Links between ethnic discrimination, mental health, protective factors, and hair cortisol concentrations in asylum seekers living in Germany.

Objective: Asylum seekers often experience ethnic discrimination on the flight or in the host country, which may be associated with chronic stress and impaired mental health. Dysregulation of the hypothalamic-pituitary-adrenal axis, a known physiological correlate of chronic stress, can be assessed using hair cortisol concentrations (HCC). The present study aimed to investigate how different forms of perceived ethnic discrimination are associated with mental health outcomes, HCC, and protective factors in asylum seekers living in Germany.Methods: Somatic symptoms (PHQ-15), symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), different forms of ethnic discrimination (active harm, passive harm, institutional discrimination), and protective factors (in-group identification, social support) were assessed cross-sectionally in 144 asylum seekers (average age 32 years, average duration of stay in Germany nine months; 67% men). HCC were obtained from 68 participants. Multiple regression analyses were conducted and social support and in-group identification were tested as potential moderators.Results: Active ethnic discrimination was positively associated with all assessed mental health outcomes, and all forms of ethnic discrimination positively correlated with depressive symptoms. Ethnic discrimination was not associated with HCC. When controlling for other possible influences (e.g. age, gender, traumatic events), passive harm was negatively associated with depressive symptoms (ß = -0.17, p = .033) and active harm was positively associated (ß = 0.28, p = .022) with somatic symptoms. After the inclusion of the protective factors, the associations were no longer significant. Lower social support was associated with higher depressive symptoms (ß = -0.35, p < .001), posttraumatic stress (ß = -0.77, p < .001), and somatic symptoms (ß = -0.32, p < .001), but did not moderate the associations between ethnic discrimination and the mental health outcomes.Conclusions: Perceived ethnic discrimination may negatively influence asylum seekers' mental health but does not seem to be associated with HCC. Social support was associated with psychological symptom severity, but did not buffer the effects of ethnic discrimination on mental health.

The study examined the relationship between ethnic and institutional discrimination, protective factors (social support and in-group identification), hair cortisol concentrations (HCC) and mental health in asylum seekers.Ethnic discrimination was associated with mental health outcomes and social support, but not with HCC.Lower social support was associated with higher depressive and somatic symptoms, but did not moderate the relationship between ethnic discrimination and mental health.

The associations between social support and mental health among Chinese immigrant pregnant and parenting women.

BACKGROUND: While it is recognized that social support can alleviate mental health symptoms, this relationship is not well-understood among Chinese pregnant and parenting immigrants in the United States. This study aims to bridge this gap by exploring the relationships between different types of social support and women's anxiety and depression, and examining how these associations vary with pregnancy status. METHODS: Data were obtained from a cross-sectional survey conducted in Simplified Chinese or Mandarin between March-June 2021 among 526 women who were pregnant and/or parenting a child under five years. The Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, and Social Support scales were used to measure anxiety, depression, and social support levels. Descriptive statistics, t-tests, chi-square tests, and Pearson's correlations were employed for analysis. Hierarchical regression was conducted to investigate the main and interaction effects of social support types and pregnancy status on mental health outcomes. RESULTS: Compared to non-pregnant women, pregnant women reported higher mean scores for anxiety (non-pregnant: 55, pregnant: 59, p < 0.01) and depression (non-pregnant: 54, pregnant: 56, p = 0.02). Instrumental support displayed a significant main effect in relation to anxiety (ß=-0.13, p = 0.01) and depression (ß=-0.16, p < 0.01); emotional support exhibited a significant main effect solely on depression (ß=-0.13, p = 0.01). Notably, the interaction effects between pregnancy status and both instrumental (ß=-0.28, p = 0.01) and emotional support (ß=-0.42, p < 0.01) were significant for anxiety. In contrast, informational support did not exhibit a significant impact on either anxiety or depression. CONCLUSIONS: The findings indicate that tailoring support to the cultural context is crucial, especially for pregnant women in this Chinese immigrant community, with instrumental and emotional support being particularly beneficial in mitigating maternal anxiety.

