Systemic biases promoting the under-inclusion of marginalized groups in randomized controlled trials for co-occurring alcohol use and posttraumatic stress disorder: an intersectional analysis.

Co-occurring posttraumatic stress disorder and alcohol use disorder is a major public health concern affecting millions of people. Although this disorder affects people from all groups, research shows that, when compared to White people, people of color systematically suffer worse chronicity and burden of disorder. Additionally, research shows that people of color endure a variety of barriers to accessing treatment and often require specialized or culturally appropriate care. Consequently, the array of treatments available must have been determined to be effective for people of color when they access treatment, and people of color must be well represented in research to ensure effective treatment. Therefore, randomized controlled trials testing treatments for this disorder must include racially diverse samples and ensure treatments are effective for all groups. Further, if they lack diversity, it is necessary to explore whether and how the process of conducting randomized controlled trials is biased toward the constrained inclusion of people of color. This study used a Matrix of Domination framework as an intersectional method to investigate this question. It assessed the inclusion of people by race and sex in randomized controlled trials for co-occurring posttraumatic stress disorder and alcohol use disorder. We found that people of color and White women are significantly underincluded in randomized controlled trials and that these studies are hegemonically, disciplinarily, and structurally biased in ways that facilitate the overrepresentation of White men and the underrepresentation of marginalized groups.

Building a culture of support: The use of a social norms campaign to create a trauma-informed campus community.

In 2019, (Michigan State University) conducted a campus-wide climate survey on relationship violence and sexual misconduct (RVSM; the 'Know More' Survey), which revealed that many students, faculty, and staff did not know where to go for help or how to support survivors. Objective: The authors collaborated on the design and launch of the 'Support More' Campaign in 2021-2022, a trauma-informed social norms campaign created to educate the campus community on how to respond to disclosures of RVSM and how to access campus-based services. Methods: Undergraduate students, graduate/professional students, faculty, and staff (n = 10,993) completed another 'Know More' Survey in spring 2022. Results: Nearly one-half of respondents reported being very or somewhat aware of the 'Support More' campaign. Respondents who had utilized campaign materials found them helpful. Conclusions: Social norm campaigns can help campus communities become aware of RVSM services and how to support survivors.

An examination of individual, relational, and cultural risk for disordered eating in Asian American college students.

Objective: This study examined how individual (satisfaction of basic psychological needs), relational (perceived achievement- and dependency-oriented parental psychological control), and cultural (ethnic identity) factors may contribute to Asian American college students' (18 - 25 years of age) disordered eating. Participants: Asian American college students (N = 118) participated in the study. Methods: Participants completed a cross-sectional survey study. Moderated mediation models were used to analyze the data. Results: Analyses showed that perceived achievement-oriented, but not dependency-oriented, parental psychological control was more strongly associated with psychological needs satisfaction at higher, compared to lower, levels of ethnic identity. Conclusions: Findings highlighted the importance of both parenting and ethnic identity among Asian American college students' psychological needs and risk for disordered eating. The complex relations among achievement expectations, ethnic identity and wellbeing in Asian Americans are discussed. The results can inform intervention and prevention programs attending to the needs of this population.

Palliative Education and Care for the Homeless (PEACH): A Model of Outreach Palliative Care for Structurally Vulnerable Populations.

The Palliative Education and Care for the Homeless (PEACH) program comprises a community palliative care team serving some of the most complex clients in the healthcare system. Formal partnerships bring together physician, nursing, psychosocial and homecare, health and housing navigation supports. PEACH has served over 1,000 clients, leading field-defining research, medical education and public advocacy. The PEACH program demonstrates that innovation through deep interorganizational and intersectoral integration can drive value-based impact for the most complex clients, providing instructive lessons for public health system reform well beyond the margins faced by people who are unhoused. This paper describes how PEACH's unique model, critical community partnerships and research have been necessary for it to become a leader in community-based palliative care for structurally vulnerable people.

Adopting a "Both/And" Mindset to Address Relationship Violence and Sexual Misconduct (RVSM) in Institutions of Higher Education.

Michigan State University (MSU) created a long-term, values-based strategic plan to increase help-seeking and reduce the incidence of relationship violence and sexual misconduct. Creating systemic change in institutions of higher education is challenging, particularly so in the wake of massive institutional crises and betrayal, as we had at MSU. In this paper, we address the challenges and critiques of our strategic planning efforts offered by esteemed scholar-activists: Jacobson López (2023), Hirsch and Khan (2023), McMahon (2023), and Boots et al. (2023).

