Mental Health Service Use Among Immigrants in the United States: A Systematic Review

Association of depression and self-reported health status by birthplace and citizenship status: Results from the 2010-2018 National Health Interview Survey

BACKGROUND

Self-reported health (SRH) is an important indicator of mental health outcomes. More information, however, is needed on whether this association varies by birthplace (defined as US-born or non-US-born) and citizenship status (i.e., non-US-born citizen, non-US citizen, and US-born citizen).

METHODS

We examined the associations between SRH and depression among non-US-born US citizens, non-US citizens, and US-born citizens aged 18 years and older using weighted cross-sectional data from the 2010-2018 National Health Interview Survey (n = 139,884). Logistic regression models were used to assess the association between depression and SRH by citizenship status, adjusting for covariates.

RESULTS

US-born citizens reported the highest prevalence of depression (40.3 %), and non-US-born citizens reported the highest prevalence of poor/fair SRH (14.5 %). Individuals with fair/poor SRH had a significantly increased likelihood of depression relative to those with good/very good/excellent for non-US-born US citizens (Adjusted Odds Ratio [AOR] = 2.42, 95 % Confidence Interval [95 % CI] = 2.04-2.88), non-US citizens (AOR = 2.80, 95 % CI = 2.31-3.40), and US-born citizens (AOR = 2.31, CI = 2.18-2.45).

LIMITATIONS

The study is cross-sectional, reducing the strength of determining causal relationships. Also, there is a possible response bias due to the self-reported nature of the data.

CONCLUSIONS

Our study indicates that fair/poor SRH is significantly associated with an increased likelihood of depression regardless of an individual citizenship status. Additionally, immigrants with fair/poor SRH had higher increased odds of depression. Therefore, mental healthcare interventions tailored for immigrants can reduce mental health problems and disparities among immigrants.

Health insurance coverage moderates the relationship between metabolic syndrome and baseline memory outcomes in Latino older adults

Objective: Latino adults are at increased risk of metabolic syndrome (MetS) and have lower rates of health insurance (HI) coverage. Although inadequate HI coverage and MetS have been independently linked to poor cognition, their potential interactive effects have not yet been examined. The present study explored whether HI moderated the association between MetS and cognition. We hypothesized that Latinos with MetS that did not have HI would demonstrate poorer cognition than those with HI, whereas there would be minimal differences in cognition across HI status in those without MetS. Methods: Cross-sectional data from 805 Latino older adults enrolled in the Health and Aging Brain Study-Health Disparities was utilized. Analysis of covariance adjusting for sociodemographics examined MetS x HI interactions on memory and attention/executive functions composites. Results: Results revealed a significant MetS x HI interaction on memory (F = 4.33, p = 0.037, ηp2 = .01); Latino adults with MetS and no HI coverage had worse memory performance than those with MetS who had HI coverage (p = 0.022, ηp2 = .01), whereas there was no significant difference in memory between HI coverage groups in those without MetS (p > .05, ηp2 = .002). No MetS x HI interaction was observed for the attention/executive functions composite (F = 0.29, p = 0.588, ηp2 < .001). Conclusion: Latino older adults with MetS that do not have HI coverage may be at risk for poorer memory outcomes. Increasing the accessibility of HI coverage may help reduce cognitive health disparities in Latino older adults with vascular health comorbidities.

Psychotherapy use among migrants: a register-based longitudinal study

BACKGROUND

Migrants use less mental health services compared with non-migrant populations, but there is very little information on the use of long-term psychotherapy among migrants. Finnish register data allow for studying the whole migrant population in Finland and collecting data on all publicly supported rehabilitative psychotherapy.

METHODS

This study is based on a sample of migrants (n=185 605) and Finnish-born controls (n=185 605). Participants who had received reimbursements for rehabilitative psychotherapy during 2007-2020 were identified from a register maintained by the Social Insurance Institution of Finland. Cox regression analysis was used to study the effect of migrant status on the time until the start of therapy. Multinomial logistic regression was used to study the association between migrant status and the number of psychotherapy sessions.

RESULTS

Finnish-born participants received psychotherapy more often (n=7258) than migrants (n=1516). The adjusted HR for initiating psychotherapy among migrants compared with Finnish-born individuals was 0.27 (95% CI 0.25 to 0.28). Migrants from sub-Saharan Africa and Asia and recently arrived migrants were least likely to receive psychotherapy. Migrants were more likely to receive short treatment periods than Finnish-born controls.

CONCLUSION

Lower use of rehabilitative psychotherapy among migrant population in Finland is not likely to reflect lower need for treatment. More efforts are needed to promote equal access to psychotherapy.

Barriers and facilitators to healthcare utilisation by Arab sexual minority women migrants in the USA

Limited research on sexual minority women migrants demonstrate that they face elevated rates of mental health problems compared to their heterosexual and male counterparts, and less is known about their healthcare seeking behaviours. This study aimed to identify barriers and facilitators to mental and physical healthcare utilisation among first-generation (foreign-born) Arab sexual minority women migrants in the USA and to assess whether Penchansky and Thomas' theory of access can be used to understand their healthcare utilisation behaviours. We conducted 20 semi-structured interviews via Zoom. Employing community-engaged research methods, four advisors, Arab sexual minority women migrants and a mental health service provider, assisted in recruitment and thematic data analysis providing a rich and nuanced understanding of study findings. Five main themes demonstrated the pivotal role of cultural humility from providers and access to medical insurance in shaping healthcare-seeking decisions. Difficulties finding therapists and navigating the referral process and wait times encouraged participants to seek care outside of the USA in their Arab countries of origin. Stigma and social support further influenced participants' decisions to seek mental healthcare. The study findings inform policy and practice to foster the development of inclusive healthcare services grounded in cultural humility and to develop support groups specifically for Arab sexual minority women migrants to the USA.

Determining the role of acculturative stress in predicting mental health service use among Latinx immigrants

OBJECTIVES

Acculturative stress is an important factor that affects health for Latinx immigrants in the US, with multiple studies identifying a link between depression and acculturative stress in this population. However, far fewer studies have examined the specific role and relationship of acculturative stress on mental health service use in this population. Through the lens of Yang's 2016 Model of Immigrant Health Service Use, this study aimed to examine the role of acculturative stress in predicting mental health service use in a sample of Latinx immigrants in the Southeast US.

DESIGN

We conducted a secondary data analysis from a longitudinal study of Latinx immigrant health (n = 391).

RESULTS

Our study found that while total acculturative stress was not significantly associated with mental health service use in this sample, parenting stress was a significant predictor of mental health service use in the past six months when controlling for covariates (OR: 1.043, 95% CI [1.009, 1.078]). Additionally, important Predisposing and Need for Healthcare factors were significantly associated with mental health service use, specifically: males were less likely to utilize mental health services than females (OR: 0.401, 95% CI [0.166-0.968]), English language acculturation was positively associated with mental health service use (OR: 1.953, 95% CI [1.130, 3.377]), and depression was positively associated with mental health service use (OR: 1.107, 95% CI [1.027, 1.194]).

CONCLUSION

These findings support the need for more culturally sensitive mental health services, and the need to develop strategies to engage males and less acculturated individuals in mental health services to promote health equity among Latinx immigrants.