Interventions to promote mental health in the Occupied Palestinian Territories and Palestinian refugees: A scoping review.

BACKGROUND: The long history of the Palestinian-Israeli conflict has resulted in a public and mental health crisis. Despite the significant mental health burdens facing the Palestinian population in the Occupied Palestinian Territories (OPT) and refugee camps, this issue remains comprehensively unexplored. AIMS: This scoping review identified mental health interventions and assessed their effectiveness among populations in the OPT and Palestinian refugee camps, while addressing delivery challenges. METHOD: A scoping review was conducted using 14 databases to include relevant studies published through March 2024 using PRISMA guidelines for scoping reviews. RESULTS: Analyzing 31 intervention studies meeting the inclusion/exclusion criteria, revealed varied outcomes in interventions targeting post-traumatic stress disorder, depression, and overall mental well-being. CONCLUSIONS: While some interventions showed potential, others had limited effectiveness, underscoring the complexity of mental health needs in conflict zones. Gender- and risk-specific effectiveness was observed, emphasizing the need for tailored approaches. Challenges like low attendance rates and systemic barriers hindered intervention success. The profound impact of war on children stresses the urgency for targeted interventions. Empowerment and community connectedness are vital for resilience, along with the importance of family and community involvement and research that balances the need for strong evaluation designs with the need for ongoing mental health services. Advocacy for systemic changes is crucial to implement the complex sustainable interventions necessary to assure mental health in any population. This review highlights the importance of holistic, contextually relevant approaches for mental health intervention in OPT and refugee camps, emphasizing rigorous evaluations and community-driven approaches.

Are characteristics associated with strong Black womanhood linked to depression in older Black women?

BACKGROUND: Older Black women experience structural and intersectional disadvantages at the intersection of age, race, and gender. Their disadvantaged social statuses can translate into serious psychological health consequences. One concept that may aid in understanding psychosocial determinants of older Black women's depression risk is the "Strong Black Woman," which suggests that Black women have supernatural strength amidst experiencing adversity and are expected to "be strong" for others by providing self-sacrificial aid without complaint. OBJECTIVES: Drawing inspiration from the "Strong Black Woman" concept, the current study examined whether three psychosocial factors (i.e., mastery, anger suppression, and relational demands (from spouse, children, relatives, and friends)) were associated with depressive symptoms, clinically significant depressive symptoms, and lifetime professionally diagnosed depression among older Black women (i.e., ages 50 years and older). DESIGN: This was a cross-sectional study. Data were drawn from the 2010 to 2012 waves of the Health and Retirement Study (N = 1,217). METHODS: For past-week depressive symptoms, ordinary least squares regression analyses were conducted, and beta coefficients were reported. For clinically significant depressive symptoms (i.e., reporting three or more depressive symptoms in the past week) and lifetime professionally diagnosed depression, binary logistic regression analyses were performed, and odds ratios were reported. RESULTS: Higher levels of mastery were associated with lower risk for depressive symptoms and depression. Anger suppression was associated with higher risk for depressive symptoms and depression. Demands from children and one's spouse were associated with higher depressive symptoms while demands from family were associated with risk for lifetime depression diagnosis. Not having a spouse was associated with heightened risk of depressive symptoms and depression. Interestingly, demands from friends were not associated with depressive symptoms nor diagnosed depression. CONCLUSION: Study findings revealed important nuances in the determinants of depression among older Black women which, in turn, has implications for research and mental health care provision in this population.

Attitudes towards depression and its treatment among white, hispanic, and multiracial adults.

