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Abraham J, Cooksey KE, Holzer KJ, Mehta D, Avidan MS, Lenze EJ. A Culturally Adapted Perioperative Mental Health Intervention for Older Black Surgical Patients. Am J Geriatr Psychiatry 2024:S1064-7481(24)00356-7. [PMID: 38942694 DOI: 10.1016/j.jagp.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/30/2024]
Abstract
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.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology (JA, KJH, DM, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics, Data Science and Biostatistics (JA), Washington University School of Medicine, St. Louis, MO.
| | - Krista E Cooksey
- Department of Surgery (KEC), Washington University School of Medicine, St. Louis, MO
| | - Katherine J Holzer
- Department of Anesthesiology (JA, KJH, DM, MSA), Washington University School of Medicine, St. Louis, MO
| | - Divya Mehta
- Department of Anesthesiology (JA, KJH, DM, MSA), Washington University School of Medicine, St. Louis, MO
| | - Michael S Avidan
- Department of Anesthesiology (JA, KJH, DM, MSA), Washington University School of Medicine, St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (EJL), Washington University School of Medicine, St. Louis, MO
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Cénat JM. Racial discrimination in healthcare services among Black individuals in Canada as a major threat for public health: its association with COVID-19 vaccine mistrust and uptake, conspiracy beliefs, depression, anxiety, stress, and community resilience. Public Health 2024; 230:207-215. [PMID: 38574426 DOI: 10.1016/j.puhe.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To examine the prevalence of major racial discrimination (MRD) in healthcare services and its association with COVID-19 vaccine mistrust and uptake, conspiracy theories, COVID-19-related stressors, community resilience, anxiety, depression, and stress symptoms. STUDY DESIGN The study used a population-based cross-sectional design. METHODS Data from the BlackVax dataset on COVID-19 vaccination in Black individuals in Canada was analyzed (n = 2002, 51.66% women). Logistic regression analyses were performed to examine the association between MRD and independent variables. RESULTS 32.55% of participants declared having experienced MRD in healthcare services. Participants with MRD were less vaccinated against COVID-19, presented higher scores of vaccine mistrust, conspiracy beliefs, COVID-19 related stressors, depression, anxiety, and stress, and had lower scores of community resilience. They were more likely to experience depression (AOR = 2.13, P < 0.001), anxiety (AOR = 2.00, P < 0.001), and stress symptoms (AOR = 2.15, P < 0.001). Participants who experienced MRD were more likely to be unvaccinated (AOR = 1.35, P = 0.009). CONCLUSIONS Racial discrimination experienced by Black individuals in health services is a major public health concern and threat to population health in Canada. Federal, provincial, and municipal public health agencies should adapt their programs, strategies, tools, and campaigns to address the mistrust created by racial discrimination.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, 136 Jean-Jacques-Lussier, 4085, Vanier Hall, Ottawa, Ontario, K1N 6N5, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
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Michaels TI, Simon-Pearson L, Kane JM, Cornblatt B. Racial Disparities Among Clinical High-Risk and First-Episode Psychosis Multisite Research Participants: A Systematic Review. Psychiatr Serv 2024; 75:451-460. [PMID: 38204372 DOI: 10.1176/appi.ps.20230120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The NIH has mandated equal representation of Black, Indigenous, and people of color (BIPOC) individuals in clinical research, but it is unclear whether such inclusion has been achieved in multisite research studies of individuals at clinical high risk for psychosis or with first-episode psychosis (FEP). An assessment of inclusion rates is important for understanding the social determinants of psychosis and psychosis risk that specifically affect BIPOC individuals. METHODS The authors conducted a systematic review of the literature published between 1993 and 2022 of multisite research studies of clinical high risk for psychosis and FEP in North America to determine ethnoracial inclusion rates. Using an online systematic review tool, the authors checked 2,278 studies for eligibility. Twelve studies met all inclusion criteria. Data were extracted, and demographic characteristics, socioeconomic status, study design, and recruitment strategies used by each study were analyzed. RESULTS Most (62%) of the participants in studies of clinical high risk for psychosis were White. Compared with national data, the demographic characteristics of individuals with clinical high risk were representative across most ethnoracial groups. Black participants (43%) made up the largest ethnoracial group in FEP studies and were overrepresented compared with their representation in the U.S. population. FEP studies were more likely to recruit participants from community mental health centers than were the studies of clinical high risk. CONCLUSIONS Although these results suggest high representation of BIPOC individuals in psychosis research, opportunities exist for an improved focus on ethnoracial representation. The authors offer recommendations for practices that may increase ethnoracial diversity in future psychosis study samples.
