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Abstract
The COVID-19 pandemic was a challenging period for young people in Mexico, particularly those already contending with social and structural inequality. In March 2021, the Colectivo Frontera, a research collective based in Mexico City, Mexico, which works on advancing equity and psychosocial wellbeing among marginalized communities, carried out an 8-week, online project to provide psychosocial support and promote resilience for marginalized young people from different locations in Mexico. The project entailed weekly journaling with the Pandemic Journaling Project (PJP), as well as weekly phone sessions with a mental health specialist who provided emotional support (acompañamiento emocional) through practices of active listening. The project culminated in the Escucha (Listen) Podcast for which each youth participant created an episode about their experiences during the pandemic. Many also submitted a photo to accompany their recording; one produced a song. Participant episodes were compiled into a series of five chapters. Each chapter of the podcast centers on a common theme, including reflections on loved ones lost to COVID-19, social fragmentation, gender-based constraints on expressing emotions, and the experiences and perspectives of children. The project provides a compelling example of a low-cost approach to providing support for the mental health and wellbeing of marginalized young people. It also demonstrates the importance of creating projects that help young people make meaningful connections and that leverage their creativity to foster resilience, improve social cohesion, and elevate their perspectives and voices.
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Jagsi R, Griffith K, Krenz C, Jones RD, Cutter C, Feldman EL, Jacobson C, Kerr E, Paradis K, Singer K, Spector N, Stewart A, Telem D, Ubel P, Settles I. Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine. JAMA 2023; 329:1848-1858. [PMID: 37278814 PMCID: PMC10245188 DOI: 10.1001/jama.2023.7232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/13/2023] [Indexed: 06/07/2023]
Abstract
Importance The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.
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Affiliation(s)
- Reshma Jagsi
- Medical School, University of Michigan, Ann Arbor
- Emory University, Atlanta, Georgia
| | | | - Chris Krenz
- Medical School, University of Michigan, Ann Arbor
| | | | | | | | | | - Eve Kerr
- Medical School, University of Michigan, Ann Arbor
| | | | | | - Nancy Spector
- College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Abby Stewart
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Dana Telem
- Medical School, University of Michigan, Ann Arbor
| | - Peter Ubel
- School of Medicine, Duke University, Durham, North Carolina
| | - Isis Settles
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
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Diaz AA, Thakur N, Celedón JC. Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States. Clin Chest Med 2023; 44:425-434. [PMID: 37085230 PMCID: PMC9678822 DOI: 10.1016/j.ccm.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Neeta Thakur
- Department of Medicine, University of California at San Francisco, 505 Parnassus Avenue, Box 0841, San Francisco, CA 94143, USA
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Suite 9130, Rangos Building, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Cano MÁ, De La Rosa M, Schwartz SJ, Salas-Wright CP, Keum BTH, Lee CS, Pinedo M, Cobb CL, Field CA, Sanchez M, Castillo LG, Martinez P, Lorenzo-Blanco EI, Piña-Watson B, de Dios MA. Alcohol Use Severity among Hispanic Emerging Adults: Examining Intragroup Marginalization, Bicultural Self-Efficacy, and the Role of Gender within a Stress and Coping Framework. Behav Med 2023; 49:172-182. [PMID: 34818984 PMCID: PMC9126992 DOI: 10.1080/08964289.2021.2006130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Most research on cultural stressors and alcohol has focused on intercultural stressors. Continuing to exclude intracultural stressors (e.g., intragroup marginalization) from alcohol research will yield a biased understanding of the experiences of Hispanics living in a bicultural society. As we amass more studies on intracultural stressors, research will be needed to identify mutable sociocultural factors that may mitigate the association between intracultural stressors and alcohol. To address these limitations, we examined the association between intragroup marginalization and alcohol use severity and the extent to which gender and bicultural self-efficacy may moderate this association. A convenience sample of 200 Hispanic emerging adults ages 18-25 (men = 101, women = 99) from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Higher intragroup marginalization was associated with higher alcohol use severity. Gender functioned as a moderator whereby intragroup marginalization was associated with higher alcohol use severity among men, but not women. Also, higher social groundedness functioned as a moderator that weakened the association between intragroup marginalization and alcohol use severity. Role repertoire did not function as a moderator. Our findings are significant because they enhance the reliability of the association between intragroup marginalization and alcohol use severity, and the moderating effect of gender in this respective association. This emerging line of research suggests that alcohol interventions targeting Hispanics may have a significant limitation by not accounting for intracultural stressors.
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Affiliation(s)
- Miguel Ángel Cano
- College of Public Health & Social Work, Florida International University
| | - Mario De La Rosa
- College of Public Health & Social Work, Florida International University
| | | | | | - Brian T H Keum
- Department of Social Welfare, University of California, Los Angeles
| | | | | | - Cory L Cobb
- College of Education, University of Texas at Austin
| | - Craig A Field
- Department of Psychology, University of Texas at El Paso
| | - Mariana Sanchez
- College of Public Health & Social Work, Florida International University
| | | | | | - Elma I Lorenzo-Blanco
- Department of Human Development and Family Sciences, University of Texas at Austin Texas Tech University
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Ogbu-Nwobodo L, Shim RS, Vinson SY, Fitelson EM, Biggs MA, McLemore MR, Thomas M, Godzich M, Mangurian C. Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations. N Engl J Med 2022; 387:1613-1617. [PMID: 36300980 DOI: 10.1056/nejmms2211124] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucy Ogbu-Nwobodo
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Ruth S Shim
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Sarah Y Vinson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Elizabeth M Fitelson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - M Antonia Biggs
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Monica R McLemore
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Marilyn Thomas
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Micaela Godzich
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Christina Mangurian
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
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de Montgomery CJ, Norredam M, Krasnik A, Petersen JH, Björkenstam E, Berg L, Hjern A, Sijbrandij M, Klimek P, Mittendorfer-Rutz E. Labour market marginalisation in young refugees and their majority peers in Denmark and Sweden: The role of common mental disorders and secondary school completion. PLoS One 2022; 17:e0263450. [PMID: 35171929 PMCID: PMC8849515 DOI: 10.1371/journal.pone.0263450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Due to the circumstances of their early lives, young refugees are at risk of experiencing adverse labour market and health outcomes. The post-settlement environment is thought to play a decisive role in determining how this vulnerability plays out. This study compared trends in labour market marginalisation in young refugees and their majority peers during early adulthood in two national contexts, Denmark and Sweden, and explored the mediating role of common mental disorders and secondary school completions.
Methods
Using registry data, 13,390/45,687 refugees were included in Denmark/Sweden and 1:5 matched to majority peers. Inequalities in labour market marginalisation were investigated during 2012–2015 in each country using linear probability models and mediation analysis. Country trends were standardised to account for differences in observed population characteristics.
Results
The risk of marginalisation was 2.1–2.3 times higher among young refugees compared with their majority peers, but the risk decreased with age in Sweden and increased in Denmark for refugees. Birth-cohort differences drove the increase in Denmark, while trends were consistent across birth-cohorts in Sweden. Differences in population characteristics did not contribute to country differences. Common mental disorders did not mediate the inequality in either country, but secondary school completions did (77–85% of associations eliminated).
Conclusions
The findings document both the vulnerability of young refugees to labour market marginalisation and the variability in this vulnerability across post-settlement contexts. While the contrast in policy climates in Denmark and Sweden sharpened over time, the risk of marginalisation appeared more similar in younger cohorts, pointing to the importance of factors other than national immigration and integration policies. Institutional efforts to assist young refugees through secondary education are likely to have long-lasting consequences for their socio-economic trajectories.
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Affiliation(s)
- Christopher Jamil de Montgomery
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen K, Denmark
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Marie Norredam
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen K, Denmark
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Allan Krasnik
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen K, Denmark
| | | | - Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lisa Berg
- Center for Health Equity Studies, Stockholm University, Stockholm, Sweden
| | - Anders Hjern
- Center for Health Equity Studies, Stockholm University, Stockholm, Sweden
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria
- Complexity Science Hub Vienna, Vienna, Austria
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria
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Kim M, Kim J. Examining Predictors and Outcomes of Decent Work among Korean Workers. IJERPH 2022; 19:ijerph19031100. [PMID: 35162133 PMCID: PMC8834369 DOI: 10.3390/ijerph19031100] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 02/04/2023]
Abstract
The goal of the present study is to examine the psychology of working framework/theory with a sample of Korean workers. This study examined the structural model of sociocultural factors (i.e., economic constraints and social marginalization), psychological variables (i.e., work volition and career adaptability), and outcomes of decent work based on the psychology of working framework. This study assumed that decent work helps all workers attain a sense of self-respect, dignity, experience freedom and security in the work environment and provides an opportunity for workers to contribute to society. Data were collected from 420 Korean workers, with an average age of 39.13 years (SD = 9.26). We used a hypothesis model that did not assume a direct path from economic constraints and social marginalization to decent work and work volition and career adaptation to job satisfaction and life satisfaction. We also employed an alternative model that assumed all of its paths and compared the models’ goodness of fit based on prior studies. Results indicated that alternative models have higher goodness of fit than hypothesis models. All path coefficients were significant except for the direct path from social marginalization to work volition and career adaptability to life satisfaction. Additionally, work volition and career adaptability mediated both the relationship between social marginalization and job satisfaction and between marginalization and life satisfaction. This study enabled the comprehensive examination of the relevance of various social environments and psychological and occupational characteristics that should be considered when exploring job or life satisfaction in the process of career counseling.