Willingness to use mental health counseling in diverse groups of Asian Americans

Responding to the underutilization of mental health services in Asian American communities, we examined factors associated with their willingness to use mental health counseling. Applying Andersen's Behavioral Health Service Model, we focused on the role of mental health needs and prior use of mental health counseling in shaping the attitudes toward mental health counseling of diverse groups of Asian Americans. We conducted a secondary analysis of data from 2,609 Asian Americans aged 18 or older who participated in the Asian American Quality of Life (AAQoL) survey conducted in central Texas. Logistic regression models of willingness to use mental health counseling were tested with predisposing (age, gender, marital status, education, nativity, and English-speaking ability), mental health needs (mental distress and self-rated mental health) and enabling (prior use of mental health counseling) variables. About 67% of the overall sample indicated their willingness to use mental health counseling. Individuals who met the criteria for mental distress showed 17% lower odds of willingness to use mental health counseling. The enabling role of prior use of mental health counseling was supported; those who had used counseling were over three times more likely to be willing to use counseling in the future than their counterparts without such an experience. Given the inverse association between mental health needs and the willingness to use mental health counseling, further attention should be paid to improving Asian Americans' recognition of mental health symptoms and awareness of the benefit of mental health services. The enabling role of prior use of counseling also highlights the importance of increasing the exposure to mental health services for Asian Americans. In efforts to promote mental health literacy, reduce cultural stigma, and advocate for mental health service use, consideration of cultural and linguistic diversity within the Asian American population is imperative.

Psychiatric Healthcare Experiences of South Asian Patients with Severe Mental Illness Diagnoses and Their Families in New York City: A Qualitative Study

South Asians (SAs) underutilize mental health services compared to many racial and ethnic groups in the United States (US), yet there is limited research on the experiences of SAs living with severe mental illness (SMI). This study examined psychiatric healthcare experiences of SA patients with SMI diagnoses (e.g., severe depression, bipolar disorder, schizophrenia) in New York City. Data collection included semi-structured interviews with 36 participants (21 patients, 11 family members, 4 clinicians). Data was managed in NVivo. Two pairs of SA researchers conducted thematic analysis. Limited mental health knowledge led to delayed care for SAs due to a low perceived need for help. Ease of access, linguistic resources, patient-provider relationships, and family involvement influenced psychiatric healthcare experiences. Prescribed medications, self-motivation, communication, and religious practices were factors aiding symptom management and recovery. Findings highlight the need for improving psychiatric healthcare access and culturally-salient mental health education for SA communities.

Mental health priorities and cultural-responsiveness of the Mental Health First Aid (MHFA) training for Asian immigrant populations in Greater Boston, Massachusetts

BACKGROUND

Asians and Asian Americans have the lowest rate of mental health service utilization (25%) in the US compared to other racial/ethnic groups (39 - 52%), despite high rates of depression, anxiety, and suicidal ideation. The lack of culturally-responsive mental health trainings hinders access to mental health services for these populations. We assessed the mental health priorities of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond.

METHODS

This is community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition. We conducted focus groups with community-based organization staff and community members to assess mental health priorities of Asian populations in Boston, MA. We then evaluated the utility and cultural-responsiveness of the English-language MHFA for Asian populations through pre- and post-training questionnaires and focus groups with community participants. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews.

RESULTS

In total, ten staff and eight community members participated in focus groups, and 24 community members completed the MHFA and pre- and post-training questionnaires. Common mental health challenges in the Asian communities reported by participants were loneliness, high stigma around mental illnesses, academic pressure, and acculturation stress. Compared to pre-training, MHFA participants demonstrated lower personal mental health stigma (p < 0.001) and higher mental health literacy (p = 0.04) post-training. Participants also noted the lack of data statistics and case studies relevant to Asian populations in the training, and desired the training be offered in languages spoken by Asian ethnic subgroups (e.g., Chinese, Vietnamese).

CONCLUSION

Cultural-responsiveness of the MHFA for Asian populations could be improved with the inclusion of data and case studies that capture common mental health challenges in the Asian communities and with translation of the MHFA to non-English languages predominant in Asian communities. Increasing the cultural relevance and language accessibility of the MHFA could facilitate wider adoption of these trainings across communities and help to reduce mental health stigma and gaps in literacy and service utilization.

Potentially Inappropriate Medication in Older Persons With Dementia: Does a Migration Background Matter?

OBJECTIVES

Previous research in the general population shows more potentially inappropriate medications (PIMs) among persons with a migration background compared with persons without a migration background. This study investigated the association between non-Western (nw) migration background (MB) and dementia-specific PIMs in older adults with dementia in the Netherlands.

DESIGN

Cohort study using routinely recorded electronic health records and administrative data.

SETTING AND PARTICIPANTS

Electronic health record data of general practitioners from the NIVEL-Primary Care Database, were linked to registries managed by Statistics Netherlands (2013-2014). A total of 9055 community-dwelling older adults with dementia were included, among whom 294 persons had an nw-MB from Africa, South America, or Asia, based on their country of birth.

METHODS

We determined the presence of dementia-specific PIM prescriptions and compared this between persons with an nw-MB and without an MB, using logistic regression analysis adjusted for follow-up time, age, registered sex, and total number of prescriptions. Interaction effects of potentially relevant covariates were tested. The 3 largest nw-MB groups in the Netherlands were analyzed separately.

RESULTS

Dementia-specific PIMs were less frequently prescribed to persons with an nw-MB compared to persons without an MB with a dementia diagnosis [30.6% vs 34.4%, odds ratio (OR) 0.71, 95% CI 0.54-0.92], with especially less often a benzodiazepine prescription in the group with an nw-MB, compared to persons without an MB (15.0% vs 19.3%, OR 0.61, 95% CI 0.43-0.84). Dementia duration, living alone, household income, and degree of urbanization did not influence the associations.

CONCLUSIONS AND IMPLICATIONS

Among older adults with dementia in the Netherlands, persons with an nw-MB had less often a dementia-specific PIM prescription compared to persons without an MB. Whether this difference is a reflection of better quality of care, higher professional uncertainty, or less recognition of (mental) health problems in persons with an nw-MB and dementia, needs further investigation.

Health conditions contribution to disability burden in Spain and the role of ethnicity and migrant status: A nation-wide study

BACKGROUND

Disability is frequently associated with contextual or lifestyle factors. Some health conditions may affect the prevalence of disability differently, especially for some minority groups. This study aims to assess the impact and contribution of different health conditions to disability burden in Spain in Roma and immigrant populations, compared to the general population.

METHODS

This is a cross-sectional study. We have used data from the Spanish National Survey of 2017 and the National Health Survey of the Roma Population 2014. We have calculated frequencies of demographic variables and prevalence of health conditions grouped by body function. We also have fitted binomial additive hazard models, using the attribution method, to assess disabling impact and contribution of health conditions to disability burden. The software R was used for the computations.

RESULTS

Roma and immigrant populations had worse socioeconomic status than the general population, although the gap was more heavily marked among Roma. Roma population showed a higher prevalence in all health conditions, with a disability prevalence of 57.90%, contrary to the immigrant population, that showed a lower prevalence in all health conditions, including disability (30.79%), than the general population (40.00%). However, all health conditions were more disabling in the immigrant population. Neurological and cardiovascular diseases, and accidents among Roma, were the most disabling conditions. Nevertheless, musculoskeletal, chronic pain, and sensory diseases among Roma, had a greater contribution to disability burden, mainly due to a combination of a great prevalence and a great impact in functions of those health conditions.

CONCLUSION

Both ethnicity and migrant status have shown differences in the burden of disability. While in the general population, musculoskeletal problems have the greatest contribution to the disability burden, in immigrants it was chronic pain and in the Roma population it was sensory problems. Disparities by sex were also found, with the contribution of musculoskeletal diseases being more important in females.

Exploring early discontinuation of mental health outpatient treatment: language, demographics and clinical characteristics among migrant populations in Japan

BACKGROUND

The fast-growing migrant population in Japan and globally poses challenges in mental healthcare, yet research addressing migrants' mental health treatment engagement remains limited.