BACKGROUND: Depression is present in all societies and affects members of all racial and ethnic groups. However, attitudes about depression differ across groups and have been shown to impact help-seeking behaviors, preferences for treatments, and compliance with treatments. METHODS: Taking a cross-cultural approach, this project used a case vignette of depression to examine race/ethnic group differences in attitudes about depression and its treatment among young adults in the U.S. RESULTS: Data analyses revealed significant racial/ethnic group differences in attitudes as well as the treatments/strategies participants reported they would use. Gender x race/ethnicity interactions revealed that White and Multiracial/ethnic men were more likely to believe the vignette character should find a partner to help with symptoms, while White and Multiracial/ethnic women did not endorse those strategies. Hispanic men and women did not show a gender difference in that strategy, but gender differences were observed in other strategies. In a rare comparison, majority-minority Multiracial/ethnic participants (i.e., White selected as one of their races/ethnicities) rated identified helpers and treatments similarly to White participants and significantly higher than multiple-minority Multiracial participants (i.e., White not selected as one of their races/ethnicities). CONCLUSIONS: Findings supported previous research that indicates different U.S. racial/ethnic group ideas of depression and its treatment are potentially linked with cultural values, and we suggest that investigating these more fine-grained group differences can help to inform treating professionals as well as public health messages.

Ethnic socialisation profiles and depression among ethnic minority adolescents in China: a person-centred approach.

BACKGROUND: Ethnic socialisation plays a vital role in the development of ethnic minority adolescents. However, the generalizability of research findings beyond the context of immigrant societies in the United States remains unclear. METHODS: Utilising a person-centred approach, this study analysed a sample of 2,600 ethnic minority adolescents in China (55.8% female, Mage = 14.93 ± 1.82) to explore ethnic socialisation patterns, and their correlations with depression. RESULTS: Latent profile analysis revealed four distinct ethnic socialisation profiles: low-frequency, moderate-frequency, high-frequency and proactive integration orientation. Adolescents with the high-frequency profile displayed the highest levels of depression, followed by those with the moderate-frequency profile, whereas adolescents with the low-frequency and proactive integration orientation profiles showed a lower risk of depression. CONCLUSIONS: Within the sociocultural context of China, ethnic minority families' ethnic socialisation practices demonstrate unique characteristics. Various ethnic socialisation messages are integrated in diverse patterns to exert influence on adolescents.

The impact of acculturative stress on internalizing problems among racially and ethnically minoritized adolescents and young adults in the U.S.: A systematic review and meta-analysis.

Due to demographic changes of the U.S. population in the past few decades, more attention has been placed on understanding the sociocultural factors that have an impact on the mental health of racially and ethnically minoritized (REM) groups. One factor that has gained increased attention in recent years is acculturative stress. Acculturative stress is associated with negative mental health outcomes, such as depression, anxiety, psychological distress, and suicide ideation (SI). However, the magnitude of this association remains unclear. A systematic review and meta-analysis were conducted to provide a comprehensive review of the impact of acculturative stress on depression, anxiety, psychological distress, and SI among REM youth. We also aimed to explore whether sociodemographic variables (i.e., race/ethnicity, generational status, sex/gender, and age) moderate the relationships between acculturative stress and mental health outcomes. Forty-six peer-reviewed articles examining the link between acculturative stress and internalizing problems among REM youth in the U.S. (mean age range: 13-29) met inclusion criteria and were included in this systematic review and meta-analysis. A positive relationship of moderate size between acculturative stress and depression, anxiety, psychological distress, and SI was found. Moderation analyses also revealed that the impact of acculturative stress on depression may be greater among those who are older and for first-generation immigrants. Similarly, its impact on anxiety may also be more pronounced for first-generation immigrants. Results also suggested that the impact of acculturative stress on depression and psychological distress may be greater among men compared to women. These findings highlight the importance of making sure clinicians assess for acculturative stress when working with REM youth, as well as factors that may be contributing to an individual's acculturative stress level.

The Prevalence and Correlates of Depression, Anxiety, and Insomnia among Camp Residing Palestinian Women Migrants during the Outbreak of the War on Gaza: A Cross-Sectional Study from Jordan.