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Affiliation(s)
- Minsun Kim
- Department of Psychology and Psychotherapy, Dankook University, Cheonan 31116, Korea
- Correspondence:
| | - Jaehoon Kim
- Department of Counseling Psychology, Global Cyber University, Seoul 06022, Korea;
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Amen TB, Nolen LT. Patient Dehumanization in Medical Education: Reflections on Mr. E. Acad Med 2021; 96:1506. [PMID: 34380928 DOI: 10.1097/acm.0000000000004356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Troy B Amen
- T.B. Amen is a first-year orthopaedic surgery resident, Hospital for Special Surgery, New York, New York; ; Twitter: @TroyBAmen1
| | - LaShyra T Nolen
- L.T. Nolen is a third-year medical student, Harvard Medical School, Boston, Massachusetts; Twitter: @LashNolen
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Galán CA, Stokes LR, Szoko N, Abebe KZ, Culyba AJ. Exploration of Experiences and Perpetration of Identity-Based Bullying Among Adolescents by Race/Ethnicity and Other Marginalized Identities. JAMA Netw Open 2021; 4:e2116364. [PMID: 34297076 PMCID: PMC8303093 DOI: 10.1001/jamanetworkopen.2021.16364] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Race-based discrimination represents an ongoing public health crisis in the US, manifested by wide-ranging disparities in youth health, mental health, and violence exposure. However, studies of racial discrimination often neglect experiences of identity-based bullying (IBB) stemming from other marginalized identities, such as gender identity and sexual orientation. OBJECTIVE To examine associations between experiences of IBB based on race/ethnicity/national origin and other social identities and youth health, mental health, and violence outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed responses from an anonymous survey conducted at 13 public high schools in Pittsburgh, Pennsylvania, between October 15, 2018, and October 19, 2018. Participants included in the study were in the 9th through 12th grades. Data were analyzed from October 15, 2020, to February 14, 2021. EXPOSURES Experiences of bullying and bullying perpetration based on race/ethnicity/national origin and other social identities (ie, gender identity, sexual orientation, religion, physical or mental disability, immigration status, other unspecified reason). MAIN OUTCOMES AND MEASURES Youth health (delayed well care; forgone medical care; physical, mental, or emotional limitations), mental health (nonsuicidal self-injury, suicidal ideation), and violence involvement (weapon perpetration or survivorship, fighting, sexual assault, adolescent relationship abuse, experiencing homicide of friend or family member) were assessed using self-reported items modeled on the Centers for Disease Control and Prevention Youth Risk Behavior Survey. RESULTS Among 3939 participants, the mean (SD) age was 15.7 (1.3) years; 1380 students (36.3%) identified as Black/African American, 2086 (53.7%) as assigned female at birth, 1021 (32.6%) as belonging to a sexual minority group, and 313 (10.0%) as gender diverse. Among reported social identities, race/ethnicity-based experiences of bullying (375 students [9.5%]) and bullying perpetration (209 students [5.8%]) were the most common. Youth with multiple stigmatized identities experienced even higher rates of experiences of IBB and IBB perpetration. Specifically, the highest rates of IBB were reported by gender diverse Black and Hispanic youth. Experiencing IBB based on multiple stigmatized identities was associated with all outcomes, including delayed well care (aOR, 1.41; 95% CI, 1.20-1.65), forgone medical care (aOR, 1.64; 95% CI, 1.44-1.87), nonsuicidal self-injury (aOR, 2.86; 95% CI, 2.53-3.24), suicidal ideation (aOR, 2.49; 95% CI, 2.20-2.83), and greater violence involvement (experiencing violence: aOR, 2.90; 95% CI, 2.45-3.43; homicide survivorship: aOR, 1.19; 95% CI, 1.06-1.33). CONCLUSIONS AND RELEVANCE These results further encourage the development of youth health, mental health, and violence prevention programs that address experiences of bullying based on multiple marginalized identities.
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Affiliation(s)
- Chardée A. Galán
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lynissa R. Stokes
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nicholas Szoko
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alison J. Culyba
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Affiliation(s)
- Felicity A E Knights
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Jessica Carter
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anna Deal
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
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11
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Grunhut J. The Impact of COVID-19 on Marginalized Communities. Acad Med 2021; 96:786. [PMID: 33656010 PMCID: PMC8140633 DOI: 10.1097/acm.0000000000004032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Joel Grunhut
- Second-year medical student, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida; ; ORCID: http://orcid.org/0000-0002-8104-9679
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12
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Kragel EA, Beyer LN. Communicating About COVID-19 Through Art: Paving the Way for Inclusion. Acad Med 2021; 96:784. [PMID: 33496436 PMCID: PMC8140640 DOI: 10.1097/acm.0000000000003945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Emily A Kragel
- Medical student, East Carolina University-Brody School of Medicine, Greenville, North Carolina; ; Twitter: @coloringCOVID; ORCID: https://orcid.org/0000-0003-3898-2508
| | - Logan N Beyer
- Medical student, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-2310-0149
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Voith LA, Russell K, Lee H, Anderson RE. Adverse Childhood Experiences, Trauma Symptoms, Mindfulness, and Intimate Partner Violence: Therapeutic Implications for Marginalized Men. Fam Process 2020; 59:1588-1607. [PMID: 32134514 DOI: 10.1111/famp.12533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Adverse childhood experiences (ACEs) and trauma symptoms have been linked with intimate partner violence (IPV) perpetration and victimization among men, yet the field lacks depth in several key areas hampering progress toward violence intervention. Specifically, posttraumatic stress disorder (PTSD) dominates the field's scope of trauma symptoms under study, limiting understanding of other manifestations of trauma especially among men. Furthermore, most research focuses exclusively on men's physical IPV perpetration and rarely focuses on other types of IPV, severity of violence, or men's victimization. Also, few studies examine potential protective factors grounded in the ACE framework, such as mindfulness, among clinical populations. Finally, most research has not focused on men of color, despite some racial/ethnic minority groups disproportionate rates of IPV exposure. Therefore, the relationships between IPV frequency and severity (psychological, physical, injury) and ACEs, PTSD, trauma symptomology (separate from PTSD), and mindfulness self-efficacy were examined in a sample of 67 predominantly low-income men of color in a batterer intervention program. More than half of the sample (51.5%) reported exposure to four or more ACEs, and 31.1% met the clinical cutoff for a probable PTSD diagnosis. Higher ACE scores predicted increased rates for nearly all types of self-reported IPV perpetration and victimization. PTSD symptoms and complex trauma symptom severity together explained between 13% and 40% of IPV outcomes, and each was uniquely associated with certain types of self-reported IPV victimization and perpetration frequency and severity. Mindfulness self-efficacy was associated with decreased self-report psychological IPV perpetration and victimization frequency and severity. Clinical implications relevant to marginalized men are reviewed, including screening, training, and potential therapeutic interventions.
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Affiliation(s)
- Laura A Voith
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
| | - Katie Russell
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
| | - Hyunjune Lee
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
| | - RaeAnn E Anderson
- Department of Psychology, University of North Dakota, Grand Forks, ND
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D'cruz M, Banerjee D. 'An invisible human rights crisis': The marginalization of older adults during the COVID-19 pandemic - An advocacy review. Psychiatry Res 2020; 292:113369. [PMID: 32795754 PMCID: PMC7397988 DOI: 10.1016/j.psychres.2020.113369] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 01/15/2023]
Abstract
The world has endured over six months of the Coronavirus disease 2019 (COVID-19). Older adults are at disproportionate risk of severe infection and mortality. They are also vulnerable to loneliness and social exclusion during the pandemic. Age and ageism both can act as significant risk factors during this pandemic, increasing the physical as well as psychosocial burden on the elderly. A review was performed in relation to the psychosocial vulnerabilities of the older adults during the pandemic, with insights from the similar biological disasters in the past. Besides the physiological risk, morbidities, polypharmacy and increased case fatality rates, various social factors like lack of security, loneliness, isolation, ageism, sexism, dependency, stigma, abuse and restriction to health care access were identified as crucial in pandemic situation. Frailty, cognitive and sensory impairments added to the burden. Marginalization and human rights deprivation emerged as a common pathway of suffering for the elderly during COVID-19. The implications of the emergent themes are discussed in light of psychosocial wellbeing and impact on the quality of life. The authors suggest potential recommendations to mitigate this marginalization on lines of the World Health Organization (WHO)'s concept of Healthy Ageing and the United Nations (U.N.) Sustainable Development Goals.
