Racism-related stress and mental health among black women living in Los Angeles County, California: A comparison of postpartum mood and anxiety disorder screening scales.

PURPOSE: To assess Black women's exposure to and appraisal of racism-related stress during the postpartum period and to distinguish its impact on three indicators of postpartum mood and anxiety disorders (PMADs) symptoms. METHODS: Data from the Black Mothers' Mental Wellness Study (N = 231) and linear regression models estimated the associations between racism-related stress and the PMAD indicators: 3-item Edinburgh Postnatal Depression Scale (EPDS-3), 8-item Patient Health Questionnaire (PHQ-8), and PHQ-15. RESULTS: The majority of participants (80.5%, N = 186) experienced racism a few times a year or more, of which 37.1% (N = 69) were bothered somewhat and 19.3% (N = 36) a lot. Racism-related stress, income, level of education, and history of mental health diagnosis explained greater variance in PMAD symptoms as measured by the PHQ-8 score (R2 = 0.58, p = < 0.001) compared to the EPDS-3 (R2 = 0.46, p = < 0.001) or the PHQ-15 (R2 = 0.14, p = 0.035). CONCLUSIONS: Racism is a stressor for Black women living in Los Angeles County, California. Racism-related stress and emotional expression of PMAD symptoms were salient to the postpartum mental health of the Black women in this study. Findings from this study suggest that the PHQ-8 should be used to assess how racism impacts Black women's postpartum mental health.

Initial testing of components of the cultural determinants of trauma recovery (CDTR) theory amongst American Gender-Based violence survivors: Structural equation modelling.

AIM: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. DESIGN: A cross-sectional study using anonymous online surveys. METHODS: This study was conducted with 225 American survivors of gender-based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL-5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help-seeking (shame, frozen and problem management subscales: BHS-TR Internal) and the GBV healing (GBV-Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. RESULTS: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help-seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers; the relationship between internal help-seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers and SOC. CONCLUSIONS: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. IMPACT: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help-seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities.

Psychometric evaluation of the Social Support Questionnaire for Transactions in Turkish gender-based violence sample.

AIM: This study aims to investigate the reliability and predictive validity of the Social Support Questionnaire for Transactions (SSQT) scale. DESIGN: A psychometric design using cross-sectional data. METHOD: This cross-sectional descriptive study was conducted between February-June 2021 using snowball sampling through an online survey panel. 204 Turkish survivors of gender-based violence (GBV) participated in the research. RESULTS: The mean age of participants was 35.66 ± 12.50. Exploratory and confirmatory factor analysis examined the construct validity of the SSQT scale. The principle axis factoring (PAF) estimation method was performed, including oblique rotation (Promax) for EFA, and the diagonally weighted least squares (DWLS) estimation method was used for CFA. Test-retest reliability coefficients (r) were moderate to excellent, ranging from 0.48 to 0.88. The analyzes supported the 5-factor solution, and the reliability was evaluated with Cronbach's Alpha coefficients for Social Friendship, Daily Emotional Support, Problem-Oriented Emotional Support, Daily Instrumental Support, and Problem-Focused Instrumental Support sub-dimensions, and the total score of SSQT showing 0.87, 0.84, 0.90, 0.73, 0.83, and 0.93, respectively. The relationships between sub-dimensions of SSQT showed moderate positive correlations ranging from 0.40 to 0.60. There were weak negative correlations between SSQT and PHQ-9, PHQ-15 and GAD-7, ranging from -0.20 to -0.34, which shows the external validity of the SSQT. CONCLUSION: The relationships between sub-dimensions of SSQT and PHQ-9, PHQ-15, GAD-7 are given in the results support using the SSQT scale as a research and clinical instrument for assessing women who had experienced GBV and have/have not received social support in Turkish culture.

Understanding help-seeking barriers after Gender-Based Violence: Validation of the Barriers to Help Seeking-Trauma version (BHS-TR).

