A Culturally Adapted Perioperative Mental Health Intervention for Older Black Surgical Patients

OBJECTIVES

Perioperative mental health of older Black surgical patients is associated with poor surgical outcomes; however, evidence-based perioperative interventions are lacking. Our two study objectives included: first, examine factors affecting perioperative care experiences of older Black surgical patients with mental health problems, and second, ascertain design and implementation requirements for a culturally-adapted perioperative mental health intervention.

DESIGN SETTING AND PARTICIPANTS

We conducted six focus groups with older Black patients (n = 15; ≥50 years; surgery within the past 5 years and/or interest in mental health research; history of distress, anxiety, or depression coping with surgery/hospitalization/) from a large academic medical center. We engaged study partners, including interventionists and community members, to gather insights on intervention and implementation needs. We followed a hybrid inductive-deductive thematic approach using open coding and the National Institute on Minority Health and Health Disparities Research Framework.

RESULTS

Patients reported that their psychological well-being and long-term mental health outcomes were not appropriately considered during perioperative care. Perceived stressors included interpersonal and structural barriers to using mental healthcare services, clinician treatment biases and ageism in care, and lack of healthcare professional connections/resources. Patients utilized various coping strategies, including talk therapy, faith/spirituality, and family and friends.

CONCLUSION

This study offers valuable insights into the experiences of older Black surgical patients and the critical elements for developing a personalized perioperative mental health intervention to support their well-being before, during, and after surgery. Our findings demonstrated a need for a patient-centered and culturally adapted intervention targeting the individual/behavioral and interpersonal levels. Informed by the cultural adaptation framework, we propose a multi-component intervention that integrates psychological and pharmacological components.

Contextualizing Bicultural Competence Across Youths' Adaptation From High School to College: Prospective Associations With Mental Health and Substance Use

Bicultural competence, the ability to navigate bicultural demands, is a salient developmental competency for youth of color linked with positive adjustment. This study investigated how discrimination experiences informed developmental trajectories of behavioral and affective bicultural competence across youth's adaptation from high school to college, and how these biculturalism trajectories predicted later adjustment (i.e., internalizing symptoms and binge drinking). Data were collected between 2016 through 2020 and included 206 U.S. Latino youth (Mage=17.59, 64% female, 85% Mexican origin, 11% first and 62% second generation immigrants). Linear latent growth analyses revealed that youth who experienced greater time-varying discrimination demonstrated lower concurrent behavioral and affective bicultural competence. Higher behavioral bicultural competence intercepts were associated with fewer internalizing symptoms in the third college year. No other significant associations emerged for internalizing symptoms or binge drinking. These findings have implications for mental health equity among Latino youth during a critical period of psychopathology onset.

Evaluation of Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) implemented in community-based settings

Effective family-based interventions are needed for youth who are experiencing emotional and behavioral difficulties and who are impacted by powerful environmental stressors. Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) is a manualized and evidence-based, multicomponent family-based treatment that has been shown to be efficacious in research settings. The purpose of this paper is to report on the effectiveness of implementing CIFFTA for the treatment of Latino and Black youth and families in community settings. Utilization of services offered and changes in youth presenting problems and family functioning were used to evaluate the program. Two hundred thirty-two youth (11-18 years of age) and their caregivers were recruited over 2 years and CIFFTA was delivered by experienced masters-level family therapists over a 12-16-week period. Seventy-six percent met the 8-session criteria for retention in treatment and 71% completed treatment. Results showed significant improvements in youth behavioral and emotional presenting problems, reduction in family conflict and improvement in family cohesion and communication. Caregiver well-being such as reductions in parental stress, relational frustration, and improvement in parental confidence also showed significant improvement. Analyses of reliable change indices showed a substantial improvement in youth who entered the program in the clinical range of presenting problems. The findings point to CIFFTA's ability to retain youth and families who tend to underutilize needed services, to significant reductions in presenting problems, and to improvements in family functioning when implemented in a community setting.

Comprehensive and Integrated Services in Specialty Mental Health Treatment Facilities in the US: Differences by the Racial/Ethnic Composition of the Facility's Clientele, 2020

The integration of multiple ancillary services into mental health treatment settings may improve outcomes, but there are no national studies addressing whether comprehensive services are distributed equitably. We investigated whether the availability of a wide range of service types differs based on the facility's racial/ethnic composition. We used the 2020 National Mental Health Services Survey to identify twelve services offered in outpatient mental health treatment facilities (N = 1,074 facilities). We used logistic regression to model each of the twelve services, predicted by the percentage of a facility's clientele that was White, Black, and Hispanic, adjusted for covariates. Facilities with the highest proportions of Black and Hispanic clientele demonstrated the lowest predicted probabilities of offering comprehensive and integrated services. Our findings offer context around upstream factors that may, in part, drive treatment disparities. We orient our findings around frameworks of structural racism and inequities in mental healthcare.

Cultural adaptation of an integrated eating disorders prevention and healthy weight management program

BACKGROUND

Both eating disorder (ED) prevention and weight management interventions often focus on the thin ideal. Yet, many Black and Latina women do not view thinness as their body ideal. This study used focus groups to investigate the influence of race, ethnicity, and culture on appearance ideals and inform the cultural adaptation and integration of two established programs addressing EDs and weight management: the Body Project, and Healthy Weight Interventions.

