Social support and psychotherapy outcomes for international students in university/college counseling centers

Objective: To explore the relationship between international students' social support at intake and international student distress at end of treatment. Participants: Data was collected from participants (n = 40,085) from 90 United States universities using the Center for Collegiate Mental Health (CCMH) database. Methods: Participants completed measures of psychological distress and perceived social support. Using multilevel modeling, we predicted participants' distress at end of treatment by international student status, social support, race, and length of therapy. Results: We found that international students who reported lower social support at intake ended treatment with higher levels of psychological distress when distress at intake was controlled compared to United States peers. Conclusions: Understanding the significance of social support for international students can help to inform mental healthcare professionals' approach to psychotherapy.

Counseling Center and Therapist Effects on Changes in Suicidal Ideation among College Students Receiving Services on Campus: Comparisons across International Status, Race, Gender, and Sexual Orientation

OBJECTIVE

Examine center- and therapist-level factors that may impact suicide ideation outcomes for college students with minoritized identities.

METHOD

Data were drawn from a 2015-2017 data set collected from 136 university counseling centers that were part of the Center for Collegiate Mental Health. This study used a three-level model in hierarchical linear modeling with clients (Level 1; N = 122,212), clients nested in therapists (Level 2; N = 2,574), and therapists nested in counseling centers (Level 3; N = 120).

RESULTS

Racially/ethnically minoritized students were 20%, LGBQ + students were 100% more likely, and women students were 20% less likely to have suicidal ideation at the first session, compared to White, male, heterosexual domestic students. LGBQ + students were 20%, and international students were 50% more likely to have suicidal ideation in the last session, compared to White, male, heterosexual domestic students. Cross-level interactions revealed that when therapists had a higher percentage of international students on their caseload, international students had decreased suicidal ideation. Similarly, when therapists had a higher percentage of male students on their caseload, their male students had decreased suicidal ideation.

CONCLUSIONS

Findings from this study support the importance of experience and competence in working with minoritized students, as therapists who had more international and men students on their caseload fared better in decreasing the suicide ideation of respective students. This suggests that continued exposure to the unique challenges faced by particular minoritized groups of college students can enhance the quality of care delivered by therapists.

Online xenophobia and mental health among Venezuelan migrant youth in Colombia: The interplay with "in-person" discrimination

Emerging research provides insights into migration-related cultural stress experiences and mental health among Venezuelan migrants; however, prior studies have not considered the critical distinction between online xenophobia and in-person discrimination. To address this gap, we assess the psychometric properties of an abbreviated version of the Perceived Online Racism Scale (PORS) with Venezuelan migrant youth and examine the interplay between online xenophobia, in-person discrimination, and mental health. Survey data were collected from Venezuelan migrant youth (N = 319; ages 13-17, 49.5% female) in Colombia in April-July 2023. Confirmatory factor analysis (CFA) was used to examine the PORS, and multiple regression was conducted to examine key associations. The CFA showed excellent model fit: χ²(7) = 13.498, p = .061; comparative fit index = .989; Tucker-Lewis index = .977; root-mean-square error of approximation = .055; standardized root-mean-square residual = .026. Controlling for demographic factors, online xenophobia was associated with depressive symptoms (β = .253, p < .001) and anxiety (β = .200, p = .001). The online xenophobia-mental health association weakened when controlling for in-person discrimination but remained nevertheless significant (depression: β = .181, p = .002, anxiety: β = .135, p = .026). Interaction effects (Online × In-Person) revealed a pattern in which greater exposure to online xenophobia was associated with greater distress, but only at relatively low levels of in-person discrimination. Findings provide new insights regarding (a) the properties of an increasingly relevant measure of cultural stress, (b) how online xenophobia relates to mental health, and (c) the interplay of online and in-person cultural stressors vis-à-vis mental health among Venezuelan migrant youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Mental Health Costs of Online Heterosexism Among LGBTQ+ Individuals: Development and Initial Validation of the Perceived Online Heterosexism Scale

Experiences of heterosexism are rampant online, where bias and harassment against LGBTQ+ individuals spread conveniently and widely. Yet, research has been limited in understanding the exposure to online heterosexism among LGBTQ+ individuals partly due to the lack of a quantitative measure to advance this research. Thus, the current study developed and examined the psychometric properties of the Perceived Online Heterosexism Scale (POHS). Items were developed via a literature review, a survey of social media platforms, and an expert review. Exploratory (N = 288) and confirmatory (N = 653) factor analyses yielded a 4-factor structure and produced a 20-item scale with the following subscales: (1) Heterosexist Cyberaggression (4 items), (2) Online Heterosexist Stereotyping (4 items), (3) Online Exposure to Systemic Heterosexism (8 items), and (4) Heterosexist Online Media (four items). Internal consistency estimates ranged from .91 to .96, and the POHS accounted for 65.9% of the variance. Examination of a second-order model suggested that a total scale score can also be used. Initial construct validity was evidenced as POHS scores were associated with an existing heterosexism measure, anxiety and depressive symptoms, internalized heterosexism, and LGBTQ+ community connectedness in line with theory and empirical evidence. Implications for research practice are discussed.