It is a devastating and tragic estimate that 35% of women worldwide have experienced either physical or sexual violence at some point in their lives (United Nations, 2015) (referred to hereafter as Gender-Based Violence, or GBV). While most research focuses on reducing violence, understanding power and control in families, and evaluating services, this study focuses on overcoming trauma recovery barriers. We document the development and psychometric properties of the development of the Barriers to Help Seeking for Trauma Scale (BHS-TR) scale conducted with 309 GBV survivors. EFA and CFA confirmed a 7-factor solution that explained 68.4% of the variance, with an alpha reliability of 0.87. Factors were Shame, Frozen/Confused, Problem Management beliefs, Unavailable, Financial Concerns, Discrimination, and Constraints. Convergent validity was found with Sense of Coherence (SOC) and Beliefs about Mental Illness (BMI), and external validity was found with all the subscales and depression/PTSD except Problem Management beliefs. Cluster analysis was used to confirm that the barriers factors grouped into Internal and External Barrier dimensions. Regression showed that BMI predicted 24% of External Barriers variance, and SOC predicted 20% of the variance of the Internal barriers. Implications include the need to understand the breadth of help-seeking survivors engage in, differentiate the varieties of barriers from shame and stigma, and work with survivors "where they are" to address perceived barriers.

Photo-experiencing and reflective listening: A trauma-informed photo-elicitation method to explore day-to-day health experiences.

Despite the promise of photography in research, few methods offer a guide to leverage this medium in conjunction with experience sampling to facilitate individual reflection while capturing the experiences of participants as they interact with their social world. The purpose of this paper is to introduce a new photo-elicitation method to add to the photography research repertoire, Photo-experiencing and Reflective Listening (PEARL). PEARL leverages the benefits of experience sampling, mindful self-awareness, and trauma-informed interviewing to document daily health experiences. After engaging in an at-home photography activity, participants meet for a one-on-one interview to share and cluster their photographs to discuss key themes and needs going forward. Using a study aimed to understand the recovery experiences of survivors of sexual violence, we illustrate how PEARL can be applied to study a population of interest. The products developed through PEARL provide rich opportunities for analysis, dissemination, story amplification, and action, making it a research method helpful for those interested in improving health equity and catalyzing social change. Because of the high satisfaction voiced by the participants of this approach, PEARL shows promise as a therapeutic data collection method, where the participants leave with some benefit through new awareness gained.

Silently Screaming in the Dark: Gender-Based Dynamics of Distress in Japanese Migrants.

Prior literature has shown the female Japanese population experiences higher susceptibility to mental health disorders. The causal influences of help-seeking for distressed women were investigated through analysis of 24 interviews of Japanese immigrant women in the Detroit Metropolitan Area. The Clinical Ethnographic Narrative Interview (CENI) was utilized as the interviewing technique, investigating Japanese culture as a determinant of personal wellness. This study was a grounded theory examination of the interactions among gender, social context, cultural displacement, and a causal model for Japanese women's distress experiences. The resulting theoretical model revealed the familial and social dynamics traditional to Japanese culture developed feelings of poor self-worth common amongst study participants. This negative perception of self was exacerbated by gendered challenges of expatriation and intense pressures within this region's Japanese migrant community. These findings show the need for increased contact with at-risk populations to understand their causal models and help-seeking behaviors and expectations.

The Experience and Meaning of Physical Activity in Assisted Living Facility Residents.

Assisted living (AL) residents engage in very low levels of physical activity (PA), placing them at increased risk for mobility disability and frailty. But many residents in AL may not perceive the need to increase their PA. This study explored the experience, meaning, and perceptions of PA in 20 older adults in AL. The factors associated with PA were also examined. Qualitative data were collected using semistructured interviews and analyzed using phenomenological methodology. Six themes were identified: PA was experienced as planned exercise, activities of daily living, and social activities based on a schedule or routine; PA meant independence and confidence in the future; residents perceived themselves as being physically active; social comparisons influenced perception of PA; personal health influenced PA; motivations and preferences influenced PA. The findings highlight the importance of residents' personal perceptions of PA and effects of the social milieu in the congregate setting on PA.

Predictors of quality of life and depression among Korean-American cancer patients and their family caregivers.

OBJECTIVE: This study examined social, cultural, and appraisal factors associated with Korean-American cancer patients' and their family caregivers' quality of life (QOL) and depression. METHODS: Data were from Korean-American cancer patients and their family caregivers (N = 60 dyads) living in the United States. Study aims were examined using descriptive statistics and multiple regression. RESULTS: For patients, higher social support and lower negative appraisal of illness predicted higher patient QOL; negative appraisal of illness also predicted higher patient depression. For caregivers, older age, having fewer traditional Korean values, and more modern (individualistic) values predicted higher caregiver QOL. Caregivers who held more modern values also had less depression. CONCLUSIONS: Higher support and less negative appraisal predicted better QOL in patients. For caregivers however, the type of cultural values they held (tradition or modern) was a key factor that predicted level of QOL and depression. Assessment of support and appraisal as well as attention to cultural values may enhance their QOL and reduce depression.