METHODS

White (n = 10), Black (n = 14), and Latina (n = 6) women participated in racially and ethnically homogenous focus groups.

RESULTS

Thematic analysis identified several themes, including: (1) diverse beauty standards across groups, (2) lack of acknowledgement of racialized beauty standards in prevention and cultural appropriation, (3) culturally-specific impacts of standards, (4) harm of appearance-related comments, (5) limitations of available resources, (6) stigma/minimization of mental health, (7) barriers to inclusive programming, and (8) facilitators of inclusive programming.

CONCLUSIONS

Results suggested that current programs' emphasis on thinness limit their relevance for women of color, and perpetuate the misconception that EDs primarily affect White women. Findings highlight the need for culturally responsive prevention.

Service Coordination in Early Childhood Home Visiting: a Multiple-Case Study

Early childhood home visiting is a preventive service delivery strategy that aims to promote child and parent health, positive parenting, child development and school readiness, and family economic self-sufficiency. To meet families' needs, programs provide a combination of direct services, and referrals and linkages to community-based services. Service coordination is therefore a critical component of home visiting's role within the early childhood system of care. This multiple-case study describes facilitators and barriers to service coordination, as identified by home visiting program staff and families. We interviewed program managers, supervisors, home visitors, and families from four local home visiting programs in the eastern USA with diverse contextual characteristics that showed evidence of having strong coordination. Using multiple-case study methodology, we analyzed the data to understand key facilitators and barriers to service coordination for each case and identify and describe common themes across cases. Facilitators included interagency relationships and collaboration; a culture of teamwork; dedicated, well-connected staff; supervision; trusting relationships with families; and warm handoffs. Barriers to service coordination were limited availability and accessibility of local resources, perceived stigma among other service providers, and families' ambivalence toward some services. Home visiting staff and families emphasized that relationships at multiple levels are fundamental to service coordination, barriers are complex, and coordination is time- and labor-intensive. Coalitions that bring together diverse stakeholder groups at the state and local levels can provide meaningful coordination support to the early childhood services.

Critical gaps in understanding firearm suicide in Hispanic communities: demographics, mental health, and access to care

Suicide rates increased by 26.7% among Hispanics from 2015 to 2020, driven at least in part by highly lethal firearm suicide deaths. However, there are critical gaps in characterizing firearm suicide risks and prevention opportunities in Hispanic communities. We examined Hispanic adult firearm suicide decedents reported through the National Violent Death Reporting System from 2013-2019, focusing on demographic characteristics, firearm choices, suicidal thoughts/behaviors, mental health, and mental health treatment, compared with non-Hispanic adult firearm suicide decedents. Only 13.8% of Hispanic firearm suicide decedents were known to be undergoing treatment for a mental health or substance use problem prior to death, compared to 18.8% of non-Hispanic firearm suicide decedents. On average, Hispanic firearm suicide decedents were significantly less likely than non-Hispanic firearm suicide decedents known to have been treated for a mental health or substance use problem. These results may underscore the critical need for public health agencies and policymakers to promote initiatives integrating mental health screening into medical care, reducing mental health stigma among Hispanics, and expanding mental health treatment capacity in Hispanic communities.

Emotional wellbeing and coping among Latinx young adults in the time of COVID-19

The COVID-19 pandemic has disrupted the wellbeing of the general US population, but even more so among Latinx young adults. The current study provides a detailed picture of the emotional wellbeing and coping of Latinx young adults during the first summer of the pandemic. Six virtual focus groups (n = 21) were conducted between May and August of 2020 with a community-based sample of Latinx young adults to explore (1) how the pandemic affected wellbeing and (2) how they coped with pandemic-related stress. Contextualistic thematic analysis identified important themes and subthemes. Perceived stressors impacting emotional wellbeing yielded one overarching theme: COVID-related disruptions in the participants' environment. To manage this heightened stress, another overarching theme was self-care and intentionality during the pandemic. Future studies should examine the wellbeing of young adults across social contexts and at more recent stages of the pandemic. Findings from this study suggest culturally- and developmentally-tailored interventions are needed as this population navigates contextual stress during a sensitive period in their life.

Mental health services use and social support among Latinx families with adolescents who engage in suicidal behavior

Latinx communities experience a significant child mental health disparity. Research is needed to examine mental health services use and social support in Latinx adolescents, with particular attention to acculturative factors and youth who have high levels of clinical severity. The current study examined whether acculturation and enculturation, and related proxies, are associated with prior history of services use and social support in Latinx families with adolescents who had a recent suicidal crisis. Participants were 110 youths, recently admitted to psychiatric hospitalization, ages 12 to 17 years and their caregivers. Results indicated that approximately 20% of the overall sample did not access any formal mental health services (e.g., outpatient mental health care, primary care support, school staff support) before high acuity hospital care. First generation status and higher caregiver enculturation were associated with a lower likelihood of formal mental health services use, even when controlling for clinical covariates. Adolescent preference for Spanish was associated with lower social support. Findings suggest that families with higher enculturation and first-generation immigrant families (both caregivers and youth born outside of the U.S.), in the context of severe clinical impairment, experience systemic and sociocultural barriers conducive to limited engagement with mental health support. Implications for improving the accessibility of mental health supports are reviewed.