Racial Hate at the Intersection of Online and Offline Worlds: The Joint Impact of Online and Offline Racism on the Mental Health of Racially Minoritized Individuals

With the everyday influence of social media and online platforms, racially minoritized individuals face the risk of experiencing racial discrimination in both offline and online contexts. Yet, there is scant research on how online and offline racism could jointly impact the mental health of racially minoritized individuals. Thus, the study examined online racism as a moderator in the link between offline racism and mental health issues. Using data from 651 racially minoritized emerging adults (Mage = 22.15, SD = 3.39), a moderation analysis was conducted using the PROCESS macro with bias-corrected bootstrapping (10,000 resamples). Experiencing more offline racism was significantly associated with greater mental health issues. Online racism was a significant moderator in the link between offline racism and mental health issues. The link between offline racism and mental health issues was not significant at low levels of online racism. However, the link was significant and strengthened at mean to high levels of online racism. The results suggest complex interactions in understanding the compounding impact of online and offline racism on mental health costs among racially minoritized individuals. Implications for future research on understanding the interplay between online and offline racism are discussed.

Resisting and countering online racial hate: Antiracism advocacy and coping online with racism as moderators of distress associated with online racism

The emerging literature highlights online racism (e.g., racist online interactions, exposure to racially traumatizing content) as a contemporary stressor among racially/ethnically minoritized adults. Thus, identifying factors that can help buffer the harmful impact of online racism are imperative. We examined engagement in antiracism advocacy and online coping as moderators that can potentially buffer the link between online racism and psychological distress. Using data from 395 racially/ethnically diverse adults (Mage = 34.12, SD = 11.19), we conducted latent moderated structural equation modeling to test individual and institutional antiracism advocacy, and online coping as moderators in the link between online racism and psychological distress. Individual antiracism advocacy was not a significant moderator. Both institutional antiracism advocacy and online coping were significant moderators. For both variables, the link between online racism and psychological distress was not significant at 1 SD below the mean but was significant at the mean and 1 SD above the mean. Thus, distress associated with online racism was not significant among those engaging in low levels of institutional antiracism advocacy and online coping but mean to high levels of institutional antiracism advocacy and online coping did not appear to be protective against distress. Implications for advancing the research on coping with online racism are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of online and offline racism on cigarette smoking, marijuana use, and vaping via depressive/anxiety symptoms among racially minoritized emerging adults

Studies have found that offline and online racism are linked to mental health issues including depressive and anxiety symptoms among racially minoritized emerging adults. To cope with these symptoms, racially minoritized emerging adults may resort to substance use. Thus, we examined the relationship between offline and online racism and recent smoking behaviors (past 30 days), and whether depressive and anxiety symptoms (DAS) mediate this relationship. We hypothesized that offline and online racism would be associated with a greater probability of recent smoking through depressive/anxiety symptoms. With data from 338 participants (Mage = 23.28, SD = 2.38), we conducted a path analysis of offline racism (Everyday Discrimination Scale) and online racism (Perceived Online Racism Scale) predicting recent smoking (recent cigarette smoking, recent marijuana use, recent vaping) via depressive (Patient Health Questionnaire-9)/anxiety (Generalized Anxiety Disorder-7) symptoms. Offline racism was directly associated with recent cigarette smoking while online racism was directly associated with recent vaping. No significant indirect associations were observed with cigarette smoking and vaping. Both online and offline racism were indirectly associated with recent marijuana use via depressive/anxiety symptoms. Our findings suggest that there are nuanced differences between the impact that online and offline racism experiences may have on the DAS, and smoking behaviors of racially minoritized emerging adults. Implications for research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Witnessing racism against racial minority individuals online and loneliness among White emerging adults: Anti-racism advocacy as a moderator

Extant literature suggests that racism is associated with difficult emotional reactions and feelings of social disconnect among White individuals. These feelings of social disconnect may be particularly salient in today's digital era in which racism against racial minority individuals is conveniently and frequently witnessed via online platforms. Thus, we examined whether witnessing racism online may be associated with feelings of loneliness among White emerging adults. We also tested whether anti-racism advocacy buffered loneliness given its potential for relationship building and community organizing to promote racial justice and equity. Using data from 227 White emerging adults (M_age  = 20.86, SD = 4.82), we conducted a latent moderated structural equation modeling to test individual and institutional anti-racism advocacy as moderators in the link between witnessing racism online (racial victimization of racial minority individuals in online interactions and online content on cultural devaluation/systemic racism against racial minority individuals) and loneliness. Greater exposure to online content on systemic racism and cultural devaluation of racial minority groups significantly predicted greater loneliness. Engagement in individual anti-racism advocacy (mean to high levels) buffered this link. White allies must engage in anti-racism practice to address racism in our society, and our findings advance our understanding of the associated psychosocial costs. Implications for research and practice are discussed.

