"I can do bad all by myself": Indirect effect of social support beliefs on the Strong Black Woman schema and depressive symptoms.

OBJECTIVES: The Strong Black Woman (SBW) schema, a multidimensional construct that promotes self-reliance, self-silencing, self-sacrificial caregiving, and resilience, has been linked to depressive symptoms in Black women. Yet, additional research is needed to examine the mechanisms through which this association exists. The present study examines the indirect effect of social support beliefs on the relationship between the SBW schema and depressive symptoms. METHOD: Data from a sample of 194 Black women (Mage = 37.53, SD = 19.88) were collected using an online survey assessing internalization of the SBW schema, depressive symptoms, and social support-seeking beliefs. RESULTS: A primary dimension of the SBW schema, the expectation to manifest strength, was significantly positively correlated with depressive symptoms and negatively correlated with social support seeking. Depressive symptoms were also significantly negatively correlated with social support beliefs. In addition, an indirect effect of support-seeking beliefs was observed between the expectation to manifest strength and depressive symptoms (ab = .12, 95% CI [.02, .24]). CONCLUSIONS: Findings from this study suggest that Black women experience impairing depressive symptoms, which can be explained by race and gender-specific stress-coping ideologies and behaviors, specifically, the SBW schema. Furthermore, the SBW schema is a factor that may contribute to adverse mental health outcomes among Black women vis-à-vis decreased support-seeking beliefs. We discuss the implications of these findings and how these results can help facilitate culturally competent care for Black women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Population mental health science: Guiding principles and initial agenda.

A recent American Psychological Association Summit provided an urgent call to transform psychological science and practice away from a solely individual-level focus to become accountable for population-level impact on health and mental health. A population focus ensures the mental health of all children, adolescents, and adults and the elimination of inequities across groups. Science must guide three components of this transformation. First, effective individual-level interventions must be scaled up to the population level using principles from implementation science, investing in novel intervention delivery systems (e.g., online, mobile application, text, interactive voice response, and machine learning-based), harnessing the strength of diverse providers, and forging culturally informed adaptations. Second, policy-driven community-level interventions must be innovated and tested, such as public efforts to promote physical activity, public policies to support families in early life, and regulation of corporal punishment in schools. Third, transformation is needed to create a new system of universal primary care for mental health, based on models such as Family Connects, Triple P, PROmoting School-community-university Partnerships to Enhance Resilience, Communities That Care, and the Early Childhood Collaborative of the Pittsburgh Study. This new system must incorporate valid measurement, universal screening, and a community-based infrastructure for service delivery. Addressing tasks ahead, including scientific creativity and discovery, rigorous evaluation, and community accountability, will lead to a comprehensive strategic plan to shape the emergent field of public mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Systematic Review of Neighborhood Factors Impacting HIV Care Continuum Participation in the United States.

Social determinants have been increasingly implicated in accelerating HIV vulnerability, particularly for disenfranchised communities. Among these determinants, neighborhood factors play an important role in undermining HIV prevention. However, there has been little research comprehensively examining the impact of neighborhood factors on HIV care continuum participation in the US. To address this, we conducted a systematic review (PROSPERO registration number CRD42022359787) to determine neighborhood factors most frequently associated with diminished HIV care continuum participation. Peer-reviewed studies were included if published between 2013 - 2022, centralized in the US, and analyzed a neighborhood factor with at least one aspect of the HIV care continuum. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Study quality was guided by LEGEND (Let Evidence Guide Every New Decision) evaluation guidelines. Systematic review analysis was conducted using Covidence software. There were 3,192 studies identified for initial screening. Forty-four were included for review after eliminating duplicates, title/abstract screening, and eligibility assessment. Social and economic disenfranchisement of neighborhoods negatively impacts HIV care continuum participation among persons living with HIV. In particular, five key neighborhood factors (socioeconomic status, segregation, social disorder, stigma, and care access) were associated with challenged HIV care continuum participation. Race moderated relationships between neighborhood quality and HIV care continuum participation. Structural interventions addressing neighborhood social and economic challenges may have favorable downstream effects for improving HIV care continuum participation.