Evaluating resilience in terms of COVID-19 related behavioral health among Latinx adults during the coronavirus pandemic

The mental and behavioral health burden resulting from COVID-19 has disproportionately affected the Latinx population. Yet, no work has investigated the influence of resilience as a protective factor against COVID-19 related consequences. The aim of the current study was to evaluate resilience in relation to COVID-19 related fear, anxiety symptoms, COVID-19 anxiety-related sleep disturbances, and depression among Latinx persons (178 Latinx persons [31.5% female, Mage = 34.1 years, SD = 8.2]). It was hypothesized that greater levels of resilience would be associated with lower levels of all COVID-19 related behavioral health outcomes above and beyond the variance accounted for by years living in the United States (U.S.), degree of COVID-19 exposure, sex, age, education, and COVID-19 related work and financial troubles and home-life distress. Results indicated that greater levels of resilience were associated with lower levels of COVID-19 related fear (ΔR2 = .06, p < .001), anxiety symptoms (ΔR2 = .03, p = .005), COVID-19 anxiety-related sleep disturbances (ΔR2 = .06, p < .001), and depression (ΔR2 = .04, p = .001). Overall, the present study is the first to document the potential importance of resilience in relation to common and clinically significant COVID-19 behavioral health problems among Latinx persons.

Mental Illness and Racial Disparities in Correctional Staff-Involved Violence: An Analysis of Jails in the United States

In this study, we draw on theories of opportunity and focal concerns to examine how mental illness and race correspond to correctional staff-involved violence, particularly within the transient and diverse context of jails. Using a sample of 3,936 people incarcerated in jails from the 2011 to 2012 National Inmate Survey (NIS-3), we analyze how an individual's mental health status (number of mental illness diagnoses) and race relates to the risk of staff-inflicted victimization. Using a series of Firth's logistic regression models, we find that Black and Hispanic individuals are much more likely to be victims of correctional staff assault than their White counterparts. Those with one and two or more mental illness diagnoses are also at greater risk for staff-involved violence, respectively. Supplementary models show that those who suffer from serious mental illness are at particularly high risk for staff victimization. In a subsequent moderation analysis, we find that race does not condition the influence of mental health diagnoses on risk for staff-involved violence. Our findings reinforce the need for more research on correctional staff-involved violence and the implications of this research support calls for enhanced training of correctional staff regarding mental illness and racial bias.

Community Violence Exposure and Generalized Anxiety Symptoms: Do Callous-Unemotional Behaviors Moderate this Relation Among Urban Youth?

Community violence exposure (CVE; i.e., direct victimization and witnessed violence) is a major public health concern among youth who reside in low income, urban neighborhoods, who tend to experience CVE chronically and disproportionately. Frequent CVE is associated with generalized anxiety disorder (GAD) symptoms, such as persistent or excessive worry and difficulty concentrating. However, not all youth experiencing CVE exhibit such symptoms. One understudied factor that may moderate this relation is callous-unemotional (CU) behaviors (e.g., behaviors consistent with lack of guilt, low levels of empathy). CU behaviors are associated with lower levels of responsiveness to contextual processes; as such, CU behaviors may be associated with lower levels of GAD symptoms in the context of CVE. However, little research considers CU behaviors and GAD symptoms concurrently. To address this gap, the present study examined associations among witnessed and direct CVE, CU behaviors, and GAD symptoms among low-income, urban youth (N = 104, 50% male, Mage = 9.93 ± 1.22 years old, 95% African-American/Black). Multiple regression analyses indicated teacher-reported CU behaviors moderated the relations between CVE and caregiver-reported GAD symptoms. Post-hoc probing revealed that among youth with higher levels of CVE, higher levels of CU behaviors were associated with elevated GAD symptoms compared to their peers with lower levels of CU behaviors. Youth with lower levels of CU behaviors evidenced moderate levels of GAD symptoms regardless of their levels of CVE. Thus, low-income, urban youth who experience elevated levels of CVE may be at increased risk for co-occurring GAD and CU symptoms.

Latina mothers' mental health: An examination of its relation to parenting and material resources

The demands and stressors associated with motherhood can increase a mother's risk for mental health concerns. Latina mothers are particularly vulnerable to the relation between motherhood-related stressors and maternal mental health given that they are at an increased risk for mental health concerns, that they are likely to have their mental health needs go unmet, and that traditional Latinx cultural values/gender roles emphasize women assuming the role of primary caregiver of the family's children. In an attempt to better understand how motherhood impacts Latina mother's mental health, this study explored the relations among parental self-efficacy, parenting stress, and maternal mental health. This study also explored how a mother's perception of her material resources influenced these relations. One hundred and thirty-two Latina mothers completed questionnaires to assess parenting stress, parental self-efficacy, and maternal mental health risk. The moderating effect of maternal perception of material resources in the aforementioned relations was assessed through the creation of a composite variable derived from items in the demographic questionnaires. Multiple linear regression analyses were used. Higher levels of parenting stress, but not parental self-efficacy, were related to increased maternal mental health risk. Furthermore, mothers who perceived themselves to have lower material resources were at increased risk for diminished mental health in the context of low parental self-efficacy. Results of this study yielded important information that is necessary for informing healthcare best practices, identifying targets for future interventions, and ultimately improving the health outcomes of Latinx mothers and their families.