OBJECTIVE

This study examined language proficiency, demographic and clinical characteristics as predictors of early treatment discontinuation among migrants.

METHODS

Electronic health record data from 196 adult migrants, identified from 14 511 patients who received mental health outpatient treatment during 2016 and 2019 at three central hospitals in the Tokyo-Yokohama metropolitan region of Japan, were used. We conducted multivariable regression models to identify predictors of early discontinuation within 3 months.

FINDINGS

The study cohort (65% women, age range: 18-90 years, from 29 countries or regions) included 23% non-Japanese speakers. Japanese and non-Japanese speakers had similar discontinuation rates (26% vs 22%). Multivariable models revealed younger age (OR=0.97; 95% CI: 0.95, 0.99; p=0.016) and those with a primary diagnosis other than a schizophrenia spectrum disorder (OR=3.99; 95% CI: 1.36, 11.77; p=0.012) or a neurotic, stress-related and somatoform disorder (OR=2.79; 95% CI: 1.14, 6.84; p=0.025) had higher odds of early discontinuation. These effects were more pronounced among the Japanese speakers with significant language-by-age and language-by-diagnoses interactions.

CONCLUSION

Younger age and having a primary diagnosis other than a schizophrenia spectrum disorder or a neurotic, stress-related and somatoform disorder increased vulnerability for discontinuing mental health treatment early in Japanese-speaking migrants but not for migrants with limited Japanese proficiency.

CLINICAL IMPLICATIONS

Understanding language needs within a context of mental health treatment should go beyond assumed or observed fluency. Unmet language needs might increase vulnerability for treatment disengagement among migrants. Targeted clinical efforts are crucial for enhancing early treatment engagement and informing health practices in Japan and countries with growing migrant populations.

Examining recovery and mental health service satisfaction among young immigrant Muslim women with mental distress in Quebec

OBJECTIVE

The overall aim of this study was to understand the experiences and perspectives of immigrant Muslim women in Quebec living with mental illness, who have recently used formal mental health services such as an accredited therapist, psychologist, or clinician. Specific objectives included (i) eliciting and examining their self-identified barriers and facilitators to recovery; (ii) exploring links between religion and mental health; and (iii) self-reported satisfaction with mental health services received.

METHODS

We adopted a qualitative approach, facilitating the prioritization of participant perspectives. This involved semi-structured interviews with 20 women who (i) identified as Muslim; (ii) had used mental health services in the last three years; and (iii) were 18 + years of age. Interviews were transcribed and analyzed using thematic analysis techniques.

RESULTS

Three prominent themes emerged from the analysis. These themes were (i) stigma and misunderstandings in families (especially parents) and sometimes in the ethno-religious community, both acting as barriers to health service utilization and recovery; (ii) frustrating clinical experiences within formal mental health care settings, in particular a perceived lack of cultural and religious competence, which negatively affected service utilization and the development of a therapeutic alliance; and (iii) deeply-held religious beliefs, practices and trust in God imparting a rhythm, purpose and meaning, which were strong facilitators to recovery.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

These findings suggest that recovery from mental illness can be advanced by a three-pronged approach in this population. First, anti-stigma mental health literacy interventions could be held in collaboration with Muslim community groups. Second, there is a need for further religious and cultural competence interventions, resources and trainings for mental health professionals working with Muslims. Third, self-care resources should be developed that harness aspects of religious practices that can give structure, meaning, purpose and hope. All this could ultimately foster recovery in this population.

Inpatient Care Utilization Following Mobile Crisis Response Encounters Among Racial/Ethnic Minoritized Youth

OBJECTIVE

There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth.

METHOD

Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years.

RESULTS

In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes.

CONCLUSION

Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services.

PLAIN LANGUAGE SUMMARY

The study investigates racial and ethnic differences in the rates of inpatient care receipt after youth experience a psychiatric emergency in Los Angeles County. A total of 6,908 youth received mobile crisis response services and participated in the study. No racial/ethnic differences emerged in inpatient care use within the first month of receiving mobile crisis response services, but in the longer-term, Asian American/Pacific Islander youth were the least likely to receive inpatient care, and American Indian/Alaska Native youth were the most likely to receive inpatient. No differences in inpatient care use were observed for Black and Latinx youth relative to other youth in the study. Given the high costs for inpatient care, it remains critical to connect high-risk minoritized youth to less costly community-based care.

School-Based Behavioral Health Programming for Newcomer Youth: A Scoping Review

OBJECTIVE

Newcomer youth experience health disparities in accessing behavioral health services. School-based mental health programming is proposed a potential solution to address these disparities. The present study uses a scoping review methodology to examine the state-of-the-art of the evidence base for school-based mental health programming for newcomer youth. Studies were categorized into a tiered typology using the framework established by the National Center for School Mental Health.

METHODS

Several databases were examined as well as the results of one scoping and two systemic recent reviews.

RESULTS

A total of 37 studies were included in the present analysis, over half from the last decade. Most studies were conducted in the United States and Europe, and most programs were focused on mental health promotion and wellness (Tier 1) or were multi-tiered. Programming for younger children, especially those in early childhood settings, were underrepresented.

CONCLUSIONS

While the literature is promising regarding programming for newcomer youth, particularly the advent of complex multi-tiered programming, many gaps still remain. For example, most programs do not provide information on how programming was adapted for different groups of newcomers with different cultural and contextual needs. Tier 1 programs lack theoretical foundations or theories of change in the design of programming. Further, more research is needed for a group with rising numbers across high- and middle-income countries, particularly for programming targeting early and middle childhood.

Modifiable parental factors associated with the mental health of youth from immigrant families in high-income countries: A systematic review and meta-analysis

Parental factors play a major role in youth mental health and many youth in high-income countries have at least one overseas-born parent. It is, hence, important to understand how immigrant parenting is associated with youth mental health in high-income countries. Following PRISMA guidelines, this review sought to identify modifiable parental factors to inform parenting interventions to prevent mental health problems in youth aged 0-18 years whose parents migrated voluntarily for economic reasons from low and middle-income countries to high-income countries. Sixteen parental factors were identified from 56 studies that were associated with five outcomes - youth self-esteem (k = 17), general stress (k = 4), acculturative stress (k = 4), anxiety symptoms (k = 9), and depressive symptoms (k = 41). A sound evidence base was found for one or more of these outcomes associated with protective factors - caring and supportive parenting and parental monitoring; and risk factors - parent-youth acculturative and general conflict, parental withdrawal, interparental conflict, and parent mental health problems. This systematic review and meta-analysis identified immigrant parental factors that have robust associations with youth mental health outcomes. These findings can be used to inform parenting interventions and support immigrant parents in preventing youth mental health problems.

Enhancing immigrant families' mental health through the promotion of structural and community-based support

Immigrant communities in the United States are diverse and have many assets. Yet, they often experience stressors that can undermine the mental health of residents. To fully promote mental health and well-being among immigrant communities, it is important to emphasize population-level policies and practices that may serve to mitigate stress and prevent mental health disorders. In this paper, we describe the stressors and stress experienced by immigrant families, using Sunset Park, Brooklyn as an example. We discuss ways to build structures and policies in support of equitable environments that promote mental health at the population level and enable families and their children to thrive.

