Cultural differences in access to care

Development and Usability of a Mobile Support Application for Sexual Violence Victims Connecting With Formal Support Organizations

The lack of awareness and accessibility about the support organizations for preventing sexual violence and assisting victims hampers the effectiveness of the social safety net. A mobile application based on a connection to support agencies was developed and evaluated for usability. A group of 15 experts and a group of 30 users evaluated usability. The developed mobile application focused on "Emergency Report," "Support Agencies and Services," and "Counseling for Support." The strength of the application was acknowledged in providing easy-to-find, reliable, useful, and necessary information, highlighting the positive usability and applicability of the mobile support application for sexual violence victims.

Neurosurgical Outcomes Among Non-English Speakers: A Systematic Review and a Framework for Future Research

OBJECTIVE

In 2019, 22% of adults in the United States reported speaking a language other than English at home, representing 52% growth since 2000. This diversity in languages - and resulting possible communication barriers - represents a potential challenge to effective care. In this manuscript, we summarize clinical outcomes and healthcare utilization patterns of adult and pediatric neurosurgical patients who are non-English primary language speakers (NEPLS).

METHODS

We systematically queried 5 databases from inception through October 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify studies for inclusion. The Newcastle-Ottawa Scale was used to assess the quality of studies. Additionally, a retrospective chart review was conducted to assess differences in postoperative communication patterns in a cohort of English and Spanish speaking patients with craniosynostosis at our institution.

RESULTS

Our search yielded 442 abstracts; ten were included in the final cohort. Outcomes for 973 unique NEPLS with a neurosurgical condition were included; Spanish was the most represented language. Delivery and timing of surgical treatment was the most frequently reported metric; 75% of studies demonstrated a statistically significant delay in time to surgery or decreased likelihood for NEPLS to receive surgical treatment. Length of stay was reported in 3 studies; all demonstrated that NEPLS had longer length of stay.

CONCLUSIONS

There is a paucity of literature reporting outcomes among NEPLS. It is critical to examine NEPLS patients' outcomes and experiences, as language barriers are potentially modifiable demographic factors. We present a framework that demonstrates opportunities for further research to improve quality of care.

Adaptation models, barriers, and facilitators for cultural safety in telepsychiatry: A systematic scoping review

Introduction: Indigenous peoples, and racial and ethnic minorities around the world experience significant mental health inequities. Telepsychiatry can contribute to addressing these inequities among these populations. However, it is first crucial to ensure the cultural safety of this tool as a critical step toward health equity. This review aimed to collate evidence regarding cultural adaptations, barriers, opportunities, and facilitators for telepsychiatry services supporting minority groups. Method: Using the PRISMA extension for scoping reviews (PRISMA-ScR) guideline, we conducted a systematic scoping review and thematic analysis. Six databases were searched using the PICO framework, i.e., population, intervention, comparison, and outcomes.. Additional literature was identified through reference lists screening. We developed a table for data extraction, and the extracted data were further analyzed following Braun and Clarke's approach for thematic analysis. Results: A total of 1514 citations were screened with a final total of 58 articles included in the review. The themes related to telepsychiatry cultural adaptations emphasize the crucial role of community involvement and quality service delivery. Identified barriers were associated with service and infrastructure, and service users' socioeconomic and cultural contexts. Opportunities and facilitators for telepsychiatry were enhanced access and rapport, and multi-organizational collaborations and partnerships. Discussion: This review identified factors that can guide the adaptation of telepsychiatry evidence-based interventions to meet the needs of Indigenous peoples and racial and ethnic minorities. Telepsychiatry programs must be specifically designed for the population they seek to serve, and this review offers emerging insights into critical factors to consider in their development.

Cultural context index: A geospatial measure of social determinants of health in the United States

Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot and cold spots that are the highest and lowest CCI quintile, respectively. Hot spots census tracts were mostly located in metropolitan areas (84.8%), in the Southern census region (41.5%), and also had larger Black and Hispanic populations. The census tracts with the greatest need for culturally competent health care also had the sickest populations. Census tracts with a CCI rank of 5 ('greatest need') had higher prevalences of self-reported poor physical health (17.2%) and poor mental health (17.4%), compared to either the general population (13.9% and 14.5%) or to CCI rank of 1 ('lowest need') (11.9% and 10.8%). The CCI can pinpoint census tracts with a need for culturally competent health care and inform supply-side policy planning as healthcare and social service providers will inevitably come in contact with consumers from different backgrounds.

Engaging Black youth in depression and suicide prevention treatment within urban schools: study protocol for a randomized controlled pilot

BACKGROUND

Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City.

METHODS

A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use.

DISCUSSION

This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample.

TRIAL REGISTRATION

Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508.

Racial Differences in Self-Report of Mental Illness and Mental Illness Treatment in the Community: An Analysis of Jail Intake Data

Jails and prisons in the United States house people with elevated rates of mental health and substance use disorders. The goal of this cross-sectional study was to evaluate the frequency of racial/ethnic differences in the self-report of mental illness and psychiatric medication use at jail entry. Our sample included individuals who had been incarcerated between 2016 and 2020 at the Middlesex Jail & House of Correction, located in Billerica, MA. We used data from the "Offender Management System," the administrative database used by the jail containing data on people who are incarcerated, and COREMR, the electronic medical record (EMR) used in the Middlesex Jail & House of Correction. We evaluated two primary outcomes (1) self-reported mental illness history and (2) self-reported use of psychiatric medication, with the primary indicator of interest as race/ethnicity. At intake, over half (57%) of the sample self-reported history of mental illness and 20% reported the use of psychiatric medications. Among people who self-reported a history of mental illness, Hispanic (AOR: 0.73, 95% CI: 0.60-0.90), Black (AOR: 0.52, 95% CI: 0.43-0.64), Asian/Pacific Islander (Non-Hispanic) people (AOR: 0.31, 95% CI: 0.13-0.74), and people from other racial/ethnic groups (AOR: 0.33, 95% CI: 0.11-0.93) all had decreased odds of reporting psychiatric medications. Mental illness was reported in about one-half of people who entered jail, but only 20% reported receiving medications in the community prior to incarceration. Our findings build on the existing literature on jail-based mental illness and show racial disparities in self-report of psychiatric medications in people who self-reported mental illness. The timing, frequency, and equity of mental health services in both the community and the jail setting deserves further research, investment, and improvement.

