Racial disparities in cancer genetic counseling encounters: study protocol for investigating patient-genetic counselor communication in the naturalistic clinical setting using a convergent mixed methods design.

BACKGROUND: Despite decades of effort to reduce racial cancer disparities, Black people continue to die at higher rates from cancer than any other U.S. racial group. Because prevention is a key to the cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing racial cancer disparities is high. However, the benefits of genetic counseling are not equitable across race. Only 2% of genetic counselors self-identify as Black/African American, so most genetic counseling encounters with Black patients are racially discordant. Patients in racially discordant medical interactions tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is racial bias. Drawing on findings from prior research, we hypothesize that genetic counselor providers' implicit racial prejudice will be associated negatively with the quality of patient-provider communication, while providers' explicit negative racial stereotypes will be associated negatively with the comprehensiveness of clinical discussions of cancer risk and genetic testing for Black (vs. White) patients. METHODS: Using a convergent mixed methods research design, we will collect data from at least 15 genetic counseling providers, from two different institutions, and their 220 patients (approximately equal number of Black and White patients per provider) whose appointments are for a hereditary cancer condition. The data sources will include two provider surveys, two patient surveys, video- and/or audio-recordings of genetic counseling encounters, and medical chart reviews. The recorded cancer genetic counseling in-person and telehealth encounters will be analyzed both qualitatively and quantitatively to assess the quality of patient-provider communication and the comprehensiveness of clinical discussion. Those data will be linked to pre- and post-encounter survey data and data from medical chart reviews to test our hypotheses. DISCUSSION: Findings from this multi-site study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes (e.g., satisfaction, trust, genetic testing completion). Patient-provider communication and clinical recommendations are modifiable factors that can be integrated into current genetic counseling training curricula and thus can have immediate impact on genetic counseling training and practice.

When resilience is not enough: Imagining novel approaches to supporting Black youth navigating racism.

The narrative surrounding the impact racism has had on the well-being of Black youth has shifted across sociocultural and historical context. Early discourse around these topics were problem-saturated, focusing on deficits "within" Black youth. Over time, an important narrative shift occurred: greater attention was paid to the inherent assets of Black youth, their families, and communities, including how racial-ethnic protective factors such as racial socialization afforded them resilience. What resulted was decades of research seeking to understand the mechanisms that allow Black youth to bounce back in spite of racism-related adversity. Notwithstanding the viable practice and policy implications that have emerged from such inquiry, at what point does our focus on the resilience of Black youth - whether individual or multisystemic - fall short? It is with this question in mind that this paper challenges those committed to the optimal development of Black youth to consider yet another narrative shift: one that stands upon the legacy of cultural ecological frameworks and the seminal models underlying resilience research, and calls us toward not supporting Black youth's adaptation to racism, but toward collective efforts to transform our approach, pushing back against the perniciousness of racism.

Influence of Foreign Versus US Nativity on the Trajectory of Functional Independence Over the 10 Years After Traumatic Brain Injury: A Model Systems Study.

OBJECTIVE: Although racial/ethnic disparities have been documented in numerous outcomes after traumatic brain injury (TBI), research has yet to explore differences in rehabilitation outcomes based upon nativity (foreign-born vs US-born individuals). The purpose of this study was to compare the functional outcomes over the first 10 years after TBI for individuals born in the United States with those who were foreign-born. SETTING/PARTICIPANTS: A sample of 10 695 individuals in the TBI Model Systems database with a coding for country of birth the United States ( n = 9435) versus other than the United States ( n = 1260) was used. DESIGN/MAIN MEASURES: Outcome measures at 1, 2, 5, and 10 years after TBI included the Motor and Cognitive subscales of the Functional Independence Measure and the Supervision Rating Scale. RESULTS: Foreign-born individuals exhibited lower motor functional independence trajectories than those born in the United States, even after controlling for demographic and injury-related covariates. However, foreign-born individuals generally showed a stronger upward quadratic trajectory in motor functional independence with the greatest gains between the 5- and 10-year time points, whereas those born in the United States improved more quickly but then plateaued between the 5- and 10-year time points; these differential effects over time dissipated with the addition of demographic and injury-related covariates. Foreign-born individuals also exhibited lower cognitive functional independence trajectories, as well as greater supervision needs trajectories, than those born in the United States, even after controlling for demographic and injury-related covariates. CONCLUSION: These findings dovetail with literature suggesting that racially/ethnically diverse groups exhibit reduced functional independence after TBI. The findings may also suggest potential systematic barriers such as healthcare access and language barriers that may influence the frequency, rate, and quality of care received. The results highlight the importance of uncovering cultural distinctions and can aid in facilitating research examining foreign nativity-based disparities following TBI.

