Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease: Development of a Situation-Specific Theory for African American Emerging Adults

BACKGROUND

Emerging adulthood (18-25 years old) is a distinct developmental period in which multiple life transitions pose barriers to engaging in healthy lifestyle behaviors that reduce cardiovascular disease risk. There is limited theory-based research on African American emerging adults.

OBJECTIVE

This article introduces a synthesized empirically testable situation-specific theory for cardiovascular disease prevention in African American emerging adults.

METHODOLOGY

Im and Meleis' integrative approach was used to develop the situation-specific theory.

RESULTS

Unlocking Population-Specific Treatments to Render Equitable Approach and Management in Cardiovascular Disease is a situation-specific theory developed based on theoretical and empirical evidence and theorists' research and clinical practice experiences.

DISCUSSION

African American emerging adults have multifaceted factors that influence health behaviors and healthcare needs. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease has the potential to inform theory-guided clinical practice and nursing research. Recommendations for integration in nursing practice, research, and policy advocacy are presented. Further critique and testing of the theory are required.

Family Income and Child Depression: The Chain Mediating Effect of Parental Involvement, Children's Self-Esteem, and Group Differences

Family income is an important factor that affects depression in children and can indirectly be associated with children's development through family and individual factors. However, few studies have examined the mechanism of multiple risk factors. Therefore, this study focused on the relationship between family income and child depression, as well as the chain mediating the roles of parental involvement and children's self-esteem both in single-parent families and intact families. A total of 1355 primary school students completed questionnaires that assessed family income, parental involvement, children's self-esteem, and depression. The results showed that family income influenced child depression through both the mediating roles of parental involvement and children's self-esteem and the chain mediating role of parental involvement and children's self-esteem. Meanwhile, family income only influenced child depression through chain mediation in single-parent families. The group differences in the mechanism of depression provide a reference for empirical research on depression intervention in children from different family structures.

Risk factors and digital interventions for anxiety disorders in college students: Stakeholder perspectives

The worldwide prevalence of anxiety disorders among college students is high, which negatively affects countries, schools, families, and individual students to varying degrees. This paper reviews the relevant literature regarding risk factors and digital interventions for anxiety disorders among college students from the perspectives of different stakeholders. Risk factors at the national and societal levels include class differences and the coronavirus disease 2019 pandemic. College-level risk factors include the indoor environment design of the college environment, peer relationships, student satisfaction with college culture, and school functional levels. Family-level risk factors include parenting style, family relationship, and parental level of education. Individual-level risk factors include biological factors, lifestyle, and personality. Among the intervention options for college students' anxiety disorders, in addition to traditional cognitive behavioral therapy, mindfulness-based interventions, psychological counseling, and group counseling, digital mental health interventions are increasingly popular due to their low cost, positive effect, and convenient diagnostics and treatment. To better apply digital intervention to the prevention and treatment of college students' anxiety, this paper suggests that the different stakeholders form a synergy among themselves. The nation and society should provide necessary policy guarantees, financial support, and moral and ethical supervision for the prevention and treatment of college students' anxiety disorders. Colleges should actively participate in the screening and intervention of college students' anxiety disorders. Families should increase their awareness of college students' anxiety disorders and take the initiative to study and understand various digital intervention methods. College students with anxiety disorders should actively seek psychological assistance and actively accept and participate in digital intervention projects and services. We believe that in the future, the application of methods such as big data and artificial intelligence to improve digital interventions and provide individualized treatment plans will become the primary means of preventing and treating anxiety disorders among college students.

Working Harder than Others to Prove Yourself: High-Effort Coping as a Buffer between Teacher-Perpetrated Racial Discrimination and Mental Health among Black American Adolescents

High-effort coping (feeling like one must work harder than others to succeed due to anticipated discrimination) is an understudied concept in adolescence. The current study examined among Black American adolescents surveyed in eighth and 11^th grade (N = 630, 49% female) how high-effort coping moderated the relations between teacher-perpetrated racial discrimination and psychological distress across time, and whether the buffering role of high-effort coping varied by adolescent gender and socioeconomic status. Experiencing racial discrimination from teachers in eighth grade was positively related with depressive symptoms, anger, and suicidal ideation in 11^th grade. High-effort coping buffered against teacher discrimination for suicidal ideation among low socioeconomic status youth, as well as for anger among high socioeconomic status youth. Findings underscore the harmful influence of racial discrimination on Black American adolescents' mental health, as well as suggest that among certain subpopulations, high-effort coping may be one psychologically protective resource through which Black American youth retain positive feelings that are undermined by racial discrimination, and thus promote mental well-being.