Profiles of online racism exposure and mental health among Asian, Black, and Latinx emerging adults in the United States

Online racism is a digital social determinant to health inequity and an acute and widespread public health problem. To explore the heterogeneity of online racism exposure within and across race, we latent class modelled this construct among Asian (n = 310), Black (n = 306), and Latinx (n = 163) emerging adults in the United States and analysed key demographic and psychosocial health correlates. We observed Low and Mediated Exposure classes across all racial groups, whereas High Exposure classes appeared among Asian and Black people and the Systemic Exposure classes emerged uniquely in Asian and Latinx people. Generally, the High Exposure classes reported the greatest psychological distress and unjust views of society compared to all other classes. The Mediated and Systemic Exposure classes reported greater mental health costs than the Low Exposure classes. Asian women were more likely to be in the Mediated Exposure class compared to the Low Exposure class, whereas Black women were more likely to be in the Mediated Exposure class compared to both High and Low Exposure classes. About a third of each racial group belonged to the Low Exposure classes. Our findings highlight the multidimensionality of online racism exposure and identify hidden yet divergently risky subgroups. Research implications include examination of class membership chronicity and change over time, online exposure to intersecting oppressions, and additional antecedents and health consequences of diverse forms of online racism exposure.

Gendered racism, family and external shame, depressive symptoms, and alcohol use severity among Asian American men

OBJECTIVE

We investigated whether gendered racism predicts depressive symptoms and alcohol use severity among Asian American men (AAM) through indirect relations via culture-specific family and external shame.

METHOD

We analyzed convenience data from 409 AAM. Sample age (M = 21.24), nativity, ethnicity, education, income, and self-reported social class were diverse and controlled for. We path modeled direct associations among gendered racism and depressive symptoms and alcohol use severity, and their indirect (mediated) associations through family and external shame.

RESULTS

About 21% and 25% of the sample met the clinical cutoffs for depressive symptoms and risky alcohol use, respectively. Gendered racism predicted depressive symptoms indirectly via external shame, and predicted alcohol use severity directly and indirectly via family shame. The hypothesized model fits the data better than an alternative model with shame factors as predictors.

CONCLUSION

Gendered racism is an insidious psychiatric risk factor for AAM and appears to exacerbate family and external shame, which may subsequently and divergently increase depressive symptoms and alcohol use severity. Findings highlight the role of cultural factors within gendered racism-related stress processes among AAM. Future research should consider longitudinal designs and additional mediating and outcome variables to examine the behavioral health sequelae of gendered racism among AAM. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of Online Racism on Suicide Ideation Through Interpersonal Factors Among Racial Minority Emerging Adults: The Role of Perceived Burdensomeness and Thwarted Belongingness

While a growing number of studies have documented significant links between online racism (e.g., racist interactions, contents on racial violence) and comorbid factors (e.g., depression) associated with suicide risk, no studies have examined whether online racism predicts suicide ideation and if interpersonal factors can help explain this link. Thus, the current study examined the direct relationship between online racism and suicide ideation among racial minority emerging adults, and the indirect relationships via the interpersonal factors (perceived burdensomeness and thwarted belongingness). Using data from a convenience sample of 338 racial minority emerging adults, we conducted a path analysis with online racism predicting suicide ideation through thwarted belongingness and perceived burdensomeness. Online racism significantly predicted suicide ideation via perceived burdensomeness but not thwarted belongingness. Post hoc multi-group analysis found that this pathway was consistent across Black, Asian, and Latinx groups but was completely mediated for the Asian group. The findings suggest that online racism can increase feelings of being a burden to society, which can trigger thoughts of suicide. This process may be particularly salient among Asian individuals. Implications for future research are discussed.

Gendered racial microaggressions, internalized racism, and suicidal ideation among emerging adult Asian American women

BACKGROUND

Despite suicide being the leading cause of death among emerging adult Asian American women (AAW), little is known about the risk factors.

AIM

We tested whether gendered racial microaggressions stress (GRMS) would be associated with AAW's suicidal ideation, and whether internalized racism (self-negativity, IRSN; weakness stereotypes, IRWS; and appearance bias, IRAB) would exacerbate this link based on self-devaluating implications of internalized racism.