Diversifying Clinical Child and Adolescent Psychology: A Change Gonna Come.

OBJECTIVES: Workforce diversity is an ongoing challenge in the field of clinical child and adolescent psychology. This article discusses individual, institutional, and nonspecific factors that contribute to a lack of diversity among clinical child and adolescent psychologists and offers suggestions to diversify and advance the field of clinical child and adolescent mental health. METHOD: Seventeen professors, licensed psychologists, faculty, and clinicians in the field of clinical child and adolescent psychology answered questions about workforce diversity and who is permitted access to the field. No formal research was conducted. RESULTS: Individual factors included: racial discrimination and microaggressions, feelings of isolation, otherness, and not belonging. Institutional factors included: racism in academia, racial underrepresentation, ethnocentric and culturally-biased training, biased admissions selection processes, financial barriers, and lack of institutional commitment. Nonspecific factors were: values misalignment, hidden expectations, suboptimal mentoring, and limited research opportunities. CONCLUSIONS: Drawing on recent scholarship and the Contexts, Actions, and Outcomes (CAO) Model, we recommend institutional changes in programs, policies, practices, resources, climate, partnerships, and inquiry to improve diversity in the field of clinical child and adolescent psychology.

Exploring the association between parental ethnic-racial socialization and parental closeness on Black-White biracial adolescents' choice of racial identification toward blackness.

OBJECTIVE: To explore the influences of Black-White biracial adolescents' choice to racially identify with Blackness, parental ethnic-racial socialization (ERS) messages, parental race, and perceived parental closeness were examined. Specifically, this study investigated how messages that promote monoracial Black pride and messages that prepare youth for monoracial Black bias may be related to adolescents' identification with Blackness, and whether parental race or parental closeness moderated these relationships. METHOD: Three hundred thirty Black-White biracial adolescents (Mage = 14.82) were recruited across the United States via social media. Participants completed the Racial Socialization Questionnaire for Biracial Adolescents and a demographic questionnaire to indicate how close they felt to each parent. The analytic sample (n = 280) included respondents who racially identified as exclusively Black, blended Black, or exclusively biracial. RESULTS: Multinomial logistic regression analyses revealed significant differences in the association between ERS messages and adolescent racial identification based on the race of the parent socializer. Further moderation analyses indicated that parental closeness, particularly regarding fathers, amplifies these findings. CONCLUSION: Maternal and paternal ERS messages are differentially associated with biracial adolescents' choice of racial identification toward Blackness. interestingly, ERS messages from White parents seem to significantly influence racial identification compared to Black parents. Parental closeness further elucidates these findings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ethnic-racial identity and ethnic-racial socialization competency: How minoritized parents "walk the talk".

OBJECTIVES: Ethnic-racial identity (ERI) has important implications for individual psychosocial functioning as well as familial processes. For example, parents' ERI can shape children's developmental contexts through ethnic-racial socialization (ERS). Yet, existing research has tended to focus on the content or frequency of socialization messages themselves rather than on internal factors like socialization competence. Such competence, as reflected through confidence, skills, and stress, represents critical dimensions that permeate the socialization process and can impact the delivery of messages. The present study examines whether parents' ERI (i.e., private regard, centrality, exploration) is related to perceptions of their socialization competence. METHOD: Data from 203 Black, 194 Asian American, and 188 Latinx parents (N = 585, Mage = 44.46 years, SD = 9.14, 59.70% mothers) of adolescents between the ages of 10-18 were collected via Qualtrics panels. RESULTS: Across all parents, private regard, centrality, and ethnic-racial exploration were positively associated with perceived confidence and skills in engaging in ERS. Regard was additionally associated with lower socialization stress. CONCLUSIONS: The results point to consistent benefits of ERI in helping parents navigate ERS, furthering the understanding of ERI's developmental implications through parents' comfort with and ability to "walk the talk" with their children. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Let's talk: The impact of gendered racial socialization on Black adolescent girls' mental health.