Creating a University Strategic Plan to Address Relationship Violence and Sexual Misconduct (RVSM): An Application of Principles-Focused Evaluation at Michigan State University.

This paper describes a multi-year initiative at Michigan State University (MSU) to change our institutional response to relationship violence and sexual misconduct (RVSM) in the aftermath of a large-scale institutional crisis. While the circumstances at MSU are unique, many universities have faced or will face moments that bring RVSM issues into the spotlight. To inform other colleges and universities, we describe how we developed a 5-year strategic plan to transform services for survivors and develop prevention programming for multiple audiences and at multiple levels of analysis. We titled this framework Know More. Do More. Support More, whereby "know more" reflects our ongoing use of campus climate surveys and data sharing to educate our community about RVSM; "do more" includes our institutional-level strategic plan for culture change; and "support more" provides guidance to our community members on how to respond to disclosures in a trauma-informed way and connect survivors to support services. We discuss the challenges and opportunities that stemmed from our choice to work "within the system" to create this model, as well as the ethical dilemmas we faced in these partnerships.

Eating disorders treatment experiences and social support: Perspectives from service seekers in mainland China.

OBJECTIVE: This study explored treatment experiences and social support among individuals with eating disorders (EDs) in mainland China. METHOD: Subscribers of a Chinese online social media platform (WeChat) focused on EDs were invited to complete a screening questionnaire that included the Eating Disorder Diagnostic Scale for the DSM-5. Of the 116 questionnaire responses, 31 met inclusion criteria for follow-up interviews. Individuals who never sought treatment were not eligible for follow-up interviews, but provided brief explanations about why they did not seek treatment. All eligible participants (n = 31) completed a semi-structured interview about their experiences with ED treatment and social support. Qualitative data from the interviews and survey responses regarding not seeking treatment were subjected to inductive data-driven thematic analysis with deductive coding to illuminate treatment and social support experiences or reasons for not seeking treatment. RESULTS: Themes emerged from interviews revealed positive inpatient treatment experiences for anorexia nervosa, but negative outpatient treatment experiences, unaffordable care, and ineffective psychopharmacological treatments. Parents, friends, and partners were sources of social support, but participants largely felt misunderstood or blamed by these same entities. Shame, not recognizing ED as an illness, and financial constraints were listed as the primary reasons for not seeking treatment. DISCUSSION: The importance of hearing patients' perspectives, improving ED literacy in China, increasing knowledge of culturally specific manifestations of EDs, and developing culturally responsive services and dissemination of treatment resources are emphasized.

Intersectionality Research in Psychological Science: Resisting the Tendency to Disconnect, Dilute, and Depoliticize.

Psychological science has been slow to incorporate intersectionality as a concept and as a framework for conducting research. This limits not only the potential for intersectionality theory, but also limits the potential impact of the research claiming to use it. Mennies and colleagues conducted a study of psychopathology and treatment utilization using a large racially diverse sample of youth and frame their work as intersectional because they compare across three social categories (race, sex, and social class) and consider social issues that may impact the groups studied. We argue that while this represents a preliminary step, it does not represent intersectionality theory and praxis. In this article we review intersectional theory and praxis, examine psychological science and its resistance to fully incorporating intersectionality, and highlight how research must shift to be truly intersectional. Finally, we issue a call to the field to integrate intersectionality theory and praxis and to resist the tendency to dilute and depoliticize intersectionality theory and disconnect from its social justice frame.

Upending racism in psychological science: Strategies to change how science is conducted, reported, reviewed, and disseminated.

As efforts to end systemic racism gain momentum across various contexts, it is critical to consider antiracist steps needed to improve psychological science. Current scientific practices may serve to maintain white supremacy with significant and impactful consequences. Extant research practices reinforce norms of homogeneity within BIPOC (Black, Indigenous, and other People of Color) populations, segregate theories, and methods derived from BIPOC groups, apply disparate standards to the evaluation of research on white versus BIPOC populations, and discourage BIPOC scholars from pursuing research careers. Perhaps consequently, disparities persist on a range of psychologically relevant outcomes (e.g., mental and physical health). This article presents examples of how epistemic oppression exists within psychological science, including in how science is conducted, reported, reviewed, and disseminated. This article offers a needed contribution by providing specific concrete recommendations for different stakeholders, including those involved in the production, reporting, and gatekeeping of science as well as consumers of science. Additionally, a discussion of accountability steps are offered to ensure that psychological science moves beyond talk and toward action, with possible strategies to measure outcomes, stimulate progress, promote dialogue and action, challenge inequity, and upend the influence of white supremacy in psychological science. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of Its Provision.