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Affiliation(s)
- Timothy I Michaels
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Laura Simon-Pearson
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - John M Kane
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Barbara Cornblatt
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
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Franklin JB, Leewiwatanakul B, Taylor AD, Baller EB, Zwiebel SJ. Consultation-Liaison Case Conference: Overcoming Bias in the Differential Diagnosis of Psychosis. J Acad Consult Liaison Psychiatry 2024; 65:195-203. [PMID: 37717789 PMCID: PMC10947773 DOI: 10.1016/j.jaclp.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/28/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
We present the case of a 34-year-old Black patient with no significant psychiatric history who presented with catatonia and psychotic symptoms following a recent severe acute respiratory syndrome coronavirus-2 infection, whose diagnosis of coronavirus disease 2019 encephalitis was delayed by premature attribution of his symptoms to a primary psychiatric etiology. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include the diagnosis and management of coronavirus disease 2019 encephalitis, cognitive bias, and racial bias. Specifically, this case illustrates the role of the consultation-liaison psychiatrist in identifying medical conditions that may overlap with psychiatric presentations and in advocating for marginalized patients.
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Affiliation(s)
- Joshua B Franklin
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Bruce Leewiwatanakul
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Adrienne D Taylor
- Division of Medical Psychiatry, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Erica B Baller
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Samantha J Zwiebel
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Cénat JM, Broussard C, Jacob G, Kogan C, Corace K, Ukwu G, Onesi O, Furyk SE, Bekarkhanechi FM, Williams M, Chomienne MH, Grenier J, Labelle PR. Antiracist training programs for mental health professionals: A scoping review. Clin Psychol Rev 2024; 108:102373. [PMID: 38232574 DOI: 10.1016/j.cpr.2023.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
Racism has been shown to be directly deleterious to the mental health care received by minoritized peoples. In response, some mental health institutions have pledged to provide antiracist mental health care, which includes training mental health care professionals in this approach. This scoping review aimed to synthesize the existing published material on antiracist training programs among mental health care professionals. To identify studies, a comprehensive search strategy was developed and executed by a research librarian in October 2022 across seven databases (APA PsycInfo, Education Source, Embase, ERIC, MEDLINE, CINAHL, and Web of Science). Subject headings and keywords relating to antiracist training as well as to mental health professionals were used and combined. There were 7186 studies generated by the initial search and 377 by the update search, 30 were retained and included. Findings revealed four main antiracist competencies to develop in mental health professionals: importance of understanding the cultural, social, and historical context at the root of the mental health problems; developing awareness of individual biases, self-identity and privilege; recognizing oppressive and racism-sustaining behaviors in mental health care settings; and, employing antiracist competencies in therapy. Professionals who have taken trainings having the main components have developed skills on the interconnectedness between racialized groups' mental health and the cultural, religious, social, historical, economic, and political issues surrounding race, necessary for successful clinical practice and for providing anti-racist mental health care. This scoping review presents a summary of the essential antiracist competencies drawn from the literature which must be applied in a mental health care setting, to improve help seeking behaviors, and reduce distrust in mental health care professionals and settings.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on Black Health, Ottawa, Ontario, Canada.