OBJECTIVE: For Black adolescent girls to develop a healthy sense of self, families must prepare them to cope with the realities of experiencing oppression at the nexus of racism and sexism. In this study, we examined the associations of positive and negative gendered racial socialization with mental health outcomes for Black adolescent girls. METHOD: To test the hypothesis that socialization messages of gendered racial pride and empowerment (GRPE) moderate the relationship between messages of internalized gendered racial oppression (IGRO) and indicators of psychological well-being (i.e., depressive, anxiety, and stress symptoms), a series of hierarchical multiple regression analyses were conducted based on the experiences of 282 Black adolescent girls (Mage = 15.40). RESULTS: Findings show that more frequent messages of IGRO were associated with more depression, anxiety, and stress symptoms in Black girls. Findings also suggest that more frequent messages of GRPE reduce the negative associations between messages of IGRO and Black adolescent girls' mental health symptoms to attenuation. CONCLUSIONS: Mental health symptoms in Black girls are able to be moderated by parents' intentional messaging of GRPE. These findings may provide a strategy to protect Black youth from the deleterious consequences of negative messages around race and gender. Future studies may wish to examine the impact of socialization messages of GRPE and IGRO on Black boys' mental health symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Differentiating competency from content: Parental racial socialization profiles and their associated factors.

For Black parents, the racial socialization (RS) process represents a critical parenting practice. Although the field has historically focused on the content of parents' RS, it is also important to consider caregivers' perception of their competence to effectively teach their children to navigate their racialized world. The present study investigated patterns of RS by exploring 332 Black caregivers' report of both content and competency. Using Latent Profile Analysis (LPA), we identified three profiles of RS: Multifaceted & More Competent (MMC), Unengaged & Moderately Competent (UModC), and Negative, Stressed, & Less Competent (NSLC). Additionally, we explored the role of several previously established correlates of parental RS, including sociodemographic factors (i.e., age, gender, and socioeconomic status), caregiving status (e.g., mother, father, and aunt), and parents' race-related experiences (i.e., history of RS, racial identity, and experiences with racial discrimination). Generally, the NSLC profile consisted of caregivers who were younger than those in the other two profiles, while those in the UModC profile tended to have younger children, relatively. Interestingly, caregivers in the UmodC profile reported receiving significantly less RS in childhood and experienced less racial discrimination than those in the other two profiles. Numerous differences were found across profiles for dimensions of racial identity. The emergence of these varied profiles, as well as the identification of factors that differentiated them, extends our understanding of RS and highlights the importance of considering parents' notions of feeling confident, skillful, and less stressed as they navigate such a vital developmental process for their children.

Para los padres negros, el proceso de socialización racial (SR) representa una práctica fundamental de crianza. Aunque esta área históricamente se ha centrado en el contenido de la SR de los padres, también es importante tener en cuenta la percepción que tienen los cuidadores de su competencia para enseñarles eficazmente a sus hijos a orientarse en su mundo racializado. En el presente estudio se investigaron los patrones de SR analizando el informe de 332 cuidadores negros sobre contenido y competencia. Utilizando el análisis de perfiles latentes (APL), identificamos tres perfiles de SR: polifacéticos y más competentes (PMC), no comprometidos y moderadamente competentes (NCModC) y negativos, menos competentes y estresados (NMCE). Además, analizamos el papel que juegan varias correlaciones de SR de los padres previamente establecidas, incluidos los factores sociodemográficos, (p. ej., la edad, el género y la situación socioeconómica), la situación de cuidado (p. ej.: la madre, el padre, la tía) y las experiencias de los padres relacionadas con la raza (p. ej., los antecedentes de SR, la identidad racial, y las experiencias con la discriminación racial). Generalmente, el perfil NMCE estuvo compuesto por cuidadores que eran más jóvenes que los de los otros dos perfiles, mientras que los del perfil NCModC fueron propensos a tener hijos más pequeños, relativamente. De modo interesante, los cuidadores del perfil NCModC informaron haber recibido una SR considerablemente menor en la niñez y sufrieron menos discriminación racial que los de los otros dos perfiles. Se encontraron numerosas diferencias entre los perfiles con respecto a las dimensiones de identidad racial. El surgimiento de estos perfiles variados, así como la identificación de los factores que los diferenciaron, amplían nuestra comprensión de la SR y destacan la importancia de tener en cuenta las intenciones de los padres de sentirse seguros, habilidosos y menos estresados a medida que transitan este proceso tan fundamental del desarrollo para sus hijos.

Interrupting the Pathway From Discrimination to Black Adolescents' Psychosocial Outcomes: The Contribution of Parental Racial Worries and Racial Socialization Competency.

