Examining Financial Strain and Subjective Social Status in Terms of Behavioral Health Among Latinx Adults in a Federally Qualified Health Center.

There is a growing recognition that Social Determinants of Health (SDoH) can inform some sources of physical and mental health disparities among the Latinx population. The current study sought to expand previous research by exploring the singular and interactive influence of financial strain and subjective social status-two common and clinically important SDoH factors-on pain intensity, pain disability, general depression, social anxiety, and anxious arousal. The current sample consisted of 155 Latinx adults (81.3% female; Mage = 40.02 years, SD = 10.61) presenting for care at a Federally Qualified Health Center (FQHC). Multivariate results demonstrated that financial strain was statistically significantly associated with greater pain intensity, pain disability, general depression, and anxious arousal, but not social anxiety. Further, lower subjective social status was related to greater general depression, social anxiety, and anxious arousal but not with higher levels of pain indices. An interactive effect was found wherein the combination of higher levels of financial strain and low levels of subjective social status was related to general depression and anxious arousal. This is the first study to empirically evaluate the main and interactive effects of financial strain and subjective social status regarding numerous physical and mental health symptoms. These findings clarify how two prevalent SDoH factors influence health outcomes. Specifically, the results suggest that a multi-risk conceptualization can advance a fine-grained understanding of Latinx health disparities by showing differential associations between SDoH factors and clinical outcomes that are frequently the source of health inequities in the Latinx population.

Metabolic Monitoring for Children and Adolescents Prescribed Second-Generation Antipsychotics: A Qualitative Study with Child Psychiatrists.

Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.

Exploring pain experience and anxiety sensitivity among Latinx adults in a federally qualified health center.

The Latinx population is the largest minority group in the United States (U.S.) and is expected to continue to grow through at least 2050. Although there is growing recognition of the importance of pain among Latinx individuals, few studies have examined individualized psychological processes governing pain severity and disability in Latinx populations. One psychological factor that has shown promise in relation to pain experience specifically and clinical conditions more generally is anxiety sensitivity. The present investigation sought to (1) characterize the severity of pain among an unselected sample of adult Latinx individuals attending a Federally Qualified Health Center (FQHC); (2) evaluate the severity of anxiety sensitivity as a function of pain severity; and (3) test the potential explanatory relevance of anxiety sensitivity as an individual difference factor for pain intensity, pain disability, psychological inflexibility for emotional distress, and global life impairment. Participants included 406 adult Spanish-speaking Latinx persons (87.2% female; Mage = 40.26 years, SD = 11.20, and 98.3% used Spanish as their first language) who attended an FQHC in Houston, Texas. Analyses revealed that 62.6% of the sample had at least some pain, and 21.9% of the same had high intensity, moderate interference, or severe interference chronic pain. Further, results provided evidence for anxiety sensitivity as a function of pain grade, such that individuals with grade 2 (high-intensity pain), grade 3 (moderate pain interference), and grade 4 (severe pain interference) chronic pain reported significantly higher levels of anxiety sensitivity than those with grade 0 pain (no chronic pain). Additionally, after controlling for age, gender, marital status, years of education, years living in the U.S., and generalized anxiety, anxiety sensitivity significantly accounted for significant variance in pain intensity, inflexibility in relation to emotional distress, and life impairment. Overall, the current study builds upon what is currently understood about anxiety sensitivity among the Latinx population and uniquely extends past work by linking individual differences in this construct to clinically relevant aspects of pain experience and life impairment among adults attending FQHC's. Additional clinical attention should be focused on anxiety sensitivity to offset pain disparities among this established health disparities group.

Perceived Discrimination, Experiential Avoidance, and Mental Health among Hispanic Adults in Primary Care.