METHOD

Using a sample of 309 AAW (M_age = 20.00, SD = 6.26), we conducted a moderated logistic regression with GRMS predicting suicidal ideation (endorsement or no endorsement) and the three internalized racism factors (IRSN, IRWS, and IRAB) as moderators.

RESULTS

GRMS significantly predicted suicidal ideation with a threefold increase in the odds of suicidal ideation. Only IRSN significantly exacerbated this link at low to mean levels.

CONCLUSION

Gendered racial microaggressions is likely a risk factor for suicidal ideation among AAW, particularly for those who internalize negative images of themselves as Asian individuals.

Online racism, depressive and anxiety symptoms, coping-related drinking motives, and alcohol use severity among Black, Latina/o/x, and Asian emerging adults

Online racism has been associated with alcohol-related coping, likely to deal with mental health symptoms that arise from experiencing racial discrimination in online settings. Thus, we examined online racism as a risk factor for alcohol-related problems by examining depressive/anxiety symptoms and coping-related drinking motives as mediators among Black, Latina/o/x, and Asian emerging adults in the U.S. We hypothesized that online racism would be associated with greater alcohol use severity through depressive/anxiety symptoms and coping-related drinking motives sequentially. With data from 322 participants (Mage = 23.28; Black, n = 108; Latina/o/x, n = 118; and Asian, n = 96), we conducted a multi-group path analysis of online racism (Perceived Online Racism Scale) linked to alcohol use (Alcohol Use Disorders Identification Test) via depressive (Patient Health Questionnaire-9)/Anxiety (Generalized Anxiety Disorder-7) symptoms and coping-related drinking motives (Drinking Motives Questionnaire-Revised Short Form). The hypothesized indirect pathway was significant in all groups. The direct effect was also significant for Latina/o/x and Asian groups. For the Black group, the direct effect was not significant, highlighting the salience of the mental health symptoms and drinking motives in explaining the link between online racism and alcohol use. Collectively, the results help to contextualize the risks of alcohol-related problems from experiencing contemporary forms of racial trauma such as online racial discrimination and provide implications for intervention development.

Online Racism, Rumination, and Vigilance: Impact on Distress, Loneliness, and Alcohol Use

We examined the potential anticipatory response (rumination, vigilance) associated with online racism and its impact on psychological distress, loneliness, and alcohol use severity. With a sample of 407 racial minority adults, we conducted a path analysis to examine the indirect relation of online racism on our outcome variables via online racism-related rumination and offline racism-related vigilance. Online racism was significantly linked to psychological distress, alcohol use severity, and loneliness. Rumination and vigilance explained significant indirect relations between online racism and psychological distress and loneliness. Only rumination explained the significant indirect relation between online racism and alcohol use severity. Posthoc multigroup analysis suggested that the path model estimates for the full sample applied equivalently to the African American/Black, Asian/Asian American, and Latinx/Hispanic American groups. Online racism is likely an unjust burden for racial minority individuals that may give rise to prolonged rumination and anticipation about facing racial discrimination in their offline world.

Coping with online racism: Patterns of online social support seeking and anti-racism advocacy associated with online racism, and correlates of ethnic-racial socialization, perceived health, and alcohol use severity

Given the emerging public health concerns of online racism, we examined potential coping approaches for racial/ethnic minority adults. Using a latent class regression model (N = 407), we examined patterns of online social support seeking and anti-racism advocacy engagements that were associated with online racism among racial/ethnic minority adults. We also examined whether these patterns were associated with ethnic-racial socialization messages (cultural socialization, promotion of mistrust, preparation for racial bias), perceived health, and alcohol use severity. Three distinct latent groups were identified with meaningful group differences: triggered/reactive (alcohol use risk, higher promotion of mistrust), moderate engagement (no risk), disengaged/non-reactive (higher promotion of mistrust, higher cultural socialization, alcohol use risk) groups. Online social support seeking and advocacy engagement may have both benefits and costs in coping with online racism. Those who engage at optimal/balanced levels appear to report better well-being. Implications for research and practice are discussed.

COVID-19 Racism, Depressive Symptoms, Drinking to Cope Motives, and Alcohol Use Severity Among Asian American Emerging Adults

The COVID-19 pandemic has incited widespread anti-Asian racism, which is linked to numerous behavioral health consequences including depressive symptoms. As racism-induced depressive symptoms are linked to coping-related alcohol use and because alcohol-related problems represent a significant public health concern in this population, we investigated whether COVID-19 racism predicted alcohol use severity through depressive symptoms and drinking to cope motives among Asian American emerging adults (N = 139; Mage = 23.04; 50% women, 50% men). We conducted a serial mediation wherein COVID-19 racism predicted alcohol use severity sequentially through depressive symptoms and drinking to cope motives. COVID-19 racism directly and significantly predicted alcohol use severity. The indirect effect via depressive symptoms and drinking to cope motives was also significant, suggesting that COVID-19 racism is likely a risk factor for alcohol-related problems. Results inform intervention science and highlight the need for policy and behavioral health services to curb COVID-19 racism.

