Training in Cultural Competence for Mental Health Care: A Mixed-Methods Study of Students, Faculty, and Practitioners from India and USA.

Although the need to train clinicians to provide effective mental health care to individuals from diverse backgrounds has been recognized worldwide, a bulk of what we know about training in cultural competence (CC) is based on research conducted in the United States. Research on CC in mental health training from different world populations is needed due to the context-dependent nature of CC. Focusing on India and USA, two diverse countries that provide complementary contexts to examine CC, we explored graduate students', practicing clinicians', and faculty members' perspectives regarding CC training they received/provided and future training needs using mixed-methods. The data were collected using focus groups (n = 25 groups total: 15 in India, 11 in USA), and a survey (n = 800: 450 in India, 350 in USA). Our data highlight the salient social identities in these countries, and the corresponding constituents of CC training. Participants in India described a practical emphasis to their CC training (e.g., learning about CC through life experiences and clinical practice experiences) more so than through coursework, whereas participants in USA described varying levels of coursework related to CC along with practice. Participants in both countries considered enormity of CC as a challenge, while those in the US also identified CC training limited to a white, straight, male perspective, hesitancy in engaging with diversity topics, and limited time and competence of the faculty. Strengths of CC training in India and USA are mutually informative in generating recommendations for enhancing the training in both countries.

Towards a decolonial developmental science: Adolescent development in the Majority World taking center stage.

While aspiring to be a diverse and global science, developmental science continues to be dominated by EuroAmerican epistemologies, researchers, and communities in its published scholarship. Adolescents in communities across Africa, Asia, the Middle East, and Latin America comprise 85% of the world's adolescent population, and yet their experiences and perspectives are marginalized in our science. Adolescents in the Majority World live in highly diverse social, cultural, political, economic, educational and healthcare contexts that contribute to their development, and we have much to learn from their experiences. This article situates the marginalization of the global majority within coloniality embedded in developmental science. The article describes the impetus for this special issue Towards a decolonial developmental science and the process of putting it together, along with providing an overview of the 18 articles in this collection that push us towards decoloniality. The special issue serves as a call to transform developmental science to be decolonial by empowering adolescent development in Majority World communities to take center stage. Adolescent development research from Majority World communities has the potential to challenge the knowledge base generated from Minority World samples, contributing to a science that is comprehensive, inclusive, and can inform prevention and intervention efforts to support the well-being of adolescents globally.

Perspectives of researchers engaging in majority world research to promote diverse and global psychological science.

Journal analyses have documented the historical neglect of research pertaining to the Majority World in psychological science, and the need for inclusivity is clearly articulated to ensure a science that is comprehensive and globally applicable. However, no systematic efforts have explored the perspectives of researchers working with Majority World communities regarding the challenges they experience in conducting and disseminating research and ways to address them. Our aim was to explore these challenges from the perspective of these researchers using an embedded mixed-methods design. Based on responses of 232 researchers who engage in psychological research with Majority World communities (68.1% from Africa, Asia, or Latin America, remaining from the Minority World), we identified challenges in three areas: (a) stemming from an inherent bias against Majority World research, (b) experienced by all researchers, which nonetheless are heightened for those engaging in research with Majority World populations, and (c) specific to researchers affiliated with Majority World institutions. Based on the findings, we recommend journal editorial teams and funding agencies: (a) acknowledge and address the bias inherent in the publication and funding process, (b) recruit editorial team members, program officers, and reviewers from the Majority World, (c) train editorial team members, program officers, and reviewers from the Minority World to thoughtfully evaluate Majority World research, and (d) provide resources for researchers affiliated with Majority World institutions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the Relationship between Academic Expectations and Suicidal Ideation among College Students in India Using the Interpersonal Theory of Suicide.

