Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders.

ABSTRACT: Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1-10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.

Discrimination and Internalizing Symptoms in Rural Latinx Adolescents: The Protective Role of Family Resilience.

OBJECTIVE: There is a well-documented relationship between discrimination and increases in internalizing symptoms among rural Latinx youth. Among numerous assets in these adolescents' lives, family resilience emerges as a culturally relevant and robust protective factor. However, it is still unclear whether family resilience is equally protective across different internalizing symptom clusters and whether this buffering effect is independent of other interconnected resilience sources. METHOD: Latinx adolescents from an underserved rural community (n = 444; Mage = 15.74, SDage = 1.22; 51% male) reported on their internalizing symptoms, experiences of discrimination, and sources of resilience. We examined whether perceived family resilience moderated the association between perceived discrimination and self-reported depressive, somatic, and anxiety symptoms over and above adolescents' sex, self-reported level of acculturation, as well as perceived individual and contextual resilience. RESULTS: Analyses showed that perceived discrimination experiences were robustly associated with higher levels of self-reported internalizing symptoms, while perceived family resilience was related to lower self-reported symptomatology. Closer examination revealed that perceived family resilience buffered the negative effects of perceived discrimination on self-reported depression and somatic symptoms, but not anxiety symptoms. CONCLUSIONS: This study addresses a gap in the literature by identifying differential protective effects of family resilience that might be explained by cultural values and practices in rural Latinx families. Findings suggest that interventions that incorporate family members and promote supportive family environments may benefit rural Latinx youth with a broad range of internalizing symptoms.

Trauma Exposure and Mental Health Symptoms in Rural Latinx Adolescents: The Role of Family Processes.

Previous research suggests that rural Latinx youth are more likely to experience traumatic events and are at higher risk for developing subsequent psychopathology compared to non-Latinx white youth. The aim of this study is to understand how family processes and values affect risk for internalizing and externalizing symptoms among rural Latinx youth (N = 648, mage = 15.7 (SD = 1.2)) who are exposed to trauma. Multiple mediation analyses were performed to understand if family variables such as familism and family conflict explain the relationship between trauma exposure and psychopathology. Results suggest that familism partially mediates the relationship between trauma exposure and internalizing and externalizing symptoms, whereas family conflict partially mediates the relationship between trauma exposure and externalizing symptoms. These findings show that family variables are differentially impacted by trauma and have a separate and unique impact on mental health outcomes among rural Latinx youth. Specifically, our findings suggest that familial support or closeness may constitute a nonspecific protective factor for psychopathology among Latinx youth, whereas family conflict creates a stressful home environment that may deter adolescent trauma recovery and lead specifically to externalizing symptoms.

Vicarious Improvement Among Parents Participating in Child-Focused Cognitive-Behavioral Therapy for Anxiety.

Parental variables likely have important and bidirectional influences on the etiology of child anxiety. Although some child-focused cognitive-behavioral therapy (CCBT) anxiety trials have found vicarious improvements among parents who participated in their children's treatment, this is an understudied area. We hypothesized that parental variables (psychopathology, stress, and burden) will significantly decrease from pre-to post-CCBT and will be associated with child treatment response. We explored whether intervention delivery method-in-person CCBT versus parent-mediated bibliotherapy-influenced vicarious parental improvements. Parental variables decreased from pre- to post-CCBT and were associated with child treatment response. Effects did not interact with delivery method. Parent participation in anxiety CCBT may result in vicarious improvements for parents.

Family factors mediate discrimination related stress and externalizing symptoms in rural Latino adolescents.

INTRODUCTION: Externalizing disorders are more prevalent in rural than urban settings and account for disproportionately high mental health service costs for rural adolescents. Although cultural stressors such as discrimination have been associated with externalizing problems in ethnic minority youth broadly, this relationship is understudied in Latinos, particularly those in rural settings. Further, though the associations of family processes such as familism and family conflict have been studied in relation to youth externalizing symptoms, whether these processes change in the face of adolescent discrimination stress remains unknown. METHODS: A moderated multiple mediation model was used to examine the association between perceived discrimination, externalizing symptoms, and the indirect effect of family factors (familism, and family conflict) in a large sample (n = 455) of rural Latino youth. We also evaluated whether indirect and direct effects of discrimination on externalizing symptoms differed in boys versus girls. RESULTS: Familism and family conflict each independently mediated the relationship between discrimination related stress and externalizing symptoms. However, discrimination had a direct effect on externalizing symptoms for boys only. In girls, this association held only when family factors were accounted for. Post-hoc analyses reveal that the moderating effect of sex on discrimination is driven by differences in rule-breaking behavior, as opposed to aggressive behavior. CONCLUSION: Findings suggest that discrimination is associated with changes in the family environment which in turn invoke elevated risk for externalizing problems. Further, family-focused interventions that address externalizing problems may be especially effective for adolescent girls.