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Affiliation(s)
- Migita D'cruz
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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15
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Kumar K, Mehra A, Sahoo S, Nehra R, Grover S. The psychological impact of COVID-19 pandemic and lockdown on the migrant workers: A cross-sectional survey. Asian J Psychiatr 2020; 53:102252. [PMID: 32593970 PMCID: PMC7305726 DOI: 10.1016/j.ajp.2020.102252] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Krishan Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
BACKGROUND AND AIMS 2019-coronavirus disease (COVID-19) is causing insurmountable psychosocial impact on the whole mankind. Marginalized community, particularly those with substance use disorders (SUD), are particularly vulnerable to contract the infection and also likely to suffer from greater psychosocial burden. This article analyses the intricate bi-directional relationship between COVID-19 and addiction. METHODS Pubmed and Google Scholar are searched with the following key terms- "COVID-19", "SARS-CoV2", "Pandemic", "Addiction", "Opioid", "Alcohol", "Smoking", "Addiction Psychiatry", "Deaddiction", "Substance use disorders", "Behavioral addiction". Few newspaper reports related to COVID-19 and addiction have also been added as per context. RESULTS People with SUD are at greater risk of worse COVID-19 outcome. There is surge of addictive behaviors (both new and relapse) including behavioral addiction in this period. Withdrawal emergencies and death are also being increasingly reported. Addicted people are especially facing difficulties in accessing the healthcare services which are making them prone to procure drugs by illegal means. CONCLUSION COVID-19 and addiction are the two pandemics which are on the verge of collision causing major public health threat. While every effort must be taken to make the public aware of deleterious effects of SUD on COVID-19 prognosis, the resumption of deaddiction services and easier accessibility of prescription drugs are needs of the hour.
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Affiliation(s)
- Mahua Jana Dubey
- Department of Psychiatry, Specialist Medical Officer, Department of Psychiatry, Berhampore Mental Hospital, Berhampore, Mushridabad, West Bengal, India.
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India.
| | - Subham Chatterjee
- Department of Psychiatry, Institute of Psychiatry, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India.
| | - Payel Biswas
- Department of Radiodiagnosis, Care & Cure Hospital, Barasat, West Bengal, India.
| | - Subhankar Chatterjee
- Department of General Medicine, Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India.
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Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, Lahiri D, Lavie CJ. Psychosocial impact of COVID-19. Diabetes Metab Syndr 2020; 14:779-788. [PMID: 32526627 PMCID: PMC7255207 DOI: 10.1016/j.dsx.2020.05.035] [Citation(s) in RCA: 848] [Impact Index Per Article: 212.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Along with its high infectivity and fatality rates, the 2019 Corona Virus Disease (COVID-19) has caused universal psychosocial impact by causing mass hysteria, economic burden and financial losses. Mass fear of COVID-19, termed as "coronaphobia", has generated a plethora of psychiatric manifestations across the different strata of the society. So, this review has been undertaken to define psychosocial impact of COVID-19. METHODS Pubmed and GoogleScholar are searched with the following key terms- "COVID-19", "SARS-CoV2", "Pandemic", "Psychology", "Psychosocial", "Psychitry", "marginalized", "telemedicine", "mental health", "quarantine", "infodemic", "social media" and" "internet". Few news paper reports related to COVID-19 and psychosocial impacts have also been added as per context. RESULTS Disease itself multiplied by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. These have been fueled by an "infodemic" spread via different platforms of social media. Outbursts of racism, stigmatization, and xenophobia against particular communities are also being widely reported. Nevertheless, frontline healthcare workers are at higher-risk of contracting the disease as well as experiencing adverse psychological outcomes in form of burnout, anxiety, fear of transmitting infection, feeling of incompatibility, depression, increased substance-dependence, and PTSD. Community-based mitigation programs to combat COVID-19 will disrupt children's usual lifestyle and may cause florid mental distress. The psychosocial aspects of older people, their caregivers, psychiatric patients and marginalized communities are affected by this pandemic in different ways and need special attention. CONCLUSION For better dealing with these psychosocial issues of different strata of the society, psychosocial crisis prevention and intervention models should be urgently developed by the government, health care personnel and other stakeholders. Apt application of internet services, technology and social media to curb both pandemic and infodemic needs to be instigated. Psychosocial preparedness by setting up mental organizations specific for future pandemics is certainly necessary.
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Affiliation(s)
- Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India.
| | - Payel Biswas
- Department of Radiodiagnosis, Care & Cure Hospital, Barasat, West Bengal, India.
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India.
| | - Subhankar Chatterjee
- Department of General Medicine, Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
| | - Mahua Jana Dubey
- Department of Psychiatry, Specialist Medical Officer, Department of Psychiatry, Behrampore Mental Hospital, Berhampore, Mushridabad, West Bengal, India.
| | - Subham Chatterjee
- Department of Psychiatry, Institute of Psychiatry, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India.
| | - Durjoy Lahiri
- Department of Neuromedicine, R.G. Kar Medical College & Hospital, Kolkata, West Bengal, India.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine New Orleans, Louisiana, USA
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19
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Gray R. [Not Available]. Rev Med Suisse 2020; 16:1392. [PMID: 32672022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Rebecca Gray
- Département des policliniques, Unisanté, Lausanne
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20
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Shadravan S, Stephens D, Appel O, Ochoa K. Cross-Sectional Study of Homeless High Service Utilizers in Los Angeles County Jails: Race, Marginalization and Opportunities for Diversion. Ethn Dis 2020; 30:501-508. [PMID: 32742155 PMCID: PMC7360173 DOI: 10.18865/ed.30.3.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the demographic, legal, and clinical characteristics of a cross-section of incarcerated homeless individuals with the highest utilization of Los Angeles (LA) County public services in order to increase opportunities for focused jail diversion. Methods The "5% list" (N=5,905 in February 2018), LA County's list of homeless individuals with the highest 5% utilization of public services, was cross-matched with the total jail population to obtain a sample of 333 homeless high-utilizing individuals. This sample was compared with the overall jail population (N=17,121) from publicly available aggregate data by Chi-square testing. Results 84% of the high-utilizing sample were male, 38% Black, 37% Hispanic, 21% White. 67% were prescribed psychiatric medication. Compared with the overall jail population, the sample was significantly older, with a greater proportion of Black and White persons, and a lesser proportion of Hispanic individuals relative to the overall jail population. A significantly greater proportion of high-utilizing individuals faced misdemeanor charges. Conclusion These data highlight the compounding effects of homelessness, race, and mental illness on carceral and social vulnerability. Findings suggest homeless high utilizers in jail with mental illness are likely to benefit from court-based diversion efforts aimed at housing and treatment.
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Affiliation(s)
- Sonya Shadravan
- Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA
- Office of Diversion and Reentry, Los Angeles County Department of Health Services, Los Angeles, CA
| | - Dustin Stephens
- Office of Diversion and Reentry, Los Angeles County Department of Health Services, Los Angeles, CA
- Harbor-UCLA Medical Center, Department of Psychiatry, Los Angeles, CA
| | - Oona Appel
- Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA
- Office of Diversion and Reentry, Los Angeles County Department of Health Services, Los Angeles, CA
| | - Kristen Ochoa
- Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA
- Office of Diversion and Reentry, Los Angeles County Department of Health Services, Los Angeles, CA
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21
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Ogunbajo A, Iwuagwu S, Williams R, Biello KB, Kahler CW, Sandfort TGM, Mimiaga MJ. Validation of depressive symptoms, social support, and minority stress scales among gay, bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: a mixed methods approach. BMC Public Health 2020; 20:1023. [PMID: 32600303 PMCID: PMC7325044 DOI: 10.1186/s12889-020-09127-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global North. The validity and reliability of these instruments-to our knowledge-have never been thoroughly investigated among GBMSM in Nigeria. The aim of the current study was to determine the validity and reliability of the English versions of the Center for Epidemiologic Studies Depression Scale (CESD-R), Multidimensional Scale of Perceived Social Support (MSPSS), and LGBT Minority Stress Measure among a large multi-state sample of GBMSM Nigeria. METHODS Between January and June 2019, we conducted cognitive interviews (N = 30) and quantitative assessments (N = 406) with GBMSM in Nigeria. The cognitive interviews assessed comprehension of scale items and elicited suggestions for scale modifications. The quantitative assessment was used to gather psychosocial health data and to evaluate psychometric properties and construct validity of the modified scales. We utilized confirmatory factor analysis to assess factor structure, correlation coefficients, and Cronbach's alpha to examine scale validity and internal consistency. RESULTS Based on participant feedback from the cognitive interviews, we made slight modifications (i.e., culturally appropriate word substitutions) to all three scales. Results of quantitative analyses indicated good psychometric properties including high factor loadings, internal consistency and construct validity among the CESD-R, MSPSS, and LGBT Minority Stress Measure among GBMSM in Nigeria. CONCLUSION These results suggests that modifying research scales to be more culturally relevant likely do not jeopardize their validity and reliability. We found that modified scales measuring depressive symptoms, perceived social support, and minority stress among GBMSM in Nigeria remained valid. More research is needed to explore whether the psychometric properties remain if the scales are translated into broken English (Pidgin) and other traditional Nigerian languages (Yoruba, Igbo and Hausa).
