Family matters: A qualitative study of stressors experienced by Korean American college students during the COVID-19 pandemic.

Objective: This study explores mental health stressors related to family dynamics of Korean American college students during the time of the COVID-19 pandemic. Participants: In January 2021, using purposive sampling, we recruited 15 Korean American student leaders at a west coast university. Methods: Self-identified leaders were interviewed via Zoom, and data were transcribed verbatim and analyzed using a thematic analytic approach based on grounded theory. Results: Students leaders' perceived sources of family stress for Korean American college students centered on three themes: (1) loss of independence, (2) family pressure, and (3) strained family relationships. Conclusion: Study findings offer insight for college mental health programming regarding family stressors, especially as related to moving back home with family.

Exploring second generation Korean American alcohol use through church-based participatory research: A rapid ethnographic assessment in Los Angeles, California, United States.

The prevalence of heavy drinking is high among Korean Americans (KAs), but alcohol treatment utilisation is low. Korean American drinking behaviours may be attributable to the Korean drinking culture. However, relatively little research has been conducted to explore this narrative. The aim of this paper was to examine the social and cultural contexts of drinking and help-seeking behaviours among second generation KAs. In 2016, we conducted a rapid ethnographic assessment (REA) in partnership with a Korean American church in Los Angeles. The REA involved participant observation and ten unstructured interviews. We used constructivist grounded theory to analyse the themes emerging from field notes and interview transcripts. Respondents perceived the existence of a Korean drinking culture in the United States that has been passed down from prior generations and preserved in ethnic enclaves. This Korean drinking culture was marked by festive occasions with heavy drinking, but the extent to which respondents adopted this drinking culture may have depended on their ethnic identities and connections to the community. For many second generation KAs, identity and community were tied to religious life. We found that KAs perceived professional treatment and recovery resources to be underutilised. We offer insights about church-based participatory research as an approach to studying drinking among KAs.

Mental Health Status, Need, and Unmet Need for Mental Health Services Among U.S. Pacific Islanders.

OBJECTIVE: This study examined the mental health status, need for services, and unmet need of community-dwelling Native Hawaiian and other Pacific Islanders (NHPI). METHODS: Survey data were collected from 223 NHPI adults of Samoan or Marshallese heritage. Surveys were translated into Samoan and Marshallese by using back-translation, with feedback from cultural experts. Severity of depression, anxiety, and alcohol use were measured, as were perceived need for and avoidance of, or delay in, seeking mental health services. Logistic regressions calculated adjusted odds ratios for past-year perceived need for services and avoidance or delay of needed services, controlling for depression, anxiety, and alcohol use. RESULTS: Participants' screened prevalence of major depression, generalized anxiety disorder, and alcohol use disorder was 21%, 12%, and 22%, respectively. In the past year, 35% and 26% of participants reported needing services and avoiding or delaying needed services, respectively. Urban Samoan and rural Marshallese participants did not differ significantly in measures of depression, anxiety, or alcohol use, even though the groups had significant demographic differences. Female gender and greater familiarity-contact with persons with mental illness were significant predictors of both reporting service need and reporting avoiding or delaying services. CONCLUSIONS: Community-dwelling NHPIs reported a heavy burden of depression, anxiety, and alcohol use, and high perceived need for services, yet low levels of help-seeking. The large unmet need in the sample suggests that a gap may exist between service need and engagement in U.S. NHPI communities that could be targeted with culturally tailored approaches that promote engagement in care.

Mental illness stigma among Pacific Islanders.

Native Hawaiians and other Pacific Islanders (NHPI) rarely seek mental health treatment for reasons that are minimally understood. To assess the mental illness stigma context in NHPI communities that may be contributing to low help-seeking, this study collected novel stigma data from two large U.S. NHPI communities from October 2017 to January 2018, then compared this data to national stigma data from the U.S. public. Survey data were collected from 222 community-dwelling NHPI participants recruited by research-trained NHPI staff. Surveys incorporated well-established vignettes describing persons with major depression and schizophrenia. Study data were compared to U.S. general public data from the 2006 General Social Survey: the largest U.S. stigma study. Compared to the U.S. public, NHPI participants reported greater stigma toward mental illness in ways likely to impede help-seeking including: (1) more frequently endorsing stigmatizing causal attributions of depression and schizophrenia, (2) less frequently perceiving disorders as serious, and (3) more commonly desiring social distance from persons with depression. Study data are the first to reveal the presence of a strongly stigmatizing context in NHPI communities likely to hinder NHPI help-seeking. Thus, culturally tailoring anti-stigma interventions to appropriately target NHPI mental health attitudes and beliefs may prove effective in promoting NHPI help-seeking.