The association between alcohol use and sexual assault victimization among college students differs by gender identity and race.

PURPOSE: Alcohol use and sexual assault (SA) are common on college campuses. The purpose of this study is to examine if the association between alcohol use and SA differs by gender identity, sexual orientation, race, or ethnicity. METHODS: A total of 3,243 college students aged 18-25 at two large, minority-serving, public universities in the southwest and southeast United States completed an online survey about alcohol and sexual behaviors. Two negative binomial regressions were conducted to examine main effects and interaction effects. RESULTS: Almost half of the sample reported a SA victimization history. The main effects negative binomial regression indicated that more drinks per week, older age, identifying as a cisgender woman (vs. cisgender man), identifying as a gender minority (vs. cisgender man), and identifying as a sexual minority (vs. heterosexual) were associated with more severe SA victimization. Participants who identified as Latine (vs. non-Latine White) reported less severe SA. The negative binomial regression assessing interactions indicated that the association between alcohol use and SA severity was stronger among cisgender women and gender minority identities than cisgender men, and Black identities than non-Latine White identities. CONCLUSION: Findings suggests that alcohol use is an important factor for SA severity among all students, but that the association is stronger among some with marginalized identities. Given that perpetrators target people who hold some marginalized identities, prevention programming could address cisnormative, heteronormative, and White normative ideas about alcohol and sex to attain social justice and health equity.

The illusion of inclusion: contextual behavioral science and the Black community.

Anti-racism approaches require an honest examination of cause, impact, and committed action to change, despite discomfort and without experiential avoidance. While contextual behavioral science (CBS) and third wave cognitive-behavioral modalities demonstrate efficacy among samples composed of primarily White individuals, data regarding their efficacy with people of color, and Black Americans in particular, is lacking. It is important to consider the possible effects of racial stress and trauma on Black clients, and to tailor approaches and techniques grounded in CBS accordingly. We describe how CBS has not done enough to address the needs of Black American communities, using Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) as examples. We also provide examples at the level of research representation, organizational practices, and personal experiences to illuminate covert racist policy tools that maintain inequities. Towards eradicating existing racism in the field, we conclude with suggestions for researchers and leadership in professional psychological organizations.

Conceptualizing Community Mental Health Service Utilization for BIPOC Youth.

Historically, children and adolescents who identify as Black, Indigenous, and other people of Color (BIPOC) have had inequitable access to mental healthcare, and research shows that they are significantly less likely than their white American counterparts to utilize available services. Research identifies barriers that disproportionately impact racially minoritized youth; however, a need remains to examine and change systems and processes that create and maintain racial inequities in mental health service utilization. The current manuscript critically reviews the literature and provides an ecologically based conceptual model synthesizing previous literature relating to BIPOC youth barriers for service utilization. The review emphasizes client (e.g. stigma, system mistrust, childcare needs, help seeking attitudes), provider (e.g. implicit bias, cultural humility, clinician efficacy), structural/organizational (clinic location/proximity to public transportation, hours of operation, wraparound services, accepting Medicaid and other insurance-related issues), and community (e.g. improving experiences in education, the juvenile criminal-legal system, medical, and social service systems) factors that serve as barriers and facilitators contributing to disparities in community mental health service utilization for BIPOC youth. Importantly, we conclude with suggestions for dismantling inequitable systems, increasing accessibility, availability, appropriateness, and acceptability of services, and ultimately reducing disparities in efficacious mental health service utilization for BIPOC youth.

Black Moms Matter: A Qualitative Approach to Understanding Barriers to Service Utilization at a Children's Advocacy Center Following Childhood Abuse.