| | - Cathy Broussard
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Grace Jacob
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Cary Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Institute for Mental Health at The Royal, Ottawa, Ontario, Canada
| | - Kim Corace
- The Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Institute for Mental Health at The Royal, Ottawa, Ontario, Canada
| | - Gloria Ukwu
- Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Onesi
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Monnica Williams
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; Canada Research Chair on Mental Health Disparities, Ottawa, Ontario, Canada
| | - Marie-Hélène Chomienne
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Research Chair on the Health Status of Black Immigrant Francophones, Ottawa, Ontario, Canada; Institut du Savoir Montfort, Ottawa, Ontario, Canada
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Jaka S, Singh S, Vashist S, Pokhrel S, Saldana E, Sejdiu A, Taneja S, Arisoyin A, Mogallapu R, Gunturu S, Bachu A, Patel RS. Pediatric anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis: Exploring psychosis, related risk factors, and hospital outcomes in a nationwide inpatient sample: A cross-sectional study. PLoS One 2024; 19:e0296870. [PMID: 38349905 PMCID: PMC10863852 DOI: 10.1371/journal.pone.0296870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/20/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Our study aims to examine the risk factors for comorbid psychosis in pediatric patients hospitalized for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and its impact on hospital outcomes. METHODS We conducted a cross-sectional study using the nationwide inpatient sample (NIS 2018-2019). We included 3,405 pediatric inpatients (age 6-17 years) with a primary discharge diagnosis of anti-NMDAR encephalitis. We used binomial logistic regression model to evaluate the odds ratio (OR) of variables (demographic and comorbidities) associated with comorbid psychosis. RESULTS The prevalence of comorbid psychosis in anti-NMDAR encephalitis inpatients was 5.3%, and majorly constituted of adolescents (72.2%) and females (58.3%). In terms of race, Blacks (OR 2.41), and Hispanics (OR 1.80) had a higher risk of comorbid psychosis compared to Whites. Among comorbidities, encephalitis inpatients with depressive disorders (OR 4.60), sleep-wake disorders (OR 3.16), anxiety disorders (OR 2.11), neurodevelopmental disorders (OR 1.95), and disruptive behavior disorders (OR 2.15) had a higher risk of comorbid psychosis. Anti-NMDAR encephalitis inpatients with comorbid psychosis had a longer median length of stay at 24.6 days (vs. 9.8 days) and higher median charges at $262,796 (vs. $135,323) compared to those without psychotic presentation. CONCLUSION Adolescents, females, and Blacks with encephalitis have a higher risk of psychotic presentation leading to hospitalization for anti-NMDAR encephalitis. Identification of demographic predictors and comorbidities can aid in early recognition and intervention to optimize care and potentially reduce the healthcare burden.
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Affiliation(s)
- Sanobar Jaka
- Department of Population Health, Section on Tobacco, Alcohol and Drug Use, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sukhnoor Singh
- Department of Psychiatry, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Sreshatha Vashist
- Department of Psychiatry, N.C. Medical College and Hospital, Panipat, Haryana, India
| | - Sandesh Pokhrel
- Department of Psychiatry, Nepal Medical College, MBBS, Attarkhel, Kathmandu, Nepal
| | - Ericka Saldana
- Department of Psychiatry, Salvadoran University Alberto Masferrer, San Salvador CP, El Salvador
| | - Albulena Sejdiu
- Department of Psychiatry, St. Chyril and Methodius St Chyril and Methodius, Skopje, North Macedonia
| | - Sanjana Taneja
- Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
| | - Abimbola Arisoyin
- Department of Psychiatry College of Medicine, Psychiatry Department Idiaraba, University of Lagos, Lagos, Nigeria
| | - Raja Mogallapu
- Department of Psychiatry, West Virginia University School of Medicine, Martinsburg, WV, United States of America
| | - Sasidhar Gunturu
- Department of Psychiatry, Bronxcare Health System, Bronx, NY, United States of America
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Anil Bachu
- Department of Psychiatry, Baptist Health System—University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Rikinkumar S. Patel
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
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Cénat JM, Lashley M, Jarvis GE, Williams MT, Bernheim E, Derivois D, Rousseau C. The Burden of Psychosis in Black Communities in Canada: More than a Feeling, a Black Family Experience. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:10-12. [PMID: 37635288 PMCID: PMC10867408 DOI: 10.1177/07067437231197263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa Research Chair on Black Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Myrna Lashley
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - G. Eric Jarvis
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Monnica T. Williams
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Emmanuelle Bernheim
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Civil Law, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Derivois
- Department of Psychology, Université Bourgogne Franche Comté, Dijon, France
| | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
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Affiliation(s)
- Els van der Ven
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam (van der Ven); Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, New York (Susser)
| | - Ezra Susser
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam (van der Ven); Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, New York (Susser)
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Faber SC, Metzger IW, La Torre J, Fisher C, Williams MT. The illusion of inclusion: contextual behavioral science and the Black community. Front Psychol 2023; 14:1217833. [PMID: 38022926 PMCID: PMC10643524 DOI: 10.3389/fpsyg.2023.1217833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
Anti-racism approaches require an honest examination of cause, impact, and committed action to change, despite discomfort and without experiential avoidance. While contextual behavioral science (CBS) and third wave cognitive-behavioral modalities demonstrate efficacy among samples composed of primarily White individuals, data regarding their efficacy with people of color, and Black Americans in particular, is lacking. It is important to consider the possible effects of racial stress and trauma on Black clients, and to tailor approaches and techniques grounded in CBS accordingly. We describe how CBS has not done enough to address the needs of Black American communities, using Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) as examples. We also provide examples at the level of research representation, organizational practices, and personal experiences to illuminate covert racist policy tools that maintain inequities. Towards eradicating existing racism in the field, we conclude with suggestions for researchers and leadership in professional psychological organizations.