Psychedelic medicine is an emerging field that examines entheogens, psychoactive substances that produce non-ordinary states of consciousness (NOSC). 3,4-methylenedioxymethamphetamine (MDMA) is currently in phase-3 FDA clinical trials in the United States (US) and Canada to treat the symptoms of posttraumatic stress disorder (PTSD). MDMA is used in conjunction with manualized therapy, because of its effectiveness in reducing fear-driven stimuli that contribute to trauma and anxiety symptoms. In 2017, the FDA designated MDMA as a "breakthrough therapy," signaling that it has advantages in safety, efficacy, and compliance over available medication for the treatment of trauma-, stress-, and anxiety-related disorders such as PTSD. In the US and Canada, historical and contemporary racial mistreatment is frequently experienced by Black people via a variety of macro and micro insults. Such experiences trigger physiological responses of anxiety and fear, which are associated with chronically elevated stress hormone levels (e.g., cortisol and epinephrine), similar to levels documented among those diagnosed with an anxiety disorder. This paper will explore the benefits of entheogens within psychedelic assisted-therapy and their potential benefits in addressing the sequelae of pervasive and frequent negative race-based experiences and promoting healing and thriving among Black, Indigenous and other People of Color (BIPOC). The author(s) discuss the ethical responsibility for providing psychedelic-assisted therapy within a culturally competent provider framework and the importance of psychedelic researchers to recruit and retain BIPOC populations in research and clinical training.

A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis.

BACKGROUND: Cognitive behavioural therapy (CBT) is a widely used treatment for depression. However, limited resource availability poses several barriers to patients seeking access to care, including lengthy wait times and geographical limitations. This has prompted health care services to introduce electronically delivered CBT (eCBT) to facilitate access. Although previous reviews have compared the effects of eCBT to face-to-face CBT, there is an overall lack of adequately powered and up-to-date evidence in the literature to provide a reliable comparison between the two modes of administration. The purpose of this study is to evaluate the effects of eCBT compared to face-to-face CBT through a systematic review of the literature. METHODS: To be eligible for this review, studies needed to be randomized controlled trials evaluating the clinical effectiveness of any form of eCBT compared to face-to-face CBT. These encompassed studies evaluating a wide range of outcomes including severity of symptoms, adverse outcomes, clinically relevant outcomes, global functionality, participant satisfaction, quality of life, and affordability. There were no restrictions on participant age or sex.We searched MEDLINE, EMBASE, Psych Info, Cochrane CENTRAL and CINAHL databases from inception to February 20th, 2020 using a comprehensive search strategy. All stages of literature screening and data extraction were completed independently in duplicate. Data extraction and risk of bias analyses, including GRADE ratings, were conducted on studies meeting inclusion criteria. Qualitative measures are reported in a narrative summary. We pooled quantitative data in meta-analyses to provide an estimated summary effect. This review adheres to PRISMA reporting guidelines. FINDINGS: In total, we included 17 studies in our analyses. Our results demonstrated that eCBT was more effective than face-to-face CBT at reducing depression symptom severity (Standardized mean difference [SMD]: -1.73; 95% confidence interval [CI]: -2.72, -0.74; GRADE: moderate quality of evidence). There were no significant differences between the two interventions on participant satisfaction (SMD 0.13 95%; CI -0.32, 0.59; GRADE: low quality of evidence). One RCT reported eCBT to be less costly than face-to-face CBT (GRADE: low quality of evidence). Results did not differ when stratified by subgroups such as participant age and study location. INTERPRETATION: Although we found eCBT to have moderate evidence of effectiveness in reducing symptoms of depression, high heterogeneity among studies precludes definitive conclusions for all outcomes. With the current reliance and accessibility of technology to increasing number of people worldwide, serious consideration in utilizing technology should be given to maximize accessibility for depression treatments. Our results found eCBT is at least as effective as face to face CBT, thus eCBT should be offered if preferred by patients and therapists. FUNDING: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Discrimination and Ethnic-Racial Socialization Among Youth Adopted From South Korea Into White American Families.