Addressing Mental Health Challenges of Samoan Americans in Southern California: Perspectives of Samoan Community Providers.

While a variety of health concerns have been documented, little is presently known about the mental health challenges facing Samoan Americans in Southern California. This community-based research study investigated the perspectives of Samoan healthcare providers affiliated with two Los Angeles County agencies regarding: 1) mental health challenges; 2) obstacles to use of formal services to address mental health concerns, and 3) recommendations and needed resources for development of culturally responsive interventions to address mental health challenges. Eleven healthcare advocates affiliated with two agencies specializing in health and social services for Samoans participated in a 90-minute group discussion and/or an individual interview. Qualitative data were analyzed using a thematic data analytic approach based on grounded theory. Participants strongly self-identified as Samoan or mixed-race Samoan and were primarily female (73%). Key themes from these discussions are presented to highlight this seminal discussion. Despite concerns regarding substance use, depression, and suicide, significant cultural resources were noted as sources of resilience that could be incorporated into prevention and intervention for Samoan Americans coping with mental health problems. The perspectives of these community advocates for the Samoan community reflect a low level of mental health awareness and identify urgent unmet mental health needs among Samoan Americans in Southern California. Findings support prioritization of mental health awareness interventions and education regarding available services. Systemic efforts to integrate physical and mental health care services may be aligned with traditional Pacific Islander concepts of mental health and facilitate addressing the unmet mental health needs of underserved Samoan Americans.

Psychological Distress Behavioral Patterns Among Latinos: We Don't See Ourselves as Worthless.

A cross-sectional study of 4921 Latinos from the National Health Interview Survey was conducted to examine behavioral patterns of psychological distress among Latinos. Latent class analysis was used to ascertain psychological distress behavioral profiles among Latinos. Analysis revealed four latent classes of distress, which included moderate psychological distress (13.6%); mild sadness, nervousness, and restlessness (13.0%); high psychological distress (2.8%); and no psychological distress (70.7%). Worthlessness, a widely-accepted dimension of distress, was not a significant behavioral trait. Results from the present study suggest that underlying cultural elements affect the subjective interpretations of symptoms reported by Latinos. These findings highlight distress profiles among Latinos and the possibility of overlooking behaviors that are uniquely indicative of distress, potentially leading to the underreporting of serious psychological distress in this population. Furthermore, these findings shed light on other paradoxical issues impacting the mental health of Latinos.

Beliefs About Etiology and Treatment of Mental Illness Among Korean Presbyterian Pastors.

This descriptive study explored pastors' beliefs about etiology and treatment of mental illness. Surveys were completed by mail by 202 Korean and Euro-American Presbyterian clergy. Nearly one-third of Korean pastors viewed bad parenting and demon possession as very important causes of mental illness, in contrast to the more than two-thirds of Euro-American pastors who viewed genetics and chemical imbalances as the most important causes. Compared with their Euro-American counterparts, Korean pastors soundly endorsed spiritual treatment of mental illness. The findings of this study suggest the value of understanding the views of pastors working with populations that underutilize formal mental health services.

Development of a spirituality-infused cognitive behavioral intervention for individuals with serious mental illnesses.

OBJECTIVE: Spirituality offers a vital coping resource that can bolster mental health and psychosocial well-being for individuals with serious mental illnesses (SMI). However, limited research on spirituality-infused evidence-based interventions exists to assist providers in mobilizing spirituality as a mental health resource. This article presents the cognitive-behavioral intervention Spiritual Strategies for Psychosocial Recovery (SSPR), developed to promote recovery among ethnoculturally diverse individuals with SMI by strengthening their coping mechanisms for internal and external distress through spiritual means. METHODS: SSPR was developed in 5 steps: (1) observation of current recovery services at a partnering psychosocial rehabilitation center; (2) creation of a treatment manual based on extant literature, the authors' evidence-based practice expertise, and observational data; (3) testing of specific SSPR skills with consumers; (4) refinement of the manual by using testing data; and (5) testing of the manual for feasibility with 37 consumers. RESULTS: Initial feasibility testing indicated that the intervention was accepted and valued by participants and providers; did not trigger psychiatric disturbances; and provided accessible spirituality-based distress coping tools for helping participants manage psychological difficulties in the community. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: SSPR and its nondenominational spirituality-based distress coping skills appear to be well tolerated by consumers and providers. Thus, SSPR might be useful for providers seeking to address consumers' distress coping by capitalizing on their existing or potential spiritual strengths. Future research is needed to evaluate the intervention's effectiveness with randomized controlled trial designs in clinical and community settings. (PsycINFO Database Record

Remission of symptoms in community-based psychosocial rehabilitation services for individuals with schizophrenia.