Self-reported anxiety and depression problems and suicide ideation among black and latinx adults and the moderating role of social support

Suicide is a critical public health problem. Over the past decade, suicide rates have increased among Black and Latinx adults in the U.S. Though depression is the most prevalent psychiatric contributor to suicide risk, Black and Latinx Americans uniquely experience distress and stress (e.g., structural adversity) that can independently operate to worsen suicide risk. This makes it important to investigate non-clinical, subjective assessment of mental health as a predictor of suicide ideation. We also investigate whether social support can buffer the deleterious impact of poor mental health on suicide ideation.We analyzed data from 1,503 Black and Latinx participants of the Washington Heights Community Survey, a 2015 survey of residents of a NYC neighborhood. Multivariable logistic regression was conducted to examine the effect of subjectively experienced problems with anxiety and depression on suicide ideation independent of depression diagnosis, and the role of social support as a moderator.Estimated prevalence of past two-week suicide ideation was 5.8%. Regression estimates showed significantly increased odds of suicide ideation among participants reporting moderate (OR = 8.54,95% CI = 2.44-29.93) and severe (OR = 16.84,95% CI = 2.88-98.46) versus no problems with anxiety and depression, after adjustment for depression diagnosis. Informational support, i.e., having someone to provide good advice in a crisis, reduced the negative impact of moderate levels of anxiety and depression problems on suicide ideation.Findings suggest that among Black and Latinx Americans, subjective feelings of anxiety and depression account for a significant portion of the suicide ideation risk related to poor mental health. Further, social support, particularly informational support, may provide protection against suicide ideation.

Exploring graduate student mental health and service utilization by gender, race, and year in school

OBJECTIVE

The current study explored differences in mental health problems, services utilization, and support of graduate students by gender, race/ethnicity, and year in school.

PARTICIPANTS

Participants consisted of 734 graduate students from a large, Midwestern university.

METHODS

Graduate students answered a series of questionnaires in fall 2021 assessing their mental health, services utilization, and perception of services.

RESULTS

Women (vs men) and participants in their second year and beyond (vs first year) reported greater mental health problems, negative impact of the pandemic, and more services utilization. White (vs non-White) participants reported greater negative impact of the pandemic, greater services utilization, and less financial strain. Finances, lack of knowledge about resources, and inadequate communication from the university about services were reported as treatment barriers.

CONCLUSION

Graduate students struggle with mental health, and universities may need to improve communication with and tailor their services to graduate students specifically to better support them.

Assessing the Influence of Child Sexual Behavior on Depression among Black SMM in the Southeastern United States

Limited studies have examined the associations between child sexual abuse (CSA) and depression among Black sexual minority men (SMM) in the Southeastern United States (US). As, such, the current study examined the critical gap in understanding the impact of CSA on Black SMM's mental health. Specifically, we tested the associations between contextual CSA factors and depression among a large population-based sample of Black SMM living in two cities in the Southern US. Data were obtained from the MARI Study, a sample of Black SMM ages 18-66 years, recruited from the Jackson, MS and Atlanta, GA metropolitan areas (n = 507). Depression was assessed using the 9-item CES-D scale. We conducted multivariable regression analyses to examine the association between depression with history of CSA and other child sexual-related variables (i.e., age of perpetrator and age of sexual abuse), controlling for key confounders. Our results indicated that CSA (β = 0.14, p < 0.001) was positively associated with depression. Our results also indicated that Black SMM who reported being sexually abused at the ages of 6 to 10 (β = 0.30, p < 0.01) and 16 to 18 (β = 0.25, p < 0.05) were positively associated with depression. These findings suggest that there is a need to provide culturally and safe mental health services in the Southeastern US for CSA survivors.

Understanding Perceptions of Depression and Depression Care across Culture and Context

Depression is a leading cause of disability, affecting approximately 300 million people globally [...].

Examining Expectations Among Polynesian Americans About Seeking Psychotherapy

OBJECTIVE

Research on culturally diverse clients has investigated expectations about psychotherapy and intention to seek counseling. However, few studies have investigated how these factors may be linked to specific client expectations, such as advice-seeking (the client expecting the therapist to give advice) and audience-seeking (the client expecting to lead the sessions) behaviors, particularly for U.S. racial-ethnic minority populations.

METHODS

This study used a survey to investigate 593 Polynesian Americans' gender and ethnic preferences for therapists, as well as the mediating effects of advice- and audience-seeking behaviors and their associations with intention to seek counseling and expectations about psychotherapy.

RESULTS

Results indicated that audience-seeking behavior mediated the association between expectations about the psychotherapy process and intention to seek counseling for psychological and interpersonal concerns and between expectations about psychotherapy outcomes and intention to seek counseling for academic concerns.

CONCLUSIONS

Culturally competent counseling for Polynesian Americans, a fast-growing yet understudied population in the United States, is needed, particularly by psychotherapists working with these individuals. Expectations about the process of therapy, such as audience-seeking behavior, may be important to consider in working with this population.