The Hispanic population is the largest minority group in the United States and frequently experiences racial discrimination and mental health difficulties. Prior work suggests that perceived racial discrimination is a significant risk factor for poorer mental health among Hispanic in the United States. However, little work has investigated how perceived racial discrimination relates to anxiety and depression among Hispanic adults. Thus, the current study evaluated the explanatory role of experiential avoidance in the relation between perceived racial discrimination and anxiety/depressive symptoms and disorders among Hispanic adults in primary care. Participants included 202 Spanish-speaking adults (Mage = 38.99, SD = 12.43, 86.1% female) attending a community-based Federally Qualified Health Center. Results were consistent with the hypothesis that perceived racial discrimination had a significant indirect effect on depression, social anxiety, and anxious arousal symptoms as well as the number of mood and anxiety disorders through experiential avoidance. These findings suggest future work should continue to explore experiential avoidance in the association between perceived racial discrimination and other psychiatric and medical problems among the Hispanic population.

Evaluating the Role of Anxiety Sensitivity on Behavioral Health Outcomes among Latinx Persons.

Background: Mexican Americans represent the largest subpopulation among Latinx persons and experience numerous health inequalities for psychological symptoms and behavioral health problems. First generation Mexican Americans are particularly vulnerable to such disparities and past work suggests that the experience of acculturative stress may play a vital role in terms of mental and physical health problems among this population. The current study sought to bridge past work on acculturative stress among first-generation Mexican Americans by exploring the role of anxiety sensitivity (AS; fear of the negative consequences of internal sensations) as a potential mediational factor in terms of psychological and behavioral health problems among this group. Methods: The current study consisted of 369 first generation Mexican American persons (86.2% female, 40.1 years of age (SD = 11.1) years in the U.S. attending a Federally Qualified Healthcare Center located in an urban southwestern community. We explored whether AS served as a mediator between acculturative stress and some of the most common and disabling clinical problems among this group, including social anxiety, anxious arousal, general depression, insomnia and pain intensity and disability. Result: Consistent with prediction, there was a statistically significant indirect effect of acculturative stress via AS across all criterion variables apart from pain intensity (depression [ab = - 0.17, SE = 0.05, 95% CI [0.08, 0.26]], insomnia [ab = 0.07, SE = 0.02, 95% CI [0.03, 0.10]], social anxiety [ab 0.05, SE = 0.02, 95% CI [0.02, 0.08]], anxious arousal [ab = 0.08, SE = 0.03, 95% CI [0.03, 0.12]], pain disability [ab = 0.05, SE = 0.02, 95% CI [0.02, 0.09]]). Comparative models were run to evaluate the specificity of hypothesized statistically significant models. For all models except anxious arousal and general depression, the alternative model was rejected, adding support to the hypothesized pathway. Conclusion: Overall, this work provides initial support for the role of AS in terms of the relation between acculturative stress and numerous psychological and behavioral health problems among Mexican American adults in a clinical setting.

Anxiety sensitivity and acculturative stress: Concurrent relations to mental health among Spanish-speaking Latinx in primary care.

The Latinx population suffers from mental health inequalities. Although past work has implicated acculturative stress and anxiety sensitivity as important individual difference factors for anxiety and depression in this group, it is presently unclear how they work together to influence more severe anxiety and depressive symptom expression among Latinx. To help address this gap in the existing literature, the current study evaluated the role of concurrent anxiety sensitivity and acculturative stress, in terms of anxiety and depressive symptoms and disorders, in a Latinx population in a primary care setting. Participants included 142 Latinx individuals (86.7% female; Mage = 39.66, SD = 11.34). After accounting for shared variance, the results indicated that both anxiety sensitivity and acculturative stress were significantly associated with anxious arousal symptoms, social anxiety, and depressive symptoms. However, anxiety sensitivity, but not acculturative stress, was significantly related to a number of mood and anxiety disorders. These findings suggest the importance of assessing both anxiety sensitivity and acculturative stress in routine mental health screening, as both factors may be related to poorer psychological health among this group.

Heart-Focused Anxiety Among Latinxs in Primary Care: Relations to Anxiety, Depression, Pain, and Functional Impairment.