OBJECTIVE: As the second most populous country in the world, India accounts for over 20% of the global suicide deaths. Notably, young adults make up 38% of those who die by suicide in India. Yet, the literature on factors associated with suicide within this age group in India is limited. The Interpersonal Theory of Suicide (IPTS) posits thwarted belongingness and perceived burdensomeness as constructs that heighten the risk for suicide. Testing mechanisms that may mediate the relationship between common stressors for young adults in India, such as academic expectations, and suicidal ideation are important to better understand factors contributing to suicide risk within this country. METHOD: Indian college students (N = 432, Mage = 19.41, 73.1% male) completed questionnaires on academic expectations, thwarted belongingness, perceived burdensomeness, collectivism, and suicidal ideation. RESULTS: Current suicidal ideation was endorsed at a rate of 38%. Academic expectancy from the self, perceived burdensomeness, and thwarted belongingness was significantly associated with suicidal ideation. The only significantly mediated pathway was academic expectancy from others to suicidal ideation through perceived burdensomeness. Collectivism was not a significant moderator in the model. DISCUSSION: The sample endorsed high rates of suicidal ideation, highlighting the need for culturally appropriate interventions. Thwarted belongingness, perceived burdensomeness, and academic expectations from oneself may be relevant treatment targets for reducing suicidal ideation among college students in India.HIGHLIGHTSOver one-third of Indian university students endorsed suicidal ideation.Suicidal ideation related to one's own more than others' academic expectations.Results offer support for the Interpersonal Theory of Suicide within this context.

Caste and COVID-19: Psychosocial disparities amongst rural Indian women during the coronavirus pandemic.

The COVID-19 pandemic has exacerbated preexisting mental health disparities. In India, marginalization based on caste membership, gender, and rural residence are critical determinants of inequity across the lifespan. Guided by the theoretical frameworks of minority stress and intersectionality, this study examined caste-based disparities in fear of coronavirus (FOC), mental health symptoms, and perceived loneliness amongst rural women in north India during the COVID-19 pandemic. Participants (N = 316) completed self-report measures and were classified into three groups based on their responses: General caste (GC, n = 124), other backward castes (OBC, n = 122), and scheduled caste or tribe (SC/ST, n = 71). Using a three-way ANOVA and Tukey t-tests, women in SC/ST and OBC groups reported greater FOC (OBC d = .37; SC/ST d = .40) and greater mental health symptoms (OBC d = .58; SC/ST d = .43) relative to the GC group. OBC, but not SC/ST, group also reported higher perceived loneliness (d = .32). The results were consistent after adjusting for demographic variables such as wealth and highlight caste as an important social determinant for well-being during the COVID-19 pandemic amongst rural Indian women.

What Do White Parents Teach Youth About Race? Qualitative Examination of White Racial Socialization.

Research has examined racial socialization practices within families of color, but less is known regarding what White parents teach their children about race and/or racism. To explore White racial socialization processes, we interviewed 30 White parents of White children ages 7-17 years living in the Midwest. Using thematic analysis, we identified 22 themes organized into four domains: Content of conversations, factors to consider in socialization, developmental differences, and White identity/privilege. A majority of parents reported conversations about current or historic racial events, while relatively few also reported speaking specifically about systemic racism and microaggressions. Parents viewed adolescents as better able to handle difficult topics than children. Findings contribute to theoretical frameworks and may inform the development of educational resources.

Parental beliefs about positive affect and parental depressive symptoms predicting parents' positive emotion socialisation in India.

Emerging literature examines implications of parental socialisation of positive affect (PA) for children's socio-emotional functioning, though little is known about predictors of parental PA socialisation behaviours in diverse families around the world. Based on the literature that suggests that parental cognitions (Okagaki & Bingham, 2005) and their own mood state contribute to their parenting (Dix & Meunier, 2009), we examined two parent-related factors (parental beliefs regarding PA and depressive symptoms) as predictors of parental responses to their adolescents' PA in an urban middle-class sample of mothers and fathers from India (N = 267; 40.4% mothers). Parents completed measures of their PA-related beliefs, depressive symptomatology, and their responses to adolescents' PA at two-time points, 5 months apart. Parental PA-related beliefs showed low stability and depressive symptoms showed moderate stability across time. There were concurrent bivariate associations between parental PA-related beliefs and their socialisation behaviours, though these relations did not hold in multivariate path analyses across time. Parental depressive symptoms at T1 inversely predicted family savouring at T2 and positively predicted dampening at T2. These findings provide the first line of evidence indicating that parental cognitions and their own mood contribute to their emotion-related parenting behaviours in India.

