Parental socialization of mental health in Chinese American families: What parents say and do, and how youth make meaning.

Parental mental health socialization is a process by which parents shape how youth develop and maintain beliefs, attitudes, and behaviors regarding mental health and help-seeking behaviors. Although culture shapes parental mental health socialization, few studies have examined specific parental socialization practices regarding mental health and help-seeking, especially as a culturally anchored process. Using a qualitative approach, this study explores youth-reported parental socialization of mental health within Chinese American families by examining focus group data from 69 Chinese American high school and college students. Findings revealed that youth received parental messages that conveyed culturally anchored conceptualizations of mental health that included stigmatized views of mental illness and perceptions of mental distress as not a legitimate problem. Parents responded to youth distress in culturally consonant ways: by encouraging culturally specific coping methods, dismissing or minimizing distress, or responding with silence. Youth engaged in the active interpretation of parental messages through cultural brokering, bridging the gap between their parents' messages and mainstream notions of mental health and help-seeking. Overall, our findings point to the significant role of culture in parental mental health socialization in Chinese American families and the need to integrate culturally specific understandings of mental health into future interventions for Asian American youth.

Racial discrimination and the moderating effects of racial and ethnic socialization on the mental health of Asian American youth.

This study investigates trajectories of racial discrimination, racial and ethnic socialization (RES), and their interaction effects with social positions (nativity and gender) on mental health. A longitudinal study of 786 Filipino American (FA) and Korean American (KA) youth from the Midwestern United States (Mage.Wave1  = 15) confirmed that discrimination increased and significantly contributed to the upward trend of mental health distress, whereas the impact of RES differed by its type and by ethnicity. For example, promotion of mistrust and ethnic-heritage socialization were protective among U.S.-born FA youth, but for KA youth, preparation for bias was protective regardless of nativity and gender. This study highlights the importance of considering social positions to better understand the role of RES in youth psychological adjustment.

Racial Stereotypes and Asian American Youth Paradox.

Asian Americans are simultaneously stereotyped as a perpetual foreigner and a model minority. This cross-sectional study of 308 Filipino American youth (mean age 18 years; 47% emerging adult; 72% U.S.-born; 57% female) and 340 Korean American youth (mean age 18 years; 39% emerging adult; 59% U.S.-born; 49% female) is the first to investigate both the direct and interactive effects of these seemingly opposite stereotypes on internalizing and externalizing outcomes, and how these relations differ by ethnicity, age group (adolescence vs. emerging adulthood), and nativity (foreign-born vs. U.S.-born). The results confirm that the perpetual foreigner stereotype predicts more internalizing problems, whereas aspects of the model minority stereotype (i.e., achievement orientation and unrestricted mobility) had different effects by ethnicity. Those who deeply internalize the model minority stereotype were found to be particularly vulnerable. Furthermore, the interactive effects of these stereotypes were more prominent during emerging adulthood than in adolescence, regardless of ethnicity. These nuanced and complex mechanisms need to be thoroughly understood in order to develop appropriate and effective public health or school interventions that can support Asian American young people in dealing with the harmful effects of racial stereotypes.

The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use.

BACKGROUND: The college years represent a period of increased vulnerability for a wide range of mental health (MH) challenges. The onset of common psychiatric conditions occurs during this period of development. Increases in depression, anxiety, and suicidality among U.S. college students have been observed. This study identified prevalence and correlates of MH diagnoses and suicidality in a recent sample of U.S. college students. METHODS: The Spring 2015 American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed MH diagnoses and suicidality from U.S. undergraduate students (n = 67,308) across 108 institutions. RESULTS: Stress was strongly associated with a greater likelihood of suicide attempts and MH diagnoses, even among students reporting 1-2 stressful events (OR [odds ratio] range 1.6-2.6, CI [confidence interval] = 1.2-3.2). Bisexual students were more likely to report MH diagnoses and suicidality, compared to heterosexual and gay/lesbian students (OR range 1.5-3.9, CI = 1.8-4.3), with over half engaging in suicidal ideation and self-harm, and over a quarter reporting suicide attempts. Transgender students reported a higher rate of MH diagnoses and suicidality relative to females (OR range 1.9-2.4, CI = 1.1-3.4). Racial/ethnic minority students were generally less likely to report MH diagnoses relative to Whites, although the likelihood for suicidality was mixed. CONCLUSIONS: The high rate of multiple stress exposures among the U.S. college population and the high impacts of stress on MH and suicidality point to an urgent need for service utilization strategies, especially among racial/ethnic, sexual, or gender minorities. Campuses must consider student experiences to mitigate stress during this developmental period.