Food Related Challenges and Mental Health Among U.S. African Migrants: A Narrative Review

The United States' (US) African immigrant (AI) population is growing, yet they are underrepresented in health and nutrition research. This population experiences difficulties finding culturally appropriate foods and navigating the US food environment (FE), is highly food insecure (FI), and vulnerable to mental disorders. This review examined the current evidence for AIs' food and mental health outcomes and connections; and identified gaps in the literature and future research opportunities. A literature search was conducted using Google Scholar, PubMed, CINAHL, MEDLINE, and SCOPUS. Twenty-one studies were identified, reporting high (37-85%) FI rates, poor diet quality, and increased risk of mental disorders among participants. Challenges in the FE, lack of transportation, limited access to ethnic foods, low SES, and language barriers were associated with FI and poor diet quality. Similarly, discrimination, substance use, and immigration status were associated with depression and anxiety. However, studies examining the connection between AI's food experience and mental health are lacking. AIs are at a higher risk for FI, poor diet quality, and mental disorders. Ethnic-specific research to understand the connection between their food and mental health is needed to reduce nutrition and mental health disparities.

Mental Health Care Use by Ethnicity and Preferred Language in a National Cohort of Community Health Center Patients

OBJECTIVE

Disparities in U.S. mental health care by race and ethnicity have long been documented. The authors sought to compare specialty mental health service use among non-Hispanic White, English-preferring Hispanic, and Spanish-preferring Hispanic patients who accessed care in community health centers (CHCs).

METHODS

Retrospective electronic medical records data were extracted for patients ages ≥18 years who received care in 2012-2020 at a national CHC network. Zero-inflated Poisson regression models were used to estimate the likelihood of receiving mental health services, which was compared with expected annual rates of mental health service use.

RESULTS

Of the 1,498,655 patients who received care at a CHC during the study, 14.4% (N=215,098) received any specialty mental health services. English- and Spanish-preferring Hispanic patients were less likely to have had a mental health visit (OR=0.69, 95% CI=0.61-0.77, and OR=0.65, 95% CI=0.54-0.78, respectively). Compared with non-Hispanic White patients, Spanish-preferring Hispanic patients had an estimated annualized rate of 0.59 (95% CI=0.46-0.76) mental health visits.

CONCLUSIONS

Among patients who were likely to receive specialty mental health services, Spanish-preferring patients had a significantly lower rate of mental health care use. Although overall access to mental health care is improving, unequal access to recurring specialty mental health care remains among patients who do not prefer to use English.

A qualitative exploration of interprofessional collaborative practice between genetic counselors and mental health providers

Genetic counselors (GCs) typically provide short-term counseling and assess patient needs, including the need for ongoing psychosocial support. While some patients may benefit from a referral to a mental health provider (MHP), previous research identified barriers to this process due to patient characteristics, the GC work environment, and MHP availability. Adoption of interprofessional collaborative practice (IPCP), a model where multiple healthcare professionals from diverse training disciplines collaborate to deliver patient care, may mitigate these barriers. Evidence suggests that IPCP both increases patient satisfaction and reduces healthcare spending. Anecdotal evidence suggests that GCs and MHPs may use IPCP in select institutions, but there is limited research examining these relationships. This study aims to characterize the benefits, barriers, and limitations of current IPCP practice between GCs and MHPs. Six semi-structured interviews with GCs and MHPs were completed and analyzed thematically. Four themes emerged: (1) mental health concerns in GC sessions and GC scope of practice; (2) establishing and maintaining IPCP between GCs and MHPs; (3) benefits, barriers, and limitations of IPCP; and (4) next steps to develop future IPCP. The findings suggest that there are varying approaches to IPCP that are influenced by perceptions of provider scope of practice. IPCP may mitigate some previously described referral barriers related to logistics, and the availability of trusted MHPs with knowledge of a GCs specialty, thereby improving patient and provider satisfaction.

Criminological and Psychiatric Profiles of Immigrant and Refugee Offenders: A Retrospective Analysis of Cases in a Forensic Setting

This study aimed to scrutinize the characteristics of immigrant and refugee offenders within our institution, focusing on factors such as immigrant status, country of birth, duration of residence in Turkey, as well as psychiatric, socio-demographic, and criminal profiles. The data were obtained through a retrospective examination of case records referred to the Observation Department of the Council of Forensic Medicine for the assessment of criminal responsibility between 2017 and 2022. The study categorized the cases into two groups: refugees and immigrants, comprising 35 and 22 offenders, respectively. Significant differences in educational levels were identified between immigrants and refugees within our study group (p < .001). Notably, drug use disorders were more prevalent among refugees, whereas alcohol use disorders were more common among immigrants, with statistical significance (p < .005). During forensic psychiatric assessments, 57.1% of refugees and 54.5% of immigrants required interpretation services. The most prevalent offense in the refugee group was homicide (37.1%), followed by child sexual abuse (28.6%). In contrast, homicide (31.8%) and theft and extortion (22.7%) were the most common offenses for the immigrant group. Six cases (10.5%) were judged to have reduced or no criminal liability. Among the cases, 52.6% had a history of prior outpatient psychiatric referrals, with the most frequent diagnosis being atypical psychosis at 10.5%. The findings underscore the necessity for additional research and targeted interventions to address the mental health and criminological complexities confronted by this vulnerable population.

Influence of biopsychosocial factors on self-reported anxiety/depression symptoms among first-generation immigrant population in the U.S

BACKGROUND

Despite increasing studies on mental health among immigrants, there are limited studies using nationally representative samples to examine immigrants' mental health and its potential biopsychosocial contributing factors, especially during the COVID-19 pandemic. We explored and estimated the influence of life satisfaction, social/emotional support, and other biopsychosocial factors on self-reported anxiety/depression symptoms among a nationally representative sample of first-generation immigrants in the U.S.

METHODS

We conducted a secondary data analysis using the 2021 National Health Interview Survey among first-generation adults aged ≥ 18 years (n = 4295). We applied survey weights and developed multivariable logistic regression model to evaluate the study objective.

RESULTS

The prevalence of daily, weekly, or monthly anxiety/depression symptoms was 10.22% in the first-generation immigrant population. There were 2.04% daily, 3.27% weekly, and 4.91% monthly anxiety/depression among the population: about 8.20%, 9.94%, and 9.60% experienced anxiety symptoms, whereas 2.49%, 3.54%, and 5.34% experienced depression symptoms daily, weekly, and monthly, respectively. The first-generation population aged 26-49 years were less likely to experience anxiety/depression daily, weekly, or monthly compared to those aged 18-25. Females (versus males) were more likely to experience anxiety/depression daily, weekly, or monthly. Those who identified as gay/lesbian had higher odds of experiencing anxiety/depression daily, weekly, or monthly compared to heterosexual persons. Relative to non-Hispanic White individuals, non-Hispanic Asian, Black/African American, and Hispanic individuals had lower odds, while other/multi-racial/ethnic groups were more likely to experience anxiety/depression daily, weekly, or monthly. A higher life satisfaction score was associated with lower odds of experiencing anxiety/depression daily, weekly, or monthly. Having social/emotional support sometimes/rarely or using healthcare within the past one/two years was associated with experiencing anxiety/depression daily, weekly, or monthly.

CONCLUSIONS

The findings reveal significant burden of anxiety and depression among first-generation population in the U.S., with higher risks among subgroups like young adults, females, sexual minorities, and non-Hispanic White and other/multi-racial individuals. Additionally, individuals with lower life satisfaction scores, limited social/emotional support, or healthcare utilization in the past one or two years present increased risk. These findings highlight the need for personalized mental health screening and interventions for first-generation individuals in the U.S. based on their diversity and health-related risks.

