping is closely linked to cardiovascular morbidity and mortality. Self-reported experiences of everyday discrimination have also been associated with negative cardiovascular health outcomes.

METHODS

Seventy-eight hypertensive and normotensive women and men (n = 30 black and 48 white) reported on their experiences of everyday discrimination (Everyday Discrimination Scale) and underwent two separate 24-hour ambulatory BP monitoring (ABPM) sessions approximately 1 week apart.

RESULTS

Correlation analysis revealed that higher endorsement of everyday discrimination was significantly associated with less diastolic BP (DBP) and systolic BP (SBP) dipping (p < .05). Subsequent hierarchical regression analyses indicated that everyday discrimination explained 8% to 11% of the variance in SBP and DBP dipping above and beyond other demographic and life-style-related factors, including race, age, 24-hour BP, body mass index, and current socioeconomic status. The relationship between discrimination and dipping was significantly stronger on the second night of monitoring. Finally, analyses revealed that everyday discrimination mediated the relationship between race and BP dipping.

CONCLUSIONS

These findings suggest that experiences of everyday discrimination are associated with less nocturnal SBP and DBP dipping above and beyond the effect of known covariates. The use of multiple ABPM sessions may facilitate the detection of relationships between psychological variables and BP dipping.

Adverse impact of mood on flow-mediated dilation

OBJECTIVE

To examine the impact of mood states on endothelial function, as measured noninvasively by brachial artery flow-mediated dilation (FMD). Substantial literature indicates that negative mood is linked to cardiovascular disease (CVD). However, the mechanisms underlying this relationship are not well defined. CVD is often preceded by dysfunction of the endothelium.

METHODS

Healthy adults (n = 70; mean age, 36 years) completed the Profile of Mood States (POMS), which contains six subscales (depression/dejection; tension/anxiety; anger/hostility; confusion/bewilderment; fatigue/inertia; vigor/activity) that are used to compute a total mood disturbance score for overall psychological distress. FMD was calculated (maximum percentage change in brachial artery diameter) from ultrasound assessment of arterial diameter at baseline and for 10 minutes after occlusion.

RESULTS

Regressions showed that increases in POMS total mood disturbance scores were associated with decreases in endothelial function. Mood disturbance explained 10% of the variance in FMD (p < .01), after controlling for age, sex, mean arterial pressure, body mass index, and socially desirable response bias. An exploratory set of separate regressions conducted to decompose the link between FMD and total mood disturbance revealed that the following POMS subscales were inversely correlated with FMD: depression/dejection, tension/anxiety, anger/hostility, fatigue/inertia (p's < .05), and confusion/bewilderment (p < .01).

CONCLUSIONS

Mood disturbance could contribute to CVD via impaired vasodilation. These preliminary results show that even mild levels of adverse psychological states, particularly depressed, anxious, angry, confused, and fatigued states, might be linked to increased cardiovascular risk.

The effects of ethnic discrimination and socioeconomic status on endothelin-1 among blacks and whites

BACKGROUND

Ethnic disparities in cardiovascular disease (CVD) may partially reflect differences in chronic stress burden that vary by social class and exposure to ethnic discrimination. Stress is associated with increased endothelin-1 (ET-1). This study examined the relationship of ET-1 to socioeconomic status (SES) and to perceived ethnic discrimination among black (n = 51) and white (n = 65) adults (mean age 36.5).

METHODS

The Perceived Discrimination subscale of the Scale of Ethnic Experience measured exposure to discrimination and the Hollingshead Two-Factor Index of Social Position assessed SES. Plasma ET-1 was sampled upon awakening after an overnight admission.

RESULTS

SES and ET-1 levels were similar across ethnic groups, but mean discrimination scores were higher among blacks than whites (P < 0.001). Multiple regressions found that the SES x ethnicity interaction was associated with ET-1 (P < 0.05), after adjustment for gender, resting mean arterial pressure (MAP), body mass index (BMI), and exercise frequency. Regressions stratified by ethnicity revealed that lower SES correlated with higher ET-1 in whites (P < 0.001), but not blacks, and accounted for 21% of the variance. Another series of regressions revealed an interaction effect of ethnicity by discrimination on ET-1 (P < 0.05). Increased discrimination correlated with increased ET-1 among blacks (P < 0.05), but not whites, and explained 11% of the variance after adjustment for SES, gender, exercise frequency, and socially desirable response bias.

CONCLUSIONS

Thus, ET-1 levels increased in association with different psychosocial burdens in blacks and whites. Plasma ET-1 was higher among whites with lower SES and among blacks with higher levels of perceived ethnic discrimination, regardless of SES.

Race and the validity of self-reported cancer screening behaviors: development of a conceptual model

BACKGROUND

Many estimates of cancer screening are based on self-reported screening behavior. There is growing concern that self-reported screening measures may be less accurate among members of racial and ethnic minority groups. This would have considerable implications for research on racial and ethnic disparities in cancer screening.

OBJECTIVES

To review the literature on the relationship between race/ethnicity and the accuracy of self-reported cancer screening behavior and develop a conceptual framework that would provide a deeper understanding of factors underlying this relationship.

METHODS

We developed a conceptual framework drawing from diverse literatures including validation studies examining the accuracy of self-reported cancer screening behaviors and articles on survey response bias.