A qualitative examination of the mental health impact of Covid-19 in marginalized communities in Guatemala: The Covid Care Calls survey

BACKGROUND

The mental health impact of Covid-19 from the perspective of individuals experiencing psychological distress during lockdown period in marginalized, high-risk communities remains underinvestigated.

AIMS

This study aims to identify key factors related to psychological distress resulting from the Covid-19 pandemic across highly vulnerable districts in Guatemala.

METHODS

The Covid Care Calls (CCC) survey was administered to households in 11 districts in Guatemala to gather information about medical, mental health, and psychosocial status during the lockdown period; provide referral for care; and disseminate information on evidence-based protective measures to stem the spread of the virus. The 330 individuals participated the survey. Conventional content analysis was used to analyze survey data.

RESULTS

Most commonly reported mental health issues since the start of the pandemic were anxiety (46%), stress (36%), and exacerbation of pre-Covid-19 mental health conditions (19%). Depression and burnout were equally reported by 12% of participants. Only 2% reported issues with safety in the home. Concerns about catching the virus and economic worries were the most commonly reported sources of psychological distress.

CONCLUSION

Results of this study indicate a high prevalence of anxiety, stress, and increased prior mental health symptoms resulting from the onset of the Covid-19 pandemic in low-income, high-risk communities across Guatemala. Efforts focused on enhancing coping strategies as well as psychoeducation to address stigma and increase help-seeking for depression are particularly important.

Familism and Parenting Stress in Latinx Caregivers of Young Children with Developmental Delays

Several studies have documented the difficult experience of raising a child with a developmental delay (DD; DeGrace et al., 2014) but the majority of research has focused on non-Latinx White families and their experiences in childrearing and interacting with service providers (Hayes & Watson, 2013; Blanche et al., 2015). Additionally, stigma associated with mental illness and DD disproportionally affects Latinx communities (Burke et al., 2019). Familism plays a unique role among families of Latinx backgrounds (Moore, 1970; Coohey, 2001) and may act as a buffer to caregiver mental health. The current study aims to (1) determine the association between affiliate stigma and parenting stress among Latinx parents of young children with DD and (2) test whether familism moderates the relationship between affiliate stigma and parenting stress. Results revealed that the relationship between affiliate stigma and parenting stress was strongest in caregivers who reported low levels of familism, suggesting that familism may act as a buffer. More research is needed to further unpack the protective factors of familism on caregiver mental health.

Saving a seat at the table for community members: co-creating an attachment-based intervention for low-income Latin parent-youth dyads using a promotor/a model

Evidence for the effectiveness of attachment-based interventions in improving youth’s socioemotional health increases each year, yet potential for scalability of existing programs is limited. Available programs may have lower acceptability within low-income immigrant communities. Co-designing and implementing interventions with trained community workers (Promotors) offers an appealing solution to multiple challenges, but community workers must have high investment in the program for this to be a workable solution. This study examines the experiences of promotors involved in the co-creation and delivery of an attachmentbased intervention program for low-income Latinx youth (ages 8 to 17) and their mothers. Promotors (N=8) completed surveys, reporting on the experiences of each therapy group in terms of group dynamic (e.g., promotors’ connectedness to each group, perceived program relevance). Following the completion of the intervention study, promotors participated in interviews in which they described their experiences in co-creating the intervention, delivering the intervention to the community, and their recommendations for improving the intervention. Overall, promotors perceived group dynamics as positive, though the mother groups were evaluated as significantly higher in quality (e.g., lower conflict) than the youth groups. Interviews revealed that promotors enjoyed the cocreation process and identified important areas for improvements for the intervention (incorporation of more visuals, creation of agelimited groups, reducing number of youth sessions) and evaluation (reduction in length, modification of language). Integrating input from promotors in the process of co-creating and implementing an intervention can benefit every member of the community from the program participants to the providers themselves.