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI 02912 USA
- Center for Health Equity, Brown School of Public Health, Providence, RI USA
| | | | - Rashidi Williams
- Equality Triangle for Health and Peoples Development Initiative, Warri, Delta Nigeria
| | - Katie B. Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI 02912 USA
- Center for Health Equity, Brown School of Public Health, Providence, RI USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI 02912 USA
| | - Theodorus G. M. Sandfort
- HIV Center for Clinical and Behavioral Studies New York State Psychiatric Institute and Columbia University, New York, USA
| | - Matthew J. Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI 02912 USA
- Center for Health Equity, Brown School of Public Health, Providence, RI USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI USA
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Kearns RA, Neuwelt PM, Eggleton K. Permeable boundaries? Patient perspectives on space and time in general practice waiting rooms. Health Place 2020; 63:102347. [PMID: 32543433 DOI: 10.1016/j.healthplace.2020.102347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
This paper considers an under-examined space in primary health care - the reception area/waiting room. This space can be challenging to negotiate, particularly for those who experience social marginalisation. We begin by situating the significance of the 'entry into the health care setting' in the patient journey in terms of time as well as space. Through an analysis of interview and focus group data gathered in a New Zealand study, we highlight ways that patients view these spaces as firmly bounded and confronting. In reflecting on the data, we then identify the potential for these spaces to be more permeable. We conclude that this spatio-temporal context need not be one of constraint. Rather, there are ways in which the boundaries of this space can be potentially enabling to those required to pause in the process of enacting patienthood.
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Affiliation(s)
- Robin A Kearns
- School of Environment, University of Auckland, New Zealand.
| | - Pat M Neuwelt
- School of Population Health, University of Auckland, New Zealand.
| | - Kyle Eggleton
- School of Population Health, University of Auckland, New Zealand.
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Wadsworth LP, Potluri S, Schreck M, Hernandez-Vallant A. Measurement and impacts of intersectionality on obsessive-compulsive disorder symptoms across intensive treatment. Am J Orthopsychiatry 2020; 90:445-457. [PMID: 32134311 DOI: 10.1037/ort0000447] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Historically, intensive obsessive-compulsive and related disorder (OCRD) treatment settings have been underrepresentative in terms of patient race and ethnicity. The present study piloted a novel technique to measure multiple marginalized identities and assess their impact on obsessive-compulsive disorder (OCD) symptoms and treatment response across intensive residential treatment (IRT). Participants included 715 residents receiving IRT for OCRD. Measures included the Yale-Brown Obsessive-Compulsive Scale, Dimensional Obsessive-Compulsive Scale (DOCS), Obsessive Beliefs Questionnaire-44, and measures of depression and quality of life. In addition, we piloted a marginalized identity score, an additive measure of intersectionality. Most patients endorsed holding primarily privileged identities. Higher marginalized identity score was significantly correlated with higher depression symptom severity and lower quality of life throughout treatment. Both at baseline and discharge, higher marginalized identity score was significantly and positively correlated with greater OCD symptom severity. Higher marginalized identity score was significantly associated with greater severity of DOCS1, DOCS2, DOCS4, and obsessive beliefs across multiple domains. Consistent with previous literature, patients in our IRT setting were not demographically representative of the general population. Individuals with more marginalized identities endorsed higher symptoms of OCD, obsessive beliefs, OCD dimensions, and depression, as well as lower quality of life at admission and discharge. Results support increased consideration of the role marginalization plays in symptom severity, symptom presentation, and treatment response across treatment settings. Further investigation is warranted to better address the multiplicative effects of holding intersecting marginalized identities and how treatment may be adapted to ameliorate these inequities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Pedersen A, Haslund-Thomsen H, Curtis T, Grønkjær M. Talk to Me, Not at Me: An Ethnographic Study on Health-Related Help-Seeking Behavior Among Socially Marginalized Danish Men. Qual Health Res 2020; 30:598-609. [PMID: 31431140 DOI: 10.1177/1049732319868966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research shows that men tend to have delayed health-related help-seeking behavior. In this ethnographic study, we explored influential factors related to health-related help-seeking behavior among socially marginalized men who seem not to benefit from existing municipal health care services in a large Danish municipality. The study included 200 hours of participant observations and 25 ethnographic interviews with men between 45 and 65 years of age in their own homes and in public parks among their peers. In this study, we found that the men had several complex and interacting social- and health-related conditions, which seemed to affect their health-related help-seeking behavior. We conclude that collaborative initiatives between the outreach team who occasionally visits bench sites in the public parks and the municipal health care services in the local areas could lay the groundwork for encouraging men's health-related help-seeking behavior and aid men in supporting each other.
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Affiliation(s)
- Annette Pedersen
- Aalborg University, Aalborg, Denmark
- University College of Northern Denmark, Aalborg, Denmark
| | | | - Tine Curtis
- Aalborg University, Aalborg, Denmark
- Centre for Applied Health Research, Aalborg Municipality, Denmark
| | - Mette Grønkjær
- Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Aalborg, Denmark
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25
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England JW, Duffy RD, Gensmer NP, Kim HJ, Buyukgoze-Kavas A, Larson-Konar DM. Women attaining decent work: The important role of workplace climate in Psychology of Working Theory. J Couns Psychol 2020; 67:251-264. [PMID: 32105129 DOI: 10.1037/cou0000411] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Grounded in Psychology of Working Theory (PWT), the current study investigated predictors of decent work among a sample of employed women (N = 528). A structural equation model was examined finding that women's experiences of marginalization, work volition, and career adaptability all directly predicted the attainment of decent work, and economic constraints and marginalization experiences indirectly predicted decent work via work volition. Additionally, workplace climate for women employees was examined as both a predictor and moderator variable to explore best positioning of this additive construct. Workplace climate did not significantly moderate any model paths; however, it was a unique predictor of work volition and decent work, suggesting that this construct may be better positioned as a predictor variable in understanding the work experiences of women. These results highlight the importance of further investigating the role of workplace climate in PWT as well as the need for refining our understanding of how marginalized employees achieve decent work. Implications of the present study's results are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Haram J Kim
- Department of Psychology, University of Florida
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26
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Devkota B, Maskey J, Pandey AR, Karki D, Godwin P, Gartoulla P, Mehata S, Aryal KK. Determinants of home delivery in Nepal - A disaggregated analysis of marginalised and non-marginalised women from the 2016 Nepal Demographic and Health Survey. PLoS One 2020; 15:e0228440. [PMID: 31999784 PMCID: PMC6992204 DOI: 10.1371/journal.pone.0228440] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In Nepal, a substantial proportion of women still deliver their child at home. Disparities have been observed in utilisation of institutional delivery and skilled birth attendant services. We performed a disaggregated analysis among marginalised and non-marginalised women to identify if different factors are associated with home delivery among these groups. MATERIALS AND METHODS This study used data from the 2016 Nepal Demographic and Health Survey. It involves the analysis of 3,837 women who had experienced at least one live birth in the five years preceding the survey. Women were categorised as marginalised and non-marginalised based on ethnic group. Bivariate and multivariable logistic regression analysis were performed to identify factors associated with home delivery. RESULTS A higher proportion of marginalised women delivered at home (47%) than non-marginalised women (26%). Compared to non-marginalised women (35%), a larger proportion of marginalised women (64%) felt that it was not necessary to give birth at health facility. The multivariable analysis indicated an independent association of having no or basic education, belonging to middle, poorer and the poorest wealth quintile, residing in Province 2 and not having completed of four antenatal care visits per protocol with home delivery among both marginalised and non-marginalised women. Whereas residing in a rural area, residing in Province 7, and at a distance of >30 minutes to a health facility were factors independently associated with home delivery only among marginalised women. CONCLUSION We conclude that poor education, poor economic status, non-completion of four ANC visits and belonging to Province 2 particularly determined either group of women to deliver at home, whereas residing in rural areas, living far from health facility, and belonging to Province 7 determined marginalised women to deliver at home. Preventing mothers from delivering at home would thus require focusing on specific geographical areas besides considering wider socio-economic determinants.