A Pilot Feasibility Study of Reconnecting to Internal Sensations and Experiences (RISE), a Mindfulness-Informed Intervention to Reduce Interoceptive Dysfunction and Suicidal Ideation, among University Students in India.

Although 20% of the world's suicides occur in India, suicide prevention efforts in India are lagging (Vijayakumar et al., 2021). Identification of risk factors for suicide in India, as well as the development of accessible interventions to treat these risk factors, could help reduce suicide in India. Interoceptive dysfunction-or an inability to recognize internal sensations in the body-has emerged as a robust correlate of suicidality among studies conducted in the United States. Additionally, a mindfulness-informed intervention designed to reduce interoceptive dysfunction, and thereby suicidality, has yielded promising initial effects in pilot testing (Smith et al., 2021). The current studies sought to replicate these findings in an Indian context. Study 1 (n = 276) found that specific aspects of interoceptive dysfunction were related to current, past, and future likelihood of suicidal ideation. Study 2 (n = 40) was a small, uncontrolled pre-post online pilot of the intervention, Reconnecting to Internal Sensations and Experiences (RISE). The intervention was rated as highly acceptable and demonstrated good retention. Additionally, the intervention was associated with improvements in certain aspects of interoceptive dysfunction and reductions in suicidal ideation and eating pathology. These preliminary results suggest further testing of the intervention among Indian samples is warranted.

Examining psychometric properties of the Interpersonal Needs Questionnaire among college students in India.

BACKGROUND: With the second-highest population in the world, suicide-related deaths in India are high, and adults under 30 are particularly at an increased risk. However, empirical examinations of factors contributing to suicide in India and assessments of reliability and validity of self-report measures assessing these constructs are rare. AIMS: The present study examined the psychometric properties of the Interpersonal Needs Questionnaire (INQ). MATERIALS & METHODS: Undergraduate students in India (N = 432) completed the INQ and questionnaires assessing suicidal ideation, depression, fearlessness about death, and pain tolerance. RESULTS: Confirmatory factor analyses of the 15-item INQ indicated that after removing three items assessing perceived burdensomeness, the two-factor structure of INQ demonstrated acceptable fit with good internal consistency for each of the subscales (α = .84-.90). In line with the interpersonal-psychological theory of suicidal behavior (IPTS), thwarted belongingness and perceived burdensomeness interacted to predict suicidal ideation. Additionally, these constructs were positively associated with suicidal ideation and depression, and weakly correlated with fearlessness about death and pain tolerance. DISCUSSION: Results support the relevance of the IPTS for understanding suicidal ideation among college students in India. CONCLUSION: The results suggest that modified INQ demonstrates strong internal consistency, as well as good construct, criterion, and discriminant validity among Indian college students.

Development and validation of caregiver stress and support scale for caregivers of individuals with disabilities in Singapore.

PURPOSE: Few available measures include culturally salient stressors and support systems for caregivers of offspring with disabilities in Asia. The purpose of this study was to develop and validate a self-report measure that included relevant stressors and sources of support for caregivers of offspring with disabilities. MATERIALS AND METHODS: Open-ended interviews with eight caregivers in Singapore, along with existing measures were used to develop items. The original 34 items were administered to caregivers of offspring with disabilities in Singapore (n = 234, 85% mothers). Based on an examination of factor loadings, internal consistency, and feedback from professionals, the scale was revised and administered to 370 caregivers (78% mothers), along with other measures of stress, support, depression, and well-being. RESULTS: Exploratory factor analysis of the original 34-item scale yielded two factors, Sources of Stress and Sources of Support. After scale revision, confirmatory factor analysis showed that a two-factor structure demonstrated a fair fit. The subscales showed adequate internal consistency and test-retest reliability, and significant associations in expected directions with other measures of stress and support, as well as with depressive symptoms and well-being. CONCLUSIONS: The measure has adequate reliability and validity, with implications for use by local service providers.Implications for rehabilitationCaregivers face unique challenges, such as stressors associated with caregiving, with varying support systems available to reduce the stress.A psychometrically-sound measure can be used to assess sources of stress and support, monitor services, and address service gaps for caregivers.The Sources of Caregiver Stress and Support Scale is a contextually-sensitive self-report measure for caregivers of people with disabilities in Singapore.