Online digital storytelling video on promoting men's intentions to seek counselling for depression: The role of empathy

BACKGROUND

Applying the narrative transportation theory, we sought to test the role of a male-sensitive digital storytelling video as a source to persuade men to develop greater intentions to seek counselling based on their empathic reactions to the storyteller.

METHODS

Using a post-test only design, a total of 247 diverse adult men (M = 35.86, SD = 12.75) were randomly assigned to either the brochure or video condition and subsequently reported on their state empathy, perceived persuasiveness, and intentions to seek counselling. Controlling for previous counselling experience, a three-way interaction analysis was conducted to assess the significance of the relationship between persuasiveness and intentions to seek counselling across the two conditions, and whether empathy moderated this association in each condition.

RESULTS

For men who viewed the brochure, greater persuasiveness was linked to lower intentions to seek counselling at all levels of empathy; although, at high empathy, the relationship was not significant. A similar trend was observed for men who viewed the video at low and mean empathy levels. However, for men who reported high empathy after viewing the video, greater persuasiveness was significantly linked to greater intentions to seek counselling.

CONCLUSION

Empathy may play a viable role in promoting intentions to seek counselling among men who view persuasive digital storytelling content on depression. However, more research needs to be conducted on the conditions that make it favourable for men to have empathic reactions to the contents. Implications for research and the potential for intervention are discussed.

Congruence and discrepancy in Asian American women's perception and stress appraisal of gendered racial microaggressions: Relationships with depressive symptoms and internalized racism

Prior research demonstrates significant links between discrimination and mental health by assessing either encounters with or stress appraisal of discrimination. However, research has yet to examine the dynamic interplay between frequency and stress appraisal (e.g., high frequency-low stress appraisal) and their linkage to depressive symptoms. Using a sample of 309 Asian American women (M _age = 22.81, SD = 0.26), we used a polynomial regression and response surface analysis to model the congruence and discrepancy between frequency and stress appraisal of gendered racial microaggressions experienced by Asian American women and how they are related to depressive symptoms and internalized racism. The dynamics between frequency and stress in relation to depressive symptoms were further probed at low, mean, and high levels of internalized racism. Greater congruence between frequency and stress was significantly associated with depressive symptoms (medium to large effect) and internalized racism (small effect). A discrepancy between higher frequency and lower stress was significantly associated with greater internalized racism. Further, when looking across levels of internalized racism, greater congruence between frequency and stress was significantly associated with greater depressive symptoms at low and mean levels of internalized racism but not at high levels. Gendered racial microaggressions are associated with adverse mental health outcomes among Asian American women, contributing to greater depressive symptoms and internalized racism. Further consideration should be given toward how internalized racism shapes differences in the perceptions and stress appraisal of gendered racial microaggressions, and subsequent mental health outcomes among Asian American women.

The Development and Validation of the Heterosexism Erasure Scale

The heterosexism erasure construct captures attitudes, which deny or minimize the systemic oppression of lesbian, gay, bisexual, and queer (LGBQ) persons in the United States. Heterosexism erasure expands the interrogation of denying or minimizing discrimination (Neville at al., 2006) beyond the realm of White supremacy and into the domain of heteronormativity. The purpose of this project was to develop a psychometrically sound measure of heterosexism erasure. Two independent samples were gathered to conduct exploratory ( n = 425) and confirmatory ( n = 367) factor analyses to assess for initial reliability and validity evidence of the Heterosexism Erasure Scale (HES). Results suggest that the final 13-item HES provides a general index of heterosexism erasure as well as assesses two related, but distinct factors named Heterosexism Denial and Heterosexism Minimization. Results support the internal consistency and factor structure of the measure. Expected relationships between the HES and existing measures provide validity evidence for the instrument.

Benefits and harms of social media use: A latent profile analysis of emerging adults

The rise in social media use among emerging adults in the United States has been well-documented, but researchers are still working on identifying how the type-not just the frequency-of use impacts psychological well-being. We identified "profiles" of social media use among young adults based on the frequency and purposes of use, and examined their associations with benefits and harms to psychosocial well-being, using data from 2828 incoming undergraduate students (M age = 18.29 years; age range: 17 to 25 years). Using Latent Profile Analysis, we identified three unique profiles of individuals who used social media with varying levels of intensity across different purposes: Active Users (32.4%), Passive Users (25.3%), and Average Users (42.4%). Each profile was associated with varying levels of beneficial and harmful psychosocial outcomes. Compared to Average Users, (a) Active Users reported significantly better psychosocial well-being, but also more harmful outcomes; and (b) Passive Users experienced significantly lower levels of perceived social media benefits and social connectedness, while also reporting less problematic social media use and social media stress. Implications of these findings for research and practice are discussed.

