Different factors identified by stakeholder group for barriers and facilitators to measurement-based care implementation in behavioral health clinics.

INTRODUCTION: Despite the benefits of measurement-based care (MBC) in the behavioral health setting, there have been difficulties in implementation and low saturation. Although barriers and facilitators to MBC implementation have been identified, research has generally only included the perspective of one stakeholder group. The current study aims to examine the similarities and differences-by stakeholder group-in the identified barriers to and facilitators of implementing MBC in the behavioral health setting. METHOD: A purposeful sampling approach was used to recruit and conduct interviews and focus groups with stakeholders (clinicians, clinic leaders, and administrative staff) from four behavioral health clinics at an academic medical center that is part of a larger healthcare system. The data coding process included a directed content analytic approach whereby the coding team used an iterative process to analyze deidentified transcripts starting with a codebook based on the Consolidated Framework for Implementation Research (CFIR) constructs. RESULTS: A total of 31 clinicians, 11 clinic leaders, and 8 administrative staff participated in the interviews and focus groups. There was convergence among all stakeholder regarding which CFIR constructs were identified as barriers and facilitators, but there were differences in the specific thematic factors identified by stakeholders as barriers and facilitators within each of these implementation constructs. The barriers and facilitators that stakeholders identified within each CFIR construct were often connected to their specific role in implementing MBC. CONCLUSION: Collecting information on barriers and facilitators to MBC implementation from the multiple stakeholders involved in the process may enhance successful implementation of MBC given the variation between groups in identified thematic factors. Administrative staff perspectives, which have not been reported in the literature, may be of particular importance in planning for successful MBC implementation.

Treatment Seeking for Anxiety and Depression Among Black Adults: A Multilevel and Empirically Informed Psycho-Sociocultural Model.

Black adults with anxiety and/or depressive disorders underutilize outpatient psychotherapy and pharmacological treatment compared to White adults. Notably, anxiety and depressive disorders tend to be chronic and Black individuals with these disorders experience greater functional impairment than White individuals. Documented racial disparities in mental health treatment initiation indicate a need for research that addresses culture-specific barriers to treatment. This review paper critically evaluates existing theoretical models of treatment seeking among Black adults to inform a novel integrated, culturally contextualized model. This model extends previous ones by incorporating factors relevant to treatment seeking among Black adults (e.g., racial identity, perceived discrimination, medical mistrust) and critically examines how these factors intersect with key factors at three levels of influence of the treatment seeking process: the individual level, the community level, and the societal level. We posit interactions among factors at the three levels of influence and how these may impact treatment seeking decisions among Black adults. This model informs suggestions for enhancing interventions designed to support outpatient service use among Black adults.

Perceived injunctive norms and cannabis-related problems: The interactive influence of parental injunctive norms and race.

Cannabis use among college students is associated with negative consequences, including those that can negatively affect academic functioning. Perceived descriptive and injunctive norms are among the strongest predictors of college cannabis use and related problems, and perceived norms differentially relate to cannabis outcomes depending on the reference group (e.g., close friends, family members). However, no known studies have examined the effect of race on these relationships. Yet, given that African American students are more strongly affected by parental influence than Caucasian students and that they endorse more social motives for cannabis use, African American students may be affected by perceived norms regarding parents and friends differentially from Caucasian students. The current study tested the moderational role of race on the relationship between perceived norms and cannabis use and related problems. Cannabis-using undergraduates (N = 103; 78.6% female) completed an online survey. Race moderated the relationship between injunctive norms regarding parents and cannabis-related problem severity such that among African American students (but not Caucasian students), endorsement of more permissive perceived parental injunctive norms was related to greater cannabis-related problem severity (but not cannabis use frequency). Interactions were not significant between race and descriptive norms or between race and peer injunctive norms. African American students who perceive that their parents are more accepting of cannabis use may be especially at risk for cannabis-related problems. Results underscore the importance of considering cultural factors in identification of vulnerability factors related to cannabis problems.

Willingness to Seek Treatment Among Black Students With Anxiety or Depression: The Synergistic Effect of Sociocultural Factors With Symptom Severity and Intolerance of Uncertainty.