Factors Influencing on Mental Health Help-seeking Behavior Among Korean Women: A Path Analysis.

PURPOSE: The purpose of the study was to identify factors influencing mental health help-seeking behavior among women in the community. METHODS: A cross-sectional design was used. Participants were 402 women in South Korea. Data were analyzed using descriptive statistics, Pearson's correlation coefficient, and a path analysis by IBM SPSS 21.0 and AMOS 21.0. RESULTS: There was a significant, but weak positive correlation between perceived need and help-seeking intentions for formal mental health help (r=0.09, p<0.05). In the path analysis, significant the factors influencing help-seeking intentions were perceived need, attitude, and belief toward mental illness, and the attitude of them had the greatest effect. These factors accounted for 12.2% of the total variance, and the model fit was acceptable. CONCLUSION: The findings of the study reveal that positive mental illness interpretation and consequence can predict mental health help-seeking behavior of women as well as the perceived need for mental health help.

The Role of Social Support for Patients with Mental Disorders in Primary Care in Brazil.

The aim of this article was to identify the health care providers and other agencies in a given region where psychiatric patients included in the study reside. In addition, we evaluated how these patients perceive social support for specific needs related to mental health. This study was carried out using fieldwork and face-to-face semistructured interviews with 25 patients who were receiving psychiatric treatment through primary health care. We performed structural analysis of the data focusing on relationship structure. We identified that a significant number of health care providers were involved with the patients; however, some of them were ignored by patients interviewed. Participants cited mostly general practitioners, psychiatrists, and nurses, as professional references.

Semantic Examination of a Japanese Center for Epidemiologic Studies Depression: A Cautionary Analysis Using Mixed Methods.

Background Cross-cultural research relies on the linguistic, conceptual, and semantic equivalence of instruments. Widely used translations of the Center for Epidemiologic Studies Depression (CESD) for cross-cultural samples should be analyzed to reaffirm conceptual and semantic equivalence. Purpose This methodological study aimed to discover and resolve problematic translations of a Japanese version of the CESD. Design Sequential explanatory mixed method design using spiraling integration. Methods Sample includes 34 first-generation Japanese women living in the US and 72 community-based women in Japan. Ethnographic analysis of the semantic meanings of items was followed by t tests to compare original and retranslated item means, as well as Cronbach's reliability and corrected item-total correlations analyses. Results Six problematic items were retranslated: bothered, failure, hope, restless sleep, happiness, and "getting going." Reliabilities for the CESD that included the new CESD item translations were the same; however, most item-scale correlations were higher for the revised translations across the two groups. Conclusions We conclude that both failure and "getting going" may be culturally bound items. Implications for cross-cultural and ethnographic nursing research include planning mini-ethnographic analysis when using translations to discover and reconcile cultural differences in connotations, motivations, and goals.

Protective Factors Affecting Trauma Recovery Among Female South Asian Immigrant Intimate Partner Violence Survivors: A Scoping Review.

Intimate partner violence (IPV) is a pressing public health issue affecting women worldwide. Thirty percent of women experience some form of violence throughout their lifetime globally, and South Asian countries have a higher prevalence of IPV (33%-51%). Notably, IPV has detrimental psychological impacts not only on women but also on their children. Despite this, limited empirical attention has explored protective factors for IPV trauma recovery. This review examines protective factors aiding South Asian immigrant IPV survivors' trauma recovery using Joanna Briggs Institute JBI methodology. The study draws on PubMed, Scopus, and PsychINFO data, resulting in 20 articles retrieved using Rayyan software. Protective factor's themes and subthemes revealed in the literature operated at multiple levels, including personal, interpersonal, community, and professional factors. Personal factors were selfhood, collective self, and adaptation, as well as those that enabled the utilization of interpersonal, community, and professional factors; interpersonal factors were family and friends, children as motivators, and religion; and community and professional factors were resources and technology usage. Immigrant status and culture significantly impacted the protective factors, acting as barriers among some IPV survivors. Therefore, future research should focus on exploring the experiences and cultural values of South Asian immigrant women with other influencing factors that may hinder the development and impact of protective factors on IPV trauma recovery. These findings can help design culturally sensitive support services that incorporate the unique needs of female South Asian immigrant IPV survivors.

