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Michaels TI, Simon-Pearson L, Kane JM, Cornblatt B. Racial Disparities Among Clinical High-Risk and First-Episode Psychosis Multisite Research Participants: A Systematic Review. Psychiatr Serv 2024; 75:451-460. [PMID: 38204372 DOI: 10.1176/appi.ps.20230120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The NIH has mandated equal representation of Black, Indigenous, and people of color (BIPOC) individuals in clinical research, but it is unclear whether such inclusion has been achieved in multisite research studies of individuals at clinical high risk for psychosis or with first-episode psychosis (FEP). An assessment of inclusion rates is important for understanding the social determinants of psychosis and psychosis risk that specifically affect BIPOC individuals. METHODS The authors conducted a systematic review of the literature published between 1993 and 2022 of multisite research studies of clinical high risk for psychosis and FEP in North America to determine ethnoracial inclusion rates. Using an online systematic review tool, the authors checked 2,278 studies for eligibility. Twelve studies met all inclusion criteria. Data were extracted, and demographic characteristics, socioeconomic status, study design, and recruitment strategies used by each study were analyzed. RESULTS Most (62%) of the participants in studies of clinical high risk for psychosis were White. Compared with national data, the demographic characteristics of individuals with clinical high risk were representative across most ethnoracial groups. Black participants (43%) made up the largest ethnoracial group in FEP studies and were overrepresented compared with their representation in the U.S. population. FEP studies were more likely to recruit participants from community mental health centers than were the studies of clinical high risk. CONCLUSIONS Although these results suggest high representation of BIPOC individuals in psychosis research, opportunities exist for an improved focus on ethnoracial representation. The authors offer recommendations for practices that may increase ethnoracial diversity in future psychosis study samples.
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Affiliation(s)
- Timothy I Michaels
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Laura Simon-Pearson
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - John M Kane
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Barbara Cornblatt
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
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Raposa ME, Smithers DJ, Coleman CM, Harlow BL. Depression and help-seeking behaviors among college students: Findings from the Healthy Minds Study 2018-2019. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38227913 DOI: 10.1080/07448481.2023.2299397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To determine the likelihood of using formal and informal mental health services among college students according to prior history of depression diagnosis and presence of depression symptoms. PARTICIPANTS College students from 79 universities in the U.S. and Canada who participated in the Healthy Minds Study, 2018-2019. METHODS Odds ratios and 95% confidence intervals via logistic regression were estimated for the likelihood of using informal and formal mental health services stratified by depression diagnosis and severity of depression symptoms and further stratified by race/ethnicity. RESULTS We report increased odds of using formal mental health services with increasing depression severity symptoms and increased odds of using formal mental health services among students without a clinical depression diagnosis. The odds of service utilization varied by race/ethnicity. CONCLUSIONS The likelihood of seeking mental health services differs depending on the history of formal depression diagnosis, current symptoms, and race/ethnicity among college students.
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Affiliation(s)
- Madison E Raposa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Daniel J Smithers
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Chad M Coleman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Shi J, Chen Y, Jiang Y, Li Y, Wang W, Zhao H, Guo L, Liao Y, Zhang H, Gao C, McIntyre RS, Zhang WH, Han X, Lu C. Stigma and its associations with medication adherence in major depressive disorder. Psychiatry Res 2024; 331:115664. [PMID: 38070363 DOI: 10.1016/j.psychres.2023.115664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/02/2024]
Abstract
This study sought to evaluate internalized stigma (IS) and perceived stigma (PS), in persons (n = 522) living with major depressive disorder (MDD), with a view to analyzing the association of IS and PS with medication adherence in a cohort of participants with MDD in China. Perceived stigma is the awareness of societal negative views and attitudes towards depression, and IS is applying others' attitudes to oneself, both measured by the Depression Stigma Scale (DSS). Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). We observed that 76.0 % of participants reported IS and 84.5 % reported PS. Factors associated with increased IS included older age, marital status, disease history, and a higher baseline Patient Health Questionnaire-9 (PHQ-9). Higher education level, family income, and scores on the Connor-Davidson Resilience Scale (CD-RISC) were associated with lower levels of IS. Higher education levels, Childhood Trauma Questionnaire (CTQ) scores, and living with others were also associated with higher PS, while engagement in exercise and higher number of prior episodes were associated with lower PS. IS had a negative association with medication adherence, whereas PS did not significantly associate with adherence. In conclusion, a testable hypothesis is derived from our data that strategies targeting IS amongst persons with MDD may improve overall rates of adherence to antidepressant treatment, a necessary prelude to improving recovery.