Prenatal Life Events, Maternal Employment, and Postpartum Depression across a Diverse Population in New York City.

This study examined racial/ethnic disparities in three core postpartum depression (PPD) symptoms, and identified specific predictors of PPD including sociodemographic variables, life stressors and maternal employment. White, African American, Hispanic, and Asian/Pacific Islander women from the New York City area (n = 3010) completed the 2009-2011 Pregnancy Risk Assessment Monitoring System. African American women were less likely to have PPD than White women. Maternal employment during the postpartum was associated with an increased likelihood of PPD for White women relative to women who were not employed. Life stressors and maternal employment should be considered as culturally contextualized factors related to postpartum depression.

Explicating Acculturation Strategies among Asian American Youth: Subtypes and Correlates across Filipino and Korean Americans.

Acculturation strategy, a varying combination of heritage and mainstream cultural orientations and one of the significant determinants of youth development, has been understudied with Asian American youth and particularly at a subgroup-specific level. This study used person-oriented latent profile analysis (LPA) to identify acculturation strategy subtypes among Filipino American and Korean American adolescents living in the Midwest. Associations between the subtypes and numerous correlates including demographics, family process and youth outcomes were also examined. Using large scale survey data (N = 1580; 379 Filipino American youth and 377 parents, and 410 Korean American youth and 414 parents; MAGE of youth = 15.01), the study found three acculturation subtypes for Filipino American youth: High Assimilation with Ethnic Identity, Integrated Bicultural with Strongest Ethnic Identity, and Modest Bicultural with Strong Ethnic Identity; and three acculturation subtypes for Korean American youth: Separation, Integrated Bicultural, and Modest Bicultural with Strong Ethnic Identity. Both Filipino American and Korean American youth exhibited immersion in the host culture while retaining a strong heritage identity. Although bicultural strategies appear most favorable, the results varied by gender and ethnicity, e.g., integrated bicultural Filipino Americans, comprised of more girls, might do well at school but were at risk of poor mental health. Korean American separation, comprised of more boys, demonstrated a small but significant risk in family process and substance use behaviors that merits in-depth examination. The findings deepen the understanding of heterogeneous acculturation strategies among Asian American youth and provide implications for future research.

Advances in EBI Development for Diverse Populations: Towards a Science of Intervention Adaptation.

This introduction examines major issues and challenges as presented in this special issue of Prevention Science, "Challenges to the Dissemination and Implementation of Evidence Based Prevention Interventions for Diverse Populations." We describe the Fidelity-Adaptation Dilemma that became the origin of dynamic tensions in prevention science. It generated controversies and debates and new perspectives on the dissemination and implementation of evidence-based interventions (EBIs) within diverse populations. The five articles in this special issue address many of these challenges. These dynamic tensions have culminated in a reframing of this dilemma that now argues that fidelity and adaptation are both equally important imperatives. These five articles also examine the abiding challenges of engagement and sustainability. Also, two commentaries from expert research investigators reflect on these five articles and their contributions to prevention science. The current introduction describes this "second generation" of EBIs as they may contribute towards a reduction of the health disparities and inequities that disproportionately affect sectors of the major ethnocultural populations in the USA. We also present a systems analysis of approaches and challenges in the dissemination and implementation of EBIs within the contemporary integrative care environment. Finally, we mention an initiative for, "building a science of intervention adaptation," that proposes systematic research and the creation of an archive of scientific data on the benefits and problems of intervention adaptation. Collectively, these new directions can integrate scientific rigor and sensitivity to cultural factors, for enhancing the effectiveness and reach of this second generation of evidence-based interventions with diverse ethnocultural populations.

Advancing Understanding of Acculturation for Adolescents of Asian Immigrants: Person-Oriented Analysis of Acculturation Strategy Among Korean American Youth.

Acculturation strategy, a significant predictor of immigrant adaptation, has been under-studied with Asian Americans, in particular, Asian American youth. Using person-oriented latent profile analysis, this study identified acculturation strategies among Korean American early adolescents living in the Midwest. Two-hundred ninety-one families were interviewed in 2007 that included 220 youth (mean age 13, 47.7 % female), along with 272 mothers and 164 fathers (N = 656). They were re-interviewed in 2008 (N = 588). The study found three distinct acculturation strategies: separation (11.8 %, n = 26), integrated bicultural (66.9 %, n = 150), and modest bicultural (21.3 %, n = 44). Integrated bicultural youth reported the strongest sense of ethnic identity and the most favorable characteristics, providing empirical support for the benefit of biculturalism. The findings further suggest that separation may not be as detrimental as previously thought, and modest bicultural-biculturalism that is not fully developed-may in fact be less desirable among Korean American youth.