Dealing with distress from the COVID-19 pandemic: Mental health stressors and coping strategies in vulnerable latinx communities

Distress secondary to the COVID-19 pandemic has been substantial, especially in vulnerable Latinx communities who are carrying an undue share of the pandemic-related social, health and economic burden in the United States. In collaboration with 43 community health workers (CHWs) and Promotor/as serving the needs of underserved Latinx communities in South Texas and guided by principles of community-based participatory research (CBPR), the purpose of this study was to identify relevant mental health stressors and related consequences, and to identify strategies for coping with distress among underserved Latinx communities during the COVID-19 pandemic. Data were collected on July 2020 using mixed methods to obtain more in-depth information. Surveys were administered, and three focus groups were conducted. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed systematically by starting with a priori questions and themes followed by data categorisation, reduction, display and conclusion drawing. Results showed six themes related to mental health stressors including economics (e.g., job insecurity), immigration (e.g., undocumented status), misinformation, family stress (e.g., changes in family dynamics and the home environment), health (e.g., limited healthcare access) and social isolation. Coping skills of the community were categorised into four themes with multiple codes including behavioural strategies (e.g., identifying reliable information), cognitive strategies (e.g., collectivistic thinking), social support and spirituality. Findings indicate that underserved Latinx communities are dealing with substantial distress and mental health concerns secondary to the COVID-19 pandemic; yet these are resilient communities. Implications of these findings can inform development of resources, interventions, best practices and training avenues to address the mental health needs of underserved Latinx communities, while considering relevant cultural and contextual factors that may influence their effectiveness.

Increasing Access and Quality of Behavior-Analytic Services for the Latinx Population

Latinxs are the largest minority group in the United States, making up approximately 18% of the total population. Although there is a critical need for the behavioral health care system, including behavior analysts, to provide services to support the needs of the Latinx community, access to quality behavioral and mental health services continues to be lacking for the Black, Indigenous, and people of color populations. This article highlights some of the cultural and language factors that should be considered by behavior-analytic providers who have a shared responsibility to make culturally and linguistically appropriate services available to this population. Additionally, recommendations for systemic action across service providers, professional organizations, behavior-analytic training programs, and researchers are suggested to address these barriers. Recommendations for bringing about this systemic change are suggested across three domains: (a) increasing diversity in the behavior-analytic workforce, (b) enhancing training in cultural- and language-related issues, and (c) conducting research on cultural and language adaptations to behavior-analytic evidence-based treatments.

Symptoms of PTSD and Depression among Central American Immigrant Youth

The aim of this paper is to explore the mental health challenges that Central American immigrant youth face before and after arriving in the United States. This population is hard to reach, marginalized, and disproportionately exposed to trauma from a young age. This paper investigates the mental health stressors experienced by Central American immigrant youth and asylum seekers, including unaccompanied minors, surveyed in the U.S. in 2017. This mixed methods study uses qualitative data from interviews along with close-ended questions and the validated PHQ-8 Questionnaire and the Child PTSD Symptom Scale (CPSS). These new migrants face numerous challenges to mental health, increased psychopathological risk exacerbated by high levels of violence and low state-capacity in their countries of origin, restrictive immigration policies, the fear of deportation for themselves and their family members, and the pressure to integrate once in the U.S. We find that Central American youth have seen improvements in their self-reported mental health after migrating to the U.S., but remain at risk of further trauma exposure, depression, and PTSD. We find that they exhibit a disproportionate likelihood of having lived through traumatizing experiences that put them at higher risk for psychological distress and disorders that may create obstacles to integration. These can, in turn, create new stressors that exacerbate PTSD, depression, and anxiety. These conditions can be minimized through programs that aid immigrant integration and mental health.

'You withhold what you are feeling so you can have a family': Latinas' perceptions on community values and postpartum depression

OBJECTIVE

The purpose of this study was to explore the postpartum depression (PPD) beliefs and experiences of mothers who access local community faith-based organisations providing family services to low-income, predominantly immigrant Latino populations.

DESIGN

Using a qualitative research design, we conducted 18 focus groups with Latina mothers to inquire about their community values and beliefs of PPD. All groups were conducted in Spanish.

SETTING

An academic research team located in Houston, Texas, USA, partnered with six faith-based organisations in five cities to recruit and host focus groups at the site of the organisation.

PARTICIPANTS

One hundred and thirty-three women participated in the focus groups across all sites. Thirty-seven of them (27.8%) had given birth to a child in less than 1 year. Inclusion criteria included mothers 18 years and older and Latino ethnicity.

RESULTS

A six-step process was used to apply thematic analysis to sort data into the themes. All mothers had heard of depression after childbirth, some had experienced it and most remarked that the personal experience and community acceptance of it vary by family. The main findings suggest that mothers take pride in parenting by instilling values to support family and the value of relying on family for emotional support. Findings reveal that many mothers suffer and sacrifice for their children, they feel judged and feel they must hide their emotions. Factors such as birth and postpartum customs from a native country, gender roles and beliefs of what a good mother shape their beliefs and messages about PPD.

CONCLUSION

Our findings indicate that programme developers should consider family and community focused education and intervention efforts to help decrease stigma and increase understanding of PPD.