Racial discrimination can lead to psychosocial problems for Black adolescents, including internalization (e.g., depression) and externalization (e.g., conduct problems). Black parents (N = 186; Mage = 42.9) of adolescents (ages 10-18) were assessed to investigate how parental worries and racial socialization competency (i.e., confidence, skills, and stress) contribute to the association between parental discrimination experiences and their adolescents' psychosocial problems. Mediation analyses indicated that the total direct models with discrimination, worries, and problems had good fit, and that the addition of worry mediated the discrimination-problems association. Furthermore, racial socialization competency moderated the association between worry and problems, wherein greater competency was associated with less impact of worry on problems. Findings illuminate potential intervention targets for buffering discrimination's influence on adolescents' psychosocial functioning.

The initial development and validation of the Racial Socialization Competency Scale: Quality and quantity.

OBJECTIVES: The present study investigated the reliability and validity of the Racial Socialization Competency Scale (RaSCS). As posited by the Racial Encounter Coping Appraisal and Socialization Theory (RECAST), the RaSCS consists of 3 factors representing 3 novel dimensions of racial socialization competency present in families (e.g., stress, skills, and confidence). METHOD: Responses to the RaSCS were collected from 361 self-identified Black and African American parents and primary caretakers across the United States. RESULTS: After factor analysis, three scales and 27 items were maintained. Evidence was consistently found for 2 subscales within the stress dimension, namely "Call to Action" and "General" racial socialization stressors. Dimensions were also related to their respectively hypothesized constructs, including overall stress, racial socialization frequency, and self-efficacy. CONCLUSIONS: Future directions and recommendations on the measure's use, particularly in the context of interventions, are also discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impostor Phenomenon and Psychological Well-Being: The Moderating Roles of John Henryism and School Racial Composition Among Black College Students.

The impostor phenomenon (IP), or erroneous cognitions of intellectual incompetence, is a risk factor for poor psychological adjustment among Black emerging adults. Grounded in Lazarus and Folkman's Stress and Coping Framework, the current study investigated John Henryism's active coping and institutional racial composition as moderators of the association between IP and indicators of psychological well-being among 266 Black students (77% women; M age = 19.87) attending predominately White institutions (PWIs) and historically Black colleges/universities (HBCUs). Hierarchical moderation regression analyses revealed that IP was associated with decreases in well-being indicators among students attending PWIs and HBCUs. Moreover, students who attended PWIs and reported higher levels of John Henryism (+1 SD) were most vulnerable to increases in social anxiety, particularly at higher levels of IP. Results suggest that the interaction between IP, John Henrysim, and institutional racial composition may negatively influence psychological well-being. We discuss how these findings can be used to inform clinical and educational practices to best support Black college students.

Coping, Discrimination, and Physical Health Conditions Among Predominantly Poor, Urban African Americans: Implications for Community-Level Health Services.

African Americans and ethnic minorities experience racial discrimination in a variety of settings. Racial discrimination is a potent stressor that has been linked to psychosocial stress and poor physical health. To cope with discriminatory experiences and daily life event stressors, African Americans frequently use the concept of John Henryism (a high effort coping strategy with prolonged exposure to stress). This cross-sectional analysis explored the relationship between racism/discrimination, John Henryism, and health problems in a predominately African American sample. Data were collected through health care screenings for hypertension, diabetes, and obesity and a self-report survey to assess experiences of discrimination and use of John Henryism. Logistic and linear regression models were used to assess the relationship between the John Henryism score, racism/discrimination score, and health problems among 352 participants. John Henryism was associated with a decrease in systolic blood pressure (b = - 12.50, 95% CI = - 23.05, - 1.95) among men, after adjusting for experiences of racism/discrimination and demographic characteristics. Experiences of racism/discrimination were associated with an increase in systolic blood pressure (b = 11.23, 95% CI = 0.38, 22.09) among men, after adjusting for John Henryism and demographic characteristics. Among women, there was no association found between John Henryism and experiences of racism/discrimination with systolic blood pressure. No association was found between John Henryism and experiences of racism/discrimination with being overweight/obese in women nor men. The study found that John Henryism was positively associated with the health of men, while experiences of racism/discrimination were negatively associated with their health. Limitations of the study are discussed, and recommendations are made to guide future research exploring the concept of John Henryism as a relevant factor between stress, racial discrimination and poor health.

Racial discrimination, John Henryism coping, and behavioral health conditions among predominantly poor, urban African Americans: Implications for community-level opioid problems and mental health services.

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.

Future Directions in Research on Racism-Related Stress and Racial-Ethnic Protective Factors for Black Youth.