Black families are significantly less likely to receive evidence-based trauma treatment services; however, little is known about factors impacting engagement, particularly at Children's Advocacy Centers (CACs). The goal of this study is to better understand barriers and facilitators of service utilization for Black caregivers of CAC referred youth. Participants (n = 15) were randomly selected Black maternal caregivers (ages 26-42) recruited from a pool of individuals who were referred to receive CAC services. Black maternal caregivers reported barriers to accessing services at CACs including a lack of assistance and information in the referral and onboarding process, transportation issues, childcare, employment hours, system mistrust, stigma associated with the service system, and outside stressors such as stressors related to parenting. Maternal caregivers also shared suggestions for improving services at CACs including increasing the length, breadth, and clarity of investigations conducted by child protection services and law enforcement (LE) agencies, providing case management services, and having more diverse staff and discussing racial stressors. We conclude by identifying specific barriers to the initiation and engagement in services for Black families, and we provide suggestions for CACs seeking to improve engagement of Black families referred for trauma-related mental health services.

Exploring Naturalistic Diffusion of an Evidence-Based Mental Health Intervention across Peer Networks of Youth in Sierra Leone.

BACKGROUND: Understanding the mechanisms by which evidence-based interventions (EBIs) for mental health are naturally diffused among youth in low-and middle-income countries-particularly those with histories of violence and civil unrest-can illuminate which intervention elements are most transferrable and inform scale-up decisions that support youth adjustment. This study explored the diffusion of an evidence-based mental health intervention-the Youth Readiness Intervention (YRI)-among peer networks of Sierra Leonean youth (aged 18-30) who participated in a trial of the intervention as integrated into youth entrepreneurship programs. METHODS: Trained research assistants recruited index participants who had completed the YRI integrated within entrepreneurship training (N = 165) and control index participants (N = 165). Index participants nominated three of their closest peers. Nominated peers were recruited and enrolled in the current study (N = 289). A sub-sample of index participants and peers participated in dyadic interviews (N = 11) and focus group discussions (N = 16). Multivariate regression analysis compared YRI knowledge levels among YRI participants' peers relative to control participants' peers. RESULTS: Qualitative findings supported the diffusion of several YRI skills and components across peer networks (i.e., progressive muscle relaxation and diaphragmatic breathing). Quantitative findings indicated that YRI knowledge was significantly higher for YRI participants' peers (ß = 0.02, p < 0.00) compared to control participants' peers. CONCLUSION: Findings suggest that diffusion of evidence-based intervention components can occur naturally among peers in post-conflict LMIC settings. Developing tools to promote the diffusion of the most transferrable EBI components across peer networks could help maximize the benefits of mental health interventions for youth adjustment and resilience in post-conflict settings.

Race- and university-specific norms associated with alcohol use among Black college students.

Approximately one-third of college students engage in heavy episodic drinking. Although White students drink more than Black students, White individuals are more likely to mature out of heavy drinking, whereas Black individuals drink more as they age and experience disproportionate alcohol-related consequences. Compared to their White counterparts, limited research has examined factors associated with alcohol use among Black college students. Descriptive drinking norms based on the typical college student are strong predictors of college student drinking, but previous research found that this association was weaker for Black college students. Therefore, the current study is a preliminary examination of perceived drinking norms (descriptive) and approval (injunctive) based on race for Black college students. Further, we explored likelihood of excessive drinking around other Black students. The current study included survey responses of 192 Black college students from a large southeastern US university. Results indicated that university and race-specific descriptive norms, but not university and race-specific injunctive norms, were associated with more drinks per week. These findings suggest that descriptive norms with Black students at the participant's university as the normative reference group are associated with alcohol use among Black students. Further, greater likelihood of drinking excessively around peers who share the same racial identity may impact alcohol consumption for this population. Current prevention programs for college student drinking are tailored by gender rather than race; however, preliminary findings from the current study suggests that tailoring by race may be an effective way to prevent alcohol misuse among Black college students.