Peer Support in Behavioral Health care: why it can work in the Latinx context

Las personas de origenes latinoamericanos son menos propensas a comprometerse con el cuidado de salud mental y la participación en servicios de salud mental, comparado a otros grupos raciales y étnicos. Las bajas tasas de participación en servicios de salud mental en parte de la comunidad Latinx en los Estados Unidos (EE. UU.) se puede atribuir parcialmente alfuncionamiento de los sistemas de cuidado, los cuales no son sensibles a la cultura Latinx o al español como lengua. Las Investigaciones han demostrado que intervenciones centradas en la cultura, que promueven los valores culturales de la comunidad Latinx, informan una mayor participación y satisfacción en el tratamiento y los servicios de salud mental. Un enfoque efectivo, informado por la cultura, que puede mejorar la participación de la comunidad Latinx en servicios de salud mental es el apoyo de compañerxs. En el enfoque de apoyo de pares, se contrata a personas con experiencias vividas en salud mental y adicciones como compañeros de apoyo para ayudar a quienes han vivido experiencias similares. Los estudios de investigación que miden la efectividad de los enfoques de apoyo entre pares han mostrado mejoras en las vidas de quienes reciben el apoyo, ayudando con el sentido de esperanza, calidad de vida, y bienestar. Los resultados también han demostrado disminución de hospitalizaciones, visitas a la sala de emergencia y menor uso de sustancias y participación en actividades criminales. El apoyo entre compañerxs en el contexto Latinx parece un ajuste natural dados sus valores colectivos compartidos (p. ej., simpatía, personalismo, respeto, confianza, familismo). Este articulo discute como los valores de apoyo entre compañerxs se relacionan con los valores colectivistas; y como se pueden infundir más los valores Latinx en el entrenamiento, desarrollo y supervisión de los compañerxs de apoyo para mejorar el cuidado de salud mental informado por la cultura.   

Crosscutting environmental risk with design: A multi-site, multi-city socioecological approach for Iowa's diversifying small towns

Globally, the influx of refugee, migrant, and immigrant populations into small centers of industrialized agriculture has called attention to a looming public health crisis. As small towns shift from remote villages into rural, agri-industrial centers, they offer limited access to amenities needed to support human well-being. Our study focused on three Iowa towns that continue to experience an increase in under-represented minority populations and decline of majority populations as a proxy for studying shifting populations in an era of industrialized agriculture and global capital. We aimed to understand the socioecological impact of built environments-outdoor locations where people live and work-and likelihood of environmental exposures to impact vulnerable populations. Urban socioecological measures tend to present contradictory results in small towns due to their reliance on density and proximity. To compensate, we used post-occupancy evaluations (POE) to examine built environments for evidence of access to environmental design criteria to support healthy behaviors. The study systematically identified 44 locations on transects across three small towns to employ a 62 item POE and assess multiple environmental criteria to crosscut design with environmental health disparities. Principal-components factor analysis identified two distinct significant components for environmental risk and population vulnerability, supporting similar studies on parallel communities. Multilevel modeling found a divergence between supportive environmental design coupled with an increase environmental risk due to location. The combined effect likely contributes to environmental health disparities. The study provides a strategy for auditing small town built environments as well as insight into achieving equity.

Psychological Distress and Physical Health Symptoms in the Latinx Population During the COVID-19 Pandemic: Exploring the Role of Anxiety Sensitivity

Objective

The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial physical and mental health consequences. Rates of mortality and hospitalization are highest among those of racial and ethnic minority persons, including Latinx persons. Further, Latinx persons have been experiencing elevated mental health problems in response to the pandemic compared to non-Latinx Whites. The current study examined whether individual differences in anxiety sensitivity (AS) related to more severe emotional distress associated with social distancing, financial strain, fear of COVID-19, and physical health symptoms stemming from the COVID-19 pandemic among Latinx adults.

Methods

Participants included 188 Latinx persons (31.4% female, M_age = 34.1 years, SD = 8.16) recruited via an online survey panel program.

Results

Results indicated that AS significantly contributed to increased severity of the emotional stress response associated with social distancing (ΔR² = 0.15, p < 0.001), financial strain (ΔR² = 0.15, p < 0.001), physical health symptoms (ΔR² = 0.03, p = 0.006), and fear of COVID-19 (ΔR² = 0.15, p < 0.001). These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and work and home life COVID-19-related stress.

Conclusions

These cross-sectional findings suggest AS may be an important individual difference factor for better understanding mental health among Latinx persons in the context of the COVID-19 pandemic.

The relationship between violence and depression in migrant women through their experiences in care services

Based on ethnographic work with undocumented immigrant women who developed depressive episodes due to various forms of violence, this article recovers the women's experience of care in the clinic space of their host country. Through therapeutic itineraries of care, the article focuses on the case studies of two women of Mexican origin in New York City to describe, based on their experience, the communication and the encounter between the doctor and patient; the expectations of migrant women regarding mental health care services; and the explanatory models of depression of both the patients and the treating physicians. This analysis seeks to contribute to the knowledge regarding ways of treating the mental health problems of undocumented women in contexts of violence.

