Satisfaction, engagement, and outcomes in internet-delivered cognitive behaviour therapy adapted for people of diverse ethnocultural groups: an observational trial with benchmarking

Introduction

Depression and anxiety are the most common mental health disorders worldwide. Internet-Delivered Cognitive Behaviour Therapy (ICBT) can reduce barriers to care to broad cross sections of the population. However, People of Diverse Ethnocultural Backgrounds (PDEGs) other than White/Caucasian underutilize mental health services and are under represented in clinical trials of psychological interventions.

Methods

To address this research gap we adapted an evidence-based ICBT program for PDEGs. The current pilot study explores the engagement, satisfaction, and effectiveness in the adapted ICBT program by PDEGs (N=41) when benchmarked against a sample of PDEGs (N=134) who previously completed a non-adapted version of the ICBT program.

Results

An intent-to-treat analyses showed that the adapted ICBT program is effective in reducing anxiety and depression symptoms among PDEGs. Large within-group pre-to post-treatment Cohen's effect sizes of d = 1.23, 95% CI [0.68, 1.77] and d = 1.24, 95% CI [0.69, 1.79] were found for depression and anxiety, respectively. Further, 81.8% of the PDEGs who received the adapted ICBT reported overall satisfaction, 90.9% reported increased confidence in managing symptoms, and 70.7% completed majority of the psychoeducational lessons in the ICBT program.

Conclusion

No statistically significant differences in the clinical outcomes, engagement, and satisfaction were found between the pilot study and benchmark sample. Future directions for ICBT research with PDEGs are described.

Clinical trial registration

https://beta.clinicaltrials.gov/study/NCT05523492, identifier NCT05523492.

Cultural immersion, acculturation strategies, and depressive symptoms among first-generation Vietnamese migrants in Germany

BACKGROUND

Worldwide migration represents a major challenge of the 21st century. Despite the strong association between acculturation and mental health, research findings on underlining mechanisms remain inconsistent. Prior research urges to investigate sample characteristics in a more structured manner.

AIMS

The purpose of this study was to systematically investigate factors impacting acculturation and depressive symptoms in a large, not exclusively clinical, sample of Vietnamese migrants in Germany.

METHOD

This study investigated, with multiple regressions, factors (age at arrival, gender, education, religiousness, language skills, residence status, economic status, occupational status, migration motivation, duration of stay, and depressive symptoms) impacting the two dimensions of acculturation, dominant society immersion (DSI) and ethnic society immersion (ESI), in a not exclusively clinical sample (n = 582) of first-generation Vietnamese migrants in Germany. Further, this study examined the relationship between depressive symptoms, DSI and ESI with correlations and acculturation strategies with an ANOVA.

RESULTS

Integration (72.5%) was the most common acculturation strategy, followed by separation (26.8%). In contrast, assimilation (0.5%) and marginalization (0.2%) were very rare acculturation strategies. As predictive factors for DSI lower depressive symptoms scores, male gender, higher education, and better German language skills were found significant. For ESI, less German language skills and older age at arrival were found to be significant. Higher ESI and DSI were correlated to lower depressive symptom scores. Compared to the three other acculturation strategies, integration was linked to the lowest depressive symptoms scores.

CONCLUSIONS

The current study identified crucial factors in the acculturation process, such as depressive symptoms, language skills, education, gender, and age at arrival. Our findings emphasize that immersion into both the dominant and the ethnic culture plays an essential supportive role in the mental health of migrants.

Intention to obtain a COVID-19 vaccine among Brazilian immigrant women in the U.S

Background

COVID-19 has disproportionately impacted low-income immigrant communities. There is concern that the current uptake of COVID-19 vaccines is suboptimal and that this may be contributing to COVID-19 inequities. However, little is known about the acceptability of COVID-19 vaccines among immigrants in the U.S. Our goal was to gauge COVID-19 vaccine intentions among Brazilian immigrant women living in the U.S.