There is a public health need to better characterize the individual-based differences that may be involved in the expression and maintenance of psychological and related health problems among Latinx individuals. One individual difference factor that may be relevant to the nexus of psychological and physical concerns is heart-focused anxiety. The current study sought to evaluate the potential explanatory relevance of heart-focused anxiety as an important individual difference factor for anxiety, depression, pain experience, and functional impairment. Participants included 158 Latinx adults (Mage = 39.26, SD = 13.19; 85.4% female) from a primary health clinic. Results indicated that heart-focused anxiety was significantly related to anxious arousal, pain intensity, pain disability, and functional impairment. However, no significant effects were evident for depressive symptoms. These data indicate that heart-focused anxiety may be an underrecognized cognitive factor relevant to better understanding anxiety and pain among Latinx adults in primary care.

Reversibility of psychotropic medication induced weight gain among children and adolescents with bipolar disorders.

OBJECTIVE: To assess the reversibility of weight gain associated with psychotropic medications in children. METHODS: A retrospective cohort study was conducted using an ambulatory electronic medical records database. Individuals under 18 years of age were identified if they were initiating a new course of second generation/atypical antipsychotics (SGA) or mood stabilizers (MS) following a bipolar disorder diagnosis and subsequently discontinued treatment within 24 months of treatment initiation. RESULTS: Of the 297 children who had experienced positive BMI percentile increase (mean±SD: 8.71±11.94) during the treatment of SGA and/or MS, treatment discontinuation led to an average of 1.88 (±13.41) unit decrease in BMI percentile during a 12-month period since the treatment discontinuation. Repeated measure mixed model analysis showed that the reduction of BMI percentile after treatment discontinuation was neither associated with the treatment regimens patients previously received, nor associated with time since the treatment discontinuation. The three statistically significant predictors were baseline BMI percentile, BMI percentile gained during the treatment, and comorbid substance abuse disorder. CONCLUSION: Children with bipolar disorder were able to lose a fraction of weight gained during pharmacotherapy after the treatment discontinuation, however, their BMI percentile may not return to the prior treatment level within a year post-medication discontinuation.

Examining the Relationship Between Pain Intensity and Emotional Eating Among Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity.

There is limited understanding of pain and its relationship to emotional eating among Latinos as well as knowledge about potential mechanisms that may underlie their association. We explored whether anxiety sensitivity (fear of the negative consequences of anxiety) explained the relation between pain intensity and emotional eating among a sample of Latinos. Participants were 79 (87.3% female; Mage = 42.04, SD = 12.01) predominately female Latino attendees of a Federally Qualified Health Center. As hypothesized, results indicated that pain intensity yielded a significant indirect effect through anxiety sensitivity for emotional eating. Alternative models wherein anxiety sensitivity served as the predictor and pain intensity as the indirect effect were also significant. Such novel data highlight the potential bi-directional relationship between pain intensity and anxiety sensitivity in terms of emotional eating. Overall, pain intensity and anxiety sensitivity may serve as mechanisms that underlie emotional eating among Latino adults.

Acculturative stress and alcohol use among Latinx recruited from a primary care clinic: Moderations by emotion dysregulation.

Among Latinx in the United States, alcohol is the most widely abused substance and is associated with a range of negative consequences. Acculturative stress is one factor that is relevant regarding Latinx substance use although more work is needed in this area. In theory, those with more adaptive emotion regulation capabilities may be better able to buffer against the adverse effects of acculturative stress on alcohol use because the person has more and better strategies to deal with life stress. Thus, the current study sought to examine the moderating role of dysregulation in the association of acculturative stress and alcohol use among Latinx in primary care. Latinx adults (N = 94; Mage = 38.5 years, SD = 10.8; 86.6% female) recruited from a Federally Qualified Health Center provided self-reported ratings of acculturative stress, emotion dysregulation, and alcohol use. All measures were in Spanish. Covariates included sex, marital status, age, years in the United States, negative affectivity, and clinic visit reason (patient vs. person accompanying patient). There was a statistically significant interaction of acculturative stress and emotion dysregulation (ß = 1.65, t = 2.29, p = .025) on alcohol use, which accounted for 4.8% of additional variance over and above covariates and the nonsignificant main effects. Simple slope analyses revealed that acculturative stress was associated with alcohol use among those with high (ß = 0.28, t = 2.04, p = .045), but not low (ß = -0.28, t = -1.26, p = .210) levels of emotion dysregulation. The current results indicate that emotion dysregulation moderates the association between acculturative stress and alcohol use among Latinx in primary care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Examining the indirect effect of posttraumatic stress symptoms via emotion dysregulation on alcohol misuse among trauma-exposed Latinx in primary care.

