Multi-site, multi-country randomized clinical trial of an acute traumatic brain injury caregiver transition assistance program in Latin America.

BACKGROUND: Individuals with traumatic brain injury (TBI) in Latin America experience high levels of disability and extremely poor functional outcomes, and their informal caregivers play a key role in their rehabilitation and care. OBJECTIVE: To improve TBI rehabilitation through stronger informal caregiving, this study developed and evaluated an evidence-based and culturally appropriate Transition Assistance Program (TAP) for informal caregivers of individuals with TBI in Latin America, specifically targeting the time period before and after the transition from hospital to home. METHODS: A sample of 89 people with a new TBI and their primary informal caregiver (n = 178) was recruited from two hospitals in Mexico City, Mexico, and in Cali, Colombia. Caregivers were randomly assigned to either the TAP group or to a control group receiving the standard care provided by the hospital. Caregivers completed measures of depression and burden, and individuals with TBI completed measures of depression and self-perceived burden on caregivers before hospital discharge and at 2- and 4-month follow ups. RESULTS: Caregivers in the TAP group reported significantly lower burden than those in the control group and marginally lower depression. Individuals with TBI whose caregivers had been in the TAP group reported significantly lower depression than those whose caregivers had been in the control group, and a non-significant but lower self-perceived burden on their caregivers. CONCLUSION: The results suggest that the TAP has strong potential to benefit both TBI caregivers and individuals with TBI during the transition from acute TBI hospitalization to home in Latin America, generally showing small-or medium-sized effects on key outcomes.

State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People.

Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018−2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.

Predictors of Alcohol Use in Safety-Net Primary Care: Classism, Religiosity, and Race.

Class-based discrimination may impact problematic drinking in low-income populations, which may be buffered by personal religiosity. However, little is known how race may impact this association. The purpose of this study was to examine racial differences in the effect of class-based discrimination on problematic drinking as moderated by comfort with God and determine if there were conditional direct effects of class-based discrimination on problematic drinking by race. In this cross-sectional study, participants (N = 189) were patients of an urban, safety-net primary care clinic who completed questionnaires assessing experiences of class-based discrimination, attitudes toward God, and alcohol use. Data were collected from 2015 to 2016 and analyzed using the Hayes PROCESS macro. There was a significant main effect for class-based discrimination predicting problematic drinking. Two-way interaction analyses identified a significant comfort with God by race interaction with greater comfort with God associated with less problematic drinking among white but not black respondents. Conditional direct effects showed that experiences of class-based discrimination were associated with problematic drinking at low and moderate but not high levels of comfort with God in black participants, whereas none were observed for white participants. This study provides insight on how personal religiosity, class-based discrimination, and race may intertwine to shape problematic alcohol use in primarily low-income, urban patients. Clinicians' awareness of risk and protective factors, as well as how race tempers the effects of such factors, is vital in providing better care for this population.

Heterosexism and Suicidal Ideation.

Background: Heterosexism has been identified as being a contributing factor of suicidality in sexual minority adults (SMA), and social support is believed to be important for mitigating these effects. Research evaluating racial/ethnic differences in suicidality among SMA is limited despite racial/ethnic minorities being at greater risk. Aims: We aimed to examine the associations between heterosexism, suicidal ideation, and social support in a sample of racially/ethnically diverse SMA. Method: SMA (N = 239) were recruited as part of an online survey on sexuality and health based in the United States. Results: There were significant positive main effects of heterosexism and significant negative main effects for non-White racial/ethnic identity on suicidal ideation. There were significant negative main effects for social support from family and a significant other but not from friends. A significant interaction of social support from a significant other and racial ethnic identity was qualified by a significant three-way interaction with heterosexism. Social support from a significant other buffered the effect of heterosexism on suicidal ideation among non-White but not among White SMA. All other interactions were not significant. Limitations: Within-group differences of racial/ethnic groups and other domains of social support were not examined, and the cross-sectional nature of the data precludes causal inference. Conclusion: Support from a significant other may be important for suicidality, particularly for racial/ethnic minority SMA.

Predictors of longitudinal depression trajectories after traumatic brain injury in Latin America: A multi-site study.