Counseling Across Cultures: A Half-Century Assessment

As the Special Issue of the Journal of Cross-Cultural Psychology celebrates the 50th anniversary of the International Association for Cross-Cultural Psychology (IACCP), this article aims to summarize and track the development of counseling and psychotherapy in cultural contexts over the past half-century. When the edited volume, Counseling Across Cultures (CAC) first appeared nearly half a century ago, it sent an innovative message that culture matters in counseling and psychotherapy. The CAC editors produced six more updated editions in the succeeding years by 2016. The CAC authors examined the cultural context of accurate assessment, meaningful understanding of culture-relevant concepts, and appropriate interventions in each of the seven editions. They have surveyed universal and cultural aspects of counseling and psychotherapy according to such themes as emic and etic approaches to models of mental health, therapeutic relationships and techniques, assessment and interventions, and training needs against the IACCP’s ever-growing academic and professional activities. Research on the cultural adaptation of specific psychotherapies for specific clients should enhance access to culturally sensitive and evidence-based assessments and interventions. The need for training in multicultural awareness is expected to accelerate in the age of rapid globalization. This article affirms the contribution of the foundation-building approaches of CAC and the need for developing the interface between cross-cultural psychology and related clinical and counseling fields.

How do close others to those with anxiety feel about treatment? Development and validation of the Treatment Concerns Questionnaire-Close Others

Background

The close others (e.g., family members, romantic partners) of people with anxiety and related disorders are typically involved in their treatment decisions. However, we know little about close others' attitudes towards and concerns about their loved one starting cognitive-behavioural therapy (CBT).

Methods

Study one surveyed close others of those with anxiety and related disorders (n = 33) about their concerns about their loved one starting CBT. Thematic coding was completed, and items were developed to reflect these themes, comprising a measure of treatment concerns in close others. Study two involved the administration of the novel measure to a larger sample (n = 287) to evaluate its structure, reliability, and validity.

Results

Close others endorsed having treatment concerns of moderate intensity. The final 17-item measure, the Treatment Concerns Questionnaire-Close Others (TCQ-C), has a robust four-factor structure, with internally consistent subscales including "Adverse Reactions", "Personal/Family Consequences", "Lack of Commitment", and "Ineffectiveness". The measure shows moderate correlations with treatment expectations (convergent validity) and small correlations with respondent distress (discriminant validity).

Conclusions

The value of this measure for clinicians and future directions for research are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10318-9.

Do Patients Continue to Use Video Visits? Factors Related to Continued Video Visit Use

Many studies have assessed the factors associated with overall video visit use during the COVID-19 pandemic, but little is known about who is most likely to continue to use video visits and why. The authors combined a survey with electronic health record data to identify factors affecting the continued use of video visit. In August 2020, a stratified random sample of 20,000 active patients from a large health care system were invited to complete an email survey on health care seeking preferences during the COVID. Weighted logistic regression models were applied, adjusting for sampling frame and response bias, to identify factors associated with video visit experience, and separately for preference of continued use of video visits. Actual video visit utilization was also estimated within 12 months after the survey. Three thousand three hundred fifty-one (17.2%) patients completed the survey. Of these, 1208 (36%) reported having at least 1 video visit in the past, lowest for African American (33%) and highest for Hispanic (41%). Of these, 38% would prefer a video visit in the future. The strongest predictors of future video visit use were comfort using video interactions (odds ratio [OR] = 5.30, 95% confidence interval [95% CI]: 3.57-7.85) and satisfaction with the overall quality (OR = 3.94, 95% CI: 2.66-5.86). Interestingly, despite a significantly higher satisfaction for Hispanic (40%-55%) and African American (40%-50%) compared with Asian (29%-39%), Hispanic (OR = 0.46, 95% CI: 0.12-0.88) and African American (OR = 0.54, 95% CI: 0.16-0.90) were less likely to prefer a future video visit. Disparity exists in the use of video visit. The association between patient satisfaction and continued video visit varies by race/ethnicity, which may change the future long-term video visit use among race/ethnicity groups.

Children and young people's mental health in the English-speaking Caribbean: a scoping review and evidence map

Internationally, there is a wealth of research suggesting that many children and young people experience mental health problems. However, the evidence from low- and middle-income countries and developing nations is generally limited. This scoping review aimed to add to the body of evidence by providing an overview of the available research literature on children and young people's (CYP's) mental health in the English-speaking Caribbean region. Seven key online academic databases and grey literature sources were searched until January 2021. Records were screened against predefined criteria and suitable articles retrieved. Relevant information was then charted and summarized. All stages of the review were informed by expert consultations. Ninety-six articles from 7901 records met the inclusion criteria. Most of the studies were conducted in Jamaica, Trinidad and Tobago and Barbados while fewer studies reported findings from St Lucia, The Bahamas and St Kitts and Nevis. Research funding was not frequently reported, and participants were predominantly recruited in education settings. There was a substantial focus on depressive symptoms and behaviour problems. Little or no research was available for younger children (< 12), complex clinical cases or commonly under-represented groups. Four unique interventions were identified of which one intervention showed no significant impact on CYP. Among the commonly used outcome measures only the Jamaican Youth Checklist (teacher-reported), Beck Depression Inventory-II, Brief Screen for Depression, Trinidad and Tobago Youth Survey and Minnesota Multiphasic Personality Inventory had evidence for psychometric validity within this population. We discuss future directions, implications and recommendations for research, practice, policy and training.

Telepsychiatry to Provide Mental Health Support to Healthcare Professionals during the COVID-19 Crisis: A Cross-Sectional Survey among 321 Healthcare Professionals in France

Pandemics are difficult times for the mental health of healthcare professionals, who are more likely to present with PTSD-like symptoms. In the context of a highly contagious communicable disease, telemedicine is a useful alternative to usual care, and should be considered as a means to support healthcare professionals’ mental health. This is a multicenter (n = 19), cross-sectional study, based on a 27-item questionnaire, aiming to investigate the acceptability to healthcare workers of a telepsychiatry service as a means of providing mental health support during the COVID-19 pandemic. Between October and December 2020, 321 responses were received, showing that women, caregiving staff, and those directly involved in the care of COVID-19 patients are less favorable to the idea of receiving remote support. In our population, barriers were related to the clinical setting or ethics, and most of the respondents would not accept a drug prescription by telepsychiatry. Although telepsychiatry should be a part of the armamentarium of mental health management, it is not suitable as a stand-alone approach, and should be combined with conventional face-to-face consultations.

