Cultural pathways to psychosis care: Patient and caregiver narratives from Puebla, Mexico.

The current study used the McGill Illness Narrative Interview (MINI) to explore patients' (n = 6) and caregivers' (n = 3) narratives about how they identified and sought care for psychosis. Participants were recruited from an outpatient clinic at the Hospital Psiquiátrico Dr. Rafael Serrano, a public psychiatric hospital in Puebla, Mexico. All participants consented to complete semi-structured interviews in Spanish. Thematic analyses were used to inductively identify common themes in participants' narratives. The results indicated that during the initial symptom onset, most participants noticed the presence of hallucinations but did not seek help for this hallmark symptom. Participants described seeking care only when they or their ill relative exhibited escalating aggressive behaviors or physical symptoms that were interpreted as common medical problems. As participants became connected to specialty mental health services, they began to develop a conceptualization of psychosis as a disorder of aggression. For some participants, this conceptualization of psychosis as an illness of aggression contributed to their ambivalence about the diagnosis. These results can be understood using a cultural scripts framework, which suggests that cultural norms are influenced by collective understandings of normalcy and valorization of behaviors. Implications for community campaigns are discussed.

Leader and Provider Perspectives on Implementing Safe Alternatives for Teens and Youth - Acute (SAFETY-A) in Public School Districts Serving Racial/ethnic Minoritized Youth.

Racial/ethnic minoritized (REM) youth represent a high-risk group for suicide, yet there are striking disparities in their use of mental health services (MHS) even after risk is identified in schools. Prior research suggests that school-based risk assessments and hospitalization encounters can be negatively experienced by REM youth and families, thus deterring likelihood of seeking follow-up care. The Safe Alternatives for Teens and Youth-Acute (SAFETY-A) is a brief, strengths-based, cognitive-behavioral family intervention demonstrated to increase linkage to MHS when implemented in emergency departments. With its focus on strengths and family engagement, SAFETY-A may cultivate a positive therapeutic encounter suited to addressing disparities in MHS by enhancing trust and family collaboration, if appropriately adapted for schools. Thirty-seven school district leaders and frontline school MHS providers from districts serving primarily socioeconomically disadvantaged REM communities participated in key informant interviews and focus groups. First, interviews were conducted to understand usual care processes for responding to students with suicidal thoughts and behaviors, and perspectives on the strengths and disadvantages of current practices. An as-is process analysis was used to describe current practices spanning risk assessment, crisis intervention, and follow-up. Second, focus groups were conducted to solicit perceptions of the fit of SAFETY-A for these school contexts. Thematic analysis of the interviews and focus groups was used to identify multilevel facilitators and barriers to SAFETY-A implementation, and potential tailoring variables for implementation strategies across school districts.

Recruitment and Feasibility of Hair Cortisol Collection in a Sample of Ethnically and Sexually Diverse, Low-Income Adults: A Qualitative Community-Partnered Participatory Research Study.

The current study describes how a community-partnered participatory research (CPPR) model was used to enhance hair cortisol research engagement among low-income adults of diverse ethnicities and sexual and gender identities. Participants' reported motivations and concerns surrounding providing a hair sample are also described. Participants from a larger longitudinal study were invited to provide a hair sample and/or complete acceptability interviews. Results indicated that 71% of all persons (N=133) contacted participated in the current study, of whom 82% provided hair samples. Several themes emerged from the interviews indicating that participants were motivated to provide a hair sample due to internal and external factors; however, concerns about mistrust of research remained. Thus, collecting biospecimens in research with underserved groups requires careful consideration of benefits and risks to the individual and their communities. Our results provide guidelines for engaging low-income racially/ethnically and sexually diverse community members in biospecimen research to understand stress-health relationships.

Practitioner Review: Common elements in treatments for youth suicide attempts and self-harm - a practitioner review based on review of treatment elements associated with intervention benefits.