BACKGROUND: Latin America has exceptionally high rates of traumatic brain injury (TBI), but very little research has been conducted on longitudinal TBI outcomes in this global region. OBJECTIVE: This study examined whether cognitive dysfunction and social disadaptation in individuals with TBI in Latin America at hospital discharge predict longitudinal trajectories of depression at baseline, 2 months, and 4 months. METHODS: A sample of 109 people with a new TBI was recruited from three hospitals: Mexico City, Mexico, Cali, Colombia and Neiva, Colombia. Participants completed measures of cognitive dysfunction and social disadaptation before hospital discharge and measures of depression at baseline, 2 months, and 4 months. RESULTS: Results suggested that depression scores were found to decrease over time in a quadratic (or U-shaped) fashion, and more significant cognitive dysfunction at hospital discharge was associated with higher longitudinal depression trajectories. Social disadaptation did not exert a unique effect on depression trajectories after controlling for cognitive dysfunction. Depression trajectories changed differentially over time as a function of baseline cognitive dysfunction, such that for those with high cognitive impairment, depression scores started high and then dropped to a moderated range and plateaued, but for individuals with low cognitive dysfunction, depression scores started lower and decreased linearly but moderately. CONCLUSIONS: The results suggest a strong need for neuropsychological assessments and evidence-based cognitive rehabilitation strategies to be implemented immediately after TBI in Latin America, which could exert salubrious effects on depression trajectories over time.

Moderating influence of enculturation on the relations between minority stressors and physical health via anxiety in Latinx immigrants.

OBJECTIVES: The Latinx population in the United States has grown rapidly, now standing at over 56 million people. Discrimination and acculturative stress have been found to affect the mental and physical health of Latinx immigrants, yet enculturation has been identified as an important cultural strength for this population. The purpose of this study was to examine the relations among minority stressors, anxiety, and physical health in a sample of Latinx immigrants living in the United States. A secondary aim was to examine whether the direct and indirect effects among these variables were moderated by enculturation (i.e., moderated mediation). METHOD: A community sample of 202 Latinx immigrants completed questionnaires measuring these constructs. RESULTS: Both acculturative stress (b = -1.68, p < .001) and discrimination (b = -1.69, p < .001) yielded direct effects on physical health, as well as indirect effects (b = -.10, 95% confidence interval [-.23, -.01]; b = -.21, 95% confidence interval [-.40, -.08], respectively) through anxiety. CONCLUSIONS: Psychologists and allied health care providers are recommended to assess for the impact of minority stressors on anxiety and physical health when providing care to Latinx immigrants. Future intervention research targeting Latinx mental and physical health can consider ways to include innate cultural strengths like enculturation and partner with Latinx cultural centers, churches, and local communities to make enculturation more salient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The minority strengths model: Development and initial path analytic validation in racially/ethnically diverse LGBTQ individuals.

OBJECTIVE: The minority stress model and much research based upon it tend to adopt and reinforce a deficit-based approach. This study created and initially validated the minority strengths model, which by contrast outlines how personal and collective strengths in minority populations create resilience and positive mental and physical health. MATERIALS AND METHOD: A sample of 317 lesbian, gay, bisexual, transgender, and queer individuals from diverse racial/ethnic backgrounds completed a national online survey. RESULTS: A minority strengths path model was generated with statistically significant paths and good fit indices, including all possible significant indirect effects. The model explained 16.8% of the variance in identity pride, 19.7% in self-esteem, 32.9% in resilience, 41.6% in mental health, and 13.0% in positive health behaviors. CONCLUSIONS: The minority strengths model holds promise to stimulate research on the personal and collective strengths of minority populations and the ways in which strengths generate resilience and positive mental and physical health.

Body Appreciation in Lesbian, Bisexual, and Queer Women: Examining a Model of Social Support, Resilience, and Self-Esteem.

Purpose: There is increasing research on positive body image, but no studies to date have examined these constructs in lesbian, bisexual, and queer (LBQ) women. However, LBQ women are at increased risk for mental health concerns and disordered eating, and there is evidence that body appreciation might be both adaptive and protective. This study examined factors that could uniquely relate to body appreciation in LBQ women. Method: Women identifying as LBQ (N=150) completed demographics and measures of social support, resilience, self-esteem, and body appreciation. We tested a hypothesized mediational model of social support leading indirectly to body appreciation through resilience and self-esteem, controlling for body mass index. Results: All direct effects, except social support to body appreciation (p=0.696), were significant (ps=0.017-0.001), reflecting a full multiple mediation. As hypothesized, the effect of social support on body appreciation was indirect (p=0.011), through resilience and self-esteem. Conclusion: This is the first study to investigate factors that might facilitate positive body image in LBQ women. Although preliminary, results suggest social support, resilience, and self-esteem might be important targets of body image interventions with LBQ women.