OBJECTIVE: The aims of this study were to determine the prevalence of remission in individuals with schizophrenia at baseline and 6 months after admission to community-based psychosocial rehabilitation and whether baseline intrapersonal and environmental resources predicted remission at 6 months, controlling for relevant demographic and clinical variables. METHOD: The sample featured 187 individuals with schizophrenia spectrum disorder. To determine remission status, consensus-based criteria proposed by the Remission in Schizophrenia Working Group were adapted to identify predictors of remission outcomes, direct binary logistic regression analysis was performed. RESULTS: Findings indicated that 34.57% and 55.61% of the sample was in remission at baseline and 6 months, respectively. Remission at 6 months was predicted by shorter length of illness and being in remission at admission. CONCLUSIONS: Remission of schizophrenia is an achievable outcome in community psychosocial rehabilitation settings. Clinical characteristics exerted a significantly stronger influence on remission outcomes compared with psychosocial factors.

Correlates in the Endorsement of Psychotic Symptoms and Services Use: Findings from the Collaborative Psychiatric Epidemiology Surveys.

Endorsement of psychotic symptoms serves as an indicator of significant health issues and interpersonal distress. Seeking services is the ultimate recourse for many individuals, yet few studies have assessed the help-seeking process in a nationally representative sample. This study, guided by Lewis-Fernández et al.'s (J Nerv Ment Dis 197(5):337-347, 2009) analyses, examined the association of lifetime endorsement of psychotic symptoms with demographic, clinical and support system variables and types of services received. Based on nationally weighted epidemiological data, 11.6 % of adults reported one or more psychotic symptoms. Psychotic symptoms were associated with poor physical and mental health, specifically depressive, anxiety, and substance use disorders. Respondents were more likely to receive services from both informal and mental health providers and were more likely to be hospitalized than those not endorsing psychotic symptoms. Study findings inform community efforts to develop comprehensive services for individuals experiencing psychotic symptoms.

Interdependent recovery of adults with schizophrenia: Asian American consumer perspectives of family involvement and influence.

OBJECTIVE: Family involvement is important in the recovery experience of culturally diverse adults with schizophrenia. However, little is known about the influence of family among consumers purported to have close family ties without regular contact. This study explored Asian American consumers' views about family relationships and participation in their recovery. METHOD: Secondary analysis of qualitative data from a larger project was conducted to explore family related themes of 8 Asian Americans receiving services from recovery-focused programs in urban Southern California. RESULTS: Most consumers described their family support as adequate while simultaneously reporting limited family involvement. Asia-born and U.S.-born Asian consumers varied in describing family support, suggesting providers consider nativity in culturally responsive service delivery. CONCLUSIONS AND PRACTICE IMPLICATIONS: Families need not be present to affect the perspectives of Asian Americans receiving recovery-oriented services. The extent of family influences on recovery, beyond the initial determination of current family contact, requires further exploration.

State of spirituality-infused mental health services in Los Angeles County wellness and client-run centers.

Spiritual coping is associated with positive mental health outcomes for individuals with serious mental illness, yet spirituality-infused services are seldom offered in public sector mental health agencies. The Los Angeles County Department of Mental Health introduced a policy addressing spirituality in 2012. This study explored the breadth and degree to which spirituality-infused activities were being offered in 53 Los Angeles wellness and recovery centers after the policy was widely disseminated. More than 98 % of the centers offered options for spirituality-infused activities; one-third offered spirituality-focused groups. Los Angeles's progress may guide implementation of spirituality-infused services in other state or local public mental health systems.

Hope and burden among Latino families of adults with schizophrenia.

This study examined hope and family burden among Latino families of individuals with schizophrenia. The sample consisted of 54 family members, one family member per outpatient adult recruited from public mental health programs in a diverse urban community. Hierarchical linear regression analyses were used to test the hypothesis that the family member's increased hope for the patient's future would be associated with decreased family burden beyond effects explained by the patient's length of illness and severity of symptoms. Results supported the study hypothesis. Family hope for the patient's future was associated with four of five types of family burden. Findings point to the prominent role of hope as a source of resilience for Latino families dealing with severe mental illness of a loved one.

Community mental health allies: referral behavior among Asian American immigrant Christian clergy.

Asian American Christian faith leaders support and provide an array of services within their communities. However, little is known about their response to congregants' mental health concerns. This study examined correlates of mental health referral behavior among 103 Asian American Christian clergy in California who completed an anonymous mail survey. Using multiple regression analyses, we found that clergy's prior mental health education, knowledge of mental illness, education level, time spent providing individual counseling and referral to general practitioners were positively associated with making mental health referrals. Outreach efforts (including mental health education, and mental health referral information) to facilitate clergy's support of congregants with mental health needs are discussed.