Collective Program Social Justice Identity and Perceived Norms on Promoting Student Advocacy

A growing body of research suggests that graduate psychology training programs with a stronger collective social justice identity are likely to provide more support for students’ advocacy engagements than those with discrepant views among members. We conducted response surface analyses ( N = 178 PhD students; across 16 counseling psychology programs) to examine whether the degree of congruence and discrepancy in social justice attitudes and perceptions of training program norms (perceived social justice norms among students and faculty) between the individual student and other students in their program would be associated with students’ social justice advocacy intentions and behaviors. Higher congruence in attitudes and perceived norms (among students and faculty) were significantly associated with advocacy intentions. For advocacy behaviors, only congruently higher perceptions of faculty were significantly associated. Discrepant attitudes and perceived norms were not significantly related to students’ advocacy intentions and behaviors. Recommendations for training and research are discussed.

Center effects, therapist effects, and international student clients' drop out from psychotherapy

In 2019-2020, 1,075,496 international students pursued higher education in the United States. Many of these students endure unique experiences of psychological distress that accompanies their shared experience of studying abroad in the United States. Researchers have explored clinical experiences within this diverse group, with some suggesting that international students are at greater risk than students from the United States for dropping out of psychotherapy. This issue is underexplored in the extant psychotherapy literature. Therefore, we used a large, national data set and multilevel analyses to test if international students are more likely than students from the United States to drop out of psychotherapy, defined in this study as failure to attend one's last scheduled session. Data from 65,293 clients (n = 3,970 international students), 2,735 therapists, and 131 university/college counseling centers were included in the analysis. Results revealed that (a) international students are no more likely to drop out than United States domestic students, (b) on average, centers (ICC = 0.045) and therapists (ICC = 0.071) are differentially effective at preventing drop out, and (c) therapist effects on drop out differ for international students. We discuss these findings with respect to therapist and center roles in international students' drop out from treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Therapist and counseling center effects on international students' counseling outcome: A mixed methods study

We employed a convergent mixed methods design to examine therapist and counseling center effects on international student clients' (ISCs) counseling outcomes. Using the Center for Collegiate Mental Health (CCMH) data set (2015-2017), we conducted a three-level hierarchical linear model with clients (N = 85,110) nested in therapists (N = 1,267), and therapists nested in counseling centers (N = 111), with clients' international status predicting distress (DI) in their last sessions while controlling for initial DI. Compared to domestic students, the average last session DI was significantly higher among ISCs. Random effects were significant, suggesting that some therapists and centers were more effective in their work with ISCs than others. When the proportion of ISCs seen was accounted into the model, we found a cross-level interaction in which the last session DI differences between ISCs and domestic students were significant for centers seeing a small percentage of ISCs but not for centers with large percentages of ISCs in the caseload. Grounded theory analysis of qualitative data from 11 therapists with international backgrounds revealed therapist and center factors that converged with our quantitative findings. Participants reported adhering to general clinical frameworks when working with ISCs given the lack of training on international competence (which may help explain the effectiveness gap), but also noted nuanced culturally-informed components that likely contribute to more effectively working with ISCs. Findings around center effects were complemented by qualitative results emphasizing systemic representation and engagement with diversity, creative outreach efforts, and administrative/leadership support. Implications for practice and research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Second-generation Asian American women's gendered racial socialization

Utilizing an intersectional framework (Crenshaw, 1989) and socioecological theory (Bronfenbrenner, 1979), we investigated the gendered racialized messages Asian American women receive growing up, otherwise known as gendered racial socialization, from their family, peers, and mass media. Consensual Qualitative Research was used to analyze interview data from 12 second-generation Asian American women. The results demonstrated that (a) family socialization messages included gendered racial discrimination, body image and physical appearance, marital/dating attitudes, role responsibilities and expectations, and academic/work expectations, (b) peer socialization included oppressive messages (e.g., physical objectification, denial of identity, lack of presence) and affirming messages (e.g., positive self-concept messages), and (c) mass media socialization included oppressive messages (e.g., lack of representation, stereotypical depictions), and affirming messages (e.g., messages about empowerment). These messages impacted Asian American women's views on their body image and physical appearance, self-esteem, career/work, mental health, and critical consciousness. Implications and findings of the need to dismantle interlocking oppressive forces are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Does Witnessing Racism Online Promote Individual and Institutional Anti-Racism Advocacy Among White Individuals? The Role of White Empathy, White Guilt, and White Fear of Other Races