Background and Objectives: The current war on the Gaza strip and the circulating violent content is believed to negatively impact the mental health of the Palestinians living in refugee camps outside their homeland. This study explores the prevalence and correlates of depression, anxiety, and insomnia in a cohort of female Palestinian refugees in Jordan who have family members entangled in the persistent conflict in the Gaza strip. Materials and Methods: This cross-sectional study employed validated tools to assess depression, anxiety, and insomnia in women residing in a Gaza camp located in Jerash, Jordan. The correlates were determined by regression analysis. Results: The study unearths disconcerting statistics from 177 recruited women, revealing alarmingly high rates of severe depression (73%), anxiety (60%), and insomnia (65%). Multivariable analysis revealed that severe depression was significantly associated with prior diagnosis with chronic diseases (OR = 3.0, CI = 1.36-6.58), and having a first-degree relative in Gaza (OR = 0.42, CI = 0.20-0.85). Additionally, severe insomnia was associated with "losing relatives or friends in the war" (OR = 3.01, CI = 1.41-6.44), and "losing connection with families and friends" (OR = 3.89, CI = 1.58-9.53). Conclusions: The implications of these results are profound, underscoring the immediate and imperative need for both medical and psychiatric interventions aimed at addressing the substantial psychological burden borne by this population because of the ongoing conflict.

Sensitivity and specificity of Aboriginal-developed items to supplement the adapted PHQ-9 screening measure for depression: results from the Getting it Right study.

OBJECTIVE: To determine the psychometric properties of an Aboriginal and Torres Strait Islander-developed depressive symptom screening scale. DESIGN: Prospective diagnostic accuracy study. SETTING: Ten primary health care services or residential alcohol and other drug rehabilitation services in Australia that predominantly serve Aboriginal and Torres Strait Islander peoples. PARTICIPANTS: 500 adults (18 years or older) who identified as Aboriginal and/or Torres Strait Islander and were able to communicate sufficiently to respond to questionnaire and interview questions. Recruitment occurred between 25 March 2015 and 2 November 2016. MAIN OUTCOME MEASURE: Criterion validity of seven Aboriginal and Torres Strait Islander-developed items, using the adapted Patient Health Questionnaire 9 (aPHQ-9) and depression module of the Mini International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standards. RESULTS: The seven-item scale had good internal consistency (α = 0.83) and correlated highly with the aPHQ-9 (ρ = 0.76). All items were significantly associated with diagnosis of a current major depressive episode. Discriminant function and decision tree analysis identified three items forming a summed scale that classified 85% of participants correctly. These three items showed equivalent sensitivity and specificity to the aPHQ-9 when compared with the MINI-identified diagnosis of a current major depressive episode. CONCLUSION: Three items developed by and for Aboriginal and Torres Strait Islander people may provide effective, efficient and culturally appropriate screening for depression in Aboriginal and Torres Strait Islander health care contexts.

The Role of Inflammation and Psycho-Behavioral Factors as Mediators Between Acculturation and Time to Incident Dementia Among Older Mexican Americans.