Cultural pathways to psychosis care: Patient and caregiver narratives from Puebla, Mexico

The current study used the McGill Illness Narrative Interview (MINI) to explore patients' (n = 6) and caregivers' (n = 3) narratives about how they identified and sought care for psychosis. Participants were recruited from an outpatient clinic at the Hospital Psiquiátrico Dr. Rafael Serrano, a public psychiatric hospital in Puebla, Mexico. All participants consented to complete semi-structured interviews in Spanish. Thematic analyses were used to inductively identify common themes in participants' narratives. The results indicated that during the initial symptom onset, most participants noticed the presence of hallucinations but did not seek help for this hallmark symptom. Participants described seeking care only when they or their ill relative exhibited escalating aggressive behaviors or physical symptoms that were interpreted as common medical problems. As participants became connected to specialty mental health services, they began to develop a conceptualization of psychosis as a disorder of aggression. For some participants, this conceptualization of psychosis as an illness of aggression contributed to their ambivalence about the diagnosis. These results can be understood using a cultural scripts framework, which suggests that cultural norms are influenced by collective understandings of normalcy and valorization of behaviors. Implications for community campaigns are discussed.

Behavioral Addiction from the Asian Americans Perspective: Exploration of Public and Help-Seeking Stigma

Asian Americans have been unlikely to seek mental health services despite their needs for treatment, particularly when experiencing significant gambling or Internet gaming problems. Stigma is often considered to be a barrier to seeking help. To understand how stigma impacts Asian Americans' willingness to seek mental health services, the present study used an online survey to investigate the public stigma associated with addictive behaviors and help-seeking stigma among Asian Americans. Participants (N = 431) who self-identified as Asian American, reside in the US. Using a between-groups vignette study design, it was found that the individual with a behavioral addiction received more stigma compared to the individual who experienced a financial crisis. In addition, participants were more likely to seek help if they experienced addictive behavioral problems rather than financial problems. Lastly, this study did not reveal a significant relation between public stigma attached to addictive behaviors and Asian Americans' willingness to seek help, but it found that participants' willingness to seek help was positively associated with public stigma of help seeking (β = 0.23) and negatively associated with self-stigma attached to help-seeking (β = - 0.09). Based on these findings, recommendations are provided to inform community outreach to reduce stigma and promote mental health service utilization among Asian Americans.

Health Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review

Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.

Help-Seeking Preferences and Influencing Factors Among Chinese Nurses Exposed to COVID-19: A Person-Centered Approach

PURPOSE

This study aimed to explore help-seeking preference categories and crucial influencing factors among community nurses exposed to COVID-19 in China using a new person-centered approach.

DESIGN

A cross-sectional design including an online self-reported questionnaire survey was used.

METHODS

A total of 667 nurses who participated in COVID-19 prevention and control work were recruited. Latent class analysis and logistic regression were used to analyze the data using Mplus and SPSS.

FINDINGS

Two latent classes of help-seeking preferences were identified: high help-seeking preferences (33.58%) and low help-seeking preferences (66.42%). Most sampled nurses had relatively low help-seeking preferences when facing psychological threats during COVID-19. Logistic regression showed that career duration, perceived social support, online help-seeking intention, and social media exposure negatively affected low help-seeking preferences.

CONCLUSIONS

Career duration, perceived social support, online help-seeking intention, and social media exposure could be key factors influencing help-seeking preferences among Chinese nurses exposed to public emergencies. It is necessary to implement relevant intervention measures, such as focusing on nurses whose career durations are shorter, improving nurses' perceived social support, strengthening positive media publicity, and developing comprehensive online mental health services that promote nurses' help-seeking preferences and behaviors to reduce mental illness during public health emergencies.

CLINICAL EVIDENCE

Help-seeking preferences are relatively low among Chinese nurses during public emergencies. Based on the major influencing factors of help-seeking preferences, including social support and social media exposure, more interventions must be developed for prompting psychological help-seeking intentions among Chinese nurses.

Conventional or Alternative Mental Health Service Utilization According to English Proficiency Among Asians in the United States

After the onset of the COVID-19 pandemic in 2020, Asian Americans in the United States have experienced a surge in anti-Asian crimes, leading to heightened psychological distress among this community. Consequently, the mental well-being of Asian Americans demands greater attention than ever. Regrettably, Asians tend to underutilize or delayed mental health care treatments. This study examines the conventional and alternative mental health service utilization among Asians in the United States according to their English proficiency. From the 2015-2018 National Survey on Drug Use and Health, this study examined 3,424 self-identified non-Hispanic Asians aged 18-64 with Kessler score of at least 5. Stratified bivariate analysis and multivariable logistic regression analysis were conducted. Regardless of English proficiency, Asians did not utilize alternative mental health service more than conventional mental health service. However, those with limited English proficiency consistently utilize care less than those with English proficiency. Need factors, such as mental distress severity and self-rated health status, were significant factors associated with their mental health service utilization. English proficiency remains a structural factor in preventing Asians from utilizing mental health services regardless of the nature of services. Due to the COVID-19 pandemic, more Asians have been experiencing mental distress. This study demonstrates a particular need for mental health services that are culturally specific and Asian language friendly.

Mental Health Care Access Among Arab Immigrants in the United States: Application of Public Arena Model

Arab immigrants constitute a sizable portion of the US population, and their adjustment and relocation challenges might escalate mental health issues. Nevertheless, mental health care accessibility among such populations is not recognized as policy issue. Hence, it is crucial to explore the political tools that might be employed to improve immigrants' access to mental health treatment. The Public Arenas Model (Hilgartner and Bosk, American Journal of Sociology 94:53-78, 1988) provides better understanding of how access to mental health care is defined in the public sphere, why mental health inaccessibility among Arabs has not received attention, and how stakeholders worked to raise the public's attention to such issue (Smith, Policy, Politics & Nursing Practice 10:134-142, 2009). Ultimately, several policy options are proposed to address Arab immigrants' access to mental health care issue, including increasing mental health service providers' language proficiency and cultural competency, integration of behavioral health and primary care services for immigrant populations, and considering novel modes of mental health delivery.

Barriers and facilitators to depression care among Latino men in a primary care setting: a qualitative study

BACKGROUND

In the United States, Latinos face a wide array of cultural and structural barriers to accessing and utilizing mental health care. Latino men specifically are at high risk of receiving inadequate mental health care, possibly due to additional obstacles they experience that are related to masculinity. Among men more generally, greater adherence to emotional control and self-reliance is associated with higher depression severity and less depression help-seeking. Men experience more stigma toward depression and help-seeking and are less likely to be diagnosed with depression than women. However, Latino men's barriers and facilitators to depression care remain largely unexplored. The objective of this study was to examine barriers and facilitators to depression care that are related to masculinity among English- and Spanish-speaking Latino men in a primary care setting.

METHODS

We used convenience and purposive sampling to recruit primary care patients who self-identified as Latino men, spoke English or Spanish, and screened positive for depressive symptoms on the Patient Health Questionnaire-2 or had a history of depression. Semi-structured interviews were conducted between December 2020 and August 2021. The interview guide examined views and experiences of depression, masculinity, and barriers and facilitators to engaging in depression care. Utilizing consensual qualitative research and thematic analysis informed by modified grounded theory, barriers and facilitators to depression care were identified.

RESULTS

We interviewed thirteen participants who varied in English proficiency, education, income, and country of origin. Barriers and facilitators were placed into three domains-Self-Recognition of Depression, Seeking Help for Depression, and Depression Diagnosis and Treatment. Participants described aspects of masculinity as barriers (emotional control and pressure to provide), facilitators (honesty, courage, collaboration, practicality, and responsibility), or both (self-reliance and autonomy).

CONCLUSIONS

Masculinity influences barriers and facilitators for depression care among Latino men at the levels of self-recognition, seeking help, and diagnosis and treatment. Clinicians may promote Latino men's engagement in depression care by understanding patients' values and framing depression care as affirming masculinity. Providing education to primary care physicians and other healthcare professionals on gender and depression and addressing structural barriers are essential to providing access to all who need depression care.