The current study examined the role of White emotional responses (White empathy, guilt, and fear of other races) to (a) witnessing racism online (seeing racial/ethnic minorities discriminated in online interactions) and (b) exposure to online content on the group- and systemic-level racism against racial/ethnic minorities on White individuals' individual and institutional advocacy behaviors. Path analysis using data from 227 White adults revealed that White empathy explained significant indirect relations of witnessing online content on systemic- and group-level racism in society on individual and institutional advocacy behaviors. No significant indirect relations were found regarding witnessing racial/ethnic minorities being discriminated online interactions, but a significant direct link was observed on individual advocacy. In response to witnessing racism online, White empathy appeared to be promotive for advocacy engagement, whereas guilt and fear of other races seemed to be barriers. Limitations and implications for research are discussed.

Do therapists improve in their ability to assess clients' satisfaction? A truth and bias model

We used the truth and bias model to examine changes in tracking accuracy and under/overestimation (directional bias) on therapists' judgments about clients' satisfaction. We examined 3 factors of clinical experience that could moderate accuracy: (a) overall level of acquaintanceship with a client, operationalized as treatment length (i.e., less or more time seeing a client), (b) time point in therapy with a specific client, operationalized as session number (i.e., earlier or later in treatment with a client), and (c) order (1st client seen, 2nd client seen . . . last client seen across two years of training in a psychology clinic) in which clients were seen. We conducted a three-level hierarchical linear modeling using data on 6054 sessions, nested in 284 adult clients, nested in 41 doctoral student therapists providing open-ended psychodynamic individual psychotherapy. We found that therapists were able to accurately track client-rated session evaluations with less underestimation (i.e., lower tendency to estimate that clients were less satisfied than they actually were) as they gained experience (both treatment length and client order). Furthermore, therapists exhibited greater tracking accuracy gains over the span of shorter treatments and when working with clients earlier in their clinical training. In longer treatments and with clients seen later in training, tracking accuracy was stable and consistent. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Social justice interdependence among students in counseling psychology training programs: Group actor-partner interdependence model of social justice attitudes, training program norms, advocacy intentions, and peer relationships

Counseling psychologists have voiced the importance of nurturing social justice principles in the training of psychologists to better meet diverse people's psychological and social needs. Much of the research on training, however, has been focused on individual factors (e.g., self-efficacy, spirituality). Little empirical evidence exists on the mutual support among students and the role of shared social justice principles in counseling psychology training programs. Thus, we used the group actor-partner interdependence model (GAPIM) to test whether the advocacy intentions of a given student in the program (actor) would be related to the actor's and partner's (other students' aggregate scores in the program) social justice attitudes and perceptions of social justice norms in the training program (social justice norms among students and faculty). Peer relationship was also tested as a moderator of the associations. Structural equation modeling was used to test a series of GAPIMs with data from 178 doctoral students across 19 American Psychological Association accredited counseling psychology Ph.D. programs. Other students' collective attitudes and perceptions of the training program were stronger positive indicators of an individual student's advocacy intentions than actor variables (individual-level attitudes and perceptions). At the individual level, only actor social justice attitudes were significantly related to intentions with very small effect. Peer relationship was a significant moderator such that students in programs with closer peer relationships, who collectively perceived higher social justice norms, reported greater advocacy intentions. Implications for research and training are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Practice recommendations for addressing racism: A content analysis of the counseling psychology literature

Although racism persists as a significant public health issue that adversely impacts the mental health of people of color (U.S. Department of Health and Human Service, 2001), there has been very little systematic guidance for mental health professionals to address racism through practice (S. Harrell, 2000). Therefore, we conducted a content analysis of the peer reviewed counseling psychology literature-the first of its kind-to provide a summary and critique of the extant practice recommendations and facilitate the development and enhancement of practice efforts aimed at addressing racism. We reviewed racism-related articles published in the Journal of Counseling Psychology, The Counseling Psychologist, and Counseling Psychology Quarterly and identified 73 relevant articles, of which 51 provided practice recommendations. Based on our review of this literature, we identified eight general categories of recommendations for addressing racism: psychoeducation, validation, self-awareness and critical consciousness, critical examination of privilege and racial attitudes, culturally responsive social support, developing positive identity, externalize/minimize self-blame, and outreach and advocacy. We found that most recommendations within each category were at the individual level with far fewer at the group and systemic level. A critique of recommendations is provided along with suggestions for developing and bolstering practice, research, and consultation efforts aimed at addressing racism. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Group- and individual-level self-stigma reductions in promoting psychological help-seeking attitudes among college students in helping skills courses