A Feasibility and Acceptability Assessment of Photo-experiencing and Reflective Listening (PEARL): An Intervention to Promote Recovery Engagement After Gender-Based Harm.

Photo-experiencing and Reflective Listening (PEARL) is a trauma-informed intervention developed to promote recovery engagement in survivors of gender-based violence (GBV). This study aimed to understand the feasibility and acceptability of PEARL and identify potential healing elements. GBV survivors were recruited in Philadelphia through an online survey (n = 20). Participants completed the PEARL intervention, a postintervention survey, and a follow-up interview. Results revealed PEARL to be both feasible and acceptable, with thematic analysis revealing its ability to facilitate purposeful reflection, connection to the present, and progress toward healing goals. PEARL shows promise as an engaging strategy to promote healing for survivors of GBV.

Predicting Recovery Pathways in Jewish Ultra-Orthodox Intimate Partner Violence Survivors: A Structural Equation Modeling Approach.

Cultural and religious norms, as well as trauma-related cognitions and recovery actions, are known to impact the well-being of survivors of intimate partner violence (IPV). Although acknowledged as a key component, there is scant research on the recovery trajectories of women who have experienced IPV, in particular on survivors from collectivistic societies such as the Jewish Ultra-Orthodox (JUO) community in Israel. A mediation model examined the recovery process of 261 Israeli JUO survivors. In particular, it tested whether the normalization of violence and women's endorsement of Jewish religious norms that justify violence would be directly and negatively associated with women's well-being and positively associated with psychopathology. Additionally, it examined whether women's normalization of violence and support of religious norms would positively predict women's negative trauma-related cognitions. In turn, these cognitions were expected to negatively predict women's engagement in recovery actions, help-seeking behaviors, and faith-based responses but positively predict disengagement responses. The model further posited that women's engagement in steps toward recovery, help-seeking behaviors, and faith-based responses would positively predict women's well-being and negatively predict psychopathology. In contrast, women's disengagement responses would negatively predict women's well-being and positively predict their psychopathology. Bootstrap results indicated that supporting religious norms positively predicted women's trauma-related cognitions, which then negatively predicted women's recovery actions, help-seeking behaviors, and faith-based responses but positively predicted women's disengagement responses. Women's recovery actions and faith-based responses positively predicted women's well-being, while disengagement responses positively predicted women's psychopathology. Contrary to expectations, help-seeking behaviors positively predicted psychopathology.

The Reliability and Predictive Validity of Sense of Coherence Scale for American Survivors of Gender-Based Violence.

This study investigated the reliability and predictive validity of the Sense of Coherence (SOC) scale for 299 American survivors of gender-based violence (GBV). First, confirmatory factor analysis examined the construct validity of the SOC-13. Then, relationships between SOC and clinical scales were examined. Confirmatory factor analysis supported the 3-factor solution, and Cronbach's alpha reliability values for comprehensibility, manageability, and meaningfulness subscales and total score of SOC-13 were: .62, .53, .65, and .81, respectively. Multiple regression revealed that age, posttraumatic growth, depression, and posttraumatic stress scores explained 53% of the variance of SOC scores. We interpret this to suggest that SOC is a protective factor in GBV, especially in younger women. Clinical implications are suggested.

Development and preliminary psychometric evaluation of the COPD-related Stigma Scale.

BACKGROUND: Stigma experiences contribute to psychological distress and negatively affect healthcare-seeking behavior in people with chronic obstructive pulmonary disease (COPD). Most evidence comes from qualitative research, and no well-established measure of COPD-related stigma exists. Prior research yielded a preliminary measure of COPD-related stigma, but it required item reduction and validation. OBJECTIVES: The purpose of this study was to revise the preliminary measure, reduce the number of items, identify underlying constructs, and evaluate the reliability and validity of the shortened version. METHODS: A descriptive, cross-sectional study was conducted. Participants (N = 148; mean = 64 ± 7.27 years) completed the 51-item preliminary COPD-related Stigma Scale (COPDSS). Item-level analysis was conducted before running exploratory factor analysis (EFA). Reliability was assessed using Cronbach's alpha. Convergent validity and known-groups validity were evaluated. RESULTS: In the item-level analysis, eight items were deleted, leaving 43 items for factor analysis. A four-factor model with 24 items (α = 0.93) was derived from EFA: social stigma (α = 0.95), felt stigma (α = 0.95), anticipated stigma-oxygen (α = 0.80), and smoking-related stigma (α = 0.81). The 24-item COPDSS was significantly correlated with the 8-item Stigma Scale for Chronic Illness (r = 0.83), the Hospital Anxiety and Depression Scale (r = 0.57), and the PROMIS Physical Function (r = -0.48). The 24-item COPDSS discriminated between known groups based on age (p = .03), use of inhalers (p = .002) and use of supplemental oxygen (p < .001), and psychological distress levels (ps < .001). CONCLUSION: Findings support the reliability and validity of the 24-item COPDSS. This instrument can be used to understand underlying stigma processes in people with COPD.