Research on racism-related stress and racial-ethnic protective factors represents an important enterprise for optimizing the mental health of African American and other racial and ethnic minority youth. However, there has been a relative dearth of work on these factors in the clinical psychology research literature, and more work is needed in outlets such as these. To this end, the current article adopts a developmental psychopathology framework and uses recent empirical findings to outline our current understanding of racism-related stress and racial-ethnic protective factors (i.e., racial identity, racial socialization, Africentric worldview) for African American youth. We then provide nine recommendations-across basic, applied, and broader/cross-cutting research lines-that we prioritize as essential to advancing the future scientific investigation of this crucial research agenda. Within and across these recommendations, we issue a charge to researchers and clinicians alike, with the ultimate goal of alleviating the negative mental health impact that racism-related stress can have on the well-being and mental health of African American and other racial and ethnic minority youth.

Biracial, Black, and proud: Can racial pride protect Biracial-Black young people from identity invalidation and depressive symptoms?

A growing body of theory and research suggests that racial identity invalidation (RII)-the active denial of a person's racial identity and/or belonging to the racial group(s) they identify with-may play an important role in the mental health problems that Biracial Black-White youth face. However, research has yet to explore this empirically. The purpose of this study was to address this gap by examining whether RII was associated with depressive symptoms among Biracial Black-White adolescents and emerging adults (N = 713; 61% male; M = 18.40, SD = 3.71). From an intersectional and strengths-based lens, we also explore if (a) Biracial and Black pride individually or collectively moderate the relationship between RII and depressive symptoms and (b) if any of these associations differ by gender. The analyses included two hierarchical linear regressions (one for girls and one for boys) that were conducted using Model 3 of the PROCESS Macro in SPSS. The results indicated that RII was associated with depression symptoms for all participants. We also found several significant interaction effects illustrating that Biracial and Black pride both played a meaningful role in the relationship between RII and the mental health of the participants, but different patterns emerged for girls and boys. Collectively, the results position RII as a salient risk factor for Biracial Black-White adolescents and emerging adults while also illuminating the promotive and protective power of racial pride. The implications for research and practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Differences and similarities between ethnic-racial identity and critical consciousness links among diverse parents of color.

Parents of color's critical consciousness development (understanding of and actions to redress societal inequalities) is an important yet understudied area, especially relative to the burgeoning literature on youth's critical consciousness development. As with youth of color, ethnic-racial identity, or the meaning and importance placed on one's ethnic-racial group membership, likely plays a notable yet complex role in parents' critical consciousness. Specifically, parents' participation in activities that engage them in the culture of their racial-ethnic group (exploration), the importance they place on race-ethnicity (centrality), and their perceptions of how society views their group (public regard) may each be differentially associated with understanding of inequalities (critical reflection), motivation toward ending inequalities (critical motivation), and the behaviors parents engage in to address inequalities (critical action). Further, it is possible that associations may vary across racial-ethnic groups given different sociocultural histories, experiences (including immigrant experiences), and positionality within the United States. In the present study, we employ multigroup structural equation modeling among a sample of 203 Black, 193 Asian American, and 188 Latinx parents (total N = 584, Mage = 44.46, SD = 2.49, 59.6% mothers) of an adolescent child between the ages of 13 and 17 to examine associations between ethnic-racial identity and critical consciousness across groups. Results indicate highly complex, group-specific relations between identity and critical consciousness: public regard was most consistently predictive of critical consciousness dimensions among Black parents. Exploration and centrality were most predictive among Asian American and Latinx parents, respectively. Implications for relations between ethnic-racial identity and critical consciousness in light of different group experiences are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

We got this: Evaluating racial socialization competency among diverse ethnic-racial groups.

Historically, research on racial socialization (RS) has centered on frequency, beliefs, and content of parent-child communications, with varied applications and implications across racial and ethnic subgroups. The Racial Socialization Competency Scale (RaSCS; Anderson et al., 2020) was developed to assess three dimensions of a novel construct, RS competency (confidence, skills, stress), among Black caregivers. In this article, we investigated the psychometric properties of the RaSCS across diverse ethnic-racial groups. Participants were 778 caregivers (Mage = 44.4 years) of youth between the ages of 10 and 18 recruited from across the United States. The sample was intentionally racially and ethnically diverse, with 26.1% identifying as Black, 24.2% identifying as Latinx, 24.9% identifying as Asian American, and 24.8% identifying as White. Confirmatory factor analyses replicated the previously identified structure of the RaSCS subscales, and scores were reliable. Multigroup measurement invariance analyses supported full scalar invariance across the four racial/ethnic subgroups for the Confidence, Skills, and General RS Stress subscales and partial scalar invariance for the Call to Action RS Stress subscale. These findings suggest that the RaSCS is an appropriate tool for assessing RS competency across racial and ethnic groups and that RS competency as a universal construct is relevant across groups. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Guidance on Conversations About Race and Racism in Pediatric Clinical Settings.