BACKGROUND: Adopting a common elements approach, this practitioner review aims to highlight specific treatment elements that are common to interventions with demonstrated benefits in randomized controlled trials (RCTs) for reducing suicide attempts and self-harm in youth. Identification of common treatment elements among effective interventions offers a key strategy for clarifying the most robust features of effective interventions and improving our ability to implement effective treatment and decrease the lag between scientific advances and clinical care. METHODS: A systematic search of RCTs evaluating interventions targeting suicide/self-harm in youth (ages 12-18) yielded a total of 18 RCTs assessing 16 different manualized interventions. An open coding process was used to identify common elements present within each intervention trial. Twenty-seven common elements were identified and classified into format, process, and content categories. All trials were coded for the inclusion of these common elements by two independent raters. RCTs were also classified into those where trial results supported improvements in suicide/self-harm behavior (n = 11 supported trials) and those without supported evidence (n = 7 unsupported trials). RESULTS: Compared with unsupported trials, the 11 supported trials shared the following elements: (a) inclusion of therapy for both the youth and family/caregivers; (b) an emphasis on relationship-building and the therapeutic alliance; (c) utilization of an individualized case conceptualization to guide treatment; (d) provided skills training (e.g. emotion regulation skills) to both youth and their parents/caregivers; and (e) lethal means restriction counseling as part of self-harm monitoring and safety planning. CONCLUSIONS: This review highlights key treatment elements associated with efficacy that community practitioners can incorporate in their treatments for youth presenting with suicide/self-harm behaviors.

Age-Associated Differences in Mental Distress Among Sexual and Gender Minority Adults.

OBJECTIVE: This study aimed to use a large population-based sample to investigate age-associated differences in mental distress among sexual and gender minority (SGM) adults compared with their heterosexual, cisgender counterparts. METHODS: Data were pooled from five cycles (2014-2018) of the Behavioral Risk Factor Surveillance System (BRFSS) survey (N=762,541) and included states that administered the optional SGM module during that interval. Mean days of self-reported mental distress and the rate of frequent mental distress (≥14 days of mental distress per month) were calculated for each age and SGM identity stratum by using linear and logistic regression, respectively. Models controlled for socioeconomic factors and medical comorbid conditions. All analyses accounted for the complex survey design of the BRFSS. RESULTS: Among those ages 18-24 years, mean days of mental distress and the rate of frequent mental distress were significantly higher for SGM subgroups compared with cisgender, heterosexual adults. Among those ages 45-54, 55-64, or ≥65, no differences were noted between SGM groups and their cisgender, heterosexual peers. CONCLUSIONS: Younger SGM respondents reported the highest levels of mental distress. Differences in general mental distress were less detectable with increasing age. The findings suggest that SGM young adults have an increased need for mental health services.

Depression, Anxiety, and Suicide Risk among Ugandan Youth in Vocational Training.

The current study examines the prevalence of depression, anxiety, suicide risk, and PTSD in Ugandan youth (13-25 years) attending vocational training programs. Youth from five urban (n=224 females, 81 males) and four rural (n=153 females only) vocational training centers operated by a non-governmental organization completed demographic and mental health questionnaires. Nearly half of the youth reported moderate or severe depression and/or anxiety. More than half reported anxiety and depression-related impairment. Nearly a quarter of youth had considered or attempted suicide. More than half screened positive on the PC-PTSD screen. Rural female youth reported the most food insecurity (56.9%), trafficking (37.9%), severe depression (35.9%), depression-related impairment (56.9%), severe anxiety (26.1%), and anxiety-related impairment (55.6%). Results from this study suggest that Ugandan youth have exceedingly high rates of depression, anxiety, suicide risk, and probable PTSD. Rural female youth may be especially at risk. Relevant treatment interventions are needed that can be adapted to youth in vocational training centers.

Worse for girls?: Gender differences in discrimination as a predictor of suicidality among Latinx youth.

INTRODUCTION: Gender and ethnic differences exist in suicidal ideation, plan, and attempt among adolescents in the U.S. However, limited research has used theoretically-informed approaches to integrate how cultural and classic risk factors together account for suicide-related pathways among vulnerable populations. Informed by the interpersonal theory of suicide, the present cross-sectional study examined gender differences in the association between a cultural (i.e., discrimination) and classic (i.e., depressive symptomatology) risk factor, and suicidality among youth of Latin American heritage. METHODS: A total of 390 Latinx adolescents (ages 13-18; 50% female) attending a high school in Southern California, U.S.A. completed a series of questionnaires that included measures of depressive symptoms, suicidality (including ideation, past attempts, and likelihood of future behavior), perceived discrimination, and demographics. RESULTS: We found that discrimination was associated with increased suicidality among Latinx adolescents. The discrimination-suicidality association was stronger for girls versus boys, such that girls who experienced greater discrimination demonstrated the highest levels of suicidality. Although depression was also significantly associated with suicidality, the discrimination x gender interaction was found above and beyond the main effect of depressive symptomatology and covariates. Additional analyses revealed significant gender and moderation effects only for suicidal ideation and not for attempts. CONCLUSIONS: These findings indicate that the relationship between discrimination and suicidality (particularly ideation) is more pronounced for Latinx girls than boys. This study also highlights the importance of drawing on theory-driven and culturally informed work that incorporates classic and cultural correlates of suicidality among diverse subpopulations.