Addressing the mental health impact of COVID-19 through population health

The COVID-19 pandemic has and will continue to result in negative mental health outcomes such as depression, anxiety and traumatic stress in people and populations throughout the world. A population mental health perspective informed by clinical psychology, psychiatry and dissemination and implementation science is ideally suited to address the broad, multi-faceted and long-lasting mental health impact of the pandemic. Informed by a systematic review of the burgeoning empirical research on the COVID-19 pandemic and research on prior coronavirus pandemics, we link pandemic risk factors, negative mental health outcomes and appropriate intervention strategies. We describe how social risk factors and pandemic stressors will contribute to negative mental health outcomes, especially among vulnerable populations. We evaluate the scalability of primary, secondary and tertiary interventions according to mental health target, population, modality, intensity and provider type to provide a unified strategy for meeting population mental health needs. Traditional models, in which evidence-based therapies delivered are delivered in-person, by a trained expert, at a specialty care location have proved difficult to scale. The use of non-traditional models, tailoring preventive interventions to populations based on their needs, and ongoing coordinated evaluation of intervention implementation and effectiveness will be critical to refining our efforts to increase reach.

Mental Healthcare Provider Perceptions of Race and Racial Disparity in the Care of Black and White Clients

Black-white disparities in mental healthcare persist, despite efforts to eliminate them via culturally competent care. To gain insight into how providers implement culturally competent care practices, interviews were conducted with mental healthcare providers' about their self-reported behaviors with black and white clients and their perceptions of how race affects the treatment they provide. Thematic analysis was used to analyze 12 semi-structured interviews with providers from a Veterans Affairs healthcare system. Three sets of themes emerged: providers' general beliefs and behaviors (discomfort discussing race; belief that socioeconomic differences explained disparities; and use of coded language for race groups), providers' clinical beliefs and behaviors (race-matching enhances care and recognition of intersecting cultural identities), and providers' professional beliefs and behaviors (participation in passive racism facilitated by provider-provider alliance). Mental healthcare providers showed good awareness of intersectionality and subtle racism but held limiting beliefs that led to avoidance of discussions of race.

Culturally Responsive Trauma-Informed Services: A Multilevel Perspective from Practitioners Serving Latinx Children and Families

Using a multilevel ecological framework, we take a qualitative approach to examining important cultural considerations that support successful implementation of trauma-informed services within the Latinx community. We conducted key informant interviews with community practitioners recruited primarily in the Phoenix, AZ metro area. Themes that emerged from interviews captured societal, community, and individual barriers to effective implementation of a culturally responsive trauma-informed approach. Specifically, multilevel barriers included socioeconomic circumstances, normalization of trauma exposure, and the transgenerational impact of trauma. Practitioners also reported approaching their work using relationship-focused and family-centered frameworks as facilitators to service engagement. We highlight the critical need for a culturally responsive trauma-informed approach that stresses the importance of context, recognizes transgenerational vulnerabilities, and promotes equity and the utilization of cultural humility in order to lessen the multilayered disparities in service accessibility experienced by minoritized communities.

Barriers and Facilitators of Access to Psychological Services for Indigenous Populations: A Scoping Review and Thematic Analysis

Background: The extent to which behavior-analytic interventions are offered to Indigenous populations across CANZUS in accessible and culturally appropriate ways is unknown. We conducted a scoping review with a thematic analysis of the extant literature to find: (1) what are the barriers and facilitators for providing effective and equitable delivery of psychological services (with a behavioral component) to Indigenous populations; and (2) what tools and practices exist for an effective and equitable service delivery. Methods: We systematically reviewed Medline, CINAHL, PubMed, PsycInfo, Web of science, Ovid and INNZ databases between 1990 and 2020. For the scoping review, we adhered to the JBI methodological approach (2015) and the PRISMA strategy for the identification, selection, and appraisal of the reviewed articles. A total of 1265 unique articles met the criteria for the screening by title; 238 by abstract; 57 were included for full text assessment; and 37 were included in the final analysis. Results: Three themes were revealed to account for the barriers and facilitators of culturally friendly practices: (1) connecting practices are about interactions shaping the relationship between service provider and service client; (2) innovative practices test new approaches and innovations that could facilitate access to psychological services and overcome barriers, and (3) reflective practices are about critically examining the processes and actions undertaken toward effective cultural adaptation of services. Conclusions: Our analysis suggests that the level of success in bringing together services and the recipients of treatment (connection), showing flexibility and persistence in finding solutions (innovation) and examining the role of our behaviors in reaching our goals (reflection) is determined by the providers' action in the aforementioned three dimensions of practice.

The Effect of Language Barriers at Discharge on Pediatric Adenotonsillectomy Outcomes and Healthcare Contact

OBJECTIVE

Effective delivery of discharge instructions and access to postoperative care play a critical role in outcomes after pediatric surgery. Previous studies in the pediatric emergency department suggest that caregivers with language barriers have less comprehension of discharge instructions despite use of interpretation services. However, the impact of language barriers during discharge on surgical outcomes in a pediatric surgical setting has not been studied. This study examined the effect of parental language during discharge on number and mode of healthcare contact following pediatric adenotonsillectomy.

METHODS

A retrospective cohort study was conducted on children who underwent adenotonsillectomy at a tertiary care pediatric academic medical center from July 1, 2016 to June 1, 2018. Data were collected on consecutive patients with non-English-speaking caregivers and a systematic sampling of patients with English-speaking caregiver. Surgery-related complications and healthcare contacts within 90 days after discharge were collected. Two-tailed t tests, χ² tests, and logistic regression were performed to assess the association between parental primary language and incidence of healthcare contact after surgery.