Impact of the COVID-19 pandemic on daily life and worry among mothers in Bhaktapur, Nepal

The COVID-19 pandemic has affected many aspects of daily life worldwide, but the impact may be higher for impoverished populations. The main aim of this study is to describe the impact of the COVID-19 pandemic on different aspects of daily life in mothers in Nepal. We included 493 mothers of children aged 54-71 months participating in a randomized controlled trial on vitamin B12 supplementation. Mothers answered questions regarding the exposure and impact of the pandemic on their daily lives, and pandemic-related worries and sleep problems. We examined the extent to which worry, and sleep problems differed between mothers according to their exposure to COVID-19, socioeconomic status, and previous symptoms of depression. The mean age (SD) of the mothers was 32.3 (4.6) years and 54% had education below the secondary level. Of the mothers, 5.4% had either been exposed to someone who had tested positive or who had a family member with COVID-19. One-third of the participants responded that the pandemic had affected their economic situation, employment, and family life to a great deal. Both mothers and fathers with educational levels above 10 years or households with higher socioeconomic status had significantly higher average worry scores (maternal p = 0.020 and paternal p = 0.005). Mothers with a history of symptoms of depression had significantly more worry-related sleep problems during the pandemic (p = 0.020) than those without a history of depressive symptoms. Our study underlines the negative impact of the COVID-19 pandemic on diverse aspects of everyday life of mothers in Nepal.

The Perceived Broad Group Emotional Climate Scale: Development and Validation With Chinese Community Residents and University Students

Perceived broad group emotional climate (PBGEC) is a perceived meso-environment emotion, which refers to individuals’ perceptions and experiences of the emotion climate when interacting with group members in daily life, and is not derived from individuals’ own emotions. The purpose of this study was to develop and validate a PBGEC scale (PBGECS) for Chinese community residents and university students. A total of 1,408 residents from Chongqing completed the survey of PBGECS, the present social attitude scale, the future social expectations scale, and the social wellbeing scale, which constituted Sample 1; A total of 607 college students from Nanchang completed the survey of PBGECS and the Positive and Negative Affect Scale, which constituted Sample 2. Exploratory factor analysis revealed a two-factor structure, including positive PBGEC (PBGEC-P) and negative PBGEC (PBGEC-N). Internal consistency was strong for each factor and the full-scale (α ≥ 0.83). Confirmatory factor analysis showed that the correlated two-factor model of PBGEC and the four-factor model (including PBGEC-P, PBGEC-N, individual positive affect, and individual negative affect) demonstrated the best fit to the data, which supported the structural validity of the PBGECS. The interpretive validity, cultural validity, and population validity of the scale were also proved by examining the relationship between PBGEC and socioeconomic status, social attitude, and social wellbeing, respectively. The results show that the PBGECS demonstrated satisfactory reliability and validity, which can be used to assesses the perceived emotion climate of an individual’s surrounding environment.

Social factors and worry associated with COVID-19: Evidence from a large survey in China

OBJECTIVE

Worry about COVID-19 is an important cognitive component and manifestation of COVID-19-related anxiety. It has a social dimension and is shaped by various social factors.

DATA

We employ original data from a large survey (N = 20,632) conducted in China from April 21 to 23, 2020, which provide us with a rare opportunity to investigate COVID-19-induced worry among ordinary Chinese citizens.

RESULTS

We find individuals' socioeconomic status, family characteristics, sense of community, and perceived strictness of lockdown measures all have significant influences on worry about COVID-19.

CONCLUSIONS

First, individuals with higher socioeconomic status such as better education, better income, and more prestigious occupations have richer resources in coping with COVID-19 and are thus less worried. Second, the high human-to-human transmissibility of COVID-19 and increased family obligations during the pandemic imply that larger family size can be a worry-inducing burden. Individuals living with larger families are more worried. Third, a greater sense of community lowers worry as it buffers against the stressor and may enhance individuals' faith in the community's efficacy in containing the virus. Last, stringent lockdown measures may actually have positive psychological effects. They provide real and perceived protection and increase individuals' perceived distance from the disease, thereby reducing public worry.