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Affiliation(s)
- Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Yingchen Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Hao Zhao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Caihong Gao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China.
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Martinez JH, Tahirkheli NN, Roemer L, Ying A, Abdullah T. Coping with racial discrimination: a preliminary examination of coping strategies in college students at a University in Northeastern U.S. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 38015172 DOI: 10.1080/07448481.2023.2283737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/03/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE We examined the associations between coping strategies in response to racism and distress symptoms. SAMPLE One hundred forty-four racially minoritized students at a northeastern university completed an online survey. METHODS Participants completed self-report active and emotion-focused coping and distress symptom (i.e., depression and anxiety) measures. Hierarchical regressions were conducted to test: 1) correlations between coping strategies in response to racism and distress symptoms, and 2) whether emotional acceptance moderates the association between active coping in response to racism and distress symptoms. RESULTS Students' self-compassionate responses to their emotional reactions to discrimination uniquely predicted less distress. In contrast, reports of using resistance and education in response to discrimination were positively correlated with distress symptoms; however, these associations were no longer significant when accounting for emotional acceptance. CONCLUSIONS Our findings suggest that emotional acceptance coping may be associated with lower distress symptoms. Active coping was associated with increased distress symptoms, except when accounting for emotional acceptance coping.
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Affiliation(s)
| | - Noor N Tahirkheli
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Lizabeth Roemer
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Anna Ying
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Tahirah Abdullah
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
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Feng RY, Krygsman A, Vaillancourt T, Vitoroulis I. Experiences of racial microaggression among immigrant and Canadian-born young adults: Effects of double stigma on mental health and service use. Int J Soc Psychiatry 2023; 69:1723-1735. [PMID: 37326034 PMCID: PMC10657499 DOI: 10.1177/00207640231174374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Significant disparities in utilization of mental health services exist among immigrant and Canadian-born populations. These gaps may be associated with a 'double stigma' - stigma related to being from a racialized background exacerbated by mental health stigma. Immigrant young adults may be particularly susceptible to this phenomenon, given developmental and social transitions from adolescence to adulthood. AIMS To investigate the joint effects of racial microaggression and mental health stigma on mental health and service use among first-generation immigrant and Canadian-born university students. METHOD We conducted an online cross-sectional study among first-generation immigrant and Canadian-born university students (N = 1,280, Mage = 19.10, SD = 1.50). RESULTS Despite no differences in anxiety or depression symptoms, first-generation (foreign-born) immigrants were less likely to have received therapy and to have taken medication for mental health issues compared to Canadian-born participants. First-generation immigrants also reported experiencing higher levels of racial microaggression and stigma toward service use. Results suggest the presence of a double stigma, mental health stigma and racial microaggression, each explained significant additional variance in symptoms of anxiety and depression and medication use. No effects of double stigma for therapy use were found - while higher mental health stigma predicted lower use of therapy, racial microaggression did not predict unique variance in therapy use. CONCLUSIONS Our findings highlight the joint effects of racial microaggression and stigma toward mental health and service as barriers to help-seeking among immigrant young adults. Mental health intervention and outreach programmes should target overt and covert forms of racial discrimination while incorporating culturally sensitive anti-stigma approaches to help reduce disparities in mental health service use among immigrants in Canada.