RESULTS

A total of 136 patients were included: 85 English-speaking and 51 non-English-speaking. The groups were comparable in age, sex, and comorbidities. The non-English group had more patients with public insurance (86% vs. 56%; P < .001). Number of encounters and types of complications following discharge were similar, but the non-English group was more likely to utilize the emergency department compared to phone calls (OR, 9.3; 95% CI, 2.3-38.2), even after adjustment for insurance type (OR, 7.9; 95% CI, 1.6-39.4).

CONCLUSION

Language barriers at discharge following pediatric otolaryngology surgery is associated with a meaningful difference in how patients utilized medical care. Interventions to improve comprehension and access may help reduce preventable emergency department visits and healthcare costs.

Does childhood mental health service use predict subsequent mental health service use during Latino youth transition to young adulthood? Evidence from the Boricua Youth Study

PURPOSE

Studies document the substantial underutilization of mental health services by US Latinos in young adulthood. Rates of service use are higher in childhood, raising questions about whether mental health service use during childhood may facilitate access to services later in life. This article examines the extent to which utilization of mental health services in childhood is predictive of utilization in young adulthood among US Latinos.

METHODS

Data come from the Boricua Youth Study, a longitudinal study of Puerto Rican youth at two sites (South Bronx, New York, and the standard metropolitan area of San Juan, Puerto Rico). Data were collected in three waves during childhood (ages 5-13; surveyed 1 year apart), with an approximately 11-year follow-up in young adulthood (ages 16-29). In childhood, parents reported on youth mental health service use (Waves 1-3). In Wave 4, as youth transitioned to young adults (N = 2004), they reported on their past year mental health service use.

RESULTS

Whereas 30.2% of parents reported their child received mental health services, only 3.5% of young adults reported mental health service use in the past year. After controlling for young adult disorders and their severity, childhood disorders were associated with increased likelihood of mental health service use in young adulthood. Childhood mental health service use was also associated with young adult service use; however, this association attenuated when controlling for childhood disorders.

CONCLUSION

Findings suggest the importance of specifically considering childhood disorders in understanding mechanisms for improving access to mental health services among Latino young adults.

The Association Between Depressive Symptoms and Accumulation of Stress Among Black Men in the Health and Retirement Study

BACKGROUND AND OBJECTIVES

Among the multiple factors posited to drive the health inequities that black men experience, the fundamental role of stress in the production of poor health is a key component. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. Few studies have investigated how AL contributes to depressive symptoms among black men. The purpose of the cross-sectional study was to examine the association between AL and depressive symptoms among middle- to old age black men.

RESEARCH DESIGN AND METHODS

This project used the 2010 and 2012 wave of the Health and Retirement Study enhanced face-to-face interview that included a biomarker assessment and psychosocial questionnaire. Depressive symptoms, assessed by the endorsement of 3 or more symptoms on the Center for Epidemiological Studies-Depression 8-item scale, was the outcome variable. The main independent variable, AL, score was calculated by summing the number values that were in the high range for that particular biomarker value scores ranging from 0 to 7. black men whose AL score was 3 or greater were considered to be in the high AL group. Modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs).

RESULTS

There was a larger proportion of black men in the high AL group who reported depressive symptoms (30.0% vs. 20.0%) compared with black men in the low AL group. After adjusting for age, education, income, drinking, and smoking status, the prevalence of reporting 3 or more depressive symptoms was statistically significant among black men in the high AL group (PR = 1.61 [95% CI: 1.20-2.17]) than black men in the low AL group.

DISCUSSION AND IMPLICATIONS

Exposure to chronic stress is related to reporting 3 or more depressive symptoms among black men after controlling for potential confounders. Improving the social and economic conditions for which black men work, play, and pray is key to reducing stress, thereby potentially leading to the reporting of fewer depressive symptoms.

Race, History of Abuse, and Homelessness Are Associated With Forced Medication Administration During Psychiatric Inpatient Care

OBJECTIVE

Although previous research has suggested that racial disparities exist in the administration of forced medication (FM) in psychiatric inpatients, data remain scarce regarding other contributing variables. Therefore, this study examined sociodemographic and clinical variables associated with FM administration in psychiatric inpatients.

METHODS

Electronic medical records from 57,615 patients admitted to an academic psychiatric hospital between 2010 and 2018 were reviewed to identify patients who received FM. These records indicated that FM petitions were requested and approved for ∼6200 patients. Patients were excluded from the analysis if they met the following exclusion criteria: under 18 years of age, presence of intellectual/developmental disability, dementia, or other neurological condition, or primary diagnosis of a nonpsychiatric medical condition or a substance-induced mood or psychotic disorder. After data on those patients were excluded, the final sample included records from 2569 patients (4.5% of the total records) in which the administration of FM was petitioned for and approved. The FM group was compared with a control group of 2569 patients matched in terms of age, sex, and admission date (no-forced medication group; NFM) via propensity scoring matching. Group comparisons (FM vs. NFM group) examined sociodemographic factors (race, age, sex, living situation), clinical features (diagnosis, substance abuse, history of abuse), and outcomes (length of stay, readmission rate). Regression analyses examined the association between FM and sociodemographic, clinical, and outcome variables.

RESULTS

Compared with the NFM group, the FM group contained significantly more African Americans (P<0.001), homeless individuals (P<0.001), and individuals with histories of abuse (P<0.001). Having received FM was a significant predictor of a longer length of stay (P<0.001) and higher readmission rates (P<0.001).

DISCUSSION

These results suggest that FM is more likely to be instituted in psychiatric inpatients who are of a minority race (African American), are in a homeless living situation, and/or have a history of abuse. Moreover, FM may be associated with poorer clinical outcomes at least as measured by the length of stay and higher readmission rates. We discuss possible reasons for these results and the importance of culturally competent and trauma-focused care.