Anxiety and depressive disorders are among the most commonly diagnosed psychiatric disorders, yet they remain largely undertreated in the U.S. and Black adults are especially unlikely to seek or receive mental health services. Symptom severity has been found to impact treatment-seeking behaviors as have sociocultural factors. Yet no known research has tested whether these factors work synergistically to effect willingness to seek treatment. Further, emerging data point to the importance of transdiagnostic risk factors such as intolerance of uncertainty (IU). IU may be negatively related to seeking treatment given that Black adults may be uncertain whether treatment might benefit them. Thus, the current study examined the relations between symptom severity/IU and willingness to seek treatment for anxiety/depression problems and the impact of key sociocultural variables (i.e., cultural mistrust-interpersonal relations [CMI-IR], perceived discrimination [PED]) on these relations among 161 (85% female) Black undergraduates. Consistent with prediction, symptom severity was positively related to willingness, but unexpectedly, IU was positively related. There was a significant Symptom Severity × CMI-IR interaction such that severity was positively related to willingness among students with lower cultural mistrust, but not higher mistrust. There were also significant IU × PED interaction such that IU was positively related to willingness among students with lower PED, but not higher PED. Results highlight the importance of considering the interplay between symptom severity, transdiagnostic vulnerability factors, and sociocultural variables when striving to identify factors related to treatment seeking behaviors among anxious and/or depressed Black students.

Anxiety sensitivity and cannabis use-related problems: The impact of race.

BACKGROUND AND OBJECTIVES: Cannabis is the most widely used illicit substance among young adults. Anxiety sensitivity (AS; ie, fear of anxiety-related symptoms) is positively related to coping motives for cannabis use (which are robustly positively linked to cannabis-related problems). However, AS is unrelated to cannabis use-related problems. Yet, extant studies have been conducted on primarily White samples. It may be that among Black students, AS-physical concerns (ie, fear of physical anxiety-related sensations) are related to cannabis problems given that Black individuals are more likely than White individuals to report experiencing greater and more intense somatic symptoms when experiencing anxiety. Black individuals may rely on cannabis to cope with fear of these somatic symptoms, continuing to use despite cannabis-related problems. METHODS: The current study tested whether race moderated the relation between AS-physical concerns and cannabis problems among 102 (85.3% female) current cannabis using undergraduates who were either non-Hispanic Black (n = 51) or non-Hispanic White (n = 51). RESULTS: After controlling for frequency of cannabis use, income, and gender, race significantly moderated the relation between AS-physical concerns and cannabis use-related problems such that AS-physical concerns significantly predicted cannabis-related problems among Black and not White individuals. DISCUSSION AND CONCLUSIONS: Findings highlight the importance of considering race in identifying psychosocial predictors of cannabis-related problems. SCIENTIFIC SIGNIFICANCE: Intervention strategies for Black cannabis users may benefit from examining and targeting AS-physical concerns. (Am J Addict 2017;26:209-214).

Anxiety and cannabis-related problem severity among dually diagnosed outpatients: The impact of false safety behaviors.

Cannabis use disorder (CUD) co-occurs with anxiety disorders at high rates. Little is known about the mechanisms linking CUD and anxiety disorders. One theoretically-driven perspective is that individuals with anxiety disorders may be more apt to use FSBs (i.e., behaviors that may be effective in decreasing anxiety in the short-term, but can maintain and even exacerbate anxiety in the long-term), which can perpetuate cannabis use despite cannabis-related problems. The present study tested whether FSB use explained the relation of anxiety symptom severity with cannabis quantity and related problems among 77 adults with CUD and comorbid anxiety disorders seeking outpatient CUD treatment. Results indicated that FSB frequency was significantly related to anxiety symptom severity and cannabis problem severity, but not cannabis quantity. Anxiety symptom severity was indirectly (via FSB frequency) related to cannabis problem severity, but not to cannabis quantity. These novel findings suggest that more frequent use of FSBs may play an important role in cannabis problem severity among individuals with CUD and anxiety disorders.

Social anxiety and post-event processing among African-American individuals.