The current study examined how discrimination relates to adjustment outcomes in a sample of internationally, transracially adopted Korean Americans from the Minnesota Sibling Interaction and Behavior Study (N = 456 adoptees; Mage at T1 = 14.9, Mage at T2 = 18.3, Mage at T3 = 22.3). The moderating roles of ethnic socialization and preparation for bias by parents (i.e., ethnic-racial socialization) were also examined. Results indicated that discrimination predicted higher levels of depressive and externalizing symptoms in youth who reported less preparation for bias. In those experiencing more preparation for bias, associations were not significantly different from zero. Ethnic socialization did not moderate these associations. Such findings provide important information for adoptive parents regarding how to prepare their children to cope with discrimination.

Etiologic and treatment conceptualizations of disordered eating symptoms among mainland Chinese therapists.

OBJECTIVE: Reports of disordered eating are increasing in mainland China; however, little is known regarding Chinese psychotherapists' conceptualizations of disordered eating symptomatology. This study explores Chinese psychotherapists' conceptualizations of binge eating (BE)/vomiting symptoms and treatment considerations. METHOD: In-depth, semi-structured interviews were conducted with mainland Chinese psychotherapists (N = 41) in Mandarin. Participants were given a hypothetical case and provided their conceptualization of the patient's BE/vomiting etiology and treatment recommendations. Etiological conceptualizations were coded using directed content analysis, and treatment recommendations were grouped by intervention strategy. RESULTS: Participants described psychosocial risk factors for BE/vomiting including intrapersonal characteristics and the childhood family environment, but rarely discussed genetic and neurobiological factors. Few participants reported that they would prioritize the BE/vomiting symptoms in treatment and their specific treatment recommendations varied widely. DISCUSSION: Most research on BE/vomiting behaviors in the literature is based on Western samples with little attention to mainland Chinese populations. Participants in this study provided conceptualizations of risk factors and treatment recommendations that could generally find evidence in the existing Western literature, even if some theories are no longer supported by updated Western research and the participants focused primarily on psychosocial risks as opposed to genetic/neurobiological factors. It will be important for future research to ascertain mainland Chinese therapists' understanding of these additional types of risk. These findings also suggest a disconnect between clinical findings on neurobiological risks and Chinese therapists' knowledge and/or perceived clinical utility of these risks. Implications for treatment and research dissemination to diverse global communities are discussed.

Advancing Theory, Methods, and Dissemination in Sexual Violence Research to Build a More Equitable Future: An Intersectional, Community-Engaged Approach.

Sexual violence is a devastating trauma with long-lasting effects on survivors' health and well-being. Despite the substantial impacts of the last 25 years of research, the prevalence of sexual violence has remained stable. It will be necessary to reconceptualize our work, challenging our theories, methods, and strategies for dissemination and implementation moving forward. We outline an intersectional, community-engaged approach for sexual violence research to center the stories of survivors who face systemic oppression and inequity. Finally, we suggest applications of this approach for justice, healing, and prevention to inform our collective work to end sexual violence.

Making the Cut: Perspectives on the Surgical Management of Infective Endocarditis Among People Who Use Intravenous Drugs.

In this article we review the perspectives in the literature around surgical treatment for infective endocarditis (IE) in people who use intravenous drugs (PUID). PUID are at increased risk for IE; however, controversy exists regarding how to best manage these patients. We explore the outcomes for surgical treatment in PUID with IE, contrasting these with patients with IE who do not use drugs. We describe some of the perspectives in the literature around second valve replacement for PUID with IE, arguing that moralistic arguments are not on the basis of evidence and perpetuate the stigma experienced by PUID who seek treatment for IE. Finally, we explore the role of substance use interventions in the treatment of PUID with IE, and advocate for further evidence. PUID with IE are a highly stigmatized patient subgroup for whom best practice management strategies are not always implemented, emphasizing the need for further research and advocacy.

Reconceptualizing successful aging among black women and the relevance of the strong black woman archetype.