Approaching Mental Health Equity in Neuroscience for Black Women Across the Lifespan: Biological Embedding of Racism From Black Feminist Conceptual Frameworks.

Black women in the United States are faced with unrelenting chronic stressors that are often driven by racism and oppression and that result in mental health inequities. Similar to common U.S. societal views of Black women, ideological values about Black women's lives also permeate psychiatry and neuroscience research to prevent likely impactful research that fully examines the role of social power structures in the biological embedding of racism. This article's overall aim is to highlight the most urgent areas to address in mental health inequities utilizing a Black feminist lens that include 1) culturally grounded and contextually relevant considerations for the biological embedding of racism on mental health outcomes for Black women across the lifespan and 2) intersectional frameworks that address mental health inequities ingrained in multiple marginalization. We conclude with a call to action informed by Black feminist thought for the field of neuroscience to make a concerted effort to address mental health inequities among Black women and other disenfranchised groups from a frame of compassion, cultural humility, and a continuous pursuit of social justice.

Healing Interpersonal and Racial Trauma: Integrating Racial Socialization Into Trauma-Focused Cognitive Behavioral Therapy for African American Youth.

African American youth are more likely than their peers from other racial and ethnic groups to experience interpersonal traumas and traumatic racist and discriminatory encounters. Unfortunately, evidence-based trauma treatments have been less effective among these youth likely due to these treatments not being culturally tailored to address both interpersonal and racial trauma. In this article, we utilize the racial encounter coping appraisal and socialization theory to propose suggestions for adapting trauma-focused cognitive behavioral therapy-an evidence-based trauma treatment for children and adolescents-to include racial socialization or the process of transmitting culture, attitudes, and values to help youth overcome stressors associated with ethnic minority status. We conclude by discussing implications for the research and clinical community to best promote healing from both interpersonal and racial trauma for African American youth.

Leveraging Technology and Cultural Adaptations to Increase Access and Engagement Among Trauma-Exposed African American Youth: Exploratory Study of School-Based Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy.

African American youth are disproportionately represented among trauma-exposed youth; yet, they are significantly less likely to access and complete mental health services. Research suggests that barriers to accessing and engaging in trauma-focused treatment include both logistical factors and engagement factors. This multiple case study sought to illustrate the initial feasibility and acceptability of delivering culturally tailored, trauma-focused cognitive behavioral therapy (TF-CBT) via telehealth in a school setting with three African American youth presenting with multiple barriers to accessing treatment. Barriers to treatment, telehealth modifications, and cultural tailoring are described for each participant. The UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) was completed at pretreatment and posttreatment. Results demonstrated significant decreases in symptoms of posttraumatic stress, as evidenced by a reduction in total UCLA PTSD-RI scores to nonclinical levels for all participants at posttreatment (UCLA scores posttreatment = 8-12). In addition, at posttreatment no participants met diagnostic criteria for PTSD or adjustment disorder. This multiple case study provides preliminary support for school-based, culturally tailored TF-CBT delivered via telehealth with African American youth.

The impact of microaggressions on Black college students' worry about their future employment: The moderating role of social support and academic achievement.

OBJECTIVES: Several studies have documented the negative impact of microaggressions on anxiety among Black individuals. However, few investigations have examined the impact of microaggressions on Black college students' worries about their future employment and potential moderating factors. We examined whether there would be an association between microaggressions and worries about future employment. Furthermore, both social support and academic achievement (measured by grade point average) were purported to moderate this association. METHOD: Secondary data analysis was used, with the study sample consisting of Black college students (n = 225) from a predominately White institution. Participants had a mean age of 20.43 years (SD = 1.79), with females comprising 74.80% of the sample. RESULTS: Results revealed that social support buffered the effect of microaggressions for low-achieving students, while a buffering effect of social support was not found for high-achieving students. CONCLUSIONS: Perceived social support offers some protection against the exposure of racial microaggressions, although high-achieving Black college students (the most vulnerable to potential isolation and academic pressure) may not benefit from overall social support. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parenting profiles of academic and racial socialization: Associations with academic engagement and academic self-beliefs of African American adolescents.

