Interpersonal psychotherapy versus treatment as usual for PTSD and depression among Sichuan earthquake survivors: a randomized clinical trial.

BACKGROUND: Without effective treatment, PTSD and depression can cause persistent disability in disaster-affected populations. METHODS: Our objective was to test the efficacy of Interpersonal Psychotherapy (IPT) delivered by trained local personnel compared with treatment as usual (TAU) for Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) among adults affected by the Sichuan 2008 earthquake. A small randomized controlled trial of IPT + TAU versus TAU alone was delivered by local mental health personnel in Shifang, China. Between July 2011 and January 2012, 49 adults ≥ 18 years with PTSD, MDD or both were enrolled and randomized to 12 weekly sessions of IPT + TAU (27) or TAU (22) alone x 12 weeks. IPT was then offered to the TAU group. Unblinded follow up assessments were conducted at three and six months. IPT was a 12 session, weekly one hour treatment delivered by local personnel who were trained and supervised in IPT. TAU was continuation of prescribed psychotropic medication (if applicable) and crisis counseling, as needed. MAIN OUTCOME(S) AND MEASURES (S): Clinician Administered PTSD Scale (CAPS) PTSD diagnosis; Structured Clinical Interview for DSM-IV (SCID) for MDD diagnosis. Secondary measures included PTSD/depression symptoms, interpersonal conflict/anger, social support, self-efficacy and functioning. RESULTS: Using an intent-to-treat analysis, 22 IPT + TAU and 19 TAU participants were compared at three months post-baseline. A significantly greater reduction of PTSD and MDD diagnoses was found in the IPT group (51.9%, 30.1%, respectively) versus the TAU group (3.4%, 3.4%, respectively). Despite the small sample, the estimates for time-by-condition analyses of target outcomes (2.37 for PTSD (p = .018) and 1.91 for MDD (p = .056)) indicate the improvement was better in the IPT + TAU condition versus the TAU group. Treatment gains were maintained at 6 months for the IPT group. A similar treatment response was observed in the TAU group upon receipt of IPT. CONCLUSIONS: This initial study shows that IPT is a promising treatment for reducing PTSD and depression, the two major mental health disorders affecting populations surviving natural disaster, using a design that builds local mental health care capacity. TRIAL REGISTRATION: ClinicalTrials.Gov number, NCT01624935.

Intersection of suicidality and substance abuse among young Asian-American women: implications for developing interventions in young adulthood.

PURPOSE: The purpose of this paper is to provide a review of the current literature uncovering specific factors associated with self-harm and suicidality among young Asian American women, as well as to present the Fractured Identity Model as a framework for understanding these factors. This paper offers concrete suggestions for the development of culturally competent interventions to target suicidality, substance abuse, and mental illness among young Asian American women. DESIGN/METHODOLOGY/APPROACH: Empirical studies and theory-based papers featured in peer-reviewed journals between 1990 and 2014 were identified through scholarly databases, such as PubMed, MEDLINE, PsycINFO, JSTOR, and Google Scholar. FINDINGS: We identified several factors associated with suicidality among young Asian American women: (1) family dynamics, or having lived in a household where parents practice "disempowering parenting styles," (2) substance use/abuse, and (3) untreated mental illness(es), which are exacerbated by the stigma and shame attached to seeking out mental health services. The Fractured Identity Model by Hahm et al. (2014) is presented as a possible pathway from disempowering parenting to suicidal and self-harm behaviors among this population, with substance abuse playing a significant mediating role. Research limitations/implications - Our review focused on Asian American women, substance use among Asian Americans, and mental health among Asian Americans. Literature that focused on Asians living in Asia or elsewhere outside of the USA was excluded from this review; the review was limited to research conducted in the USA and written in the English language. PRACTICAL IMPLICATIONS: The complex interplay among Asian American culture, family dynamics, gender roles/expectations, and mental health justifies the development of a suicide and substance abuse intervention that is tailored to the culture- and gender-specific needs of Asian Pacific Islander young women. It is imperative for professionals in the fields of public health, mental health, medicine, and substance abuse to proactively combat the "model minority" myth and to design and implement interventions targeting family dynamics, coping with immigration/acculturative stresses, mental illnesses, suicidal behaviors, and substance abuse among Asian-American populations across the developmental lifespan. ORIGINALITY/VALUE: This paper provides specific suggestions for interventions to adequately respond to the mental health needs of young Asian-American women. These include addressing the cultural stigma and shame of seeking help, underlying family origin issues, and excessive alcohol and drug use as unsafe coping, as well as incorporating empowerment-based and mind-body components to foster an intervention targeting suicidality among Asian-American women in early adulthood.