Building a Contextually-Relevant Understanding of Resilience among African American Youth Exposed to Community Violence

Studies consistently demonstrate that African American youth experience disproportionate levels of community violence, which is associated with negative health and well-being outcomes among these youth. The frequency and severity of community violence exposure is a unique challenge for these youth and requires tailored approaches to promote resilience after community violence exposure. However, limited research exists that operationalizes resilience after community violence based on the unique context and lived experience of African American youth. Developing a more contextually relevant understanding of resilience is critical to reducing health inequities experienced by African American youth and promoting their well-being. Five focus groups were conducted with 39 African American adolescents (ages 13-18) exposed to community violence. Participants also completed a brief survey that included questions on demographics, adverse childhood experiences, social capital, and resilience. Focus-group transcripts were independently coded by two members of the research team and analyzed using an inductive approach. Youth highlighted key indicators of resilience including the ability to persevere, self-regulate, and change to adapt/improve. Youth also described family, peer, and cultural contexts that impact how resilience is produced and manifested, highlighting trust, perceived burdensomeness, self-determination, connectedness, and mental health stigma as key factors within these contexts. Results of this qualitative study support the development of health promotion programs for African American youth exposed to community violence that address unique risks and build on existing protective factors within family, peer, and cultural contexts.

A call to action to address rural mental health disparities

Rural residents in the USA experience significant disparities in mental health outcomes even though the prevalence of mental illness in rural and metropolitan areas is similar. This is a persistent problem that requires innovative approaches to resolve. Adopting and appropriately modifying the National Institute on Minority Health and Health Disparities research framework are the potential approaches to understanding how these disparities might be addressed through research. Using this research framework can facilitate interrogation of multiple levels of influence, encompassing complex domains of influence and consideration of the entire life course trajectory, which is consistent with several National Institute of Mental Health priorities.

Primary Care Providers' Perspectives on Prescribing Antidepressant Medication to Latino Immigrant Patients: A Preliminary Study

Latinos in the United States are less likely to take antidepressants than non-Latino whites, and more likely to prefer depression treatment in primary care. This preliminary study comprised focus groups (2) with primary care providers (12) serving uninsured immigrant Latinos regarding their experiences prescribing and counseling patients about antidepressants. Barriers and challenges included health literacy, language barriers, and illiteracy; perceived stigma; patients' concerns about addiction, polypharmacy, and adverse effects; time constraints of office visits; and difficulty discussing comorbid posttraumatic stress disorder. Messages providers try to share with patients included allowing time for medications to work, taking medications daily as prescribed, mechanisms of action, weighing risks versus benefits, and flexible options for treatment. Providers' recommendations for improving this process included better low-literacy, culturally appropriate written materials with pictures or videos discussing depression. More research is needed to understand patients' and providers' needs in optimizing counseling about antidepressants, particularly regarding underserved and at-risk US populations.

Provider Perspectives on Stressors, Support, and Access to Mental Health Care for Latinx Youth

Despite risk for mental health difficulties, Latinx youth have among the lowest rates of mental health care utilization. With this study, we contribute to our ongoing community-based participatory research (CBPR) efforts to explore stressors and protective factors experienced by low-socioeconomic status (SES) Latinx youth, and how these factors influence mental health care utilization. We interviewed community providers and stakeholders (N = 11) from organizations serving low-SES Latinx youth. Coded data yielded seven categories of specific stressors, protective factors, and processes by which these factors influence service utilization. Across categories, providers emphasized how combined family and socioeconomic risk contributed to disengagement from services and described schools and community programs as buffering this risk. Findings suggest that the unique experiences of low-SES Latinx youth contribute to low rates of service utilization, and that intervention should address specific factors at the family, school, and community level to improve access to care.

Group dynamics as a predictor of dissociation for Black victims of violence: An exploratory study of cultural betrayal trauma theory

Violence victimization is prevalent in the US and is linked to costly mental health outcomes, including dissociation and posttraumatic stress disorder (PTSD). Black Americans are at increased risk for violence victimization, while additionally enduring racism that impacts mental health. Moreover, discrimination affects outcomes of violence. Cultural betrayal trauma theory (CBTT) is a new framework for examining the impact of within-group violence victimization (termed cultural betrayal trauma) and minority status on outcomes. Furthermore, CBTT examines posttraumatic group dynamics, such as (intra)cultural pressure. As pressure to protect the minority in-group by not disclosing cultural betrayal trauma, (intra)cultural pressure may impact outcomes. The purpose of the exploratory study was to examine the impact of cultural betrayal trauma and (intra)cultural pressure on dissociation and posttraumatic stress symptoms (PTSS). Participants (N = 43) were Black/African American university students who completed online measures assessing violence victimization and outcomes. Linear regression analyses revealed that cultural betrayal trauma predicted PTSS, whereas (intra)cultural pressure predicted dissociation. The current study has implications for examining the impact of group dynamics, such as (intra)cultural pressure, in clinical interventions for Black victims of cultural betrayal trauma. Such cultural competency in mental health care treatment may help reduce mental health disparities.

Results from a community mental health assessment in a historically black church: A call for action

African Americans' rates of mental illness are similar to those of the general population, however, their rates of utilization of any mental health service is lower than many other ethnic/racial groups, specifically, non-Hispanic, Whites. Many African Americans do not receive adequate treatment for mental health issues due to several barriers to help-seeking behavior. Despite these barriers, African American communities have traditionally sought support from pastors or ministers of historically black churches in times of crises or when experiencing mental health issues. Research has shown that African Americans rely on faith, family, and their churches for emotional support rather than turning to health care professionals. To address the stigma of mental health and identify barriers to seeking mental health care in African American communities in Wichita, KS, a local Wichita historically black church, developed and hosted a mental/emotional health awareness conference. Approximately 30% of the 249 participants who attended the conference were surveyed to assess conference impact, conference satisfaction, and barriers to seeking mental health services. Results indicated approximately 37% of those surveyed lived in lower-income neighborhoods. Conference impact and satisfaction were both rated favorably. Lastly, the top three barriers to mental health care were: (1) "I don't want to be labeled," (2) "I can't afford it," and (3) "I don't know where to go for care." These data highlight the need for stigma reducing interventions and for additional policy changes to address the disparity in health-seeking behaviors of African Americans.

