Perceived Barriers and Preliminary PTSD Outcomes in an Open Pilot Trial of Written Exposure Therapy With Latinx Immigrants.

Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (Mdiff = 17.06, SDdiff = 9.97, range = 0-29, t(15) = 6.84, p < .001). Open thematic coding identified four barrier-related themes and three benefit-related themes at pretreatment. At posttreatment, three barrier-related themes and two benefit-related themes were identified. Qualitative results largely suggested that perceived barriers were common to other PTSD interventions (e.g., exposure components). Only one participant identified barriers specific to WET. Results suggested WET may reduce PTSD symptoms among Latinx immigrants. WET also appeared to be acceptable and primarily viewed as beneficial among this population. WET is a promising intervention with Latinx immigrants and warrants further testing larger trials, including testing implementation strategies that may improve access to care.

Refining the Migrant Farmworker Stress Inventory among Latino Migrant Farmworkers in Rural Nebraska.

The Migrant Farmworker Stress Inventory (MFWSI) was developed to measure the distinct stressors faced by migrant farmworkers. The most appropriate measurement and factor structure, however, has been primarily examined with exploratory methods with no studies of confirmatory factor analyses to date. The current study built on prior exploratory factor analytic approaches using the MFWSI by applying confirmatory factor analyses and other tests of validity to better delineate the component parts of migrant farmworker stress that contribute to anxiety and depression. Participants were 241 Latino migrant farmworkers recruited from rural farmworker campsites in Nebraska. Neither of the previously identified factor structures fit the data well initially. Following model respecification, only three factors remained from the original exploratory approaches. These models produced both common and unique factors, which were combined to produce a four-factor model. Results suggest that rural migrant farmworker stress may operate with at least four distinct domains: 1) economic difficulties, 2) immigration and legal status, 3) parenting and child difficulties, and 4) social isolation and related challenges. Finally, only economic difficulties predicted depression and anxiety scores, such that those reporting more stress around economic difficulties reported higher depression and anxiety symptoms. Results point to the need for additional measurement and construct refinement to inform empirical, clinical, policy, and social advocacy work.

Examining recipient and provider perceptions of mental health treatments and written exposure therapy for posttraumatic stress disorder with a Spanish-speaking sample.

Treatments of Posttraumatic Stress Disorder (PTSD) often evidence high rates of dropout, ranging from 25% to 40%, among English-speaking samples. Written Exposure Therapy (WET), a novel manualized treatment for PTSD, evidences lower dropout rates and noninferiority to CPT, one of the most efficacious interventions for PTSD. Spanish-speaking Latinxs often experience greater dropout and barriers to care. WET appears promising for this population, but acceptability and perceived barriers to WET have not been examined among Spanish-speaking Latinxs. The present study assessed perceptions and acceptability of a Spanish-language version of WET among Spanish-speaking Latinxs who scored greater than 45 on the Spanish-language version of the PCL-IV, indicating likely PTSD (n = 20) and providers (n = 12). Participants completed a mixed-methods interview regarding reasons they/clients would not want to receive the treatment, why they/clients would want to receive the treatment, potential solutions for any identified barriers, and reasons for not seeking mental health services generally. Providers, but not potential recipients, identified low literacy as a barrier for WET. Providers and potential recipients identified time as a barrier to WET and other mental health services, but the time reduction was perceived as a potential facilitator of WET. Results also suggest no specific cultural barriers were identified for WET (e.g., provider cultural competency) and that Spanish WET may reduce time-related barriers and is perceived as effective and acceptable among Spanish-speaking Latinxs. Additional work is needed to expand the reach of the intervention, given that mental health services were often perceived as untrustworthy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Combinatorial Effects of Discrimination, Legal Status Fears, Adverse Childhood Experiences, and Harsh Working Conditions among Latino Migrant Farmworkers: Testing Learned Helplessness Hypotheses.

Migrant farmwork is often characterized by harsh working conditions that carry significant physical and mental health consequences. Using a learned helplessness framework, the current study examined the extent to which discrimination, immigration legal status difficulties, and adverse childhood experiences moderated the effects of harsh working conditions on depression and anxiety. The study also examined the extent to which harsh working conditions mediated the effects of discrimination, immigration legal status difficulties, and adverse childhood experiences on depression and anxiety. Participants were 241 migrant farmworkers recruited in the Midwest. Participants completed interviews consisting of the Migrant Farmworker Stress Index (MFWSI), Adverse Childhood Events scale (ACEs), Everyday Discrimination Scale, the Centers for Epidemiology Scale for Depression (CES-D), and the seven item Generalized Anxiety Disorder scale (GAD-7). Tests of indirect effects suggested, working conditions mediated the effects of ACEs, immigration legal status fears, and discrimination on CES-D and GAD-7 scores (p-values < .05). Higher ACEs and discrimination also appeared to be associated with larger effects of harsh working conditions on depression and anxiety (p-values < .05), while legal status fears did not significantly moderate the effect of harsh working conditions on either outcome (p-values > .05). Likely through different mechanisms, adverse childhood experiences, discrimination and immigration legal status are associated with higher risk of harsh working conditions and subsequently these conditions account for much of the relations between these three stressors with depression and anxiety. Additionally, discrimination and adverse childhood experiences appear to then enhance the effects of working conditions.

El trabajo de agrícolas migrantes se caracteriza por condiciones severas que incrementanel riesgo de enfermedades médicas y de salud mental. Nuestro estudio examinó qué tantola discriminación, el miedo por el estado legal, y las experiencias adversas durante la niñez (ACEs) aumentaron el efecto de condiciones laborales severas en la depresión y ansiedad. El estudio también examinó si las condiciones laborales explican los efectos de discriminación, el miedo del estado legal, y ACEs en la depresión y ansiedad. Participantes eran 241 trabajadores migrantes agrícolas Latinos del medioccidente (midwest) de los Estados Unidos. Participantes completaron entrevistas de Migrant Farmworker Stress Index (MFWSI; una medida de estrés por trabajadores agrícolas), escala de ACEs, Everyday Discrimination Scale (medida de discriminación), Centers for Epidemiology Scale for Depression (CES-D: medida de síntomas de depresión) y Generalized Anxiety Scale (GAD-7; medida de síntomas de ansiedad). Una serie de modelos de ecuaciones estructurales examinaron ACEs, miedo por estado legal y condiciones laborales severas como predictores de CES-D y GAD-7. Pruebas de efectos indirectos indicaron que las condiciones laborales explicaron parte de los efectos de discriminación, ansiedad y miedo por estado legal en la depresión y ansiedad. También, ACEs y discriminación aumentaron los efectos de las condiciones laborales en los síntomas de depresión y ansiedad (p < .05) pero el miedo por el estado legal no cambió estos efectos (p > .05). Probablemente por mecanismos diferentes, ACEs, discriminación y miedo por el estado legal predicen condiciones laborales severas y estas condiciones incrementan el riesgo de síntomas de depresión y ansiedad. Además, la discriminación y ACEs quizás incrementan los efectos de las condiciones laborales.