U.S. Caregivers with Mental Health Problems: Parenting Experiences and Children's Functioning.

The 2007 National Survey of Children's Health was used to determine the prevalence of poor mental health among U.S. mothers, fathers, and guardians, specific parenting experiences and children's functioning. More guardians (13.7%) reported poor mental health compared to mothers (7.7%) and fathers (5.3%), generalizing to 4.6 million U.S. caregivers with poor mental health. Caregivers with poor mental health were at least 3 times more likely to report children's problematic functioning after accounting for sociodemographic factors and parenting stress and experiences. Research and clinical activities should recognize poor caregiver mental health as a condition that affects parenting and children's functioning.

Psychocultural Correlates of Mental Health Service Utilization Among African American and European American Girls.

Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization.

The Cultural Ecogram: A Tool for Enhancing Culturally Anchored Shared Understanding in the Treatment of Ethnic Minority Families.

Ethnic and racial disparities in mental health care continue to exist, highlighting the increasing concern within the realm of clinical practice as to how clinicians are to effectively integrate the central role of culture and context into the treatment delivery process for culturally diverse children and families. The current paper presents the Cultural Ecogram, - a clinical engagement tool designed to facilitate the development of a culturally anchored shared understanding - as one method that may facilitate clinician-client shared understanding on the client's cultural, ethnic and racial context central to the effective implementation of treatments with ethnic minority children and families.

Shared understanding as a gateway for treatment engagement: a preliminary study examining the effectiveness of the culturally enhanced video feedback engagement intervention.

OBJECTIVE: For ethnic minority families, the bridging of clinician-client differences is essential to their engagement in treatment. The Culturally Enhanced Video Feedback Engagement (CEVE) intervention aims to enhance client engagement through fostering clinician-client shared cultural understanding. The present study tested the effectiveness of the CEVE on client-rated clinician cultural competence and therapeutic alliance. METHOD: Nineteen ethnic minority families with children aged 3-6 years were randomized to the CEVE (n = 9) or treatment as usual (n = 10) at an outpatient clinic. RESULTS: Results from linear mixed effects regression models indicated a significant effect of the CEVE on intercept, suggesting that clinician cultural competence and therapeutic alliance were significantly higher in the CEVE condition. No effect was found for clinician growth in skills. CONCLUSIONS: The results indicate that the CEVE enhances client treatment engagement via clinician cultural competence and clinician-client alliance, suggesting its promise as a clinical engagement tool, particularly for treatments serving ethnic minority families.

Correlates of Stigma Toward Mental Health Service Use Among Filipino Americans and Korean Americans.

Asian Americans are less likely than Whites to seek mental care and when they do, there is a substantial delay in help-seeking. Stigma associated with mental health service use is one of the major barriers to help-seeking among Asian Americans. However, few studies have examined multi-layered contextual predictors of stigma to examine joint as well as unique contributions of each predictor. Using a cross-sectional study of 376 Filipino and 412 Korean American parents from the Midwestern U.S., we investigated how individual, familial, ethnic cultural, and macro level factors were associated with stigma among immigrant parents. The findings from hierarchical regressions suggest that familial and ethnic cultural factors are prominent predictors of stigma among Korean Americans, whereas macro level factors are particularly pertinent to Filipino Americans. This study highlights the significance of subgroup specific interventions to be effective in addressing unmet mental care needs in distinct subgroups of Asian Americans.

Cultural socialization in childhood: Analysis of parent-child conversations with a direct observation measure.