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Affiliation(s)
- Bikash Devkota
- Policy Planning and Monitoring Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Jasmine Maskey
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
- * E-mail: ,
| | - Achyut Raj Pandey
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Deepak Karki
- UK Department for International Development Nepal, Kathmandu, Nepal
| | - Peter Godwin
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Pragya Gartoulla
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Suresh Mehata
- Policy Planning and Monitoring Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Krishna Kumar Aryal
- DFID Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
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Niederkrotenthaler T, Mittendorfer-Rutz E, Saboonchi F, Helgesson M. The role of refugee status and mental disorders regarding subsequent labour market marginalisation: a register study from Sweden. Soc Psychiatry Psychiatr Epidemiol 2020; 55:697-704. [PMID: 32055893 PMCID: PMC7275017 DOI: 10.1007/s00127-020-01842-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to assess the role of refugee status and specific mental disorders regarding subsequent labour market marginalisation. METHODS Prospective cohort study of all refugees (n = 216,930) and Swedish-borns (n = 3,841,788), aged 19-60 years, and resident in Sweden in 2009. Hazard ratios (HRs) with 95% Confidence Intervals (CIs) for long-term unemployment (> 180 days) and disability pension (DP) were calculated with Cox regression analyses. RESULTS Mental disorders were more prevalent in refugees compared to Swedish-born individuals, with greatest differences seen for post-traumatic stress disorder (PTSD; refugees 1.3%; Swedish-born individuals 0.1%). Regarding long-term unemployment, refugees without a mental disorder had an adjusted HR (aHR) of 2.68 (95% CI 2.65-2.71) compared to Swedish-born individuals without mental disorders, which was above the aHR of refugees (aHR 2.33, 95% CI 2.29-2.38) and Swedish-born individuals (aHR 1.44, 95% CI 1.43-1.45) with mental disorders. Regarding DP, compared to Swedish-born individuals without mental disorders, the aHRs were 1.44 (95% CI 1.34-1.54) for refugees without, but 6.11 (95% CI 5.84-6.39) for refugees with mental disorders. Swedish-born individuals with mental disorder had an aHR of 3.96 (95% CI 3.85-4.07). With regard to specific disorders, the aHRs for refugees, as compared to Swedish-born individuals without mental disorders, were markedly increased for all disorders (e.g. PTSD: long-term unemployment aHR: 2.03 (95% CI 1.89-2.18); DP 7.07 (95% CI 6.42-7.78). CONCLUSION Mental disorders are more prevalent in refugees than in Swedish-born individuals but do not appear to increase their risk of long-term unemployment. Refugee status and mental disorders strongly contribute to the risk of DP, indicating that factors beyond medical considerations contribute to their granting of DP.
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Affiliation(s)
- Thomas Niederkrotenthaler
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Fredrik Saboonchi
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Red Cross University College, Stockholm, Sweden
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
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Polk W, Hill NE, Price M, Liang B, Perella J, Savitz-Romer M. Adolescent Profiles of Marginalization and Connection at School: Relations With Academics and Mental Health. J Res Adolesc 2020; 30 Suppl 1:209-225. [PMID: 30338869 DOI: 10.1111/jora.12460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
School context serves as a testing ground for exploring social relationships and satisfying needs for connection and affirmation, but often includes feelings of rejection. With a diverse high school sample (n = 645; 55% female; 61% White, 18% African American, 10% Latino, 10% Asian American, 1% Multiracial), patterns of experiences with marginalization and connection were identified and their associations with achievement and mental health examined. Using two-step cluster analysis, three clusters were identified: above the fray, exposed and protected, and targeted and unsupported. Ethnic/racial background was not related to cluster membership. Except for gender and well-being, associations between cluster membership and outcomes were similar across demographic background. The above the fray and the exposed and protected clusters were associated with better outcomes.
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Butler-Warke A. Foundational stigma: Place-based stigma in the age before advanced marginality. Br J Sociol 2020; 71:140-152. [PMID: 31840245 DOI: 10.1111/1468-4446.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/09/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
This paper joins the debate on the formation of territorial stigma by uncovering the existence of a form of "foundational stigma" that preceded place-based stigma of the era of advanced marginality. I show that not only were the traces of stigma present prior to the era of advanced marginality but that these early traces facilitate later forms of stigma by providing the necessary foundations upon which adhesive and detrimental stigma was operationalized. Following a critical discourse analysis approach, this paper examines coverage in the British press of Toxteth, Liverpool between 1900 and 1981 as a paradigmatic case study to show that this primitive stigma existed in three key ways: relating to inter-community strife, to crime, and to substandard housing conditions. These traces of stigma laid the foundations for later forms of stigma based on the presence of the poor, violent, deviant other that would be operationalized by dominant voices during the era of advanced marginality.
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Affiliation(s)
- Alice Butler-Warke
- School of Applied Social Studies, Robert Gordon University, Aberdeen, UK
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Knerich V, Jones AA, Seyedin S, Siu C, Dinh L, Mostafavi S, Barr AM, Panenka WJ, Thornton AE, Honer WG, Rutherford AR. Social and structural factors associated with substance use within the support network of adults living in precarious housing in a socially marginalized neighborhood of Vancouver, Canada. PLoS One 2019; 14:e0222611. [PMID: 31545818 PMCID: PMC6756550 DOI: 10.1371/journal.pone.0222611] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The structure of a social network as well as peer behaviours are thought to affect personal substance use. Where substance use may create health risks, understanding the contribution of social networks to substance use may be valuable for the design and implementation of harm reduction or other interventions. We examined the social support network of people living in precarious housing in a socially marginalized neighborhood of Vancouver, and analysed associations between social network structure, personal substance use, and supporters' substance use. METHODS An ongoing, longitudinal study recruited 246 participants from four single room occupancy hotels, with 201 providing social network information aligned with a 6-month observation period. Use of tobacco, alcohol, cannabis, cocaine (crack and powder), methamphetamine, and heroin was recorded at monthly visits. Ego- and graph-level measures were calculated; the dispersion and prevalence of substances in the network was described. Logistic mixed effects models were used to estimate the association between ego substance use and peer substance use. Permutation analysis was done to test for randomness of substance use dispersion on the social network. RESULTS The network topology corresponded to residence (Hotel) with two clusters differing in demographic characteristics (Cluster 1 -Hotel A: 94% of members, Cluster 2 -Hotel B: 95% of members). Dispersion of substance use across the network demonstrated differences according to network topology and specific substance. Methamphetamine use (overall 12%) was almost entirely limited to Cluster 1, and absent from Cluster 2. Different patterns were observed for other substances. Overall, ego substance use did not differ over the six-month period of observation. Ego heroin, cannabis, or crack cocaine use was associated with alter use of the same substances. Ego methamphetamine, powder cocaine, or alcohol use was not associated with alter use, with the exception for methamphetamine in a densely using part of the network. For alters using multiple substances, cannabis use was associated with lower ego heroin use, and lower ego crack cocaine use. Permutation analysis also provided evidence that dispersion of substance use, and the association between ego and alter use was not random for all substances. CONCLUSIONS In a socially marginalized neighborhood, social network topology was strongly influenced by residence, and in turn was associated with type(s) of substance use. Associations between personal use and supporter's use of a substance differed across substances. These complex associations may merit consideration in the design of interventions to reduce risk and harms associated with substance use in people living in precarious housing.
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Affiliation(s)
- Verena Knerich
- Departments of Computer Science, and Cultural Anthropology, Ludwig-Maximilians University, Munich, Germany
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sam Seyedin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Siu
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Louie Dinh
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Sara Mostafavi
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
- Medical Genetics, Department Office, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Villa AM. Invisible deaths among youth in the south of Buenos Aires: biographical reconstructions and itineraries of the experience of families and friends. Salud Colect 2019; 15:e1707. [PMID: 31269117 DOI: 10.18294/sc.2019.1707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022] Open
Abstract
Many sources of secondary data and some previous studies highlight the magnitude of homicides among young people in marginalized populations of the southern part of the City of Buenos Aires. With an approach that incorporates the perspectives of the sociology of individuation, the anthropology of moralities, and the psychic processes involved in subjectivation, an in-depth cases study was conducted between the years 2014 and 2016. A set of biographies of young people who died in front of other young people were reconstructed through the testimonies of families and friends of dead youth. The work aims to delve into the different contexts and conditions of possibility of the experiences of these actors, in which the process of biographical reconstruction linked to youth sociabilities, along with pain and vulnerabilities after a death, can lead to a social critique of the naturalization of the violence among young people in the everyday life of marginalized neighborhoods.
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Affiliation(s)
- Alejandro Marcelo Villa
- Licenciado en Psicología. Especialista en Ciencias Sociales y Salud. Investigador asociado, Consejo de Investigación en Salud, Ministerio de Salud, Gobierno de la Ciudad Autónoma de Buenos Aires. Buenos Aires, Argentina.
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Marinos V, Whittingham L. The role of therapeutic jurisprudence to support persons with intellectual and developmental disabilities in the courtroom: Reflections from Ontario, Canada. Int J Law Psychiatry 2019; 63:18-25. [PMID: 30144944 DOI: 10.1016/j.ijlp.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/23/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
It is generally recognized that persons with intellectual and developmental disabilities (IDD) are at greater risk than the general population when they encounter the criminal justice system due to vulnerabilities such as cognition, memory and language (Jones, 2007). To date, little evidence has been generated regarding best practice to support persons with IDD in the criminal justice system, specifically the courtroom. Various models of problem-solving courts have developed across Canada to divert cases composed of complex human social problems to more appropriate community-based treatment and supports. Past Canadian authors have raised critical questions that require reflection about the broader theory of Therapeutic Jurisprudence (TJ) and its current implementation in problem-solving courts. Given the risk and vulnerabilities of persons with IDD in the criminal justice system, problem-solving courts (specifically mental health courts) hold great promise to address some of the unique needs of these individuals. We reflect on the critical questions raised by previous Canadian authors regarding problem-solving courts and suggest some considerations that need to be addressed to maximize the benefits of these courts for persons with IDD.