BACKGROUND: Social anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to social anxiety in predominantly White samples are related to social anxiety among historically underrepresented groups. DESIGN: We tested whether one such vulnerability factor, post-event processing (PEP; detailed review of social event that can increase state social anxiety) was related to social anxiety among African-American (AA; n = 127) persons, who comprise one of the largest underrepresented racial groups in the U.S. Secondarily, we tested whether AA participants differed from non-Hispanic White participants (n = 127) on PEP and social anxiety and whether race moderated the relation between PEP and social anxiety. METHOD: Data were collected online among undergraduates. RESULTS: PEP was positively correlated with social anxiety among AA participants, even after controlling for depression and income, pr = .30, p = .001. AA and White participants did not differ on social anxiety or PEP, ß = -1.57, 95% CI: -5.11, 1.96. The relation of PEP to social anxiety did not vary as a function of race, ß = 0.00, 95% CI: -0.02, 0.02. CONCLUSIONS: PEP may be an important cognitive vulnerability factor related to social anxiety among AA persons suffering from social anxiety.

Solitary cannabis use frequency mediates the relationship between social anxiety and cannabis use and related problems.

BACKGROUND AND OBJECTIVES: Individuals with elevated social anxiety are seven times more likely to meet criteria for cannabis use disorders, yet social anxiety is unrelated to more frequent cannabis use. The lack of relation to cannabis use frequency may be at least partially due to lack of attention to cannabis use context. It may be that socially anxious persons engage in frequent solitary cannabis use, perhaps using before social situations in the hope that being intoxicated during the social event will help them feel less anxious. In fact, using cannabis alone has been associated with experiencing more cannabis-related problems in prior work. METHODS: The current study sought to identify whether solitary cannabis use frequency mediated the relationship between social anxiety and cannabis-related problems among 276 current cannabis using undergraduates who completed an online survey of putative predictors of substance use. RESULTS: Social anxiety was robustly related to more frequent solitary (but not social) cannabis use and solitary cannabis use frequency uniquely mediated the relation of social anxiety to cannabis use and related problems. DISCUSSION AND CONCLUSIONS: Frequent solitary use appears to play an important role in the experience of cannabis-related problems among socially anxious persons. SCIENTIFIC SIGNIFICANCE: Intervention strategies may benefit from targeting frequent solitary cannabis use, particularly among at-risk users such as those with elevated social anxiety.

Cannabis use frequency and use-related impairment among African-American and White users: the impact of cannabis use motives.

OBJECTIVES: Cannabis use motives are differentially related to cannabis-related impairment and coping motives appear to have the strongest relation to use-related impairment. However, it is currently unknown whether African-American individuals differ from White persons in reasons for using cannabis. It is also unknown whether motives' relations to cannabis use and related impairment vary as a function of race. The present study examined the role of race on cannabis use motives and tested whether motives' relations with cannabis use and related impairment differed by race. DESIGN: The sample consisted of 111 (67.6% non-Hispanic White, 32.4% African-American) current cannabis-using adults. RESULTS: African-American participants did not significantly differ from White participants on cannabis use frequency or use-related impairment. African-American participants endorsed more social motives than White participants. Race interacted with social, coping, and conformity motives to predict cannabis-related impairment such that these motives were positively related to cannabis impairment among African-American, but not White, participants. CONCLUSION: Although African-American and White participants do not differ in their cannabis use frequency or cannabis-related impairment, they appear to use cannabis for different reasons. Further, conformity, coping, and social motives were differentially associated with cannabis-related impairment as a function of race. Findings suggest motives for cannabis use should be contexualised in the context of race.

Addictive Behavior Interventions Among College Students.

PURPOSE OF REVIEW: Addictive behaviors among college students are a significant public health concern. This manuscript reviews the past two years of literature on prevention and treatment approaches for college students who engage in addictive behaviors. RECENT FINDINGS: In-person skills-based interventions and motivational interventions that incorporate personalized feedback are effective in the short-term but little support was found for long-term effects. Although web-based interventions reduced certain addictive behaviors (e.g., alcohol, problematic gambling), in-person interventions that include motivational interviewing components and personalized feedback appear to be more efficacious. SUMMARY: Research has largely focused on alcohol and little is known about the utility of interventions for students who use tobacco or illicit substances or who engage in problematic gambling. Research on interventions for these high-risk behaviors is recommended.