Patterns of Intimate Partner Violence Victimization and Perpetration Among Sexual Minority Women: A Latent Class Analysis.

This study explored patterns of intimate partner violence (IPV) victimization and perpetration in 150 sexual minority women (SMW): 25.3% had been sexually victimized, 34% physically victimized, 76% psychologically victimized, and 29.3% suffered an IPV-related injury. A latent class analysis found four behavioral patterns: (1) minor-only psychological perpetration and victimization; (2) no IPV; (3) minor-severe psychological, physical assault, and injury victimization, and minor-only psychological, physical, and injury perpetration; and (4) severe psychological, sexual, physical assault, and injury victimization and perpetration. Individuals who experienced and/or perpetrated all types experienced the greatest heterosexism at work, school, and in other contexts.

Common health problems in safety-net primary care: Modeling the roles of trauma history and mental health.

OBJECTIVE: This study described trauma exposure and investigated mediational effects of mental health on the relationships between trauma and pain, sleep, smoking, and general health. METHOD: Participants were 210 low-income primary care patients. The study used a crosssectional, self-report survey design. RESULTS: Eighty-five percent of the sample reported adult trauma and 54% reported four or more childhood traumas. Moderate or higher depression and anxiety levels were present in 59% and 48% of participants, respectively. Structural equation model fit was good for sleep, pain, and general health, showing that trauma indirectly affected health variables via mental health. CONCLUSIONS: Participants endorsed substantial adult and childhood trauma, which likely had cascading effects on mental health and common primary care presenting health issues.

Understanding the association between discrimination and depression among sexual minority people of color: Evidence for diminishing returns of socioeconomic advantage.

OBJECTIVE: To examine the differential association of heterosexism and racism on depression as moderated by socioeconomic status (SES) among sexual minority people of color. METHOD: A cross-sectional sample of sexual minority people of color (n = 170) was surveyed on their experiences of heterosexism, racism, depression, and SES in a national online study based in the United States. RESULTS: Bivariately, SES was inversely associated with depression, racism, and heterosexism. Moderation analyses found that for individuals with less socioeconomic advantage, the associations between heterosexism and depression were not as strong. However, at higher socioeconomic advantage, heterosexism was more strongly positively associated with depression. CONCLUSION: These results suggest that the effects of discrimination on depression in sexual minority individuals of color may be accentuated at higher socioeconomic levels. Implications suggest helping sexual minority clients of color from higher SES backgrounds explore the effects of discrimination on their mental health.

Distress Tolerance as a Correlate of Tobacco Dependence and Motivation: Incremental Relations over and above Anxiety and Depressive Symptoms.

Distress tolerance-the capacity to withstand distressing states-is implicated in the etiology of regular smoking. The present study extends past research by examining whether relations between perceived distress tolerance and smoking-related factors: (1) differ across subdimensions of distress tolerance (Tolerance, Appraisal, Regulation, Absorption); (2) extend across measures of dependence, negative reinforcement smoking, and craving; and (3) are incremental to depressive and anxiety symptoms. Results showed that global distress tolerance was associated with measures of dependence, negative reinforcement, and craving even after controlling for affective symptomatology. Subdimensions of distress tolerance were not uniquely related to smoking outcomes in unadjusted or adjusted models. These findings suggest that: (a) distress tolerance is uniquely implicated in smoking over and above affective symptomatology; and (b) specific subdimensions of distress tolerance do not provide more information about smoking-related characteristics than global dimensions; and

The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample.