Examination of potential disparities in suicide risk identification and follow-up care within the Veterans Health Administration

To improve the identification and intervention of suicide risk, the Veterans Health Administration implemented the use of electronic patient record flags (PRF) to indicate when a veteran is identified as high risk for suicide and to increase the clinical contacts made with the veteran. The current study utilized an intersectional approach to assess potential disparities in the likelihood of receiving a PRF and the likelihood of receiving post-PRF follow-up care among veterans with substance use disorders (SUDs). Among 458,092 veterans who received a SUD diagnosis in 2012, Black veterans were less likely to receive a PRF, although Black-disabled veterans and Black-female veterans were more likely to receive a PRF. Homelessness was related to greater likelihood of receiving a PRF and post-PRF care. Hispanic/Latinx veterans who experienced homelessness were more likely to receive post-PRF care, while disabled veterans who experienced homelessness were less likely. Hispanic/Latinx, female veterans, and Black-disabled veterans were significantly less likely to receive post-PRF care. Overall, few marginalized or intersecting identities were associated with decreased PRF or decreased follow-up care. There are opportunities for specific strategies that promote engagement in VA follow-up services for veterans identifying as Hispanic/Latinx women, disabled Black veterans, and disabled homeless veterans.

After the Affordable Care Act: the Effects of the Health Safety Net and the Medicaid Expansion on Latinxs' Use of Behavioral Healthcare in the US

This study investigated the association between the implementation of the Affordable Care Act (ACA) and Latinxs' use of behavioral health services in the US. Organizational responses from the 2010, 2014, and 2016 National Mental Health Service Survey were used to examine the number and proportion of outpatient Latinx admissions over time, as well as the role of Medicaid expansion and health safety net funding on Latinxs' admissions. Findings showed that there was an increase in Latinx admissions post-ACA (2014). However, 2 years post-implementation (2016), Latinx admissions were at levels lower than prior to the healthcare reform. Despite this overall decrease, behavioral health safety net organizations, particularly those located in states that adopted the expansion of Medicaid, served more Latinxs than behavioral health service organizations outside the safety net. Policy and practice implications to strengthen behavioral safety net organizations that serve Latinxs are discussed.

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

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

Cultural competence and metaphor in mental healthcare interactions: A linguistic perspective

OBJECTIVES

The aim of this study is to understand how Spanish-speaking patients conceptualize mental health issues. This study uses a linguistic perspective to focus on how 23 Mexican-origin patients and their doctor talk about mental health during psychiatric interviews conducted in Spanish and how they negotiate cultural barriers.

METHODS

This work analyzes when the doctor and his patients reference metaphors (e.g. feeling "empty," feeling "low"). Metaphors are pervasive in all cultures and languages and reveal important information about people's attitudes and feelings about a range of conditions and circumstances.

RESULTS

This work demonstrates the role of metaphor and linguistic analysis in uncovering culturally based constructions of mental health. The results reveal that the doctor and patients reference different sets of metaphors, which, at times, causes miscommunication.

CONCLUSIONS

Practitioner awareness of how patients use metaphorical expressions in health is crucial for promoting advanced cultural and linguistic competence and ultimately, patient-centered care.

PRACTICE IMPLICATIONS

The main findings have implications for health communication with minority groups such as Spanish-speaking Latinos/as in the United States. Practitioners working with Spanish-speaking patients should be familiar with how Latinos/as conceptualize health and how to avoid or repair confusion caused by cultural barriers.

Transitions, Suicidality, and Underappreciated Autism Spectrum Disorder in a High School Student

Alex is a 14-year-old Portuguese-American boy with a psychiatric history starting at age 5 who presents to your primary care practice after an insurance change.He was delivered prematurely at 32 weeks and diagnosed with congenital hypothyroidism at the age of 6 weeks and growth hormone deficiency at the age of 2 years; he is in active treatment for both. He otherwise met developmental milestones on time yet continues to have significant fatigue despite adequate sleep and vitamin D supplementation.His family history is remarkable for maternal anxiety, depression, suicidal thoughts, and previous attempted suicide, as well as anxiety, alcoholism, depression, and attention-deficit/hyperactivity disorder (ADHD) in the extended family.Alex has had multiple psychiatric diagnoses by sequential providers. He was diagnosed with generalized anxiety disorder and ADHD by 5 years of age, major depressive disorder by 11 years of age, persistent depressive disorder by 12 years of age, and ultimately disruptive mood dysregulation disorder because of severe and persistent temper outbursts associated with negative mood and behavioral dysregulation, leading to recurrent crisis evaluations. He has been psychiatrically hospitalized twice, in the fifth and seventh grade, for suicidal ideation (SI) and elopement from home, respectively. He recently completed a 2-week acute residential placement, during which no medication changes were made. Current medications include escitalopram 20 mg daily, guanfacine 1 mg 3 times daily, sustained release bupropion 100 mg twice daily, levothyroxine, vitamin D, and a weekly somatropin injection. He has not been able to tolerate psychostimulants or nonstimulant agents because of treatment-emergent SI.Now in the ninth grade, he continues to be easily distracted by peers, with impulsive behaviors and reduced self-regulation. Despite receiving special education services since the fifth grade, his academic performance has been poor, and he has limited motivation. Previous testing indicated average in an intelligence quotient test, with relative deficits in working memory compared with above average strength in fluid reasoning. He dislikes school and has few friends. He has always been noted to be "immature." He displays temper tantrums at home and school around transitions and behavioral expectations and has complained of feeling "different" and misunderstood by peers in addition to having difficulty reading social cues. His interests include acting and playing Fortnite and other video/computer games. His screen time is limited to 1 to 2 hr/d by the family.As the new clinician, you raise the possibility of undiagnosed autism spectrum disorder as a unifying/underlying diagnosis with his mother, who disagrees and does not consent to additional workup despite your recommendations. How would you proceed with next steps to best support your patient and his family in obtaining further clarifying evaluation?