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Affiliation(s)
- Ruo Ying Feng
- School of Psychology, Faculty of Social Sciences, University of Ottawa, ON, Canada
| | - Amanda Krygsman
- Counselling Psychology, Faculty of Education, University of Ottawa, ON, Canada
| | - Tracy Vaillancourt
- School of Psychology, Faculty of Social Sciences, University of Ottawa, ON, Canada
- Counselling Psychology, Faculty of Education, University of Ottawa, ON, Canada
| | - Irene Vitoroulis
- School of Psychology, Faculty of Social Sciences, University of Ottawa, ON, Canada
- Counselling Psychology, Faculty of Education, University of Ottawa, ON, Canada
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Lagera PGD, Chan SR, Yellowlees PM. Asynchronous Technologies in Mental Health Care and Education. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2023; 10:1-13. [PMID: 37360962 PMCID: PMC10157570 DOI: 10.1007/s40501-023-00286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/28/2023]
Abstract
Purpose of review Patients, providers, and trainees should understand the current types of asynchronous technologies that can be used to enhance the delivery and accessibility of mental health care. Asynchronous telepsychiatry (ATP) removes the need for real time communication between the clinician and patient, which improves efficiency and enables quality specialty care. ATP can be applied as distinct consultative and supervisory models in clinician-to-clinician, clinician-to-patient, and patient-to-mobile health settings. Recent findings This review is based on research literature and the authors' clinical and medical training, using experiences with asynchronous telepsychiatry from before, during, and after the COVID-19 pandemic. Our studies demonstrate that ATP provides positive outcomes in the clinician-to-patient model with demonstrated feasibility, outcomes and patient satisfaction. One author's medical education experience in the Philippines during COVID-19 highlights the potential to utilize asynchronous technology in areas with limitations to online learning. We emphasize the need to teach media skills literacy around mental health to students, coaches, therapists, and clinicians when advocating for mental well-being. Several studies have demonstrated the feasibility of incorporating asynchronous e-tools such as self-guided multimedia and artificial intelligence for data collection at the clinician-to-clinician and patient-to-mobile health level. In addition, we offer fresh perspectives on recent trends in asynchronous telehealth in wellness, applying concepts such as "tele-exercise" and "tele-yoga." Summary Asynchronous technologies continue to be integrated into mental health care services and research. Future research must ensure that the design and the usability of this technology puts the patient and provider first.
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Affiliation(s)
- Pamela Gail D. Lagera
- Division of Hospital Medicine, Clinical Informatics, University of California, San Francisco, CA USA
| | - Steven R. Chan
- Division of Hospital Medicine, Clinical Informatics, University of California, San Francisco, CA USA
- Department of Psychiatry, University of California, San Francisco, CA USA
- Department of Psychiatry, University of California, Davis, CA USA
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Bayne HB, Mejia J, Mosley DV. The Social Justice Consultation Corps: An interdisciplinary training initiative. COUNSELOR EDUCATION AND SUPERVISION 2022. [DOI: 10.1002/ceas.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hannah B. Bayne
- Department of Counselor Education University of Florida Gainesville Florida USA
| | - Jeannette Mejia
- Department of Counseling Psychology University of Florida Gainesville Florida USA
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Morales J, Quan E, Arshed A, Jordan A. Racial Disparities in Access to Psychedelic Treatments and Inclusion in Research Trials. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20221123-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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9
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Cleary R, Armour C. Exploring the role of practitioner lived experience of mental health issues in counselling and psychotherapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rua Cleary
- Research Centre for Stress, Trauma, & Related Conditions (STARC), School of Psychology Queen's University Belfast Belfast UK
| | - Cherie Armour
- Research Centre for Stress, Trauma, & Related Conditions (STARC), School of Psychology Queen's University Belfast Belfast UK
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Subramanian I, Hinkle JT, Chaudhuri KR, Mari Z, Fernandez H, Pontone GM. Mind the gap: Inequalities in mental health care and lack of social support in Parkinson disease. Parkinsonism Relat Disord 2021; 93:97-102. [PMID: 34887173 PMCID: PMC9664995 DOI: 10.1016/j.parkreldis.2021.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Inequalities in mental healthcare and lack of social support during the COVID-19 pandemic have lowered quality of life and increased overall burden of disease in people with Parkinson's (PWP). Although the pandemic has brought attention to these inequalities, they are long standing and will persist unless addressed. Lack of awareness of mental health issues is a major barrier and even when recognized disparities based on race, gender, and socioeconomic factors limit access to already scarce resources. Stigma regarding mental illness is highly prevalent and is a major barrier even when adequate care exists. Limited access to mental healthcare during the pandemic and in general increases the burden on caregivers and families. Historically, initiatives to improve mental healthcare for PWP focused on interventions designed for specialty and academic centers generally located in large metropolitan areas, which has created unintended geographic disparities in access. In order to address these issues this point of view suggests a community-based wellness model to extend the reach of mental healthcare resources for PWP.