A longitudinal examination of the relation between academic stress and anxiety symptoms among adolescents in India: The role of physiological hyperarousal and social acceptance.

Academic stress is a critical aspect of adolescent experience around the world, but particularly in countries with dense populations that lead to highly competitive college admissions. With a population of over one billion people, the competition for higher education in India is significantly high. Although research has shown that academic pressures are associated with anxiety in adolescents, this work is primarily cross-sectional. The current study examined academic stress and anxiety symptoms over time and assessed physiological hyperarousal as a mediator and social acceptance as a moderator of this relation in a sample of adolescents from India (N = 282, 13-18 years, 84% female). Adolescents completed measures of academic stress, physiological hyperarousal, social acceptance and anxiety symptoms at two-time points, 5 months apart. Findings demonstrate direct effects of academic stress on changes in symptoms of generalised anxiety and panic, as well as indirect effects through physiological hyperarousal. Social acceptance did not moderate the relation, although it uniquely predicted changes in panic disorder symptoms over time. The findings of this study contribute to the scientific understanding of a potential mechanism through which academic stress leads to anxiety among adolescents in India.

Clinicians' Perspectives on Diagnostic Markers for Depression Among Adolescents in India: An Embedded Mixed-Methods Study.

Limited research has investigated whether clinicians around the world find diagnostic criteria for depression that were originally developed in the West are useful with diverse populations. Using an embedded mixed-methods design in India, we examined (a) clinicians' and trainees' (n = 143) ratings of the usefulness of the criteria for Major Depressive Disorder (MDD) outlined in two major diagnostic systems (Diagnostic and Statistical Manual of Mental Disorders-5; DSM-5 and International Classification of Mental and Behavioral Disorders-Tenth Edition; ICD-10), and (b) narrative descriptions of clinical cases of adolescent depression and usefulness of diagnostic and screening instruments in day-to-day practice using semi-structured interviews in a subsample of clinicians (n = 24). Qualitative findings demonstrated that Indian clinicians identified markers of depression that were consistent with the current diagnostic manuals (affective, cognitive, somatic symptoms), and the numeric ratings suggested that clinicians found a majority of DSM-5 and ICD-10 criteria for MDD to be useful. However, Indian clinicians also identified additional markers of adolescent depression (i.e., interpersonal conflicts and issues, impairment in school-related functioning, anger-based symptoms, anxiety-based symptoms, additional somatic complaints not included in DSM-5 or ICD-10), highlighting the need to modify existing diagnostic criteria to be more inclusive. The findings suggest the need for culturally informed diagnostic practices that consider a wide range of clinical presentations of depression among adolescents worldwide.

Reports of adolescent emotion regulation and school engagement mediating the relation between parenting and adolescent functioning in India.

Much like other parts of Asia, late adolescence in India is a particularly stressful time with academic pressures of a highly competitive examination system that determines future occupational success. The present study examined interrelations among reports of parenting, adolescents' regulation of academics-related emotions, school engagement, adolescent socio-emotional functioning and state-exam performance. Four hundred and fifty 10th and 12th graders from suburban high schools in India participated, along with their mothers. At the beginning of the school year, mothers completed measures of parenting, and adolescents completed measures of emotion regulation, school engagement and behaviour problems. At the end of the school year, grades from state exams were obtained from the schools. A multiple mediator model was tested using structural equation modelling. Authoritarian parenting was positively related to adolescent behaviour problems, but not adolescent state-exam performance. Maternal non-supportive responses to adolescent negative emotion were indirectly positively related to adolescent behaviour problems through adolescent emotion dysregulation. Adolescent school engagement mediated the positive relation between maternal supportive responses to adolescent negative emotion and adolescent state-exam performance. These findings underscore the relevance of adolescent emotions for their academic functioning, with implications for the development of interventions for those who struggle during these highly stressful years.

Reports of maternal socialization goals, emotion socialization behaviors, and child functioning in China and India.