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Affiliation(s)
- Voula Marinos
- Brock University, 1812 Sir Isaac Brock Way, St. Catharines, Ontario L2S 3A1, Canada.
| | - Lisa Whittingham
- Brock University, 1812 Sir Isaac Brock Way, St. Catharines, Ontario L2S 3A1, Canada
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Hanson S, Gilbert D, Landy R, Okoli G, Guell C. Cancer risk in socially marginalised women: An exploratory study. Soc Sci Med 2019; 220:150-158. [PMID: 30445340 PMCID: PMC6323356 DOI: 10.1016/j.socscimed.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 12/02/2022]
Abstract
BACKGROUND Cancer is a leading cause of premature death in women worldwide, and is associated with socio-economic disadvantage. Yet many interventions designed to reduce risk and improve health fail to reach the most marginalised with the greatest needs. Our study focused on socially marginalised women at two women's centres that provide support and training to women in the judicial system or who have experienced domestic abuse. METHODS This qualitative study was framed within a sociological rather than behavioural perspective involving thirty participants in individual interviews and focus groups. It sought to understand perceptions of, and vulnerability to, cancer; decision making (including screening); cancer symptom awareness; and views on health promoting activities within the context of the women's social circumstances. FINDINGS Women's experiences of social adversity profoundly shaped their practices, aspirations and attitudes towards risk, health and healthcare. We found that behaviours such as unhealthy eating and smoking need to be understood in the context of inherently risky lives. They were a coping mechanism whilst living in extreme adverse circumstances, navigating complex everyday lives and structural failings. Long term experiences of neglect, harm and violence, often by people they should be able to trust, led to low self-esteem and influenced their perceptions of risk and self-care. This was reinforced by negative experiences of navigating state services and a lack of control and agency over their own lives. CONCLUSION Women in this study were at high risk of cancer, but it would be better to understand these risk factors as markers of distress and duress. Without appreciating the wider determinants of health and systemic disadvantage of marginalised groups, and addressing these with a structural rather than an individual response, we risk increasing cancer inequities by failing those who are in the greatest need.
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Affiliation(s)
- Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
| | | | | | | | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
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Blackie M, Wear D, Zarconi J. Narrative Intersectionality in Caring for Marginalized or Disadvantaged Patients: Thinking Beyond Categories in Medical Education and Care. Acad Med 2019; 94:59-63. [PMID: 30134270 DOI: 10.1097/acm.0000000000002425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Categories are essential to doctors' thinking and reasoning about their patients. Much of the clinical categorization learned in medical school serves useful purposes, but an extensive literature exists on students' reliance on broad systems of social categorization. In this article, the authors challenge some of the orthodoxies of categorization by combining narrative approaches to medical practice with the theoretical term "intersectionality" to draw students' attention to the important intersecting, but often overlooked, identities of their patients. Although intersectionality applies for all patients, the focus here is on its importance in understanding and caring for marginalized or disadvantaged persons.Intersectionality posits that understanding individual lives requires looking beyond categories of identity in isolation and instead considering them at their intersection, where interrelated systems of power and oppression, advantage and discrimination are at play and determine access to social and material necessities of life. Combined with narrative approaches that emphasize the singularity of a person's story, narrative intersectionality can enable a more robust understanding of how injustice and inequality interrelate multidimensionally to produce social disadvantage.The authors apply this framework to two films that present characters whose lives are made up of numerous and often-contradictory identities to highlight what physicians may be overlooking in the care of patients. If the education of physicians encourages synthesis and categorization aimed at the critically useful process of making clinical "assessments" and "plans," then there must also be emphasis in their education on what might be missing from that process.
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Affiliation(s)
- Michael Blackie
- M. Blackie is associate professor of health humanities, Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois. D. Wear is professor of family and community medicine, Northeast Ohio Medical University, Rootstown, Ohio. J. Zarconi is professor and chair of internal medicine and senior associate dean for health affairs, Northeast Ohio Medical University, Rootstown, Ohio
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Award for Distinguished Early Career Contributions to Psychology in the Public Interest: John E. Pachankis. Am Psychol 2018; 73:1204-6. [PMID: 30525804 DOI: 10.1037/amp0000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The APA Awards for Distinguished Scientific Early Career Contributions to Psychology recognize psychologists who have demonstrated excellence early in their careers and have held a doctoral degree for no more than 9 years. One of the 2017 award winners is John E. Pachankis. Pachankis has conducted seminal research showing that stigma harms lesbian, gay male, bisexual, and transgender (LGBT) health through mechanisms such as identity concealment, rejection hypervigilance, and achievement-contingent self-worth. Most significantly, he has put minority stress theory into practice by creating novel interventions that reduce stigma-related stress. Pachankis's award citation, biography, and a selected bibliography are presented here. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Hong JS, Peguero AA, Espelage DL. Experiences in bullying and/or peer victimization of vulnerable, marginalized, and oppressed children and adolescents: An introduction to the special issue. Am J Orthopsychiatry 2018; 88:399-401. [PMID: 29999387 DOI: 10.1037/ort0000330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This is an introduction to the special issue "Bullying and Peer Victimization of Vulnerable, Marginalized, and Oppressed Youth." The study findings included in this special issue reveal that bias-based bullying and harassment are global social problems. Each article identifies suggestions for interventions, policy, and future research. Each study presented in this special issue contributes to the bullying and school violence scholarship, which can provide avenues for serious discussions on best ways to address not only bullying but also racism, sexism, heteronormativity, homophobia, ableism, classism, and Eurocentrism, all of which accompany bias-based bullying. (PsycINFO Database Record
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Abstract
Experiencing discrimination or rejection from one's own ethnic group can have adverse effects on mental health above and beyond general ethnic discrimination alone. Intragroup marginalization is a term that involves being marginalized by members of one's own ethnic group for acting in concordance with the mainstream culture (Castillo, Conoley, Brossart, & Quiros, 2007). Minimal research has examined rejection by one's own ethnic group for acting too enculturated to one's home culture, or intragroup separation. In the current study, a community sample of Latina/o adults (N = 233), primarily women of Mexican descent, were recruited and completed self-report surveys. Using 3 hierarchical regressions, results demonstrated that intragroup marginalization and intragroup separation predicted symptoms of depression, anxiety, and alcohol misuse above and beyond that of general ethnic discrimination alone. Moreover, family and ethnic group intragroup marginalization and intragroup separation uniquely predicted different symptoms of mental health. Additional findings suggested that nativity status served as a moderator for intragroup separation and alcohol misuse, such that the relationship strengthened for U.S.-born Latina/os. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Abstract
Women are most exposed to sexual health risks within their marital relationships, primarily due to the sexually risky behaviours of their spouses. Studies show that expanding agency is critical for women to mitigate both physical and sexual health risks and is linked to increased psycho-social well-being and economic independence. Drawing on qualitative and quantitative primary data collected from a peri-urban community in Zambia, this paper explores how women exert agency in a community where few educational and economic opportunities and substantial food insecurity exacerbate women's risk for HIV within their marital relationships. It also examines how expressions of agency within marital unions can reduce HIV risk exposure and lead to socio-economic benefits. However, expressions of agency can also create physical, psycho-social and sexual health risks, particularly when spouses do not support independent decision-making and actions that women consider necessary to support the household and maintain intimacy. Findings highlight the importance of community involvement and addressing harmful socio-cultural norms to foster the realisation of women's agency.
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Affiliation(s)
- Lwendo Moonzwe Davis
- a ICF, International Health Division , University of Connecticut , Rockville , MD , USA
| | - Kristin Marie Kostick
- b Center for Medical Ethics and Health Policy , Baylor College of Medicine , Houston , TX , USA
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Rice WS, Logie CH, Napoles TM, Walcott M, Batchelder AW, Kempf MC, Wingood GM, Konkle-Parker DJ, Turan B, Wilson TE, Johnson MO, Weiser SD, Turan JM. Perceptions of intersectional stigma among diverse women living with HIV in the United States. Soc Sci Med 2018; 208:9-17. [PMID: 29753137 PMCID: PMC6015551 DOI: 10.1016/j.socscimed.2018.05.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/28/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptions of various forms of stigma and discrimination, most commonly related to their gender, race, and income level, but also incarceration histories and weight. Women perceived these interrelated forms of social marginalization as coming from multiple sources: their communities, interpersonal interactions, and within systems and structures. Our findings highlight the complexity of social processes of marginalization, which profoundly shape life experiences, opportunities, and healthcare access and uptake among women living with HIV. This study highlights the need for public health strategies to consider community, interpersonal, and structural dimensions across intersecting, interdependent identities to promote the wellbeing among women living with HIV and to reduce social structural and health disparities.