Changes in Depression and Physical Activity Among College Students on a Diverse Campus After a COVID-19 Stay-at-Home Order

The numerous negative health impacts of COVID-19, which include expected changes to psychiatric illness and physical activity (PA), are disproportionately distributed in the United States. Mental illnesses and physical inactivity are prevalent among U.S. college students. This study examined whether there was a change in minutes of PA and depression scores after a stay-at-home order and examined predictors of these changes. An online survey was sent to all undergraduate and graduate students attending a large, diverse university via an electronic newsletter. The survey requested information about demographic and academic data, cardiorespiratory fitness, and depression symptoms. Paired t-tests and logistic regression were employed. Our sample (n = 194) was predominantly female (73%), young (mean age of 25), not a sexual minority (82%), and had a mean 3.4 GPA. Students reported worse depression scores (p < 0.01) and fewer minutes of PA (p = 0.01) after the stay-at-home order. There was a small but significant (p = 0.04) correlation between changes in total minutes of PA and depression scores. Senior (p = 0.05) and Hispanic (p = 0.03) students were less likely to report worsening depression scores than freshmen and white students, respectively. Asian students were significantly more likely than white students to report decreased PA. This study suggests that COVID-19 and its consequences may be contributing to reduced PA and greater depression symptoms in college students and that sub-groups have been affected differently. Targeted interventions to promote PA and support mental health may bolster the ability for resilience of college students.

Interactions Between Socioeconomic Status and Mental Health Outcomes in the Nigerian Context Amid COVID-19 Pandemic: A Comparative Study

This study examines the mental health outcomes among the healthcare personnel and the general population and the role of socioeconomic status. Eight hundred and eighty-four (884) residents in Nigeria comprising 382 healthcare personnel and 502 general residents aged between 18 to 78 years (M = 28.75, SD = 8.17) responded to an online survey with measures of Impact of Event Scale-Revised (IES-R), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Insomnia Severity Index. Collected data were subjected to statistical analysis using the SPSS v.25. Results revealed significant difference in the prevalence of depressive symptoms (χ² = 14.26; df = 4; p < 0.01), insomnia symptoms (χ² = 40.21; df = 3; p < 0.01), posttraumatic stress symptoms (χ² = 08.34; df = 3; p < 0.05), and clinical anxiety symptoms (χ² = 06.71; df = 1; p < 0.05) among healthcare personnel and the general population, with a higher prevalence reported by the healthcare personnel. Further, socioeconomic status significantly influences prevalence of depressive symptoms (χ² = 04.5; df = 4; p < 0.05). The study concluded that the prevalence of poor mental health outcomes during the COVID-19 crisis among Nigerians is worrisome. Also, the socioeconomic status of the citizens has serious implications on depressive symptoms. The study recommends that the government and stakeholders should pay attention to policy that will favor tele-mental health services and adequate palliative measures to cushion the psycho-economic impacts of COVID-19 on residents. Also, healthcare workers should be considered for better remuneration and other welfare benefits to sustain their well-being during the present and future pandemic.

A Risk Typology for Depression in African Americans

Studies report that African Americans are likely to experience severe, chronic, and disabling depressive symptoms leading to poor depression outcomes. There are several psychosocial and sociocultural factors that individually contribute to depression in African Americans (i.e. chronic stress, negative life events, negative social interaction, social support, and religiosity). However, African Americans are a heterogeneous population and the identification of subpopulations with distinct constellations of multiple co-occurring risk and protective factors may offer greater explanatory potential into depression burden for African Americans. This study used data from the American's Changing Lives Survey to identify risk types for depression in a national sample of African American adults and older adults (n = 1174). Latent class analysis results revealed a risk typology that included 3 distinct risk patterns for African Americans. Individuals in the High Protective/Low Risk Type (41%) had high levels of religiosity and social support. Those in the Moderate Protection/Low Risk Type (44%) had moderate levels of religiosity and social support. The Low Protection/Low Risk Type (15%) had low organizational and non-organizational religiosity and relatively low social support. All three types were marked by relatively low risk factors (i.e. negative events, financial stress, and negative social interaction). Multinomial logistic regression results suggested associations between demographic characteristics (i.e. gender, age, education, marital status), depressive symptoms, and risk type. Study results have implications for the development of depression interventions that are targeted to a specific risk type and tailored to the demographic profile of individuals likely to experience poor depression outcomes.