OBJECTIVES: Latinx individuals face substantial health disparities, particularly in the areas of mental health and substance use. Among Latinx in the U.S., alcohol is the most widely abused substance and is associated with a range of negative consequences. Among Latinx, limited past work has linked trauma exposure/symptoms to alcohol misuse, however not much is known regarding how trauma exposure/symptoms may impact alcohol misuse. One potential explanatory mechanism underlying associations of traumatic stress and problematic alcohol use is emotion dysregulation. The current study sought to examine the explanatory role of emotion dysregulation in the associations of traumatic stress symptoms with alcohol misuse among trauma-exposed Latinx. Alcohol misuse was operationalized by two outcomes: alcohol use severity and probable screen for hazardous drinking. METHOD: Latinx adults (N = 238) were recruited from a Federally Qualified Health Center. Participants were interviewed using the M.I.N.I. and then completed various self-report assessments (in Spanish). Structural equation modeling was used to evaluate models. RESULTS: Structural models fit the data well. These models evidenced statistically significant indirect effects of posttraumatic stress symptoms via emotion dysregulation on alcohol use severity and probable screen for hazardous drinking. DISCUSSION AND CONCLUSIONS: In a sample comprising primarily females, posttraumatic stress symptoms may contribute to alcohol misuse and hazardous drinking attributable to maladaptive emotion regulation. Use of interventions targeting emotion dysregulation in the context of trauma and hazardous alcohol use among Latinx in primary care may be warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Perceived Racial Discrimination and Pain Intensity/Disability Among Economically Disadvantaged Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity.

The present study examined the role of anxiety sensitivity (AS; fear of the negative consequences of anxiety) in the relation between perceived racial discrimination and pain-related problems among Latinos seeking health services at a Federally Qualified Health Center. Participants included 145 adult Latinos (87.80% female, Mage = 38.07 years, SD = 11.98, and 96.2% reported Spanish as their first language). Results indicated that perceived racial discrimination was indirectly related to the pain intensity and pain disability through AS. These effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and number of axis I diagnoses. Overall, the present findings highlight the merit in focusing further scientific attention on the interplay between perceived racial discrimination and AS to better understand and inform interventions to reduce pain problems among Latinos in primary care.

Mindful attention moderating the effect of experiential avoidance in terms of mental health among Latinos in a federally qualified health center.

The present study examined the moderating role of mindful attention in the relation between experiential avoidance and anxious arousal, social anxiety, depressive symptoms, and the number of mood and anxiety disorders among a sample of Latinos seeking health services at a primary care facility. Participants included 326 adult Latinos (Mage = 39.79 years, SD = 11.27; 88.9% female; 98.2% used Spanish as their first language). Results provided empirical evidence of an interaction between mindful attention and experiential avoidance for anxious arousal, social anxiety, depressive symptoms, and the number of mood and anxiety disorders in the studied sample. Specifically, among Latinos with lower (vs higher) levels of mindfulness, greater experiential avoidance was related to greater anxiety/depressive symptoms and number of mood and anxiety disorders. Together, these data provide novel empirical evidence of the clinically relevant interplay between mindful attention and experiential avoidance regarding a relatively wide array of negative emotional symptoms and disorders among Latino primary care patients. Limitations of the study include a largely female sample and cross-sectional data.