Background: The mechanisms through which acculturation influences the onset of cognitive impairment and dementia are not well understood, especially among older Hispanics. Objective: To investigate whether inflammation and psycho-behavioral factors mediate the relationship between acculturation and incident dementia among older Mexican Americans. Methods: We analyzed the Sacramento Area Latino Study on Aging (1998-2007, SALSA), a longitudinal study (N = 1,194) with 10 years of follow-up, and used g-computation for mediation analysis with pooled logistic regression to evaluate whether acculturation (assessed by the Revised Acculturation Rating Scale for Mexican Americans [ARSMA-II]) affected dementia or cognitive impairment but not dementia (CIND) through inflammation (i.e., interleukin 6 [IL-6], tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein [hs-CRP]), smoking, alcohol consumption, and depressive symptoms. The potential mediators were assessed at baseline. Results: The 10-year average adjusted risk ratio (aRR) for the effect of high U.S. acculturation and dementia/CIND was 0.66, 95% CI (0.36, 1.30). The indirect effects were: IL-6 (aRR = 0.98, 95% CI (0.88, 1.05)); TNF-α (aRR:0.99, 95% CI (0.93, 1.05)); hs-CRP: (aRR = 1.21, 95% CI (0.84, 1.95)); current smoking: aRR = 0.97, 95% CI (0.84, 1.16); daily/weekly alcohol consumption (aRR = 1.00, 95% CI (0.96, 1.05)); and depressive symptom score (aRR = 1.03, 95% CI (0.95, 1.26)). Hs-CRP yielded a proportion mediated of -26%, suggesting that hs-CRP could suppress the potential effect of high U.S. acculturation. The other factors explored resulted in little to no mediation. Conclusions: The effect of acculturation on time to incident dementia/CIND varied over time. Our study suggests that inflammation could suppress the effect between high U.S. acculturation and dementia risk.

Ethno-racial differences in depressive symptom endorsement: Evaluation of brief forms of the Geriatric Depression Scale in older adults.

BACKGROUND: Depression among older adults is a pressing public health concern, necessitating accurate assessment tools. The Geriatric Depression Scale (GDS) offers a brief and efficient means of screening depressive symptoms, yet its performance across ethno-racial groups remains understudied. This study aimed to compare the ability of various brief forms of the GDS to detect depressive symptoms and to assess potential ethno-racial differences in symptom endorsement among White, Black/African-American, and American Indian/Alaska Native older adults. METHODS: Data were obtained from the Wisconsin Alzheimer's Disease Research Center (ADRC) clinical cohort, comprising 555 cognitively healthy individuals at risk for dementia. We used participants' baseline data for this cross-sectional analysis. Depressive symptoms were assessed using multiple brief forms of the GDS, derived from a systematic review and meta-analysis. We examined internal consistency and correlations with global Clinical Dementia Rating (CDR) scores. We conducted Kruskal-Wallis tests and post hoc pairwise comparisons to assess ethno-racial group differences in symptom endorsement. RESULTS: Descriptive statistics revealed a predominance of female and White participants, with notable representation from Black and American Indian/Alaska Native groups. All GDS versions demonstrated moderate to high internal consistency. Significant positive correlations were observed between GDS scores and global CDR scores. Ethno-racial group differences in depressive symptom endorsement were evident, with Black participants consistently reporting higher levels of symptoms across most GDS versions. However, American Indian/Alaska Native participants endorsed significantly fewer symptoms than Black participants in one GDS version. CONCLUSION: The study highlights the importance of considering ethno-racial differences in depressive symptomatology when assessing older adults. While the GDS demonstrates overall reliability, variations in symptom endorsement across different ethno-racial groups underscore the need for culturally sensitive assessment tools and interventions. Future research should further explore these group differences and develop tailored approaches to depression screening and treatment in diverse older adult populations.

Everyday Violence: Immigration Enforcement, COVID-19, and Depression among Undocumented Young Adults in California.