Although there are multiple pathways to successful aging, little is known of what it means to age successfully among black women. There is a growing body of literature suggesting that black women experience a number of social challenges (sexism and racism) that may present as barriers to aging successfully. Applying aspects of the Strong Black Women ideal, into theoretical concepts of successful aging, may be particularly relevant in understanding which factors impair or promote the ability of black women to age successfully. The Strong Black Women archetype is a culturally salient ideal prescribing that black women render a guise of self-reliance, selflessness, and psychological, emotional, and physical strength. Although this ideal has received considerable attention in the behavioral sciences, it has been largely absent within the gerontology field. Nevertheless, understanding the dynamics of this cultural ideal may enhance our knowledge while developing an appreciation of the black woman's ability to age successfully. Rather than summarize the social, physical, and mental health literature focusing on health outcomes of black women, this conceptual review examines the Strong Black Women archetype and its application to the lived experiences of black women and contributions to current theories of successful aging. Focusing on successful aging exclusively among black women enhances our understanding of this group by considering their identity as women of color while recognizing factors that dictate their ability to age successfully.

Sex differences in outcomes and harasser characteristics associated with frightening sexual harassment appraisals.

This study examined data from U.S. military personnel (1,764 men; 4,540 women) to determine whether appraisals of sexual harassment as frightening mediate the relationship between perpetrator characteristics (perpetrator sex and rank) and three psychological/job outcomes (psychological distress, role limitations, and work satisfaction), and whether these relationships were stronger for women than men. Results indicated that frightening appraisals mediated the relationship between perpetrator rank and all outcomes for both sexes. However, frightening appraisals mediated the relationship between perpetrator sex and outcomes only for women. As predicted, having a male perpetrator or a higher status perpetrator was more strongly related to frightening appraisals for women than men. However, unexpectedly, the relationship between frightening appraisals and more psychological distress, more role limitations, and less work satisfaction was stronger for men than women. We discuss the results in terms of expectancy norm violations and sexual harassment as a form of dominance.

Exploring gender differences in body image, eating pathology, and sexual harassment.

This study examines the relationship between body image (weight/shape concerns), eating pathology, and sexual harassment among men and women (N=2446). Hierarchical regressions controlling for depression revealed main effects of gender such that women reported greater weight/shape concerns, eating pathology, dietary restraint, eating concerns, and binge eating compared to men. Main effects for sexual harassment indicated that as harassment increased, participants reported increased weight/shape concerns, eating pathology, dietary restraint, eating concerns, binge eating, and compensatory behaviors. There were small but significant interactions between gender and harassment for eating pathology total score (which included each of the domains listed above), weight/shape concerns, dietary restraint, and eating concerns such that the relationship between increased harassment and increased pathology was stronger for women compared to men. The largest interaction was found for compensatory behaviors, such that while women and men's scores both increased as harassment increased, the relationship was stronger for men.

Disparities and social inequities: is the health of African American women still in peril?

An amalgam of health concerns differentially affects the behavioral, psychological, and physical well-being of African American women. These disparities are both the result of, and contributors to, marked differences in the perception, interpretation and treatment of various psychological disorders and chronic medical conditions. Data show that African American women are diagnosed with more chronic and debilitating illnesses than found in the general population, and are often misdiagnosed with a myriad of psychiatric and medical disorders. Despite these findings, ambiguity remains about the contextual factors that affect the physical and mental well-being of African American women. The focus of this review was not to describe all psychological or medical conditions with deleterious outcomes among African American women, but rather collectively address identified mental and physical health issues prevailing among African American women. This approach addresses the urgent need to better understand the health needs of African American women in the United States, and demonstrates how advancing our knowledge of this marginalized group may lead to sustaining mental and physical health-related dialogue, while advancing policy.

Sexual harassment across the color line: experiences and outcomes of cross- versus intraracial sexual harassment among Black women.

The current study examined differences in appraisal, harassment, and severity of posttraumatic stress symptoms among 105 Black women who were sexually harassed by either a White (cross-racial sexual harassment) or a Black man (intraracial sexual harassment). Analyses revealed that women appraised cross-racial more negatively than intraracial harassment, despite there being no significant differences in the likelihood of experiencing gender harassment, unwanted sexual attention, or sexual coercion. Further, cross-racial harassment was more likely to include racialized sexual harassment (harassing behaviors combining race and gender simultaneously) and higher status perpetrators. Finally, cross-racial sexual harassment had an indirect (but not direct) mediated effect on posttraumatic stress via participants' appraisals of their harassment. Specifically, the more negative appraisal associated with cross-racial sexual harassment was associated with increased posttraumatic stress symptoms. In light of these findings, consideration of perpetrator race and racially sexualized behaviors could prove significant additions to current models of sexual harassment.