Racial and ethnic differences in mental health service utilization in suicidal adults: A nationally representative study

The current study examined racial/ethnic differences in utilization of mental health services in a nationally representative sample of suicidal adults. Data were extracted from the National Survey on Drug Use and Health (NSDUH) from 2009 to 2016. Participants consisted of adults with severe suicidal ideation and/or behavior in the past 12 months (unweighted n = 17,338). Multivariate logistic regression analyses were conducted to assess racial/ethnic differences in mental health treatment utilization after adjusting for health insurance status, family income, age, sex, and major depression. Analyses were conducted separately for suicidal ideators with no attempts (i. e., "pure" ideators; unweighted n = 14,578) and for suicide attempters (unweighted n = 2760) for psychiatric inpatient and outpatient care, respectively. Racial/ethnic disparities in mental health treatment utilization were less apparent for inpatient care and most evident for outpatient care. For inpatient care, no racial/ethnic differences were observed among suicidal ideators with no attempts. Among suicide attempters, only Hispanics were less likely than non-Hispanic whites to receive inpatient care. In contrast, for outpatient care, treatment use was lower for all racial ethnic minorities, except Native American and multiracial individuals, relative to non-Hispanic whites among suicidal ideators with no attempts. Outpatient service use was also lower for non-Hispanic blacks, Hispanics, and multiracial individuals relative to non-Hispanic whites among suicide attempters. This pattern of findings is consistent with the possibility that suicidal racial/ethnic minorities may delay use of mental health services until clinical severity becomes such that elevated clinical care (i.e., inpatient treatment) is required. Future research accounting for these disparities is warranted.

Screening for Attention-Deficit/Hyperactivity Disorder and Comorbidities in a Diverse, Urban Primary Care Setting

We tested the accuracy of 2 parent-report tools, the Pediatric Symptom Checklist (PSC-35) and Child Behavior Checklist (CBCL), to identify attention-deficit/hyperactivity disorder (ADHD) and distinguish complex (highly comorbid) cases in an urban, largely Latino pediatric practice. Spanish- and English-speaking parents of children aged 6 to 10 years completed a PSC-35 and CBCL at well visits. Those with CBCL Attention Problems Subscale (CBCL-APS) T scores ≥60 plus controls completed the diagnostic MINI-KID (Miniature International Neuropsychiatric Interview) for Children. Receiver operating characteristic (ROC) curves quantified accuracy of both scales to distinguish ADHD from non-ADHD, and complex from simple ADHD. Two hundred and nine children were screened, and 41 completed diagnostic interviews. Both the CBCL-APS and PSC Attention Scale (PSC-AS) accurately identified ADHD; the CBCL-APS performed best (AUROC_{CBCL_APS} = 0.837; AUROC_{PSC_AS} = 0.728). The PSC Total and Internalizing Scores and the number of CBCL subscale elevations accurately distinguished complex from simple ADHD; the PSC Internalizing Score performed best (AUROC_{PSC_TOTAL} = 0.700; AUROC_{PSC_INT} = 0.817; AUROC_{CBCL_SUBS} = 0.762).

Preferences for Depression Help-Seeking Among Vietnamese American Adults

Culture impacts help-seeking preferences. We examined Vietnamese Americans' help-seeking preferences for depressive symptoms, through a telephone survey (N = 1666). A vignette describing an age- and gender-matched individual with depression was presented, and respondents chose from a list of options and provided open-ended responses about their help-seeking preferences. Results showed that 78.3% would seek professional help, either from a family doctor, a mental health provider, or both; 54.4% preferred to seek help from a family doctor but not from a mental health provider. Most (82.1%) would prefer to talk to family or friends, 62.2% would prefer to look up information, and 50.1% would prefer to get spiritual help. Logistic regression analysis revealed that preferences for non-professional help-seeking options (such as talking to friends or family, looking up information, and getting spiritual help), health care access, and perceived poor health, were associated with increased odds of preferring professional help-seeking. This population-based study of Vietnamese Americans highlight promising channels to deliver education about depression and effective help-seeking resources, particularly the importance of family doctors and social networks. Furthermore, addressing barriers in access to care remains a critical component of promoting professional help-seeking.

Gender differences in pathways to care for early psychosis

AIMS

Gender is a critical demographic determinant in first-episode psychosis research. We used data from the ACE Pathways to Care Project, which examined pathways to care in African-origin, Caribbean-origin and European-origin participants, to investigate the role of gender in pathways to early intervention programmes.

METHOD

A qualitative approach was used to examine gender differences in the routes to care. We conducted four focus groups and four individual in-depth interviews with 25 service users of early intervention services from African-origin, Caribbean-origin and European-origin populations.

RESULTS

Gender stereotypes negatively influence the first service contact for women, and the early phase of the help seeking process for men. Women reported trying to seek care. However, family members and service providers often questioned their calls for help. Men described having difficulties in talking about their symptoms, as the act of seeking help was perceived as a sign of weakness by peers.

CONCLUSIONS

The findings of this study suggest that gender stereotypes shape the journey to specialized care in different ways for men and women. Awareness of the impact that gender stereotypes have when a young person is seeking care for psychosis could help to promote a shift in attitudes among health-care providers and the provision of more compassionate and patient-centred care during this critical time.