Methods

We conducted an online survey between July and August 2020 offered in Portuguese and English languages among a convenience sample of Brazilian immigrant women ages 18 years and older. Women were recruited through online advertisements by community-based organizations and social media groups to complete a survey that assessed intention to get a COVID-19 vaccine, attitudes toward vaccines, and perceptions about the pandemic.

Results

Of the total sample (N = 353), most (70.8%) indicated they intended to get a COVID-19 vaccine. In bivariate analyses, vaccine intentions were significantly associated with perceptions about the severity of the pandemic, trusted sources of health information, and the number of years lived in the U.S. Multinomial logistic regression models revealed that those who did not intend to be vaccinated had lived a longer time in the U.S. (OR: -0.12 95% CI: -0.19, -0.05), perceived the pandemic to be a minor issue (OR: 1.52, 95% CI: 0.62, 2.42), and trusted information from social networks (OR: -1.94, 95% CI: -3.25, -0.63) or private news sources (OR: -1.71, 95% CI: -2.78, -0.63).

Conclusions

While most women reported they would get a COVID-19 vaccine, efforts to reach those who may be hesitant should target those who have lived in the U.S. for longer periods of time and do not perceive the pandemic to be a major crisis. Healthcare providers may be particularly suited to deliver this information given high levels of trust.

Mixed methods study protocol to explore acculturation, lifestyles and health of immigrants from the Community of Portuguese-Speaking Countries in two Iberian contexts: how to face uncertainties amidst the COVID-19 pandemic

INTRODUCTION

Studies which focus on the process of acculturation in the lifestyles, nutritional status and health of immigrants from the Community of Portuguese-Speaking Countries (CPLP) in the Iberian Peninsula are still scarce. This study aims to explore the influence of the acculturation process and dietary acculturation on the lifestyle and nutritional and health status of CPLP immigrants in Portugal and Spain, focusing on two Iberian contexts: Lisbon Metropolitan Area and the Basque Country.

METHODS AND ANALYSIS

A mixed methods sequential explanatory design, combining cross-sectional studies and semistructured interviews. Official data will also be analysed. Primary data will be collected through a questionnaire and assessment of nutritional status and body composition. The estimated samples sizes are 1061 adults (≥18 years old) in the Lisbon Metropolitan Area and 573 in the Basque Country. Time-location sampling will be used for the quantitative component and non-probabilistic sampling for the qualitative component. If safety conditions are not guaranteed due to the COVID-19 pandemic, online studies will be conducted. The semistructured interviews will complement the questionnaire data and extend knowledge about the process of acculturation of CPLP immigrants and their relationship with eating habits and physical activity. Thematic analysis will be used for qualitative data. Triangulation of data derived from different methods will be carried out. An integrative approach will be used to address potential discrepancies in findings and limitations inherent to the study design. As inter-method discrepancies may occur, triangulation protocol will be used, elaborating a 'convergence coding matrix' to display findings emerging from each component of the study.

ETHICS AND DISSEMINATION

Ethical approval was obtained through the IHMT Ethics Council (Doc No 20/2020), Portugal, and it was submitted to the Ethics Committee of the UPV/EHU (Doc No under revision), Spain.

A person-centered examination of acculturation and psychological functioning among Chinese and Korean immigrant mothers in the United States