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Affiliation(s)
- Whitney S Rice
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, Birmingham, AL, USA.
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, Canada.
| | - Tessa M Napoles
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Melonie Walcott
- School of Health Sciences, The Sage Colleges, Albany, NY, USA.
| | | | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, USA.
| | - Gina M Wingood
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, USA.
| | - Deborah J Konkle-Parker
- Department of Medicine and School of Nursing, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, USA.
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, Birmingham, AL, USA.
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY, USA.
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, USA.
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Antin TMJ, Hunt G, Sanders E. The "here and now" of youth: the meanings of smoking for sexual and gender minority youth. Harm Reduct J 2018; 15:30. [PMID: 29855377 PMCID: PMC5984472 DOI: 10.1186/s12954-018-0236-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mainstream tobacco field in the USA tends to situate youth as passive, particularly in terms of their susceptibility to industry manipulation and peer pressure. However, failing to acknowledge youths' agency overlooks important meanings youth ascribe to their tobacco use and how those meanings are shaped by the circumstances and structures of their everyday lives. METHODS This article is based on analysis of 58 in-depth qualitative interviews conducted with sexual and gender minority youth living in the San Francisco Bay area in California. Topics covered in interviews focused on meanings of tobacco in the lives of youth. Interviews lasted approximately 2.5 h and were transcribed verbatim and linked with ATLAS.ti, a qualitative data analysis software. Following qualitative coding, narrative segments were sorted into piles of similarity identified according to principles of pattern-level analysis to interpret to what extent meanings of smoking for young people may operate as forms of resistance, survival, and defense. RESULTS Analysis of our participants' narratives highlights how smoking is connected to what Bucholtz calls the "'here-and-now' of young people's experience, the social and cultural practices through which they shape their worlds" as active agents (Bucholtz, Annu Rev Anthropol31:525-52, 2003.). Specifically, narratives illustrate how smoking signifies "control" in a multitude of ways, including taking control over an oppressor, controlling the effects of exposure to traumatic or day-to-day stress, and exerting control over the physical body in terms of protecting oneself from violence or defending one's mental health. CONCLUSIONS These findings call into question the universal appropriateness of foundational elements that underlie tobacco control and prevention efforts directed at youth in the USA, specifically the focus on abstinence and future orientation. Implications of these findings for research, prevention, and policy are discussed, emphasizing the risk of furthering health inequities should we fail to acknowledge the "here and now" of youth.
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Affiliation(s)
- Tamar M. J. Antin
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
| | - Geoffrey Hunt
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
| | - Emile Sanders
- Critical Public Health Research Group, Prevention Research Center, 180 Grand Ave, Suite 1200, Oakland, CA 94502 USA
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501 USA
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41
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Dyster TG. Identity Capital and Identifying Learners at Risk for Marginalization. Acad Med 2017; 92:1070. [PMID: 28742563 DOI: 10.1097/acm.0000000000001802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Timothy Gordon Dyster
- Fourth-year student, Columbia University College of Physicians & Surgeons, New York, New York; ; ORCID: http://orcid.org/0000-0002-7362-6931
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42
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Fegert JM, Harsch D, Plener PL. [Reducing barriers for participation of children with disability]. Z Kinder Jugendpsychiatr Psychother 2017; 45:95-97. [PMID: 28320251 DOI: 10.1024/1422-4917/a000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Jörg M Fegert
- 1 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinik Ulm
| | - Daniela Harsch
- 1 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinik Ulm
| | - Paul L Plener
- 1 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinik Ulm
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43
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Löve J, Hensing G, Söderberg M, Torén K, Waern M, Åberg M. Future marginalisation and mortality in young Swedish men with non-psychotic psychiatric disorders and the resilience effect of cognitive ability: a prospective, population-based study. BMJ Open 2016; 6:e010769. [PMID: 27515748 PMCID: PMC4985865 DOI: 10.1136/bmjopen-2015-010769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Large-scale studies examining future trajectories of marginalisation and health in adolescents with mental illness are scarce. The aim of this study was to examine if non-psychotic psychiatric disorders (NPDs) were associated with future indicators of marginalisation and mortality. We also aimed to determine whether these associations might be mediated by education level and attenuated by high cognitive ability. DESIGN This is a prospective cohort study with baseline data from the Swedish Conscription register. SETTING The study was carried out in Sweden from 1969 to 2005. PARTICIPANTS All of the participants were 18-year-old men at mandatory conscription in Sweden between 1969 and 2005 (n=1 609 690). MEASURES NPDs were clinically diagnosed at conscription. Cognitive ability was measured by a standardised IQ test at conscription. National register data covered information on welfare support, long-term unemployment, disability pension (DP) and mortality over a period of 1-36 years. RESULTS NPD at the age of 18 years was a predictor of future welfare support, OR 3.73 (95% CI 3.65 to 3.80); long-term unemployment, OR 1.97 (95% CI 1.94 to 2.01); DP, HR 2.95 (95% CI 2.89 to 3.02); and mortality, HR 2.45 (2.33-2.52). The adjusted models suggested that these associations were not confounded by fathers' educational level, cognitive ability had only a minor attenuating effect on most associations and the mediating effect of own educational level was small. CONCLUSIONS The present study underlines a higher prevalence of future adversities in young men experiencing NPDs at the age of 18 years. It also indicates that higher cognitive ability may work as a potential resilience factor against future marginalisation and mortality.
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Affiliation(s)
- J Löve
- Section for Social Medicine and Epidemiology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - G Hensing
- Section for Social Medicine and Epidemiology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - M Söderberg
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - K Torén
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - M Waern
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - M Åberg
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Primary Health Care, Institute of Medicine, All at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
The article presents disability studies and elaborates, as their central feature, the distinction between societal disability and impairment which can be described on an individual and medical level. Disability studies define disability as socially caused exclusion. Participation and inclusion, seen as sociopolitical control and counter-terms, do, in fact, have a different content, depending on usage and context. Using the example of the International Classification of Functioning (ICF) and the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD), the respective understanding of disability is depicted. Against this background, the deficits of implementation of the UN CRPD, as criticized by the responsible UN Committee, are shown. Finally, a research agenda for disability studies is outlined, that deals with, among other things, implementation strategies and conflicts of interest in terms of inclusion, furthering widely unquestioned economic conditions and especially the negative impact of European austerity politics.
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Affiliation(s)
- Michael Zander
- Hochschule Magdeburg-Stendal, Osterburger Straße 25, 39576, Stendal, Deutschland.
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45
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McConnell EA, Todd NR, Odahl-Ruan C, Shattell M. Complicating Counterspaces: Intersectionality and the Michigan Womyn's Music Festival. Am J Community Psychol 2016; 57:473-488. [PMID: 27216853 DOI: 10.1002/ajcp.12051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The counterspaces framework articulated by Case and Hunter (2012), follows from community psychology's long-standing interest in the potential for settings to promote well-being and liberatory responses to oppression. This framework proposes that certain settings (i.e., "counterspaces") facilitate a specific set of processes that promote the well-being of marginalized groups. We argue that an intersectional analysis is crucial to understand whether and how counterspaces achieve these goals. We draw from literature on safe spaces and present a case study of the Michigan Womyn's Music Festival (Michfest) to illustrate the value of an intersectional analysis and explore how these processes operate. Based on 20 in-person interviews, 23 responses to an online survey, and ethnographic field notes, we show how Michfest was characterized by a particular intersection of identities at the setting level, and intersectional diversity complicated experiences at the individual level. Moreover, intersectional identities provided opportunities for dialogue and change at the setting level, including the creation of counterspaces within counterspaces. Overall, we demonstrate the need to attend to intersectionality in counterspaces, and more broadly in how we conceptualize settings in community psychology.
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Affiliation(s)
| | - Nathan R Todd
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | - Mona Shattell
- College of Nursing, Rush University, Chicago, IL, USA
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Cano MÁ, de Dios MA, Castro Y, Vaughan EL, Castillo LG, Lorenzo-Blanco EI, Piña-Watson B, Berger Cardoso J, Ojeda L, Cruz RA, Correa-Fernandez V, Ibañez G, Auf R, Molleda LM. Alcohol use severity and depressive symptoms among late adolescent Hispanics: Testing associations of acculturation and enculturation in a bicultural transaction model. Addict Behav 2015; 49:78-82. [PMID: 26092776 PMCID: PMC4478230 DOI: 10.1016/j.addbeh.2015.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/15/2015] [Accepted: 06/01/2015] [Indexed: 12/16/2022]
Abstract
Research has indicated that Hispanics have high rates of heavy drinking and depressive symptoms during late adolescence. The purpose of this study was to test a bicultural transaction model composed of two enthnocultural orientations (acculturation and enculturation); and stressful cultural transactions with both the U.S. culture (perceived ethnic discrimination) and Hispanic culture (perceived intragroup marginalization) to predict alcohol use severity and depressive symptoms among a sample of 129 (men=39, women=90) late adolescent Hispanics (ages 18-21) enrolled in college. Results from a path analysis indicated that the model accounted for 18.2% of the variance in alcohol use severity and 24.3% of the variance in depressive symptoms. None of the acculturation or enculturation domains had statistically significant direct effects with alcohol use severity or depressive symptoms. However, higher reports of ethnic discrimination were associated with higher reports of alcohol use severity and depressive symptoms. Similarly, higher reports of intragroup marginalization were associated with higher depressive symptoms. Further, both ethnic discrimination and intragroup marginalization functioned as mediators of multiple domains of acculturation and enculturation. These findings highlight the need to consider the indirect effects of enthnocultural orientations in relation to health-related outcomes.