The Explanatory Role of Insomnia in the Relationship between Pain Intensity and Posttraumatic Stress Symptom Severity among Trauma-Exposed Latinos in a Federally Qualified Health Center.

Latinos, one of the fastest growing populations in the United States, suffer from high rates of posttraumatic stress symptoms (PTS) and its clinical correlates (e.g., disability). Although research suggests the experience of pain is closely related to PTS among trauma-exposed groups, there has been little exploration of the processes that may link pain intensity to greater PTS among trauma-exposed Latinos. The current study explored insomnia, a common problem associated with both pain intensity and PTS, as a mechanism in the association between pain intensity and PTS among trauma-exposed Latinos (N = 208, Mage = 39.39 years, SD = 11.48) attending a Federally Qualified Health Center. Results indicated that insomnia partially explained the relationship between pain intensity and PTS total score (B = 0.25, 95% CI [0.12, 0.43]), as well as re-experiencing (B = 0.09, 95% CI [0.04, 0.17]), avoidance (B = 0.09, 95% CI [0.04, 0.17]), and arousal symptoms (B = 0.10, 95% CI [0.04, 0.17]). Future work is needed to explore the extent to which insomnia accounts for relations between pain and PTS using longitudinal designs to further clarify theoretical health disparity models involving these comorbid conditions.

Identifying the role of sociodemographic factors in major depressive disorder and suicidality among Spanish-speaking Latino patients in a federally qualified health center.

Rates of suicide and major depressive disorder (MDD) are currently at the highest point in the history of the United States (US). However, these rates are not distributed evenly among the population and Latinos show disproportionately high rates of both suicide and MDD. Yet, past research has infrequently explored factors related to suicide and MDD in primary care settings that serve as the major community portal for mental health among the Latino population. Thus, the current study investigated sociodemographic variables (marital status, nativity, education, employment, primary language, age, and gender) in terms of their relations with suicidal ideation, suicide risk, MDD, and MDD symptom severity among Latino primary care patients in a Federally Qualified Health Center (N = 634, M age = 39.46, SD = 11.46, 87.1% female). Results indicated that gender and Nativity were associated with suicidal ideation, older age was associated with suicide risk, and higher education and having a partner were negatively associated with MDD and depressive symptom severity. These results provide novel insight into the role of sociodemographic factors predicting suicide and MDD among Latinos in primary care, and suggest greater scientific and clinical attention can be focused on certain sociodemographic factors to offset mental health disparities among this group.

Acculturative stress and mental health among economically disadvantaged Spanish-speaking Latinos in primary care: The role of anxiety sensitivity.

The present study examined the role of anxiety sensitivity in the relation between acculturative stress and mood and anxiety symptoms and disorders among Latinos seeking health services at a primary healthcare facility. Participants included 142 adult Latinos (86.6% female, Mage = 39.05 years, SD = 12.46%, and 96.3% reported Spanish as their first language). Results indicated that acculturative stress was indirectly related to the number of mood and anxiety disorders, anxious arousal, social anxiety, and depressive symptoms through anxiety sensitivity. The observed effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and negative affectivity. Overall, the present findings suggest that there is merit in focusing further scientific attention on the interplay between acculturative stress and anxiety sensitivity to better understand and inform interventions to reduce anxiety/depressive vulnerability among Latinos in primary care.

Anxiety sensitivity and rumination: Transdiagnostic factors involved in the relation between subjective social status and anxiety and depressive symptoms and disorders among economically disadvantaged Latinos in primary care.