OBJECTIVE: To develop guidance for pediatric clinicians on how to discuss race and racism in pediatric clinical settings. METHODS: We conducted a modified Delphi study from 2021 to 2022 with a panel of pediatric clinicians, psychologists, parents, and adolescents with expertise in racism and child health through scholarship or lived experience. Panelists responded to an initial survey with open-ended questions about how to talk to youth about race and racism. We coded the responses using qualitative methods and presented them back to the panelists. In iterative surveys, panelists reached a consensus on which themes were most important for the conversation. RESULTS: A total of 29 of 33 panelists completed the surveys and a consensus was reached about the concepts pediatric clinicians should consider before, during, and after conversations about race and racism and impediments clinicians may face while having these discussions. Panelists agreed that it was within the pediatric clinician's role to have these conversations. An overarching theme was the importance of having background knowledge about the systemic nature of racism. Panelists agreed that being active listeners, learning from patients, and addressing intersectionality were important for pediatric clinicians during conversations. Panelists also agreed that short- and long-term benefits may result from these conversations; however, harm could be done if pediatric clinicians do not have adequate training to conduct the conversations. CONCLUSIONS: These principles can help guide conversations about race and racism in the pediatric clinical setting, equipping clinicians with tools to offer care that acknowledges and addresses the racism many of their patients face.

U.S. vs. Foreign Nativity and 10-Year Trajectories of Mental Health after Traumatic Brain Injury: A Model Systems Study.

BACKGROUND: Previous research has found racial and ethnic disparities in life satisfaction, depression, and anxiety after traumatic brain injury (TBI). However, limited studies have examined differences in these variables between U.S.- and foreign-born individuals with TBI. The purpose of this study was to examine whether differences exist in mental health outcomes between U.S.- and foreign-born individuals with TBI at 1, 2, 5, and 10 years after injury, as well as examine whether demographic and injury-related characteristics account for these differences. METHOD: Participants were 8289 individuals with TBI who identified as U.S.-born and 944 who identified as born outside the U.S. in the TBI Model Systems study. Participants completed measures of mental health outcomes at 1, 2, 5, and 10 years after injury. RESULTS: Foreign-born individuals with TBI had comparable levels of depression and anxiety trajectories to U.S.-born individuals, yet higher life satisfaction trajectories, even after controlling for demographic and injury-related variables. CONCLUSION: Rehabilitation professionals should consider in their clinical work the mechanisms that likely influence mental health outcomes among foreign-born individuals, including family-based values that increase resilience, as well as the possible under-reporting of mental health symptoms along the lines of cultural norms.

Racial/Ethnic Differences in Arrest Probability Trajectories after Traumatic Brain Injury: A Model Systems Study.

Background: Previous literature has documented racial/ethnic differences in traumatic brain injury (TBI) risk, cause, treatment, and rehabilitation. The purpose of the current study was to investigate potential racial/ethnic differences in arrest probability trajectories over the first 10 years after TBI and whether injury and sociodemographic characteristics accounted for these differences. Methods: The current study included 13,195 participants with moderate-to-severe TBI in the TBI Model Systems National Database who had arrest data from at least one follow-up time point (Years 1, 2, 5, and/or 10). A series of hierarchical linear models assessed racial/ethnic differences in trajectories of arrest probability over these 10 years post-injury and then included socio-demographic and injury-related covariates. Results: White individuals with TBI had lower arrest probability trajectories than Black and Native American individuals, and Asian individuals with TBI had lower arrest probability trajectories than White, Black, Latinx, and Native American persons. In many cases, racial/ethnic disparities persisted even when injury and sociodemographic characteristics were covaried. Conclusion: These results suggest that rehabilitation clinicians should assess for post-injury arrest risk factors such as age, sex, education, pre-injury unemployment, arrest history, and substance abuse, particularly in Black, Latinx, and Native American groups, and integrate programming to lessen post-injury arrest probability and improve overall rehabilitation outcomes.