To promote psychological help-seeking, researchers have studied interventions to reduce self-stigma, a personally held belief that seeking psychological help would make one undesirable and socially unacceptable. We examined the differential impact of individual- and group-level changes in self-stigma on psychological help-seeking attitudes using data from 189 college students nested within 20 sections of a semester-long helping skills lab groups. We applied multi-level polynomial regression and response surface analysis to determine whether discrepancy between pre- and posttest self-stigma scores (i.e., reduction in self-stigma) predicted change in attitudes at the individual- and section-levels. Individual reduction in self-stigma did not predict psychological help-seeking attitudes but students who maintained consistently low to moderate levels of self-stigma throughout the course developed significantly more positive attitude toward psychological help-seeking. On the other hand, we found that greater section level reductions in self-stigma significantly predicted more positive psychological help-seeking attitudes, suggesting potential importance of group norm changes and effects in modifications of individual attitudes. Implications for research and stigma reduction strategies are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Therapist effects due to client racial/ethnic status when examining linear growth for client- and therapist-rated working alliance and real relationship

Using data from 3,263 sessions nested within 144 clients, nested within 19 therapists, we examined client- and therapist-rated working alliance (WA) and real relationship (RR) at Session 3 and growth in WA and RR across the course of open-ended psychodynamic psychotherapy for clients who identified as racial/ethnic minority (REM) or as White. To be included in the analyses, therapists had to work with at least 2 REM and 2 White clients. There were no significant therapist effects for the interaction between client- or therapist-rated WA and client REM status at Session 3, or for client- or therapist-rated RR and client REM status at Session 3. There were, however, significant therapist effects due to client REM status on the interaction between client-rated linear growth in WA and RR, showing that some therapists had stronger WA and RR growth with REM than that with White clients, whereas other therapists had stronger alliance growth with White than that with REM clients. There were significant therapist effects on therapist-rated linear growth in both WA and RR, which indicated that some therapists reported stronger WA and RR growth with all of their clients, whereas other therapists reported weaker WA and RR growth for all of their clients, although this differential WA and RR growth was not related to clients' REM status. Implications for practice and research are discussed in this paper. (PsycINFO Database Record

Testing the factor structure and measurement invariance of the PHQ-9 across racially diverse U.S. college students

Today's college students are at increased risk for depression. Therefore, accurate and sustainable assessment of depressive symptoms among college students has become an important issue. One promising instrument for depression screening in college settings is the Patient Health Questionnaire-9 (PHQ-9), a 9-item self-report measure developed in primary care and designed to assess the presence of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) symptom criteria for major depressive disorder. Although the PHQ-9 has been well validated in primary care settings, no studies have examined its factor structure for diverse college populations in the United States. This study used confirmatory factor analysis to test competing measurement models and the measurement invariance of the PHQ-9 across gender (men and women) and racial/ethnic groups (African American, Asian American, European American, Latino/a American) in a sample of 857 U.S. college students. Results supported a 1-factor model of the PHQ-9. Based on configural, metric, and scalar invariance test results, the PHQ-9 assesses depressive symptoms equivalently across gender and racial/ethnic groups. In support of validity evidence, PHQ-9 scores were positively associated with alcohol use and negatively associated with mental well-being. Implications for future research and assessment are discussed. (PsycINFO Database Record

Moving beyond the binary with disordered eating research: a test and extension of objectification theory with bisexual women

In predicting disordered eating, the core model of objectification theory (Fredrickson & Roberts, 1997) has been replicated and extended in research across most sexual minority groups (e.g., Haines et al., 2008; Wiseman & Moradi, 2010), but not bisexual women. The present study tested the tenets of objectification theory with a sample of 316 bisexual women and further extended this theory by examining the roles of 2 minority stressors-antibisexual discrimination and internalized biphobia-that are contextually salient for bisexual women. A latent variable structural equation model was conducted, and the model yielded a good fit to the data. Antibisexual discrimination and internalized biphobia (but not sexual objectification experiences) yielded significant unique links with internalization of sociocultural standards of attractiveness (internalization of CSA). Next, internalization of CSA yielded a significant unique link with body surveillance. In addition, antibisexual discrimination, internalization of CSA, and body surveillance yielded significant unique links with body shame. Finally, sexual objectification experiences, internalization of CSA, and body shame yielded significant unique links with eating disorder symptomatology. Beyond the direct relations, antibisexual discrimination yielded significant positive indirect links with body surveillance, body shame, and eating disorder symptoms. Internalization of CSA yielded significant positive indirect links with body shame and eating disorder symptoms. Lastly, body surveillance yielded a significant positive indirect link with eating disorder symptoms. Implications for research and practice with bisexual women are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).