Background: The immigration enforcement system has significant effects on the health of immigrants, their families, and society. Exposure to the immigration enforcement system is linked to adverse mental health outcomes, which may have been exacerbated by sustained immigration enforcement activities during the COVID-19 pandemic. Objectives: This study was conducted to investigate the association between exposure to immigration enforcement and the mental health of undocumented young adults in California during the COVID-19 pandemic. Methods: Data are from the COVID-19 BRAVE (Building Community Raising All Immigrant Voices for Health Equity) Study, a community-engaged cross-sectional survey of the impacts of the COVID-19 pandemic on undocumented immigrants in California. A total of 366 undocumented immigrants between 18 and 39 years of age completed the online survey, which was conducted between September 2020 and February 2021. Multivariable logistic regression models were fit to examine the association between immigration enforcement exposure and depression. Results: Almost all participants (91.4%) disclosed exposure to the immigration enforcement system, with most reporting an average of 3.52 (SD=2.06) experiences. Multivariate analyses revealed that an increase in the immigration enforcement exposure score was significantly associated with higher odds of depression (adjusted odds ratio [aOR]=1.24; 95% confidence interval [CI]: 1.10, 1.40), and women were 92% more likely to report depression than were men (aOR=1.92; 95% CI: 1.12, 3.31). Those who reported deportation fears were significantly more likely to be depressed (aOR=1.24; 95% CI: 1.10, 1.40). Conclusions: Researchers should consider the mental health implications of a punitive immigration enforcement system, and policymakers should examine the impacts of immigration policies on local communities.

Assessment of unmeasured confounding in the association between perceived discrimination and mental health in a predominantly African American cohort using g-estimation.

BACKGROUND: Perceived discrimination in health care settings can have adverse consequences on mental health in minority groups. However, the association between perceived discrimination and mental health is prone to unmeasured confounding. The study aims to quantitatively evaluate the influence of unmeasured confounding in this association, using g-estimation. METHODS: In a predominantly African American cohort, we applied g-estimation to estimate the association between perceived discrimination and mental health, adjusted and unadjusted for measured confounders. Mental health was measured using clinical diagnoses of anxiety, depression and bipolar disorder. Perceived discrimination was measured as the number of patient-reported discrimination events in health care settings. Measured confounders included demographic, socioeconomic, residential and health characteristics. The influence of confounding was denoted as α1 from g-estimation. We compared α1 for measured and unmeasured confounding. RESULTS: Strong associations between perceived discrimination in health care settings and mental health outcomes were observed. For anxiety, the odds ratio (95% confidence interval) unadjusted and adjusted for measured confounders were 1.30 (1.21, 1.39) and 1.26 (1.17, 1.36), respectively. The α1 for measured confounding was -0.066. Unmeasured confounding with α1=0.200, which was over three times that of measured confounding, corresponds to an odds ratio of 1.12 (1.01, 1.24). Similar results were observed for other mental health outcomes. CONCLUSION: Compared with measured confounding, unmeasured that was three times measured confounding was not enough to explain away the association between perceived discrimination and mental health, suggesting that this association is robust to unmeasured confounding. This study provides a novel framework to quantitatively evaluate unmeasured confounding.

Efficacy of technology-based mental health interventions in minimizing mental health symptoms among in immigrants, asylum seekers or refugees; systematic review.

Digital health technologies may offer an alternate approach to augmenting the established mental health care delivery systems for migrants and promoting their mental well-being. This review aims to provide a broad examination of literature, to determine the impact of technology-based interventions on outcomes of immigrants and refugees experiencing mental health symptoms associated with pre-and postmigration stress (depression, anxiety, psychological stress, PTSD). We searched five electronic databases (PubMed, Embase, PsycINFO, Web of Science, and the ACM digital library). We included studies that looked at the effectiveness of any technologybased intervention (internet or phone-based, telepsychiatry, telemedicine, digital technology, videoconferencing, or tele video). We limited our search to articles written in English and published up until January 2202. Two reviewers independently extracted article data and evaluated the quality of studies using the Cochrane risk-of-bias criteria and ROBINS-I risk of bias evaluation tool. We found scant evidence that the use of digital interventions, such as mobile-based therapies, video conferencing, and digital platforms, is associated with a statistically significant reduction in depressive and anxious symptoms among immigrants and refugees. In the included trials, no evidence of a substantial decrease in PTSD symptoms was found following the use of a self-help mobile app. Our systematic review revealed intriguing but limited evidence that digital psychological therapies can reduce depression in immigrants and refugees. Future study with a randomized experimental design is required to examine the effectiveness of digital treatments in lowering the impacts of mental health outcomes among immigrants.