Electronic Patient-Reported Outcome Data Collection Systems in Oncology Clinical Trials: A Survey of Clinical Research Professionals (an Alliance Study).

PURPOSE: To describe clinical research professionals (CRPs)' experiences with electronic patient-reported outcome (ePRO) data collection systems in oncology clinical trials and identify correlates of CRPs' attitude toward technology. METHODS: An online survey was conducted among 210 CRPs from 125 National Cancer Institute-funded research sites. Measures included CRPs' demographic characteristics, working years, employment locations, and previous experiences with various types of ePROs. Their attitude toward technology was measured by the Technology Attitude Scale-Adapted. The Wilcoxon signed-rank test was used to compare two subdomains of attitude (perceived usefulness [PU] and perceived ease of use [PEU]). Multiple linear regression was used to explore correlates of (1) overall attitude, (2) PU, and (3) PEU. The significance level was 5%. RESULTS: Participants' median age was 41 years (range, 21-67). Most were female (90%) and White (82%). More than half of the participants had previous experiences with web-based ePROs using patients' own devices (72%) or site-/sponsor-provided on-site devices (eg, kiosks or tablets; 64%). CRPs who were 60 years or older (ß = -0.32, P < .05) or worked for 10-20 years (ß = -0.11, P < .05) had relatively negative attitudes, controlling for other factors. Previous experiences with more ePRO types were associated with more positive attitudes (ß = 0.08, P = .02). Similar correlates were found with PU but not with PEU. CONCLUSION: This study revealed that CRPs had various experiences with ePRO systems and attitudes toward technology. Age, working years, and previous experiences with ePROs were correlates of overall attitude toward technology and PU. These findings suggest necessary targeted training to facilitate ePRO use in oncology clinical trials by improving CRPs' awareness and attitude toward technology.

Healing After Violence: The Effect of Perception of Social Support on Posttraumatic Growth in Female University Students.

This study investigated the Turkish validity and reliability of the Healing After Gender-based Violence Scale (GBV-Heal) and the relationship between social support perception, posttraumatic growth in university students who are victims of gender-based violence. The study sample consisted of 167 female students who experienced gender-based violence. The Turkish version of GBV-Heal of Kaiser-Meyer-Olkin value was 0.892; the Bartlett Sphericity Test result was determined as χ2 = 195,053, and the obtained variables were found suitable for factor analysis. Perception of social support related to post-violence healing in female university students is effective on posttraumatic growth.

Using Mixed Methods Integration to Evaluate the Structure of Help-Seeking Barriers Scale: A Survivor-Centered Approach.

Despite the high prevalence of adverse health and trauma-related outcomes associated with intimate partner violence (IPV), help-seeking and service utilization among survivors is low. This study is part of a larger mixed-methods and survivor-centered validation study on the Icelandic Barriers to Help-Seeking for Trauma (BHS-TR) scale, a new barriers measure focused on trauma recovery. A mixed-methods legitimation strategy of integration was employed to evaluate the BHS-TR structure in samples of IPV survivors. The merging of qualitative (n = 17) and quantitative (n = 137) data through a joint display analysis revealed mainly complementarity findings, strengthening the scale's overall trustworthiness and validity evidence. Divergent findings involved items about mistrust, perceived rejection, stigmatization, fearing vulnerability, and safeguarding efforts that were significant help-seeking barriers in the survivors' narratives, whereas factor analysis indicated their removal. These BHS-TR items were critically evaluated in an iterative spiraling process that supported the barriers' influence, illuminated core issues, and guided potential refinements. This work contributes to the growing field of mixed methods instrument validation placing equal status on qualitative and quantitative methods and emphasizing integration to provide more complete insights. Moreover, the study's findings highlight the added value of further exploring divergence between two sets of data and the importance of giving attention to the voices of the target population throughout the validation process.