Increasing transcultural competence in clinical psychologists through a web-based training: study protocol for a randomized controlled trial

BACKGROUND

In mental health care, the number of patients with diverse cultural backgrounds is growing. Nevertheless, evaluated training programs for transcultural competence are missing. Barriers for engaging in transcultural therapy can be identified in patients as well as in therapists. Besides language barriers, clinical psychologists report insecurities, for example, fear of additional expenses when involving a language mediator, ethical concerns such as power imbalances, or fear of lack of knowledge or incorrect handling when working with patients from other cultures. Divergent values and concepts of disease, prejudices, and stereotyping are also among the issues discussed as barriers to optimal psychotherapy care. The planned study aims to empower clinical psychologists to handle both their own as well as patients' barriers through a web-based training on transcultural competence.

METHODS

The training includes 6 modules, which are unlocked weekly. A total of N = 174 clinical psychologists are randomly assigned to two groups: the training group (TG) works through the complete training over 6 weeks, which includes a variety of practical exercises and self-reflections. In addition, participants receive weekly written feedback from a trained psychologist. The waitlist control group (WL) completes the training after the end of the waiting period (2 months after the end of the TG's training). The primary outcome is transcultural competence. Secondary outcomes consist of experiences in treating people from other cultures (number of patients, satisfaction and experience of competence in treatment, etc.). Data will be collected before and after the training as well as 2 and 6 months after the end of the training.

DISCUSSION

This randomized controlled trial tests the efficacy of and satisfaction with a web-based training on transcultural competence for German-speaking clinical psychologists. If validated successfully, the training can represent a time- and place-flexible training opportunity that could be integrated into the continuing education of clinical psychologists in the long term.

TRIAL REGISTRATION

DRKS00031105. Registered on 21 February 2023.

Migrant Men Living in Brazil during the Pandemic: A Qualitative Study

This study aims to analyze the repercussions of the ongoing COVID-19 pandemic on the health of male immigrants, refugees, and asylum seekers in Brazil. A qualitative study involving 307 adult men living in Brazil during the COVID-19 pandemic was conducted. Data were collected between August 2021 and March 2022 and interpreted based on the Transcultural Nursing Theory. Cultural care repercussions were identified in various dimensions: technological: changes in daily life and disruptions in routine; religious, philosophical, social, and cultural values: changes stemming from disrupted social bonds, religious practices, and sociocultural isolation; political: experiences of political partisanship, conflicts, government mismanagement, a lack of immigration policies, human rights violations, and xenophobia; educational/economic: challenges arising from economic impoverishment, economic insecurity, unemployment, language difficulties, and challenges in academic and literacy development during the pandemic. The persistence of the COVID-19 pandemic in Brazil had significant repercussions for the health of migrant men, resulting in a transcultural phenomenon that requires sensitive nursing care. Implications for nursing: the uniqueness of cultural care in nursing and health, as most of the repercussions found were mostly negative, contributed to the increase in social and health vulnerabilities.

Depressive Symptoms and Their Longitudinal Impact on Physical Activity and Sedentary Behaviors Among Mexican-Heritage Youth

The purpose of this study is to examine the longitudinal impact of depressive symptoms on physical activity (PA) levels, sedentary behavior, and screen time among first-generation, Mexican-heritage youth. Mexican-heritage families were recruited by promotoras de salud from colonias in Hidalgo County, Texas. Participants (n = 200 youth, 116 families in final sample) completed at-home, interviewer-administered surveys once during the summer (June-July) and once during the fall (August-December). Youth PA and sedentary behaviors were assessed using a validated 7-day recall instrument. The validated Center for Epidemiology Studies-Depression Child scale was used to assess depression symptoms. Linear mixed-effects models were used to analyze the relationships of PA and sedentary behavior with depressive symptoms. Results showed that those depression symptoms were significantly associated with decreased number of self-reported minutes of sitting and screen time over time in the full sample and among male youth. Depression symptoms also significantly decreased the number of self-reported active and moderate to vigorous PA minutes over time among male youth. Researchers can build on our findings by identifying the mechanisms driving the relationships between depression and PA/sedentary behavior. Public health-programing efforts should intentionally consider the impact that depressive symptoms have on PA.

A Qualitative Analysis of Latina Migrant Farmworkers' Perception of Mental Health: Voices From Wisconsin

INTRODUCTION

Despite evidence showing Latinos' high prevalence of mental health, little is known about Latina migrant farmworkers' mental health experiences, especially those working in Midwestern states. Considering the multiple vulnerabilities observed among Latina migrant farmworkers, it is necessary to gain insight from own accounts and perceptions of mental health and mental health-seeking experiences.

METHOD

A qualitative descriptive approach, using in-depth semi-structured interviews with open-ended questions, served to retrieve data from 34 Latina migrant farmworkers. This study was informed by Chicana, postcolonial, and Black feminist epistemologies.

RESULTS

Thematic analysis identified themes within the data. These findings pertained to the conceptualization of mental health within the contexts of family, capacities, stigma, denial, and faith.

DISCUSSION

Our results demonstrate the need for health care providers to consider Latina migrant farmworkers' perceptions about mental health and apply those in designing and implementing culturally informed policy and practice.

Psychosocial Determinants of Mental Healthcare Use Among Mexican-origin Women from Farmworker Families in Southern California

Little is known about the contribution of psychosocial factors related to mental healthcare use among Mexican-origin women from farmworker families. Therefore, this study assessed relationships between acculturative stress, depressive symptoms, mental healthcare service use, and preferences for seeking care. Linear and logistic regression models and chi-square tests were performed to analyze survey data from 78 Mexican-origin women from farmworker families. Women were recruited in collaboration with promotoras and completed measures of acculturative stress, depressive symptoms, and mental healthcare use and preferences. Overall, 29.5% of the sample reported clinically significant depressive symptomatology. Acculturative stress was positively associated with depressive symptoms (b = 0.43, 95%CI = 0.27,0.59) after controlling for years in the U.S., primary language, and demographic characteristics. In addition, acculturative stress was associated with lower odds of mental healthcare use (OR = 0.96) after controlling for years in the U.S. and depressive symptoms. However, this association was no longer statistically significant when controlling for health insurance status and access to transportation. Mexican-origin women with high levels of acculturative stress were significantly more likely to seek care from a psychiatrist/psychologist than their peers (54.3% vs. 45.7%); however, this preference was not indicative of their use of mental healthcare services. Results suggest that acculturative stress is a risk factor for depressive symptoms and might contribute to a delay in seeking mental healthcare services in Mexican-origin women from farmworker families. Thus, interventions for this group should address aspects of acculturative stress as a strategy to increase mental health services use.

The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review

Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.

Barriers To Accessing Mental Health Services Among Syrian Refugees: A Mixed-Method Study

OBJECTIVE

Although Syrian refugees have high rates of mental health problems due to war trauma, little is known on their degree of need for and contact with mental health services. Using a population sample of Syrian refugees living in Ankara, we assessed the perceived need for and contact with mental health services, as well as the barriers to access these services.

METHOD

This was a cross-sectional mixed-method study of 420 Syrian refugees living in Ankara city center, using face to face interviews administered at the respondents' home by trained, Arabic-speaking interviewers. PTSD and depression were assessed using Harvard Trauma Questionnaire and Beck Depression Inventory, respectively.

RESULTS

Of all the refugees in our sample, 14,8% (N=62) stated that they felt the need for mental healthcare since arriving in Turkey. The actual number contacting any mental health service was very low (1,4%, N=6). The most important barriers to accessing mental health services were reported by the respondents to be language problems and lack of information on available mental health services. Service providers and policymakers also reported similar topics as the most important barriers: low awareness about mental health problems, daily living difficulties, and language and cultural barriers. Multivariate analyses revealed that presence of medical or mental disorders and female gender predicted the perceived need for contacting services.