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Affiliation(s)
- Sonya C. Faber
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Isha W. Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Joseph La Torre
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Carsten Fisher
- Behavioral Wellness Clinic, LLC, Tolland, CT, United States
| | - Monnica T. Williams
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Behavioral Wellness Clinic, LLC, Tolland, CT, United States
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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Gardea-Resendez M, Ortiz-Orendain J, Miola A, Fuentes Salgado M, Ercis M, Coombes BJ, Gruhlke PM, Bostwick JM, Michel I, Vande Voort JL, Ozerdem A, McKean A, Frye MA, Taylor-Desir M. Racial differences in pathways to care preceding first episode mania or psychosis: a historical cohort prodromal study. Front Psychiatry 2023; 14:1241071. [PMID: 37732076 PMCID: PMC10507622 DOI: 10.3389/fpsyt.2023.1241071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Background There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Methods Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). Results A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. Conclusion These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.
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Affiliation(s)
- Manuel Gardea-Resendez
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Javier Ortiz-Orendain
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Alessandro Miola
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | | | - Mete Ercis
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Brandon J. Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Peggy M. Gruhlke
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - J. Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ian Michel
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Aysegul Ozerdem
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Alastair McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Monica Taylor-Desir
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Duncan S, Horton H, Smith R, Purnell B, Good L, Larkin H. The Restorative Integral Support (RIS) Model: Community-Based Integration of Trauma-Informed Approaches to Advance Equity and Resilience for Boys and Men of Color. Behav Sci (Basel) 2023; 13:bs13040299. [PMID: 37102813 PMCID: PMC10136213 DOI: 10.3390/bs13040299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Mental health and health promotion research and practice have consistently revealed the social and structural inequities that boys and men of color (BMoC) face. Moreover, scholarship highlights the importance of gender, especially the concepts of masculinity and manhood, in understanding inequities that are experienced. Providers and community leaders are finding culturally relevant ways to foster healing and restoration while addressing racial trauma and the adverse community environments tied to adverse childhood experiences (ACEs). This article introduces the restorative integral support (RIS) model to promote connectivity through networks and to acknowledge the contextual differences BMoC experience when suffering from trauma and adversities. RIS is a framework used to address adversities and trauma while increasing societal awareness and advancing equity. This community-based, multidimensional approach is offered to enhance individual, agency, community, and policymaking leadership, raising awareness of mental health concerns and trauma while offering a flexible guide to developing safe spaces and support for recovery from ACEs and trauma. This article offers an in-depth appreciation of the real-life contexts within which BMoC overcome histories of adversity and trauma, demonstrating how the RIS model is applied to advance structural transformation while fostering community resilience.
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Affiliation(s)
- Stephanie Duncan
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Correspondence: (S.D.); (H.H.); (H.L.)
| | - Heather Horton
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Correspondence: (S.D.); (H.H.); (H.L.)
| | - Richard Smith
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Richard Smith Speaks, Brooklyn, NY 11201, USA
| | | | - Lisa Good
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Urban Grief, Albany, NY 12204, USA
| | - Heather Larkin
- School of Social Welfare, University at Albany, Albany, NY 12203, USA
- Correspondence: (S.D.); (H.H.); (H.L.)
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