Childhood emotional abuse, self/other attachment, and hopelessness in African-American women

There is evidence that individuals emotionally abused as children endorse more hopelessness, a precursor of suicidal behavior in adulthood. However, there has been little focus on this association among African-Americans or on factors that may mediate the childhood emotional abuse (CEA) - adult hopelessness link. The present study examined whether CEA is linked to hopelessness in adulthood in African-American women suicide attempters and if adult self and other attachment models mediate this association. Participants included 116 African-American women recruited from a large, urban hospital. Results revealed that CEA had no direct effect on hopelessness in adulthood, but did have an indirect effect on hopelessness through attachment models. Bootstrapping analyses showed that higher levels of CEA were related to more negative self and other attachment models, which were then linked to higher levels of hopelessness. Implications for targeting attachment in suicide intervention programs are discussed.

Emotional Nonacceptance and Anxiety Sensitivity in Relation to Anxious Arousal, Social Anxiety, and Depressive Symptoms Among African American Young Adults

Past work suggests African American college students may be a segment of the college population at heightened risk for anxiety and depressive symptoms; however, there remains an overarching need to broaden our understanding of individual difference variables that may be related to adverse emotional states. The purpose of the present study was to test a theoretically driven interactive model of two individual difference variables (anxiety sensitivity and emotional nonacceptance) in relation to anxiety and depressive symptoms among 133 African American undergraduate students (76.7% female, Mage = 20.9, SD = 5.6; age range = 18-53 years). Results indicated that anxiety sensitivity was positively associated with anxious arousal symptoms at higher levels of emotional nonacceptance (β = 2.1), and more strongly associated with depressive symptoms among individuals endorsing low levels of emotional nonacceptance (β = 3.8). The present data provide novel evidence suggesting there is clinically relevant interplay between anxiety sensitivity and emotional nonacceptance. These findings aid in better understanding the expression of anxiety and depressive symptoms among this population and may represent transdiagnostic constructs of relevance for early intervention.

Racial Discrimination, John Henryism, and Depression Among African Americans

Evidence from previous studies indicates that racial discrimination is significantly associated with depression and that African Americans with higher levels of socioeconomic status (SES) report greater exposure to racial discrimination compared to those with lower SES levels. Coping strategies could alter the relationship between racial discrimination and depression among African Americans. This study first examined whether greater levels of SES were associated with increased reports of racial discrimination and ratings of John Henryism, a measure of high-effort coping, among African Americans. Second, we examined whether high-effort coping moderated the relationship between racial discrimination and depression. Data were drawn from the National Survey of American Life Reinterview (n = 2,137). Analyses indicated that greater levels of education were positively associated with racial discrimination (p < .001) and increased levels of racial discrimination were positively related to depression (p < .001), controlling for all sociodemographic factors. Greater levels of John Henryism were associated with increased odds of depression but there was no evidence to suggest that the relationship between discrimination and depression was altered by the effects of John Henryism.

Hope as a Moderator of the Relationship Between Interpersonal Predictors of Suicide and Suicidal Thinking in African Americans

Suicide is currently the third leading cause of death of African Americans between the ages of 15 and 24 years. Possible risk factors of suicidal ideation for this population include the two interpersonal constructs of the Interpersonal Theory of Suicide, perceived burdensomeness and thwarted belongingness. Past research has demonstrated that hope is negatively associated with each of these two constructs of the Interpersonal Theory of Suicide and suicidal ideation. The aim of the current study was to investigate hope as a moderator between both thwarted belongingness and perceived burdensomeness and suicidal ideation in a sample of 107 African American college students. Results supported the hypotheses, as hope moderated the relationship between thwarted belongingness and suicidal ideation and perceived burdensomeness and suicidal ideation. This study suggests that African Americans who endorse high levels of hope are at a lower risk for suicidal thoughts when having perceptions of being a burden and not belonging. Clinical implications are discussed.