Microaggression and discrimination exposure on young adult anxiety, depression, and sleep.

BACKGROUND: Increasing research examines social determinants of health, including structural oppression and discrimination. Microaggression - subtle/ambiguous slights against one's marginalized identity - is distinct from discrimination, which typically presents as overt and hostile. The current study investigated the comparative effects of each exposure on young adult anxiety, depression, and sleep. Race-stratified analyses investigated patterns across groups. METHODS: Young adults (N = 48,606) completed the Spring 2022 American College Health Association-National College Health Assessment III. Logistic regressions tested odds of anxiety symptoms, depressive symptoms, and sleep disturbance in association with microaggression and discrimination exposure. RESULTS: Microaggression and discrimination equally predicted increased likelihood of anxiety symptoms (ORMicro = 1.42, ORDiscrim = 1.46). Discrimination more strongly predicted depressive symptoms (OR = 1.59) and sleep disturbance (OR = 1.54) than did microaggression (ORDepress = 1.24, ORSleep = 1.27). Race-stratified analyses indicated stronger associations between the each exposure and poor mental health in Whites than Asian American, Black/African American, and Hispanic or Latino/a/x respondents. LIMITATIONS: Microaggression and discrimination exposure were each assessed using a single item. The outcome measures were not assessed using validated measures of anxiety, depression, and sleep (e.g., GAD-7, MOS-SS); thus results should be interpreted with caution. Analyses were cross-sectional hindering our ability to make causal inferences. CONCLUSIONS: The findings provide preliminary evidence that microaggression and discrimination exposure operate on health in distinct ways. Racially marginalized individuals may demonstrate a blunted stress response relative to Whites. Treatment approaches must be tailored to the particular exposures facing affected individuals to maximize benefits.

Differences across race and ethnicity in the quality of antidepressant medication management.

OBJECTIVE: To illustrate the importance of a multidimensional view of disparities in quality of antidepressant medication management (AMM), as well as discriminating "within-facility" disparities from disparities that exist between facilities. DATA SOURCES AND STUDY SETTING: We used data from the Veterans Health Administration's (VA) Corporate Data Warehouse (CDW) which contains clinical and administrative data from VA facilities nationally. STUDY DESIGN: CDW data were used to measure five indicators of AMM quality, including the HEDIS Effective Acute-Phase and Effective Continuation-Phase measures. Mixed effects regression models were used to examine differences in quality indicators between racial/ethnic groups, controlling for other demographic and clinical factors. An adaptation of the Kitagawa-Blinder-Oaxaca (KBO) method was used to decompose mean differences in treatment quality between racial and ethnic groups into within- and between-facility effects. DATA EXTRACTION METHODS: Demographic, clinical, and health service utilization data were extracted for patients in fiscal year 2017 with a diagnosis of depression and a new start of an antidepressant medication. PRINCIPAL FINDINGS: The decomposition of the overall differences between White and Black patients on receiving an initial 90-day prescription (46.7% vs. 32.7%), Effective Acute-Phase (79.7% vs. 66.8%), and Effective Continuation-Phase (64.0% vs. 49.6%) HEDIS measures revealed that most of the overall effects were "within-facility," meaning that Black patients are less likely to meet these measures regardless of where they are treated. Although the overall magnitude of disparities between White and Hispanic patients on these three measures was very similar (46.7% vs. 32.7%; 79.7% vs. 69.2%; 64.0% vs. 53.6%), the differences were more attributable to Hispanic patients being treated in facilities with overall lower performance on these measures. CONCLUSIONS: Discriminating within- and between-facility disparities and taking a multidimensional view of quality are essential to informing efforts to address disparities in AMM quality.

Connected for life: How social connectedness can help prevent suicide in American Indian and Alaska Native communities.