CONCLUSION

Our results show that, although refugees report high rates of mental health problems, the perceived need for and actual contact with services are very low. To address this treatment gap, and to provide adequate care for refugees with mental health problems, common barriers (language and awareness) should be identified and dealt with.

Late life anxiety and depression symptoms, and suicidal behaviors in racial/ethnic minority older adults in community-based organizations and community clinics in the U.S

OBJECTIVE

Late life anxiety and depression represent a significant source of disability, with racial/ethnic minority older adults in the U.S. showing marked disparities in healthy aging. Community-based organizations (CBOs) and community clinics serve these populations for preventive care, yet few identify their mental health service needs. We examine the association between race/ethnicity and risk of mild-to-severe symptoms of anxiety and depression, and suicidal behaviors in minority older adults.

METHOD

Data come from the multisite randomized controlled trial Building Community Capacity for Disability Prevention for Minority Elders, which screened 1,057 adults (45.5% Asian, 26.8% Latinx, 15.0% non-Latinx Black, 8.5% non-Latinx White, and 4.2% American Indian) aged 60 + years at CBOs and clinics in Massachusetts, New York, Florida, and Puerto Rico. Screened participants completed the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, the Geriatric Depression Scale-15 (GDS-15) for depression symptoms, and the Paykel Suicide Risk Questionnaire for suicidal behaviors.

RESULTS

28.1% of older adults reported mild-to-severe anxiety symptoms, 30.1% reported mild-to-severe depression symptoms, and 4.3% reported at least one suicidal behavior. Compared to non-Latinx Whites, Latinxs had higher odds of mild-to-severe anxiety and depression symptoms and one or more suicidal behaviors, and Asians had higher odds of mild-to-severe depression symptoms only.

CONCLUSIONS

There is an urgent need to improve outreach for screening and preventive mental health care for minority older adults. Expanding outreach and community-based capacity to identify and treat minority older adults with mental health conditions represents an opportunity to prevent disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants

BACKGROUND

Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations.

METHODS

English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456).

RESULTS

Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions.

CONCLUSION

Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.

Cultural-Responsiveness of the Mental Health First Aid Training for Asian Immigrant Populations in Greater Boston, Massachusetts

Background

The COVID-19 pandemic and rise in anti-Asian racism have had adverse mental health impacts in Asian communities. The lack of culturally-responsive and linguistically-accessible mental health trainings hinders access to mental health services for Asian populations. In this study, we assessed the mental health needs of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond.

Methods

This community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition employed two phases. In phase 1, we conducted focus groups with BCNC and AWFH staff and peer educators to assess mental health priorities of Asian populations in Boston. Findings informed phase 2, which evaluated cultural responsiveness of the MHFA through pre- and post-training questionnaires and focus groups with community participants. The pre-training questionnaire asked about mental health needs and barriers, help-seeking behaviors, and literacy; and personal and Asian community stigma. The post-training questionnaire and focus group with community participants asked about cultural competence of MHFA training for Asian populations. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews.

Results

In total, 10 staff/educators and 8 community members participated in focus groups. They identified common mental health needs and workforce and culturally-responsive community strategies to support persons with mental health issues. Twenty-four community participants completed pre- and post-training questionnaires. They reported the MHFA training reduced mental health care stigma and increased mental health literacy. Recommendations to increase cultural-responsiveness of the MHFA were to include mental health case studies common in Asian populations and provide the training in other languages (e.g., Chinese, Vietnamese).

Conclusion

Cultural responsiveness of the MHFA for Asian populations could be improved with the inclusion of case studies specific to the Asian communities and accessibility of the training in other languages. Increasing the cultural relevance and language accessibility of these trainings could help reduce mental health stigma and gaps in mental health awareness and service utilization among Asian populations.

Mediation analysis of mental health characteristics linking social needs to life satisfaction among immigrants

Background

Life satisfaction contributes to improved long and healthy lives, enhanced biological function, better mental health, and decreased mortality risks. Social needs (e.g., food security, employment, healthcare utilization) are important determinants of mental health and life satisfaction among immigrants. However, there is limited literature on how social needs influence mental health, which, in turn, affects life satisfaction among immigrants. We examined whether mental health influences the mechanisms of the relationship between social needs and life satisfaction among immigrants.

Methods

We used the 2021 cross-sectional National Health Interview Survey data on U.S. immigrants (n = 4320) aged ≥18 years. We conducted weighted mediation analyses with multiple linear regression. Life satisfaction (scores 0-10; ≥1 as higher life satisfaction) was the dependent variable; independent variables were food security, employment, and healthcare utilization; and the mediator, serious psychological distress (SPD: scores 0-24; ≥1 as higher SPD).

Results

The total effect (not accounting for SPD) of food insecurity (vs. secure) on life satisfaction was negative (β = -0.61, p < 0.001); the direct effect (after accounting for SPD) was not statistically significant (β = -0.21, p = 0.153), while the indirect effect (food insecurity's effect explained by SPD) was negative (β = -0.40, p < 0.001). The total (β = 0.32, p < 0.001), direct (β = 0.24, p = 0.004), and indirect (β = 0.09, p = 0.006) effects of being employed (vs. unemployed) on life satisfaction were positive. The total (β = -0.12, p = 0.116) and direct (β = -0.03, p = 0.683) effects of healthcare utilization within the past year (vs. more than a year) on life satisfaction were not statistically significant, whereas the indirect effect was negative (β = -0.09, p < 0.001).

Conclusions

SPD mediates the effect of food security, healthcare utilization, and employment on life satisfaction, suggesting the need to improve social needs and mental health among immigrants.

Rethinking mental healthcare for refugees

After several years of downturn in new resettlement, the United States is projected to admit 125,000 refugees in the current fiscal year. Refugee communities have known risks of developing mental health problems due to high rates of exposure to war and conflict-related trauma and chronic stressors associated with displacement and resettlement. In this commentary, we examine limitations in the current system of mental health care available to newly arriving refugee communities and make recommendations for expanding and redesigning services to better meet the needs of culturally diverse refugee communities. This includes drawing on public health and prevention frameworks to implement a continuum of services including basic services and security, trauma-informed prevention services to meet the needs of individuals, families and communities and specialized clinical care for those that need it. Across all services, we recommend robust engagement and partnership with refugee community leaders to design and deliver programs.

Moving Toward Inclusion: Access to Care Models for Uninsured Immigrant Children

Policy Points Models for access to care for uninsured immigrant children that mitigate structural and sociopolitical barriers to inclusive health care include funding structures (e.g., state-sponsored coverage) and care delivery systems (e.g., federally qualified health centers,). Although the quintessential model of access to care necessitates health coverage for all children regardless of immigration status or date of United States entry, incremental policy change may more realistically and efficiently advance equitable access to high-quality health care. Intentional advocacy efforts should prioritize achievable goals that are grounded in data, are attentive to the sociopolitical milieu, are inclusive of diverse perspectives, and would meaningfully impact health care access and outcomes.

Intimate Partner Violence Polyvictimization and Health Outcomes

This study examines how gender interacts with polyvictimization patterns in survivors' health problems using 8,587 survivors of intimate partner violence from the National Intimate Partner and Sexual Violence Survey, a nationally representative sample collected in 2010. Polyvictimization included six categories that were created in our previous work: sexual violence, physical and psychological violence, coercive control, multiple violence, stalking, and psychological aggression. Multiple violence was associated with chronic pain, headache, difficulty sleeping, and poor health perception. Females experiencing coercive control were more likely to have chronic pain than males. The appropriate assessment of gendered patterns of polyvictimization, and relevant subsequent services and support will better address health problems among survivors.