Ethnic differences in beliefs regarding Alzheimer disease among dementia family caregivers.

OBJECTIVE: The purpose of this study was to examine ethnic differences in female dementia family caregivers' knowledge, attitudes, and beliefs about Alzheimer disease (AD). METHODS: Baseline data were collected from 215 female caregivers before their participation in various psychoeducational intervention programs. Caregivers were questioned about the epidemiology, etiology, and treatment of AD. Logistic regressions and one-way analysis of variance were conducted to assess ethnic differences. RESULTS: Hispanic and Chinese caregivers were more likely to believe that AD is a normal part of aging and that AD can be diagnosed by a blood test than the white group. These beliefs about AD may delay help-seeking activities for these patients and their family caregivers. CONCLUSION: Increased public education about AD is needed in these communities. Results are discussed in terms of barriers to accessing information about AD and ways to improve public informational outreach activities, so that the intended audiences are reached more effectively.

Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: results of a pilot study.

OBJECTIVE: Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress. However, few studies evaluate treatments for them. This study evaluated the efficacy of in-home intervention, based on cognitive behavior therapy principles, to relieve stress and depression in female Chinese American caregivers (CGs). METHODS: Fifty-five CGs who met inclusion criteria were randomly assigned to a telephone support condition (TSC) or to an in-home behavioral management program (IHBMP) for 4 months. In the TSC, biweekly calls were made and relevant material was mailed. In the IHBMP, specific psychological skills were taught to deal with caregiving stress. CGs were assessed before and after treatment. Outcome measures evaluated overall perceived stress, caregiving-specific stress, and depressive symptoms. RESULTS: CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC. There was no difference in overall stress. CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP, but showed little improvement in the TSC. CGs with higher self-efficacy benefited from both treatments. CONCLUSION: This intervention is promising and warrants replication in future studies. Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement.

Recruiting Chinese Americans for dementia caregiver intervention research: suggestions for success.

OBJECTIVE: The purpose of this study was to compare the relative effectiveness of three recruitment modalities for enrolling Chinese-American and white family caregivers into research studies to evaluate intervention strategies. METHODS: A total of 116 Chinese Americans and 134 whites were screened for eligibility to participate in one of two clinical intervention trials. Participants were recruited using: 1) media sources; 2) nonprofessional referral sources; or 3) professional referrals. Each participant was asked an open-ended question about how they became aware of the programs offered. RESULTS: A smaller proportion of Chinese Americans (39%) than whites (50%) who responded to recruiting strategies actually enrolled as subjects. There was a significant interaction between ethnicity and recruitment strategy. Chinese-American caregivers who were recruited by nonprofessional sources were less likely to enroll in the intervention studies than those who were recruited through media sources or professional referrals. Whites, on the other hand, were more likely to be recruited through nonprofessional sources than the other two. CONCLUSIONS: A consumer-oriented approach, which included direct face-to-face contact with key community leaders, generated the highest number of Chinese-American participants. Culture-specific factors such as trust-building with social service agencies, demonstrating genuine commitment to the well-being of the target community, and linguistic and ethnic matching between research staff and potential participants appear helpful to successful research recruitment in this rapidly increasing segment of dementia caregivers.

THE EFFECT OF BEREAVEMENT DUE TO SUICIDE ON SURVIVORS' DEPRESSION: A STUDY OF CHINESE SAMPLES.

The affective effect of suicide on people around is assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), and some correlates are examined to identify characteristics of the bereaved individuals who score high on depression. We used the informants of 66 suicides as subjects for study and the informants of 66 living people as the control group. For each suicide and living person, we interviewed two informants: one family member and one friend. Data collection was accomplished in China in the summer of 2003. Results indicate that the bereaved people (informants of the suicides) are more likely to experience depression than those people in the control group. The closer the relationship to the suicide, the higher the degree of depression. While the survivor's education and income are negatively correlated with his or her depression level, neither age nor gender is a predictor of depression in the sample. Given the strong relationship between suicide and depression, the bereaved survivors of suicide could be a high risk group of suicide. Further and larger study is warranted to investigate more details of the high risk group so as to recommend prevention measures.