Intrinsic motivation as a mediator of relationships between symptoms and functioning among individuals with schizophrenia spectrum disorders in a diverse urban community.

This study investigated intrinsic motivation as a mediator of the relationship between clinical symptoms and functioning. The mediation model was tested with a sample of 166 adults with schizophrenia spectrum disorders attending psychosocial rehabilitation programs in a diverse urban community. Ethnic minority status was examined as a moderator of the mediation model. Motivation was measured using items reflecting intrapsychic drive. Symptoms were assessed with the expanded Brief Psychiatric Rating Scale and functioning with the Role Functioning Scale. Motivation was a significant mediator of the relationship between functioning and all symptom scores; fully mediating the relationship between functioning and negative, disorganized, and global symptoms, and partially mediating the relationship between positive symptoms and functioning. Motivation scores between ethnic minority and nonminority individuals differed significantly (p < 0.05), but no moderation effect was indicated. The strong mediation effect schizophrenia of motivation on the symptoms-functioning relationship supports future work to translate findings into effective recovery-oriented services.

Culturally Based Intervention Development: The Case of Latino Families Dealing With Schizophrenia.

OBJECTIVES: This article describes the process of developing a culturally based family intervention for Spanish-speaking Latino families with a relative diagnosed with schizophrenia. METHOD: Our iterative intervention development process was guided by a cultural exchange framework and based on findings from an ethnographic study. We piloted this multifamily group 16-session intervention with 59 Latino families in a randomized control trial. Data were collected on family- and client-level outcomes, and poststudy focus groups were conducted with intervention participants. RESULTS: Preliminary evidence indicates that the intervention is effective by increasing illness knowledge and reducing family burden. CONCLUSIONS: This work can provide a model for how to integrate cultural factors into psychosocial services and enhance interventions in real-world settings for culturally diverse populations.

Using the cross-cultural care survey to assess cultural competency in graduate medical education.

BACKGROUND: Cultural competency is an important part of medical policy and practice, yet the evidence base for the effectiveness of training in this area is weak. One reason is the lack of valid, reliable, and feasible tools to quantify measures of knowledge, skill, and attitudes before and/or after cultural training. Given that cultural competency is a critical aspect of "professionalism" and "interpersonal and communication skills," such a tool would aid in assessing the impact of such training in residency programs. OBJECTIVES: The aim of this study is to enhance the feasibility and extend the validity of a tool to assess cultural competency in resident physicians. The work contributes to efforts to evaluate resident preparedness for working with diverse patient populations. METHOD: Eighty-four residents (internal medicine, psychiatry, obstetrics-gynecology, and surgery) completed the Cross-Cultural Care Survey (CCCS) to assess their self-reported knowledge, skill, and attitudes regarding the provision of cross-cultural care. The study entailed descriptive analyses, factor analysis, internal consistency, and validity tests using bivariate correlations. RESULTS: Feasibility of using the CCCS was demonstrated with reduced survey completion time and ease of administration, and the survey reliably measures knowledge, skill, and attitudes for providing cross-cultural care. Resident characteristics and amount of postgraduate training relate differently to the 3 different subscales of the CCCS. CONCLUSIONS: Our study confirmed that the CCCS is a reliable and valid tool to assess baseline attitudes of cultural competency across specialties in residency programs. Implications of the subscale scores for designing training programs are discussed.

A culturally relevant conceptualization of depression: an empirical examination of the factorial structure of the Vietnamese Depression Scale.

BACKGROUND: Despite the high risk of depression among Vietnamese refugees, there has been insufficient attention to the psychometric properties of the most utilized scale, the Vietnamese Depression Scale (VDS: Kinzie et al., 1982). AIM: The primary aim of the study is to empirically derive the factorial structure of the VDS to support its use as a culturally responsive depression screening tool in community samples of Vietnamese adults. METHOD: The factorial structure, reliability, and associations of the VDS factors with recognized socio-demographic correlates were examined using data collected from interviews with a non-probability community sample of 180 Vietnamese refugee adults in the Houston area. RESULTS: The empirically derived factorial structure of the VDS approximated the theorized conceptualization of depression introduced by the scale's originators. Three factors (depressed affect, somatic symptoms, and cultural-specific symptoms) accounted for 65% of the variance. As hypothesized, the VDS factors correlated with age and acculturation variables. CONCLUSION: Overall results suggest that the conceptualization of depression among this sample of Vietnamese refugees has both universal and culturally specific features. Implications for providing culturally responsive mental health services are offered.