Adapting a transdiagnostic digital mental health intervention for use among immigrant and refugee youth in Seattle: a human-centered design approach

Digital mental health interventions show promise in addressing mental health needs, especially among youth and marginalized communities. This study adapted the World Health Organization -developed STARS (Sustainable Technology for Adolescents to Reduce Stress) digital mental health intervention for use among youth and young adults aged 14-25 from immigrant and refugee communities in Seattle, Washington. Human-centered design methods centered around qualitative semi-structured interviews were used to contextually and culturally adapt the intervention and prioritize the needs and preferences of the intended end user. Intervention prototypes were modified and then presented to the target groups in iterative cycles until saturation was achieved. Qualitative interviews occurred in three iterations of five participants each. Modifications were documented according to the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) implementation science framework. Modifications aligned with the FRAME process elements: (a) tailoring/refining, which included adapting language to less resemble digital phishing scams; (b) changes in packaging or materials, which included naming the chatbot and adopting a corresponding avatar; (c) adding/removing, which included changing existing emojis and adding additional media types including graphics interchange format images, pictures, and voice memos; (d) shortening/condensing, which included shortening the length of individual text sections as well as deleting redundant language; (e) lengthening/extending, which included allowing the user to choose to receive content catered to teenagers or to adults; and (f) loosening structure, including giving users options to skip parts of modules or to engage with additional material. The modified STARS intervention shows promise for engagement with immigrant and refugee youth in Seattle and can be examined for clinical effectiveness. Adaptations increased the relevance of content to the intended end user, expanded options for personalization and customization of the user experience, and utilized language that was age appropriate, engaging, and did not invoke feelings of stigma or distrust. Adaptations of digital mental health interventions should focus on modifications that maximize acceptability and appropriateness to intended audiences.

Screening for post-traumatic stress disorder among Latinx immigrant children

ABSTRACT

Latinx children face psychosocial, linguistic, and economic challenges that put them at an increased risk of developing mental health conditions. Primary care providers should be equipped to recognize the complex mental health needs of this growing population. This article explores some of the barriers to mental health screenings in Latinx children and presents culturally sensitive, validated screening tools for primary care providers.

An 18-week model of Parent-Child Interaction Therapy: clinical approaches, treatment formats, and predictors of success for predominantly minoritized families

Introduction

Disruptive behavior disorders are among the most prevalent pediatric mental health referrals for young children. However, families from historically minoritized social identities have experienced disparities in treatment access, retention, and outcomes. Evidence-based interventions such as Parent-Child Interaction Therapy (PCIT) have been found to be effective in reducing children's disruptive behaviors in minoritized families. However, variable treatment length as a result of skill-based graduation criteria (e.g., observed caregiver verbalizations) may slow and/or hinder treatment progress, particularly for families where expected treatment verbalizations are less linguistically relative (e.g., no exact English to Spanish translations) and/or culturally familiar. Time-limited PCIT has been proposed as a strategy for promoting equity in treatment completion and outcomes amongst minoritized families, because treatment progression and/ or completion is not contingent upon caregiver linguistic skill demonstration.

Methods

The current study evaluated the overall effectiveness of an 18-week model of PCIT and examined predictors of retention and treatment outcomes. Participants (N = 488 dyads) included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged two to eight years, and their caregivers.

Results

Overall findings indicate that the 18-week PCIT model is an effective intervention for reducing children's externalizing and internalizing behaviors and improving caregiver parenting skills for most treatment completers. Despite advances in treatment completion, some caregiver social identities and PCIT treatment characteristics were predictive of lower completion rates and/or less optimal treatment outcomes.

Discussion

Overall, this study provides strong support for widely disseminating use of the 18-week model of PCIT for most families served. Clinical implications and considerations for continued treatment inequity are discussed.

Why are African immigrants in Montreal reluctant to use mental health services?: a systematic inventory of reasons

PURPOSE

Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada.

METHODS

The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis.

RESULTS

An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics.

CONCLUSION

Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care.

Determinants of the intention to seek psychotherapeutic consultation at work - a cross-sectional study in Germany

BACKGROUND

Psychotherapeutic consultation at work (PT-A) provides employees with mental illnesses or subclinical symptoms a short-term and low-threshold access to psychotherapeutic care. However, practical experience shows that the utilisation rate seems low compared to expected demand. Therefore, this study aimed to identify determinants of utilisation by exploring associations between sociodemographic characteristics, psychological well-being, stigma-related barriers and psychosocial safety climate and the intention to seek PT-A.

METHODS

Within a cross-sectional study, 658 participants were recruited via various social media channels in Germany. Participants answered an online questionnaire on potential determinants of (1) intention to seek PT-A in general and of intention to seek PT-A to specifically discuss (2) occupational burden and (3) private burden. Multiple ordinal regression analyses were conducted for the whole study sample and for the subgroups of participants screened positive and negative for current depression.

RESULTS

Lower stigma-related barriers were associated with higher general intention to seek PT-A among all study groups. Lower psychological well-being was associated with higher general intention to seek PT-A and with higher intention to seek PT-A to discuss occupational and private burden, but only so in the subgroup of employees who were screened negative for current depression. Treatment experience was associated with higher intention to seek PT-A for occupational burden among participants screened negative but not among participants screened positive for current depression. No associations were found between age, gender, education or psychosocial safety climate and any variable of intention to seek PT-A.

CONCLUSION

Those results give an overview on potential determinants for the intention to seek PT-A, but future research with longitudinal designs is needed to confirm that those factors also determine actual utilisation of PT-A. Based on the results, practical implications might include antistigma campaigns and promotion of PT-A adapted to the aims of the consultation.

Factors Associated with Professional Mental Help-Seeking Among U.S. Immigrants: A Systematic Review

Structural and cultural barriers have led to limited access to and use of mental health services among immigrants in the United States (U.S.). This study provided a systematic review of factors associated with help-seeking attitudes, intentions, and behaviors among immigrants who are living in the U.S. This systematic review was performed using Medline, CINAHL, APA PsycInfo, Global Health, and Web of Science. Qualitative and quantitative studies examining mental help-seeking among immigrants in the U.S. were included. 954 records were identified through a search of databases. After removing duplicates and screening by title and abstract, a total of 104 articles were eligible for full-text review and a total of 19 studies were included. Immigrants are more reluctant to seek help from professional mental health services due to barriers such as stigma, cultural beliefs, lack of English language proficiency, and lack of trust in health care providers.

A Scoping Review of the Relationship Between Physical Activity and Mental Health Among Immigrants in Western Countries: An Integrated Bio-Psycho-Socio-Cultural Lens

Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners.

Correlates of Stigma Toward Mental Health Service Use Among Filipino Americans and Korean Americans

Asian Americans are less likely than Whites to seek mental care and when they do, there is a substantial delay in help-seeking. Stigma associated with mental health service use is one of the major barriers to help-seeking among Asian Americans. However, few studies have examined multi-layered contextual predictors of stigma to examine joint as well as unique contributions of each predictor. Using a cross-sectional study of 376 Filipino and 412 Korean American parents from the Midwestern U.S., we investigated how individual, familial, ethnic cultural, and macro level factors were associated with stigma among immigrant parents. The findings from hierarchical regressions suggest that familial and ethnic cultural factors are prominent predictors of stigma among Korean Americans, whereas macro level factors are particularly pertinent to Filipino Americans. This study highlights the significance of subgroup specific interventions to be effective in addressing unmet mental care needs in distinct subgroups of Asian Americans.