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Affiliation(s)
| | - Marcel A de Dios
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | | | | | | | | | - Lizette Ojeda
- Texas A&M University, College Station, TX 77843, USA
| | | | | | - Gladys Ibañez
- Florida International University, Miami, FL 33199, USA
| | - Rehab Auf
- Florida International University, Miami, FL 33199, USA
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Liu JJ, Lou F, Lavebratt C, Forsell Y. Impact of Childhood Adversity and Vasopressin receptor 1a Variation on Social Interaction in Adulthood: A Cross-Sectional Study. PLoS One 2015; 10:e0136436. [PMID: 26295806 PMCID: PMC4546684 DOI: 10.1371/journal.pone.0136436] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 08/03/2015] [Indexed: 01/08/2023] Open
Abstract
Background Arginine vasopressin (AVP) plays a role in social behavior, through receptor AVPR1A. The promoter polymorphism AVPR1A RS3 has been associated with human social behaviors, and with acute response to stress. Here, the relationships between AVPR1A RS3, early-life stressors, and social interaction in adulthood were explored. Methods Adult individuals from a Swedish population-based cohort (n = 1871) were assessed for self-reported availability of social integration and social attachment and for experience of childhood adversities. Their DNA samples were genotyped for the microsatellite AVPR1A RS3. Results Among males, particularly those homozygous for the long alleles of AVPR1A RS3 were vulnerable to childhood adversity for their social attachment in adulthood. A similar vulnerability to childhood adversity among long allele carriers was found on adulthood social integration, but here both males and females were influenced. Limitation Data were self-reported and childhood adversity data were retrospective. Conclusions Early-life stress influenced the relationship between AVPR1A genetic variants and social interaction. For social attachment, AVPR1A was of importance in males only. The findings add to previous reports on higher acute vulnerability to stress in persons with long AVPR1A RS3 alleles and increased AVP levels.
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Affiliation(s)
- Jia Jia Liu
- School of Nursing, Shandong University, Jinan, 250012, China
- Neurogenetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fenglan Lou
- School of Nursing, Shandong University, Jinan, 250012, China
| | - Catharina Lavebratt
- Neurogenetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Horyniak D, Higgs P, Cogger S, Dietze P, Bofu T. Heavy alcohol consumption among marginalised African refugee young people in Melbourne, Australia: motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking. Ethn Health 2015; 21:284-299. [PMID: 26169071 DOI: 10.1080/13557858.2015.1061105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Little is known about substance use among resettled refugee populations. This study aimed to describe motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking among marginalised African refugee young people in Melbourne, Australia. DESIGN Face-to-face interviews were conducted with 16 self-identified African refugees recruited from street-based settings in 2012-2013. Interview transcripts were analysed inductively to identify key themes. RESULTS Participants gathered in public spaces to consume alcohol on a daily or near-daily basis. Three key motivations for heavy alcohol consumption were identified: drinking to cope with trauma, drinking to cope with boredom and frustration and drinking as a social experience. Participants reported experiencing a range of health and social consequences of their alcohol consumption, including breakdown of family relationships, homelessness, interpersonal violence, contact with the justice system and poor health. Strategies for managing drinking included attending counselling or residential detoxification programmes, self-imposed physical isolation and intentionally committing crime in order to be incarcerated. CONCLUSION These findings highlight the urgent need for targeted harm reduction education for African young people who consume alcohol. Given the importance of social relationships within this community, use of peer-based strategies are likely to be particularly effective. Development and implementation of programmes that address the underlying health and psychosocial causes and consequences of heavy alcohol use are also needed.
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Affiliation(s)
- Danielle Horyniak
- a Centre for Population Health, Burnet Institute , 85 Commercial Rd, Melbourne , VIC 3004 , Australia
- b School of Public Health and Preventive Medicine , Monash University , 99 Commercial Rd, Melbourne , VIC 3004 , Australia
| | - Peter Higgs
- a Centre for Population Health, Burnet Institute , 85 Commercial Rd, Melbourne , VIC 3004 , Australia
- b School of Public Health and Preventive Medicine , Monash University , 99 Commercial Rd, Melbourne , VIC 3004 , Australia
- c National Drug Research Institute (Melbourne Office) , Curtin University , Suite 6, 19-35 Gertrude Street, Fitzroy , VIC 3065 , Australia
| | - Shelley Cogger
- a Centre for Population Health, Burnet Institute , 85 Commercial Rd, Melbourne , VIC 3004 , Australia
| | - Paul Dietze
- a Centre for Population Health, Burnet Institute , 85 Commercial Rd, Melbourne , VIC 3004 , Australia
- b School of Public Health and Preventive Medicine , Monash University , 99 Commercial Rd, Melbourne , VIC 3004 , Australia
| | - Tapuwa Bofu
- d Centre for Culture, Ethnicity and Health , 23 Lennox St, Richmond , VIC 3121 , Australia
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Margittai Z, Strombach T, van Wingerden M, Joëls M, Schwabe L, Kalenscher T. A friend in need: Time-dependent effects of stress on social discounting in men. Horm Behav 2015; 73:75-82. [PMID: 26122295 DOI: 10.1016/j.yhbeh.2015.05.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/27/2015] [Accepted: 05/30/2015] [Indexed: 01/15/2023]
Abstract
Stress is often associated with a tend-and-befriend response, a putative coping mechanism where people behave generously towards others in order to invest in social relationships to seek comfort and mutual protection. However, this increase in generosity is expected to be directed only towards a delimited number of socially close, but not distant individuals, because it would be maladaptive to befriend everyone alike. In addition, the endocrinological stress response follows a distinct temporal pattern, and it is believed that tend-and-befriend tendencies can be observed mainly under acute stress. By contrast, the aftermath (>1h after) of stress is associated with endocrinological regulatory processes that are proposed to cause increased executive control and reduced emotional reactivity, possibly eliminating the need to tend-and-befriend. In the present experiment, we set out to investigate how these changes immediately and >1h after a stressful experience affect social-distance-dependent generosity levels, a phenomenon called social discounting. We hypothesized that stress has a time-dependent effect on social discounting, with decisions made shortly after (20min), but not 90min after stress showing increased generosity particularly to close others. We found that men tested 20min after stressor onset indeed showed increased generosity towards close but not distant others compared to non-stressed men or men tested 90min after stressor onset. These findings contribute to our understanding on how stress affects prosocial behavior by highlighting the importance of social closeness and the timing of stress relative to the decision as modulating factors in this type of decision making in men.
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Affiliation(s)
- Z Margittai
- Comparative Psychology, University of Düsseldorf, Germany.
| | - T Strombach
- Comparative Psychology, University of Düsseldorf, Germany.
| | | | - M Joëls
- Dept. Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - L Schwabe
- Department of Cognitive Psychology, Institute for Psychology, University of Hamburg, Germany.
| | - T Kalenscher
- Comparative Psychology, University of Düsseldorf, Germany.
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50
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Abstract
What makes for a good life? The capabilities approach to this question has much to offer community psychology, particularly with respect to marginalized groups. Capabilities are freedoms to engage in valued social activities and roles-what people can do and be given both their capacities, and environmental opportunities and constraints. Economist Amartya Sen's focus on freedoms and agency resonates with psychological calls for empowerment, and philosopher Martha Nussbaum's specification of requirements for a life that is fully human provides an important guide for social programs. Community psychology's focus on mediating structures has much to offer the capabilities approach. Parallels between capabilities, as enumerated by Nussbaum, and settings that foster positive youth development, as described in a National Research Council Report (Eccles and Gootman (Eds) in Community programs to promote youth development. National Academy Press, Washington, 2002) suggest extensions of the approach to children. Community psychologists can contribute to theory about ways to create and modify settings to enhance capabilities as well as empowerment and positive youth development. Finally, capabilities are difficult to measure, because they involve freedoms to choose but only choices actually made or enacted can be observed. The variation in activities or goals across members of a setting provides a measure of the capabilities that the setting fosters.
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Affiliation(s)
- Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, #90, 230 Appleton Place, Nashville, TN, 37203-5721, USA,
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