In addition to being involved and encouraging their youth academically, many African American caregivers also employ socialization practices that prepare their adolescents for entering into a school system where they will be an ethnic minority or be taught by predominantly non-minority educators. The purpose of the current investigation was to fill existing gaps in the literature by examining two dimensions of parental socialization practices: academic socialization (parent school involvement and academic encouragement) and racial socialization (cultural pride, preparation for bias, and egalitarian messages). Additionally, this study examined how the identified profiles are associated with African American adolescents' academic outcomes (academic engagement and academic self-beliefs). A latent profile analysis was utilized to analyze data on 140 African American adolescent participants (M = 12.4; SD = 1.13; 56% female). Profiles that were identified included (a) academic socializers, (b) low race salient socializers, (c) preparation for bias socializers, (d) unengaged socializers, (e) multifaceted socializers, and (f) race salient socializers. Although there was no demographic (age, gender, SES) variation in profile membership, there were some differences in academic engagement and adolescents' academic-self beliefs. Findings highlight the importance of examining how academic and racial socialization work together and their association with adolescents' academic outcomes. Implications are discussed for school psychologists and educators.

Impact of disaster exposure severity: Cascading effects across parental distress, adolescent PTSD symptoms, as well as parent-child conflict and communication.

RATIONALE: Natural disasters are common and have potentially deleterious impacts on individuals, as well as on the relationships among family members (Adams et al., 2015; Paul, 2015). Additionally, caregiver-, offspring-, and family-level outcomes are often correlated following disaster. OBJECTIVE: Thus, longitudinal work is needed to clarify the prospective associations among such constructs following severe disasters. METHOD: The current study included 1,271 adolescents and investigated whether disaster exposure impacted adolescent posttraumatic stress disorder (PTSD) symptoms, parent distress, and family parent-child conflict and communication, as well as whether/how these factors influenced one another over time. This study used a dynamic cascade model and included adolescents (ages 12-17) and caregivers present for tornadoes in Missouri and Alabama in 2011. These participants were part of a larger study involving a web-based intervention. RESULTS: Over and above covariates (i.e., adolescent age, gender, race, treatment, prior trauma, adolescent alcohol use and depressive symptoms, and household income), families who experienced greater severity of disaster exposure had adolescents who reported more baseline PTSD symptoms and caregivers who reported more distress at baseline. CONCLUSIONS: Providing tangible resources (e.g., housing, food, transportation, essential possessions) to families post-disaster may reduce parent distress and adolescent PTSD symptoms. Additionally, reducing adolescent PTSD symptoms may prospectively improve relationships between parents and adolescents.

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review.

BACKGROUND: Adolescents living with HIV (ALWH) who transition from pediatric to adult care face several challenges that increase their risk of experiencing treatment interruptions and being lost to HIV care with resultant increased morbidity and mortality. To date, few studies have examined their outcomes post-healthcare transition (HCT), precluding the development and dissemination of evidence-based interventions aimed at retaining ALWH in HIV care both during and after HCT. We conducted a systematic review to synthesize the outcomes of ALWH post-HCT to provide suggestions for future directions. METHODS: We systematically searched several electronic databases through October 2019 using keywords for HIV, HCT and ALWH. We categorized studies by target population, country (i.e., upper-high income and low-middle income), study design (i.e., descriptive, mixed methods, quantitative), outcomes measured, and follow-up period. RESULTS: A total of 24 studies met inclusion criteria. Studies were categorized according to the following HCT outcomes: retention in HIV care post-HCT (n = 13), changes in CD4+ count and viral load post-HCT (n = 16), and mortality among ALWH post-HCT (n = 7). Most studies (n = 11) examining retention in HIV care indicated that more than 70% of ALWH were retained in care 1-2 years post-HCT while the remaining studies (n = 2) reported retention rates less than 55%. While studies indicated that CD4+ counts and viral loads tended to worsen during the first few years post-HCT, these differences were often not statistically significant. Among all ALWH who transitioned to adult care, a small proportion died within their first seven years post-HCT. Among qualitative studies, common themes included transition readiness (n = 6), provider-patient relationship in the adult clinic setting (n = 6), and concern about the adult clinic setting (n = 4). CONCLUSIONS: Transition outcomes were poorest for ALWH with unsuppressed viremia pre-HCT, suggesting that this subgroup of ALWH may need greater support from their treatment teams and caregivers during and post-HCT to improve clinical outcomes.