Cultural influences on mental health symptoms in a primary care sample of Latinx patients.

The present study examines how both between group (i.e., ethnic group membership) and within group cultural factors (i.e., nativity status, age of immigration, and perceived discrimination) may contribute to anxiety and related symptoms in Latinx with anxiety disorders. Baseline data were examined from patients who participated in one of the largest intervention studies for adults with anxiety disorders in primary care settings; 196 Latinx and 568 NLW (non-Latinx White) patients participated. Proportions of anxiety disorders were similar between Latinx and NLWs; however, Latinx, on average, had a greater number of anxiety disorders than NLWs. Levels of anxiety and depression symptom severity, anxiety sensitivity, and mental functional impairment were similar between the ethnic groups. Latinx expressed greater somatization and physical functional impairment than NLWs. Among Latinx, perceived discrimination, but not other cultural variables, was predictive of mental health symptoms while controlling for age, gender, education, and poverty. Overall, these findings suggest more similarities than differences in types and levels of anxiety and anxiety-related impairment, with some important exceptions, including greater levels of somatization and physical functional impairment among Latinx patients. Further, perceived discrimination may be an important factor to consider when examining risk for greater symptom burden among Latinx with anxiety.

Parent-reported stigma and child anxiety: A mixed methods research study.

BACKGROUND: Stigma has been frequently cited as a barrier to service use for various mental health problems. Studies suggest that stigma may be greater for childhood mental health problems that are perceived as more atypical. AIMS: This study utilized a mixed methods research design (qual + QUAN) to examine parental endorsement of stigma and its impact on service utilization among children with significant anxiety-a common childhood problem frequently perceived as normative. METHODS: Semi-structured qualitative interviews were conducted with 29 parents of anxious children. Qualitative data were coded using a grounded theory approach, and stigma-related responses were examined for emergent themes. Quantitative data was analyzed with frequency counts and chi-square analysis. RESULTS: Stigma related to children's anxiety symptoms and seeking mental health services was reported by 41.3% (n = 12) of parents. Emergent themes included: 1) Parental Concern for Negative Consequences, 2) Parent Internalized Stigma, and 3) Negative Associations with Mental Health Treatment. Latino parents discussed stigma more frequently than non-Latino White parents (70% vs. 17.6%, respectively, X2(1, N = 27) = 5.33, p < 0.05). CONCLUSIONS: Although anxiety is a common childhood problem, stigma is still frequently reported by parents and may be an important barrier to mental health service use, especially among Latino youth.

The Empathizing-Systemizing Theory, Social Abilities, and Mathematical Achievement in Children.

The Empathizing-Systemizing (E-S) theory describes a profile of traits that have been linked to autism spectrum disorders, and are thought to encompass a continuum that includes typically developing (TD) individuals. Although systemizing is hypothesized to be related to mathematical abilities, empirical support for this relationship is lacking. We examine the link between empathizing and systemizing tendencies and mathematical achievement in 112 TD children (57 girls) to elucidate how socio-cognitive constructs influence early development of mathematical skills. Assessment of mathematical achievement included standardized tests designed to examine calculation skills and conceptual mathematical reasoning. Empathizing and systemizing were assessed using the Combined Empathy Quotient-Child (EQ-C) and Systemizing Quotient-Child (SQ-C). Contrary to our hypothesis, we found that mathematical achievement was not related to systemizing or the discrepancy between systemizing and empathizing. Surprisingly, children with higher empathy demonstrated lower calculation skills. Further analysis using the Social Responsiveness Scale (SRS) revealed that the relationship between EQ-C and mathematical achievement was mediated by social ability rather than autistic behaviors. Finally, social awareness was found to play a differential role in mediating the relationship between EQ-C and mathematical achievement in girls. These results identify empathy, and social skills more generally, as previously unknown predictors of mathematical achievement.

Mathematics achievement and anxiety and their relation to internalizing and externalizing behaviors.

Although behavioral difficulties are well documented in reading disabilities, little is known about the relationship between math ability and internalizing and externalizing behaviors. Here, we use standardized measures to investigate the relation among early math ability, math anxiety, and internalizing and externalizing behaviors in a group of 366 second and third graders. Math achievement was significantly correlated with attentional difficulties and social problems but not with internalizing symptoms. The relation between math achievement and externalizing behavioral problems was stronger in girls than in boys. Math achievement was not correlated with trait anxiety but was negatively correlated with math anxiety. Critically, math anxiety differed significantly between children classified as math learning disabled (MLD), low achieving (LA), and typically developing (TD), with math anxiety significantly higher in the MLD and LA groups compared to the TD group. Our findings suggest that, even in nonclinical samples, math difficulties at the earliest stages of formal math learning are associated with attentional difficulties and domain-specific anxiety. These findings underscore the need for further examination of the shared cognitive, neural, and genetic influences underlying problem solving and nonverbal learning difficulties and accompanying internalizing and externalizing behaviors.