Mental health stigma among people of color: An examination of the impact of racial discrimination

OBJECTIVE

The primary goal of this study was to examine the relations between racial discrimination experiences and different dimensions of mental health stigma among a diverse sample of people of color.

METHOD

Participants were recruited through blast emails at a large public university and completed an online survey (N = 205). Four linear regressions were completed predicting from recent racial discrimination experiences to (1) negative beliefs about mental health problems, (2) treatments, (3) treatment seeking and (4) anticipated stigma.

RESULTS

Results indicated that recent racial discrimination experiences contributed unique variance in anticipated stigma from loved ones, as well as negative beliefs about mental health problems.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Racial discrimination contributes to increased anticipated stigma and negative beliefs about mental health problems. Addressing the impact of racial discrimination as it influences these dimensions of mental health stigma is important to promote recovery among people of color.

"Thank You for Including Us!" - Introducing a Community-Based Collaborative Approach to Translating Clinic Materials

When working with clients in another language, having culturally relevant and properly translated clinic materials is vital to effective clinical practice. Not having them presents a barrier for bilingual therapists and their clients. This paper reviews common translation methods and introduces a multi-level, community-based approach for translating clinic materials for non-English speaking clients. Informed by decolonizing practices, this five-tier method includes members from the target community as cultural brokers to verify the accuracy and nuances of language for their cultural group, as well as a constant comparative method to ensure methodological rigor in the process of inclusion. We present community member's feedback and recommendations, as well as discuss advantages and challenges of using this collaborative culturally responsive translation method.

Treatment experiences of Latinas with current or past binge eating disorder and/or bulimia nervosa

This study utilized a female sample of 43 Latinas with a history of binge eating disorder and/or bulimia nervosa to investigate disparities in health care that may act as barriers to or correlates of treatment for these women. Results indicated that 65% of our sample sought treatment for their eating disorder. The most commonly utilized treatment providers were psychologist/therapist for individual therapy and nutritionist/dietician, while therapist-led group therapy was rated as the most helpful treatment and treatment by a physician was rated as least helpful. Participants endorsed eating disorder stigma, eating disorder shame, mental health shame, and cost of treatment as the most influential barriers to seeking or receiving treatment. Acculturation to White dominant society was associated with greater perceived treatment helpfulness. Findings from this study can be used to inform treatments for Latinas in order to potentially increase effectiveness, treatment-seeking, and recovery rates.

"Because That's the Culture": Providers' Perspectives on the Mental Health of Latino Immigrant Youth

Immigrant youth experience a combination of stressors, such as isolation and discrimination, that put them at a greater risk for negative mental health outcomes. Relying on interviews with 24 service providers who work with Latino immigrant youth, this article examines how they construct and intervene in the worlds of immigrant youth to improve youth's mental health outcomes. Inductive thematic analysis revealed providers' reliance on cultural interpretations of the psychosocial circumstances facing immigrant youth. Providers alternated between drawing on discourses that reproduced stereotypes, assumptions, and biases, while simultaneously striving to transcend sociocultural differences to focus on the lived experiences of their clients. Although providers acknowledged the importance of structural barriers, such as poverty and discrimination, they "bracketed" these issues when recommending interventions. The article highlights that as cultural competence increasingly becomes part of social services, this professional discourse may distract providers' attention from more relevant targets of intervention.

"Si Dios Quiere": Fatalismo and use of mental health services among Latinos with a history of depression

Latinos are less likely to seek professional mental health care than other groups in the United States. While fatalismo has long been hypothesized to be responsible for this behavior, there is little evidence on this assumption. Using an adapted version of the Behavioral Model of Health Service Use (BMHSU), and a nationally representative sample, this study examined the association between fatalismo and mental health service use among Latinos with a history of depression. Participants (n = 703) were drawn from the 2007 Pew Hispanic Healthcare survey. Results showed that fatalismo was significantly associated with the use of psychiatric care, even after controlling for traditional deterrents of health care access and utilization. The findings underscore the importance of fatalismo in predicting Latinos' use of psychiatric care. Implications for practice are discussed.

The moderating and covarying effects of social support and pain intensity on depressive symptomology among racially and ethnically diverse older adults

Aim: To examine the interplay of social support, pain intensity and ethnicity as moderators and covariates of relationship on depressive symptomatology. Methods: Racially and ethnically diverse elders responded to measures of depressive symptomatology and social support. Results: Hispanics reported significantly higher prevalence of moderate pain intensity and depressive symptomology, and lower prevalence of high social support compared with other ethnic groups. Although social support showed reduced depressive symptomatology among those with high pain intensity, it did not play a significant role in decreasing depressive symptomatology among those with low/moderate pain intensity. Conclusion: Social support in decreasing depressive symptomatology is more effective in older adults with high pain intensity than those with moderate or low levels of pain intensity.