INTRODUCTION: Per the minority stress framework, trans individuals often experience psychological distress given the unique stress engendered by gender identity-related discrimination. Prior research has identified social support as particularly important for psychological distress and has suggested that social support may moderate this relationship. AIMS: The purpose of the current study was to explore the patterns of connections among discrimination, mental health, and suicidal ideation in trans individuals, and whether social support moderates these relationships. METHODS: Participants (N = 78) completed measures of these constructs as part of a national online survey. RESULTS: A series of simultaneous multiple regressions found that harassment/rejection discrimination was a unique positive predictor of mental health symptoms and suicidal ideation, with depression positively predicting suicidal ideation. A mediational model indicated that the association between harassment/rejection discrimination and suicidal ideation was fully mediated by depression. Three moderated meditational models were run, and one yielded a significant interaction, such that discrimination predicted suicidal ideation most strongly when participants had low social support from a significant other in comparison to moderate or high support. Further, conditional direct effects identified that discrimination led to ideation only for individuals with low support from friends or a significant other but not for those with moderate or high support. CONCLUSIONS: Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population.

Personality Traits in College Students and Caregiving for a Relative with a Chronic Health Condition.

The purpose of this study was to investigate among college students the relationship between personality traits and willingness to care for a relative with a chronic health condition. 329 undergraduate students completed an online questionnaire. Hierarchical multiple regressions found that after controlling for demographics personality traits explained 10% of the variance in willingness to provide emotional care, 7% in instrumental care, and 7% in nursing care. Within these models, greater empathy was uniquely associated with willingness to provide emotional, instrumental, and nursing care for a family member in the future. Similarly, participants with high agreeableness were more willing to provide emotional care, and participant older age was a unique predictor of instrumental care. The results can help shape research on interventions that incorporate perspective taking, motivational interviewing, and training in life skills as a means of boosting college students' willingness to provide care for a relative with a chronic health condition.

Family Dynamics and Personal Strengths among Dementia Caregivers in Argentina.

This study examined whether healthier family dynamics were associated with higher personal strengths of resilience, sense of coherence, and optimism among dementia caregivers in Argentina. Caregivers are usually required to assist individuals with dementia, and family members have typically fulfilled that role. Personal strengths such as resilience, sense of coherence, and optimism have been shown to protect caregivers from some of the negative experiences of providing care, though the family-related variables associated with these personal strengths are largely unknown. Hierarchical multiple regressions investigated the extent to which family dynamics variables are associated with each of the caregiver personal strengths after controlling for demographic and caregiver characteristics. A sample of 105 caregivers from Argentina completed a set of questionnaires during a neurologist visit. Family dynamics explained 32% of the variance in resilience and 39% of the variance in sense of coherence. Greater family empathy and decreased family problems were uniquely associated with higher resilience. Greater communication and decreased family problems were uniquely associated with higher sense of coherence. Optimism was not found to be significantly associated with family dynamics. These results suggest that caregiver intervention research focused on the family may help improve caregiver personal strengths in Argentina and other Latin American countries.

Examining the influence of family dynamics on quality of care by informal caregivers of patients with Alzheimer's dementia in Argentina.

PURPOSE: This study examined the pattern of family dynamics of Argentinian individuals with dementia that most heavily influences the quality of care provided by family caregivers (CGs). METHOD: One hundred and two CGs of individuals with Alzheimer's disease in Argentina participated in this study. The majority (75%) were female, with an average age of 57.8 years (standard deviation = 13.5) and had spent a median of 48 months (interquartile range [IQR]: 36.00-60.00) providing care to their family member with dementia, devoting a median of 60 hours (IQR: 50.00-80.00) per week to these duties. Caregivers completed Spanish versions of instruments assessing their family dynamics and quality-of-care provision. RESULTS: Hierarchical regression analyses suggested that higher quality of informal care (Provide and Respect) was related to greater levels of empathy and reduced levels of overall dysfunction in CGs' families. Higher quality of care-Provide was also related to shorter duration of time (in months) spent providing care. CONCLUSION: Dementia CG interventions in Latino populations would likely benefit from addressing difficulties experienced when providing care for a prolonged period of time, as well as programming or techniques to improve family dynamics, especially family empathy and general functioning, given the strong reciprocal influence of these factors on CG quality of care.

Multiple Mediational Model of Outness, Social Support, Mental Health, and Wellness Behavior in Ethnically Diverse Lesbian, Bisexual, and Queer Women.