A longitudinal study of Latino and non-Hispanic mothers' and fathers' depressive symptoms and its association with parent-child communication

BACKGROUND

Roughly 8% of the U.S. population report moderate or severe depression for two or more weeks and Latinos (3.7%) report higher rates of severe depression compared to non-Hispanic whites (2.6%) (Pratt and Brody, 2014). As the Latino population continues to grow in the U.S., there is little research on the manifestations for depression, and how this affects the family system longitudinally.

METHODS

Based on data from the Fragile Families and Child Wellbeing Study, a 3-step latent class analysis examined the association of self-reported parental depressive symptoms and their children's perceived levels of closeness and openness to communicate with their parents over 9 years (N=3956 families).

RESULTS

Latino parents reported four different depressive patterns, while non-Hispanic parents were more diversified and had six patterns in terms of latent class analysis. Latinos reported episodic symptoms, while NH parents were more likely to report chronic depressive symptoms over time. Regardless of race/ethnicity, parental depressive symptoms negatively affected their children's reported level of parental closeness and openness to communicate with mothers and fathers.

LIMITATIONS

As with any self-report data, the risk of social desirability bias is likely still present. Additionally, these results cannot be generalized to the broader U.S.

CONCLUSIONS

Due to the different mental health presentations over 9 years, and following the federal initiatives (National Institute of Mental Health, 2015) of early and consistent surveillance, we advise that clinicians and primary care physicians screen for depressive symptoms at least yearly.

Inequalities in a National Health Care System From the Perspective of Social Workers in Israel

This study explores social workers' perceptions of inequalities in Israel's national health care system. Unlike previous studies, which relied on patients' and practitioners' reports, it is based on interviews with 60 social workers in hospitals and ambulatory clinics. The findings show that although Israeli law provides for (almost) free, universal medical care, the treatment of persons lacking in money, education, and social affiliation may be compromised by difficulties in paying for medications, treatments, and travel to and from hospital; by difficulties in understanding doctors' instructions; and by reluctance to ask questions. Most doctors tend to focus exclusively on patients' medical needs, seem to lack sympathy with less educated patients, have little understanding of the life circumstances that impinge on their compliance, and make little effort to speak to them in the language they can understand. Practical suggestions are made with regard to the need to turn doctors' attention to their patients' non-medical needs.

Racial/Ethnic Differences in Contemporaneous Use of Mental Health and Substance Use Treatment Among Individuals Experiencing Both Mental Illness and Substance Use Disorders

This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009-2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.

Assessing the risk for suicide in schizophrenia according to migration, ethnicity and geographical ancestry

BACKGROUND

Suicide is a leading cause of mortality among those afflicted by schizophrenia. Previous studies demonstrated that the stressors associated with immigration may lead to an onset of schizophrenia and suicide separately in susceptible individuals. However, no studies have shown whether immigration may lead to suicidal behaviour for individuals with schizophrenia. Our study proposes that an individual's geographical ancestry, ethnicity or migration status may be predictive of suicide risk in schizophrenia.

METHODS

In a sample of 276 participants with schizophrenia spectrum disorders, we conducted cross-sectional assessments to collect clinical information. Self-identified ethnicity and suicide history were collected through self-report questionnaires and interview-based scales. Ancestry was identified using 292 genetic markers from HapMap. Migrants were classified as those who immigrated to Canada during their lifetime. Using a regression analysis, we tested whether a history of migration, ethnicity or geographical ancestry were predictive of a history of suicide attempts.

RESULTS

Our analysis failed to demonstrate a significant relationship between suicide history and migration, ethnicity or ancestry. However, ethnicity appears to be significantly associated with the number of psychiatric hospitalizations in our sample.

CONCLUSION

Ethnicity and migration history are not predictive of previous suicide attempts. Ethnicity may be an important demographic factor affecting access to mental health resources and frequency of hospitalizations.

Measurement of Neighborhood Context in an Urban Cohort of HIV-infected or at risk Low-Income Women

The study of neighborhood disadvantage and health relies on census socioeconomic data but would benefit from reliable survey measures of factors that influence health within low income communities. The Perceptions of Neighborhood Environment Scale (PNES) was developed for use in the general U.S. population, and its measurement properties in a cohort of low-income urban women living with or at risk for HIV are described. The scale and all but one subscale have good psychometric and ecometric reliability, as well as convergent, construct, and concurrent validity, and are not collinear with household and community area income in low-income urban neighborhoods.

The generational gap: Mental disorder prevalence and disability amongst first and second generation immigrants in Australia

Despite unprecedented numbers of migrants internationally, little is known about the mental health needs of immigrant groups residing in common countries of resettlement. The majority of studies support the 'healthy migrant hypothesis', but few studies have examined: 1) shifts in prevalence patterns across generations; 2) how prevalence relates to disability in immigrant groups. Our study examined the prevalence of common mental disorders and disability in first and second generation migrants to Australia. Twelve-month and lifetime prevalence rates of affective, anxiety, and substance use disorders were obtained from the Australian National Survey of Mental Health and Wellbeing (N = 8841). First generation immigrants (born overseas) and second generation immigrants (both parents overseas) from non-English and English speaking backgrounds were compared to an Australian-born cohort. Disability was indexed by days out of role and the WHO Disability Assessment Schedule (WHODAS12). First generation immigrants with non-English speaking (1G-NE) backgrounds evidenced reduced prevalence of common mental disorders relative to the Australian-born population (adjusted odds ratio 0.5 [95% CI 0.38-0.66]). This lower prevalence was not observed in second generation immigrant cohorts. While overall levels of disability were equal between all groups (p > 0.05), mental health-related disability was elevated in the 1G-NE group relative to the Australian-born group (p = 0.012). The findings challenge the overarching notion of the "healthy migrant" and suggest a dissociation between reduced prevalence and elevated mental health-related disability amongst first generation immigrants with non-English speaking backgrounds. These findings highlight the heterogeneous psychiatric needs of first and second generation immigrants.