Latinos face striking physical and mental health disparities. One factor associated with such disparities is subjective social status, reflecting subjective ratings of social standing. Yet there is presently a lack of empirical information about the mechanisms underlying relations between subjective social status and anxiety and depressive symptoms and disorders among Latinos in community medical services that serve as focal catchment areas for assessment and intervention programming. The present investigation examined the unique explanatory roles of 2 transdiagnostic factors, rumination and anxiety sensitivity, in the relation between subjective social status and depressive, suicidal, social anxiety, and anxious arousal symptoms as well as anxiety/depressive disorders, among Latinos seeking health services at a primary health care facility. Participants included 253 Latino adults with annual incomes of less than $30,000 (M age = 39.1, SD = 11.1). Results indicated that rumination and anxiety sensitivity each significantly (independently) mediated associations between subjective social status and all dependent variables except suicidal symptoms. For suicidal symptoms, only rumination was a mediator. The present findings suggest that rumination and anxiety sensitivity may represent mechanisms for associations between subjective social status and anxiety and depressive symptoms and disorders among economically disadvantaged Latinos in primary care settings. (PsycINFO Database Record

Examining the Synergistic Effects of Two Transdiagnostic Vulnerability Factors in Relation to Anxiety and Depressive Symptoms and Disorders Among Latinos in a Community Health Care Setting.

Latinos are one of the fastest growing racial/ethnic population in the United States yet they experience a substantial amount of mental health disparities, such as anxiety and depression, compared with non-Hispanic Whites. The current study examined the interactive effects of rumination and mindful attention on anxiety and depression symptoms among economically disadvantaged Latinos. Participants consisted of 391 Latinos (86.7% female; Mage = 38.8 years [ SD = 11.4]; 95.3% first language Spanish) who attended a community-based primary health care clinic. Results provided support for an interaction effect of rumination with mindful attention in relation to depressive, suicidal, social anxiety, and anxious arousal symptoms as well as number of mood and anxiety disorders. The pattern of findings was consistent across each of these continuous dependent measures such that the highest levels of each affective variable were found for those with a combination of higher rumination and lower mindful attention. Unexpectedly, there was no interaction in relation to the dichotomous outcome of presence of any mood/anxiety diagnosis.

Pain and Alcohol Use among Latinos in Primary Care: Examining Rumination as an Explanatory Factor.

BACKGROUND: Alcohol is a widely abused substance among Latinos. Yet, little is known regarding factors underlying hazardous drinking in this population. Growing work has linked pain to hazardous drinking, although highly limited work has focused on Latinos. OBJECTIVES: The aim of the current study was to test rumination as an underlying mechanism explaining relations between pain severity and alcohol use among Latinos. METHODS: Data from 252 low-income Latino adults (Mage = 38.7 years, SD = 10.8; 86.1% female) attending a community-based primary health care clinic were available. Participants completed measures of pain, rumination, and alcohol use. Structural equation modeling was used to evaluate the indirect effect of pain severity via rumination on alcohol use. RESULTS: The model displayed good fit to the data. There was a statistically significant indirect effect of pain severity via rumination on alcohol use. Conclusions/Importance: The current findings suggest that rumination may underlie associations of pain and alcohol use among Latinos. Future work in primary care medical settings may benefit from targeting ruminative thinking among Latinos who are experiencing pain to address hazardous drinking.

Anxiety Sensitivity and Age: Roles in Understanding Subjective Social Status among Low Income Adult Latinos in Primary Care.

One social determinant of health construct that is reliably related to health disparities among the Latino population is subjective social status, reflecting subjective ratings of social standing. Yet, little research has explored factors that may undergird variability in subjective social status among this population or in general. Accordingly, the present investigation examined one possible etiological model wherein age moderates the relation between individual differences in anxiety sensitivity (fear of the negative consequences of stress sensations) and subjective social status among a Latino primary care sample. Participants included Spanish-speaking Latino adults (n = 394; 86.5% female; average age = 39.0 years). Results demonstrated an interaction between the anxiety sensitivity and age for subjective social status among the Latino sample. Inspection of the form of the significant interaction indicated that the association between anxiety sensitivity and subjective social status was evident among older, but not younger, persons. The current findings suggest that decreasing anxiety sensitivity, especially among older Latinos, may be one possible viable therapeutic approach to change subjective social status in order to help offset health disparities among this group.