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Affiliation(s)
- Indu Subramanian
- Dept of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Southwest Parkinson's Disease Research, Education and Clinical Centers, Veterans Administration, Los Angeles, CA, USA.
| | - Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, King's College London, London, UK; Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Zoltan Mari
- Parkinson's and Movement Disorders Program, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Hubert Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gregory M Pontone
- Dept. of Neurology & Dept. of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Hanley AW, Dehili V, Krzanowski D, Barou D, Lecy N, Garland EL. Effects of Video-Guided Group vs. Solitary Meditation on Mindfulness and Social Connectivity: A Pilot Study. CLINICAL SOCIAL WORK JOURNAL 2021; 50:316-324. [PMID: 34188317 PMCID: PMC8224259 DOI: 10.1007/s10615-021-00812-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
Interest in mindfulness meditation continues to grow as accumulating evidence suggests mindfulness training encourages more positive functioning. However, basic questions about the conditions best suited for realizing mindful states remain unanswered. Prominent among these is whether a group mindfulness practice setting is more effective for novice meditators than a solitary practice setting. Answering this question has assumed new urgency due to the imposition of physical distancing measures designed to stop the spread of COVID-19. In a time of limited social contact, is a simulated group practice setting better than practicing alone? This preliminary study investigated whether environmental setting impacted mindfulness practice experience by examining the effects of three simulated meditation practice environments (1. group practice, 2. nature practice, and 3. solitary practice) on state mindfulness and perceived social connectivity in a sample of novice meditators. Significant differences emerged across the three simulated practice settings. Findings suggest watching others meditate while meditating appears to most effectively induce a state of mindfulness and strengthen feelings of social connectivity. This study supports traditional beliefs about the benefits of group mindfulness practice. These findings also have implications for social workers struggling to stretch limited resources to address growing mental health demands, especially during times of heightened social isolation due to COVID-19. If a simulated group practice confers the same cognitive benefits as solitary practice while also conferring social benefits, simulated group instruction may be preferable for therapeutic and economic reasons.
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Affiliation(s)
- Adam W. Hanley
- College of Social Work, University of Utah, Salt Lake City, USA
| | | | | | | | - Natalie Lecy
- College of Social Work, University of Utah, Salt Lake City, USA
| | - Eric L. Garland
- College of Social Work, University of Utah, Salt Lake City, USA
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Batchelder AW, Foley JD, Kim J, Thiim A, Kelly J, Mayer K, O'Cleirigh C. Intersecting internalized stigmas and HIV self-care among men who have sex with men and who use substances. Soc Sci Med 2021; 275:113824. [PMID: 33721745 PMCID: PMC8009855 DOI: 10.1016/j.socscimed.2021.113824] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/05/2021] [Accepted: 03/04/2021] [Indexed: 01/08/2023]
Abstract
RATIONALE Men who have sex with men (MSM) are disproportionately affected by HIV, substance use, and stigma related to co-existing or intersecting identities that are stigmatized or devalued by society (e.g., being a sexual minority male, a person living with HIV, or a person who uses substances). Evidence indicates that when stigma is internalized it may act as a barrier to engagement in self-care behaviors. OBJECTIVE Gaining a better understanding of how intersecting internalized stigmas affect HIV self-care among MSM who use substances. METHODS To investigate these relationships, we conducted semi-structured qualitative interviews until we reached thematic saturation (n = 33) with HIV + MSM who use substances and were sub-optimally engaged in HIV care. Interviews inquired about identity, internalized stigmas, substance use, HIV self-care behaviors, and interrelationships between concepts. RESULTS Our sample was 61% African American and 76% reported annual incomes of ≤$20,000. Approximately half of the participants explicitly described how intersecting internalized stigmas impacted their sense of self and their behavior. The overwhelming majority conveyed that internalized stigma related to substance use was the most burdensome and was considered a barrier to HIV self-care behaviors. Participants also described internalized stigmas related to HIV and sexual orientation, as well as race, effeminateness, poverty, and housing instability, which together impacted their psychological wellbeing and HIV self-care. CONCLUSIONS Our results indicate a need for clinicians to consider and address intersecting internalized stigmas, particularly internalized stigma related to substance use, to both reduce substance use and improve HIV self-care among MSM who use substances and are sub-optimally engaged in HIV care.
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Affiliation(s)
- Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA; The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
| | - Jacklyn D Foley
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
| | - Jane Kim
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA
| | - Aron Thiim
- The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - John Kelly
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
| | - Kenneth Mayer
- The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Behavioral Medicine, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA; The Fenway Health Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
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