Cultural factors influence the development of all children. Yet, current knowledge of explicit cultural socialization processes in childhood remains limited, mainly by failing to incorporate the experiences of young children. To address this critical gap, the authors introduce the OMERS-Peds task, an observational measurement designed to systematically identify and compare the content of cultural messages passed down from caregivers to offspring during early school age years. The OMERS-Peds was administered to mothers and children (n = 275) from three diverse racial/ethnic backgrounds (African American (n = 153), Hispanic (n = 61), and non-Hispanic White (n = 61)) within the longitudinal Multidimensional Assessment of Preschoolers (MAPS) Study. The OMERS-Peds coding system was used to rate how strongly families endorsed 5 key constructs: family culture, religion, identity, ethnicity, and race. A series of χ2 statistic tests were used to compare scores across racial/ethnic backgrounds, and within families (between children and their mothers). Analyses revealed that in the cultural socialization conversations occurring in early childhood, parents and children prioritize talking about their family's culture and religion. Independent of their racial/ethnic backgrounds, mothers and children seldom discussed race and ethnicity. Contrary to research with older children, differences were mainly identified within families, rather than across racial/ethnic groups. Findings support the need to include children's perspectives in the assessments of cultural socialization, as opposed to relying primarily on parent reports, and highlight the importance of having an observational methodology that allows researchers to examine parent-child bidirectional interactions during early school age years in a systematic manner. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Guest editors' introduction to the special section: Cultural adaptation of mental health interventions for Americans of East Asian descent.

Overall, this special section makes a timely and significant contribution to providing various types of culturally specific interventions as well as the evidence of clinical trials. Although the sample size of each study is rather small, each intervention illustrates innovative methods in both reaching and treating underserved and understudied populations. Moreover, these interventions provide critical groundwork for building an evidence base of interventions tailored specifically to Asian Americans (AAs). These articles demonstrate the significance of development and testing of culturally adapted or culturally grounded interventions for intervention science that effectively treat and engage culturally diverse and hard-to-reach populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An adaptive approach to family intervention: linking engagement in family-centered intervention to reductions in adolescent problem behavior.

This study used Complier Average Causal Effect analysis (CACE; see G. Imbens & D. Rubin, 1997) to examine the impact of an adaptive approach to family intervention in the public schools on rates of substance use and antisocial behavior among students ages 11-17. Students were randomly assigned to a family-centered intervention (N = 998) in 6th grade and offered a multilevel intervention that included (a) a universal classroom-based intervention, (b) the Family Check-Up (selected; T. J. Dishion & K. Kavanagh, 2003), and (c) family management treatment (indicated). All services were voluntary, and approximately 25% of the families engaged in the selected and indicated levels. Participation in the Family Check-Up was predicted by 6th-grade teacher ratings of risk, youth reports of family conflict, and the absence of biological fathers from the youths' primary home. Relative to randomized matched controls, adolescents whose parents engaged in the Family Check-Up exhibited less growth in alcohol, tobacco, and marijuana use and problem behavior during ages 11 through 17, along with decreased risk for substance use diagnoses and police records of arrests by age 18.

The ethnic context of child and adolescent problem behavior: implications for child and family interventions.

This article links the empirical literature on race and ethnicity in developmental psychopathology with interventions designed to reduce adolescent problem behavior. We present a conceptual framework in which culture is endogenous to the socialization of youth and the development of specific self-regulatory strategies. The importance of cultural influence is identified at three levels: (a) intrapersonal developmental processes (e.g., ethnic identity development, development of coping modifies mechanisms and self-regulatory mechanisms), (b) family socialization processes (e.g., racial and ethnic socialization), and (c) interaction with larger societal contexts (e.g., maintenance of bicultural competence in adapting to mainstream and ethnic cultures). We discuss limitations of current assessment and intervention practices that focus on reducing adolescent problem behavior with respect to the cultural issues identified above. We propose that empirically supported adaptive and tailored interventions for adolescent problem behavior are optimal for serving multicultural children and families. To empower such interventions to better serve children and families of color, it is essential that assessments that guide the adaptation and tailoring process include culturally salient dynamics such as ethnic identity, racial socialization, and culturally informed parenting practices.

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families.

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.

Implementing family-centered interventions within the public middle school: linking service delivery to change in student problem behavior.

The Adolescent Transitions Program is a family-centered intervention strategy designed to reduce problem behavior and prevent drug use within a public school environment. A parent consultant within a Family Resource Center (FRC) provided universal, selected, and indicated interventions that enhanced and supported positive parenting practices known to serve as protective factors. Implementation of the 3-year FRC model involved 584 students and their families in 4 middle schools. Analyses focused on the dynamics and effects of parent consultant activities and services. Differences in school "adoption" of the FRC services were found to be a function of both passage of time and school environment. Despite significant variation in implementation across schools, FRC services significantly reduced the growth in problem behavior over the course of the middle-school years. The implications of these findings for dissemination of empirically supported, school-based, family-centered interventions are discussed.