A body of literature connects parental emotion socialization behaviors to child outcomes, though little research attention has been devoted to parents' culturally embedded socialization goals that influence their socialization behaviors in diverse samples. In the present study, we examined interrelations among maternal socialization goals, emotion socialization behaviors, and child functioning in families from 2 major Asian countries, China and India. A total of 305 6th and 7th grade children and their mothers across both countries participated. Mothers completed measures of their socialization goals, their responses to children's emotions, child behavior problems, and children completed a measure of emotion regulation (ER) at a single point in time. Factor analysis of the measure of parental responses to children's emotions yielded 2 factors (supportive and nonsupportive responses), with some items from the commonly used parent-report measure Coping with Children's Negative Emotions Scale (Fabes, Eisenberg, & Bernzweig, 1990), while others reflected culturally salient socialization approaches in Asia (i.e., child training, explanation). Using these data-driven supportive and nonsupportive response composites, mediation models were tested for the full sample. Reports of mothers' supportive responses and child ER sequentially mediated the relation between maternal relational socialization goals and child internalizing problems. Reports of child emotion dysregulation mediated the relation between maternal nonsupportive responses and child externalizing problems. Findings of this study highlight the relevance of culturally salient parental socialization goals and socialization behaviors in understanding child functioning in diverse cultural groups. (PsycINFO Database Record

Meta-Emotion Philosophy Among Asian Indian Immigrant Mothers in the United States.

We explored the meta-emotion philosophies of Indian immigrant mothers living in the Midwest region of the United States to expand the scarce literature on emotion socialization in diverse families. A total of 15 mothers of teen and preteen children participated in a meta-emotion interview, in which they were asked about their own and their children's experiences of anger, sadness, and fear. We analyzed interview responses through an open-ended phenomenological approach and found the following major themes: familial context of emotions, subtle communication of emotions, and an overarching philosophy centering on inevitability of negative emotions and the importance of moving on. Mothers differed in how well they believed that they could move on. Overall, the present findings demonstrate the role culture plays in emotional experiences of immigrant mothers and serve as a reminder that theories based on European American families might have limited applicability to other cultural and ethnic groups.

"Making the child understand:" socialization of emotion in urban India.

Using a combination of quantitative and qualitative methods, this study examined mothers' socialization of child emotion in suburban middle-class families in Gujarat, India. In particular, a community sample of 602 children, 6 to 8 years, was screened for emotional/behavioral problems using a parent-report measure standardized with this population. Based on the screening, four groups of children were formed: those with internalizing problems (n = 31), externalizing problems (n = 32), and somatic complaints (n = 25), and an asymptomatic control group (n = 32). Mothers of children across groups completed a previously pilot-tested, forced-choice, self-report questionnaire of their emotions and behaviors in response to their children's anger, sadness, and physical pain, and an individual open-ended interview further exploring their socialization behaviors, immediate goals, and expectations from their children. Quantitative data revealed that mothers of children in internalizing, externalizing, and somatic complaints groups reported more negative emotions (anger, disappointment, embarrassment, restlessness) and punitive/ minimizing behaviors than the control group, with the somatic-complaints group also reporting less sympathy and emotion-/ problem-focused behaviors than the control group. Qualitative data provided a culturally grounded overarching framework to understand emotion socialization in this sample, and suggested variation across groups with respect to the type of mothers' behaviors, along with expectations for appropriate behavior.

On the relation between maternal state of mind and sensitivity in the prediction of infant attachment security.

Attachment theorists assume that maternal mental representations influence responsivity, which influences infant attachment security. However, primary studies do not support this mediation model. The authors tested mediation using 2 mother-infant samples and found no evidence of mediation. Therefore, the authors explored sensitivity as a moderator, studying the (a) interaction of mental representation and sensitivity as it predicts infant attachment security and (b) level of sensitivity in mothers whose infants' attachment security is either concordant or discordant with their own. The interactional analyses were not significant. But the match-mismatch data showed that when mother-infant attachment strategies were discordant, maternal sensitivity was more consistent with infant than maternal attachment strategy. These findings are congruent with an interpretation of sensitivity as a moderator that can block transmission of attachment strategy.