Engaging LGBTQ Communities in Community-Partnered Participatory Research: Lessons from the Resilience Against Depression Disparities Study.

BACKGROUND: The Resilience Against Depression Disparities (RADD), a community partnered, randomized comparative effectiveness study, aimed to address mental health in Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) racial/ethnic populations in New Orleans and Los Angeles. OBJECTIVES: To describe engagement methods, lessons learned, and recommendations in engaging LGBTQ individuals and agencies throughout the RADD study. METHODS: RADD used a community partnered participatory research framework to engage LGBTQ community members and agencies. Observational and quantitative data were collected to describe engagement activities and study adaptations from October 2016 to May 2019. RESULTS: Our partnered approach resulted in multiple study adaptations. The principles of cultural humility, coleadership, and addressing health determinants were important to successful engagement with LGBTQ community members and study participants. We recommend maintaining cultural humility as the tenant of all research activities. CONCLUSIONS: This project's engagement plan demonstrates that community-academic partnerships can be forged to create and modify existing study models for LGBTQ communities.

A critical review of current evidence on multiple types of discrimination and mental health.

Little is known about people who experience multiple types of discrimination (e.g., racism and heterosexism). While some work suggests that multiply discriminated groups are at higher risk for poor mental health, other studies propose that they may develop resilience against additional kinds of discrimination. We conducted a review of published studies on the relationship between multiple types of discrimination and mental health to critically examine evidence in support of broad risk and resilience models. Using PRISMA guidelines, we identified 40 studies that met our inclusion criteria. Typically, studies examined either whether experiencing multiple discrimination was related to poorer mental health, or whether one kind of discrimination was more predictive of poor mental health. Studies generally showed support for the risk model, with multiple forms of discrimination associated with higher risk for depression symptoms. Furthermore, both racism and heterosexism uniquely predicted symptoms of depression, although initial evidence suggested that only heterosexism predicted suicidality among lesbian, gay, bisexual, transgender, and queer (LGBTQ) racial/ethnic minorities. Findings on multiple discrimination and other mental health problems (e.g., anxiety, posttraumatic stress disorder [PTSD], distress, and substance use) were mixed. The current evidence suggests that multiply discriminated groups exhibit higher risk for some mental health problems, particularly depression symptoms. However, methodological problems abound in this literature (e.g., correspondence between study sample and types of discrimination assessed), which limits our ability to draw clear conclusions about multiple discrimination. We propose that to further our understanding of how multiple kinds of discrimination may affect mental health, studies must remedy these and other issues. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Pilot Study Evaluating Critical Time Intervention for Individuals With Hoarding Disorder at Risk for Eviction.

Hoarding disorder has significant health consequences, including the devastating threat of eviction. In this pilot study, critical time intervention (CTI), an evidence-based model of case management shown to be effective for vulnerable populations, was adapted for individuals with severe symptoms of hoarding disorder at risk for eviction (CTI-HD). Of the 14 adults who enrolled, 11 participants completed the 9-month intervention. Completers reported a modest decrease in hoarding severity, suggesting that, while helpful, CTI-HD alone is unlikely to eliminate the risk of eviction for individuals with severe symptoms of hoarding disorder.

Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy.

Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) show low engagement in antidepressant therapy, whether engagement is defined as pharmacotherapy access, medication initiation, pill-taking, or treatment retention. One potential reason for this disparity in depression care is the low cultural congruence of pharmacotherapy for this population. To examine Latinos' views of depression and antidepressant therapy, we conducted qualitative interviews with 30 Latino outpatients initiating antidepressants prior to their first treatment visit using the semistructured Treatment Adherence and Retention Questionnaire. These baseline interviews were randomly selected from data collected for a randomized controlled trial testing a novel intervention to enhance engagement by depressed Latino outpatients. Participant narratives were analyzed using open coding and the iterative analytical approach derived from grounded theory. Patient views about depression addressed stigmatizing views held by others in their social circle. Most participants directly refuted these views by providing alternate explanations to depression experiences. Antidepressant therapy narratives also revealed marked stigmatization, but participants tended not to refute these views. Instead, patients expressed concerns about antidepressants and showed marked ambivalence about seeking psychiatric care. Participants, however, did suggest ways in which clinicians and patients might collaborate to address their concerns about antidepressants. Some cultural views, such as concerns about addiction to or dependence on medication, may be negotiable barriers to treatment. Prescribing clinicians should address cultural views and concerns in order to improve Latino engagement in antidepressant therapy.