PURPOSE: A growing body of research has begun to examine wellness behaviors in sexual minority women. While a number of constructs have been associated with wellness behaviors in this population, including outness, social support, and mental health, no research has attempted to forge the specific and unique connections among them. The aim of the current study was to construct a theoretical chain among these variables leading to wellness behaviors among an ethnically diverse sample of sexual minority women. METHODS: A sample of 150 ethnically diverse, cisgender women identifying as lesbian, bisexual, queer, or an "other" non-heterosexual sexual orientation completed a web-administered national survey. Scales assessed participants' outness, social support, mental health, and wellness behaviors. RESULTS: In a series of simultaneous, multiple regressions, outness to one's family was positively associated with wellness behavior and social support; social support from one's family and friends was positively associated with mental health; and depression was negatively associated with wellness behaviors. Two multiple mediational models generally suggested a cascading influence of outness to one's family on wellness behaviors through social support from one's family and depression. CONCLUSION: The study is one of the first to find potentially cascading links among personal, social, and mental health variables with health behaviors in a sample of diverse lesbian, bisexual, and queer (LBQ) women. It thereby illuminates a number of potential targets for health promotion interventions in this population.

Positive and negative affect as predictors of urge to smoke: temporal factors and mediational pathways.

Elucidating interrelations between prior affective experience, current affective state, and acute urge to smoke could inform affective models of addiction motivation and smoking cessation treatment development. This study tested the hypothesis that prior levels of positive (PA) and negative (NA) affect predict current smoking urge via a mediational pathway involving current state affect. We also explored if tobacco deprivation moderated affect-urge relations and compared the effects of PA and NA on smoking urge to one another. At a baseline session, smokers reported affect experienced over the preceding few weeks. At a subsequent experimental session, participants were randomly assigned to 12-hr tobacco deprived (n = 51) or nondeprived (n = 69) conditions and reported state affect and current urge. Results revealed a mediational pathway whereby prior NA reported at baseline predicted state NA at the experimental session, which in turn predicted current urge. This mediational pathway was found primarily for an urge subtype indicative of urgent need to smoke and desire to smoke for NA relief, was stronger in the deprived (vs. nondeprived) condition, and remained significant after controlling for PA. Prior PA and current state PA were inversely associated with current urge; however, these associations were eliminated after controlling for NA. These results cohere with negative reinforcement models of addiction and with prior research and suggest that: (a) NA plays a stronger role in smoking motivation than PA; (b) state affect is an important mechanism linking prior affective experience to current urge; and (c) affect management interventions may attenuate smoking urge in individuals with a history of affective disturbance.

Associations between posttraumatic stress disorder symptom clusters and cigarette smoking.

Understanding the relationship between Posttraumatic stress disorder (PTSD) and cigarette smoking has been difficult because of PTSD's symptomatic heterogeneity. This study examined common and unique lifetime cross-sectional relationships between PTSD symptom clusters [Re-experiencing (intrusive thoughts and nightmares about the trauma), Avoidance (avoidance of trauma-associated memories or stimuli), Emotional Numbing (loss of interest, interpersonal detachment, restricted positive affect), and Hyperarousal (irritability, difficulty concentrating, hypervigilance, insomnia)] and three indicators of smoking behavior: (1) smoking status; (2) cigarettes per day; and (3) nicotine dependence. Participants were adult respondents in the National Epidemiologic Survey of Alcohol and Related Conditions with a trauma history (n = 23,635). All four symptom clusters associated with each smoking outcome in single-predictor models (ps <. 0001). In multivariate models including all of the symptom clusters as simultaneous predictors, Emotional Numbing was the only cluster to retain a significant association with lifetime smoking over and above the other clusters, demographics, and Axis-I comorbidity (OR = 1.30, p < .01). While Avoidance uniquely associated with smoking status and nicotine dependence in multivariate models, these relations fell below significance after adjusting for demographics and comorbidity. No clusters uniquely associated with cigarettes per day. Hyperarousal uniquely related with nicotine dependence over and above the other clusters, demographics, and Axis-I comorbidity (OR = 1.51, p < .001). These results suggest the following: (a) common variance across PTSD symptom clusters contribute to PTSD's linkage with smoking in the American population; and (b) certain PTSD symptom clusters may uniquely associate with particular indicators of smoking behavior. These findings may clarify the underpinnings of PTSD-smoking comorbidity and inform smoking interventions for trauma-exposed individuals.