RESULTS AND CONCLUSIONS

Evidence suggests that racial and ethnic minorities may be less likely to provide accurate reports of their cancer screening behavior and that overreporting may be particularly problematic. Research conducted in other areas suggests that these sources of measurement error may stem from cognitive and motivational processes and that they can be moderated by question wording and data collection characteristics. At this point, however, the quality of the evidence is not strong and more research is needed before definitive conclusions can be drawn.

Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment: psychometric development and links to treatment-seeking outcomes

OBJECTIVES

Understanding why people do not always engage in medical examinations that might benefit them is a public health issue which is receiving increased attention. One area of promise involves the study of medical embarrassment, although current studies are weakened in that they measure medical embarrassment in a theoretically naïve and unidimensional manner and have assumed that embarrassment is exclusively a barrier to the timely seeking of treatment.

DESIGN

Convenience sampling was used to recruit 116 male and 134 female students (mean age = 19.94 years, 47.2% Caucasian, 20.4% African-American, 32.4% Asian) from two large universities in different parts of the United States.

METHODS

Participants completed a comprehensive measure of medical embarrassment, reported on previous treatment avoidance because of embarrassment, and recorded the frequency of psychological, general and sex-related visits across the previous 5 years.

RESULTS

As expected, medical embarrassment was not unidimensional and appeared to have two distinct factors--bodily embarrassment and judgment concern. Bodily embarrassment generally predicted less frequent medical contact although not equally so across domains and it interacted with judgment concern in several cases, providing preliminary evidence that there are situations in which aspects of medical embarrassment may actually facilitate greater medical contact.

CONCLUSIONS

The data highlight the importance of considering the role of emotions other than fear in health behaviour and the means by which they may facilitate or deter the timely seeking of diagnosis and treatment.

Racial/ethnic differences in cortisol diurnal rhythms in a community sample of adolescents

PURPOSE

To identify potential physiological pathways to racial disparities in health outcomes, this study uses cortisol data collected from a community sample of 255 adolescents to examine whether there are racial/ethnic differences in cortisol slopes and levels across the waking day in naturalistic settings.

METHODS

This study uses salivary cortisol data (sampled five times per day over 3 days) to examine racial/ethnic differences in diurnal cortisol rhythms, while covarying the presence of major depressive disorder and chronic and episodic life stress (assessed by structured interviews), momentary negative emotion (reported in diaries completed with cortisol samples), and socioeconomic status, sleep, and health variables (assessed by questionnaire) previously found to be associated with cortisol levels.

RESULTS

African-American and Hispanic youth were found to have flatter cortisol slopes across the waking day than their Caucasian counterparts. Differences are due to higher bedtime cortisol levels among Hispanics and to both lower wakeup and higher bedtime levels among African-Americans. Although higher levels of negative emotion were associated with flatter diurnal rhythms, the socioenvironmental factors examined failed to explain the observed racial/ethnic differences in diurnal cortisol rhythms.

CONCLUSIONS

Significantly flatter diurnal cortisol slopes were found among African American and Hispanic adolescents, a pattern which has been related to negative health consequences. Further research is needed to examine how early these differences emerge and to identify their developmental origins. Although genetic contributions are possible, greater prenatal stress exposure, low birth weight, adverse early childhood experiences, experiences with racism or discrimination, and lifetime history of chronic stress are all reasonable psychosocial hypotheses to pursue.

Fatigue varies by social class in African Americans but not Caucasian Americans

Socioeconomic status explains many ethnic disparities in health; however, mechanisms are hard to identify. Fatigue-a frequent complaint in patients and normals-is associated with poorer quality of life. We wondered if ethnicity and social class interact to explain fatigue. A total of 40 African Americans (AAs) and 64 Caucasian Americans (CAs) completed short forms of the Profile of Mood States (POMS-SF) and Multidimensional Fatigue Symptom Inventory (MFSI-SF). Participants were divided into high-middle and low social class groups (as per Hollingshead, 1958a). After controlling for gender, body mass index, depressive symptoms, and response bias, ethnicity and social class interacted for POMS-SF fatigue. AAs in the high-middle classes reported more fatigue than AAs in the low classes and CAs in the high-middle classes. Fatigue did not differ by class for CAs nor by ethnicity in the lower classes. Similar findings emerged for MFSI-SF general fatigue. Social class is important for understanding fatigue in AAs but not CAs.

Ethnic Variation in the Impact of Emotion and Emotion Regulation on Health: A Replication and Extension

Although emotions and patterns of emotion regulation are central to models linking personality and health, the generalizability of these models to diverse populations of older adults remains untested. In this study, 1,364 community-dwelling women (aged 50-70 years) from six ethnic groups completed self-report measures of trait anger, inhibition, defensiveness, and health. As expected, reports of trait anger and emotion inhibition predicted poorer health (and defensiveness better health), even when demographics and health behaviors were controlled. However, these characteristics related to outcome differently across ethnic groups; greater anger was related to better health in all groups other than U.S-born European Americans, and increased emotion inhibition was associated with better health among immigrant Eastern European women. Results are discussed within a contextualistic model of emotions and health, and directions for future research are given.