Objectives: The present research used a person-centered approach to examine the acculturation styles of Chinese and Korean immigrant mothers in the United States and demographic characteristics and psychological functioning associated with each acculturation style. Method: The sample comprised 240 first-generation Chinese immigrant mothers (CIMs; M = 37.80 years, SD = 4.55) and 222 first-generation Korean immigrant mothers (KIMs; M = 36.00 years, SD = 3.69) of preschool children. Latent profile analysis was used to identify latent acculturation styles among CIMs and KIMs. We further examined whether mothers' acculturation styles were associated with their sociodemographic characteristics and psychological functioning within each cultural group. Results: Four acculturation styles were revealed among CIMs: (a) behaviorally undifferentiated/psychologically assimilated, (b) behaviorally marginalized/psychologically separated, (c) behaviorally psychologically assimilated, and (d) behaviorally integrated/psychologically undifferentiated. Three acculturation styles were uncovered among KIMs: behaviorally psychologically separated, behaviorally psychologically assimilated, and behaviorally psychologically integrated. Chinese behaviorally integrated/psychologically undifferentiated mothers and Korean behaviorally psychologically separated perceived the highest levels of coethnic concentration in their communities. Chinese behaviorally marginalized/psychologically separated mothers reported poorer psychological functioning than other Chinese mothers. Korean behaviorally psychologically separated mothers had poorer psychological functioning than other Korean mothers. Conclusions: Findings revealed the significant role of participation in the American mainstream culture for Asian immigrant mothers' psychological adjustment. The heterogeneity in the acculturation experiences of Asian immigrants in the United States was highlighted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Immigrant Health Differential in the Context of Racial and Ethnic Disparities: The Case of Diabetes

PURPOSE

Social and economic disparities between racial/ethnic groups are a feature of the American context into which immigrants are incorporated, and a key determinant of population health. We ask whether racial/ethnic disparities in diabetes vary by nativity and whether native-immigrant disparities in diabetes vary by race and over time in the United States.

METHODS

Using the 2000-2015 National Health Interview Survey, we estimate logistic regressions to examine the interaction of race/ethnicity, nativity, and duration in the U.S. in shaping diabetes patterns.

RESULTS

Relative to their native-born co-ethnics, foreign-born Asian adults experience a significant diabetes disadvantage, while foreign-born Hispanic, Black, and White adults experience a significant advantage. Adjusting for obesity, education, and other covariates eliminates the foreign-born advantage for Black and White adults, but it persists for Hispanic adults. The same adjustment accentuates the disadvantage for foreign-born Asian adults. For Black and Hispanic adults, the protective foreign-born effect erodes as duration in the U.S. increases. For foreign-born Asian adults, the immigrant disadvantage appears to grow with duration in the U.S. Relative to native-born White adults, all non-white groups regardless of nativity see a diabetes disadvantage because the racial/ethnic disadvantage either countervails a foreign-born advantage or amplifies a foreign-born disadvantage.

DISCUSSION

Racial/ethnic differentials in diabetes are considerable, and are influenced by each group's nativity composition. Obesity and (for the foreign-born) time in the U.S. influence these disparities, but do not explain them. These findings underscore the importance of unmeasured, systemic determinants of health in America's race-conscious society.

The impact of perceived childhood victimization and patriarchal gender ideology on intimate partner violence (IPV) victimization among Korean immigrant women in the USA

Childhood victimization experiences are common among intimate partner violence (IPV) victims. This study examines the link between childhood physical and sexual victimization experiences and adulthood IPV among Korean immigrant women in the USA. As Korean immigrants often use physical punishment to discipline their children, and reporting sexual abuse is discouraged due to stigmatization in this community, cultural factors (e.g. patriarchal values) related to childhood victimization and IPV were also examined. Survey data from Korean immigrant women in the USA were collected. Using a case-control design, we compared 64 Korean immigrant women who have experienced IPV in the past year with 63 Korean immigrant women who have never experienced IPV in their lifetime. The findings of this study reveal that IPV victims, compared with non-victims, experienced higher childhood victimization rates. Logistic regression analysis demonstrated that childhood victimization and patriarchal gender ideology strongly predict IPV victimization among Korean immigrants. However, patriarchal values did not moderate the relationship between childhood victimization and IPV. To prevent IPV among Korean immigrant population, we need to make special efforts to prevent childhood abuse and change ingrained cultural attitudes about child physical and sexual abuse among immigrant communities through culturally sensitive programs.

Time Since Migration and HIV Risk Behaviors Among Puerto Ricans Who Inject Drugs in New York City

BACKGROUND

Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites.

OBJECTIVE

Understand the persistence of these HIV behaviors.

METHODS

In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression.

RESULTS

A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants.

CONCLUSIONS

The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process.