From "crib to coffin": Navigating coping from racism-related stress throughout the lifespan of Black Americans.

Despite the proclamation of a "postracial" society, racism in the United States remains "alive and sick" (S. P. Harrell, 2000), negatively impacting the physical, psychological, and emotional well-being of Black Americans. Moreover, the complex impact of racism throughout the life span is inadequately understood. Coping with the insidiousness of racism in its myriad forms requires recognizing how it expresses across development. In this developmental overview, we apply a life-course perspective (Gee, Walsemann, & Brondolo, 2012) to investigate racism-related stress and coping over time. Within each period of development, we first explore how racism-related stress may present for Black Americans and then document what coping from this stress looks like, highlighting extant strategies and interventions where they exist. This work concludes with a set of definitional, methodological, and clinical future directions and recommendations for improving the field's ability to mitigate the deleterious impact of racism-related stress. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Association between hospital community services and county population health in the USA.

OBJECTIVES: Little research has utilized population level data to test the association between community health outcomes and (i) hospital-sponsored community services that facilitate access to care and (ii) hospital-sponsored community building services in the USA. Therefore, the purpose of this study was to examine these relationships. METHODS: A secondary data analysis of the 2016 County Health Rankings and American Hospital Association databases was conducted via zero-truncated negative Binomial regression. RESULTS: Findings indicate a statistically significant difference between the number of community healthcare access services and community building services with county's rank of health behavior. However, no statistically significant differences were found between the number of community healthcare access services and community building services with county rankings of length of life, quality of life or clinical care. CONCLUSIONS: Our findings suggest that quality measures of services may play a more important role in community health improvement and that there is opportunity for hospitals to revamp the way in which community health needs assessments are conducted. Additional federal action is needed to standardize hospital sponsored community health service data reporting so that practitioners, hospital administrators and researchers can more specifically define hospitals' role in public health protection in the USA.

African American emerging adults' experiences with racial discrimination and drinking habits: The moderating roles of perceived stress.

OBJECTIVES: Despite the abundance of research aimed at quantifying the impact of racism on the mental and physical health of African Americans, results remain inconclusive largely because of challenges with operationalization, as well as conflation with the concept of racial discrimination, which may be more readily assessed. The purpose of the current study was to: (a) determine whether racial discrimination had an impact on the degree of alcohol use and binge drinking among African American emerging adults, and if so, (b) determine whether perceived stress linked to racially discriminatory experiences moderated these associations. METHOD: We used a series of hierarchical regressions to examine associations among racial discrimination, perceived stress, and degree of alcohol consumption in a sample of African American emerging adults in the southeast (n = 235). RESULTS: We found that the association between racial discrimination and degree of alcohol consumption (alcohol use and binge drinking) was strongest among individuals who reported greater levels of perceived stress linked to racial discrimination experiences. This association, however, was not significant for individuals who reported lower levels of perceived stress in response to racial discrimination. CONCLUSIONS: African Americans who experience a high degree of perceived stress in response to experiences with racial discrimination may be at greater risk for problem drinking than their peers with less perceived stress. These findings highlight the need for novel intervention efforts aimed at mitigating the effects of stress and racial discrimination on health outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).