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

Associations of adverse childhood experiences with depression and anxiety among children in the United States: Racial and ethnic disparities in mental health.

OBJECTIVE: To assess associations of ACEs with depression and anxiety, with special emphasis on potential racial and ethnic disparities. METHOD: Data were from the National Survey of Children's Health (NSCH), 2021-2022, a large, cross-sectional, nationally representative, population-based study of United States children aged 0-17. The associations of cumulative ACEs with depression and anxiety among 104,205 children and adolescents were assessed via multivariable logistic regression, including adjustment for age, sex, race, household income, and parental educational attainment. RESULTS: ACEs were associated with depression and anxiety in a linear, dose-dependent manner. After adjustment for covariates, compared to no ACE exposures, participants with exposures to one, two, and three ACEs exhibited significantly higher odds of depression (fully-adjusted ORs and 95 % CIs = 2.18 [2.03, 2.35], 4.95 [4.55, 5.39], and 11.39 [10.18, 12.75], respectively). For anxiety, compared to no ACEs exposures, participants with exposure to one, two, and three ACEs had significantly higher odds of anxiety (fully-adjusted ORs and 95 % CIs = 1.90 [1.81, 2.00], 3.66 [3.44, 3.90], and 6.91 [6.30, 7.58], respectively). Notably, stratified analyses indicated potential effect modification by race, wherein the associations of ACEs with depression and anxiety were strongest in Black and White participants. CONCLUSION: ACEs were robustly associated with depression and anxiety in a national sample of U.S. children and adolescents, with differential impacts of ACES on mental health observed across racial and ethnic groups. These findings underscore the need for urgent government and healthcare interventions and policies to ameliorate ACEs' health effects, especially among disproportionately impacted minority groups.

Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial.

BACKGROUND: Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials' samples consisted of predominantly non-Hispanic, White individuals. OBJECTIVE: This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. METHODS: Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. RESULTS: Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). CONCLUSIONS: This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention.

Depression and Implantable Cardioverter-Defibrillator Implantation in Black Patients at Risk for Sudden Cardiac Death.

BACKGROUND: Black patients meeting indications for implantable cardioverter-defibrillators (ICDs) have lower rates of implantation compared with White patients. There is little understanding of how mental health impacts the decision-making process among Black patients considering ICDs. Our objective was to assess the association between depressive symptoms and ICD implantation among Black patients with heart failure. METHODS AND RESULTS: This is a secondary analysis of the VIVID (Videos to Address Racial Disparities in ICD Therapy via Innovative Designs) randomized trial, which enrolled self-identified Black individuals with chronic systolic heart failure. Depressive symptoms were assessed by the Patient Health Questionnaire-2 and the Mental Component Summary of the 12-Item Short-Form Health Survey. Decisional conflict was measured by an adapted Decisional Conflict Scale (DCS). ANCOVA was used to assess differences in Decisional Conflict Scale scores. Multivariable logistic regression was used to examine the association between depressive symptoms and ICD implantation. Among 306 participants, 60 (19.6%) reported depressed mood, and 142 (46.4%) reported anhedonia. Participants with the lowest Mental Component Summary of the 12-Item Short-Form Health Survey scores (poorer mental health and higher likelihood of depression) had greater decisional conflict regarding ICD implantation compared with those with the highest Mental Component Summary of the 12-Item Short-Form Health Survey scores (adjusted mean difference in Decisional Conflict Scale score, 3.2 [95% CI, 0.5-5.9]). By 90-day follow-up, 202 (66.0%) participants underwent ICD implantation. There was no association between either the Patient Health Questionnaire-2 score or the Mental Component Summary of the 12-Item Short-Form Health Survey score and ICD implantation. CONCLUSIONS: Depressed mood and anhedonia were prevalent among ambulatory Black patients with chronic systolic heart failure considering ICD implantation. The presence of depressive symptoms did not impact the likelihood of ICD implantation in this population.