Mental health literacy as a barrier and facilitator for service use: Qualitative inquiry among Palestinian Bedouins in Israel.

BACKGROUND: Mental health literacy (MHL) has been related to health behaviors and outcomes. However, studies examining MHL as a barrier and facilitator to service use are limited, especially among minority groups. AIMS: This study examined MHL as a barrier and facilitator to mental health service use among the Palestinian Bedouin minority in Israel. METHODS: Twenty-five Bedouins (15 women) from southern Israel participated in semi-structured, in-depth interviews. The participants were recruited by publishing an ad on social media about the study, then through a snowball technique. The data were analyzed thematically using ATLAS.ti.9, and the intercoder reliability was 92%. RESULTS: We identified four major themes in the interviews: (1) MHL as a barrier to service use, due to lack of knowledge about professionals in the field, mental health services, or reasons and risk factors for mental health problems; (2) traditional attitudes that acted as barriers to service use, including a preference for informal treatment, a lack of faith in mental health treatment, aversion to discussing private feelings, and the perception that mental health is a luxury; (3) MHL as a facilitator to service use by enabling accurate identification of mental distress and suggesting practical avenues for seeking help; and (4) ways to improve MHL that should be culturally sensitive and under the government agencies' responsibility. CONCLUSIONS: Interventions aimed at increasing the use of mental health services among Bedouins and reducing racial/ethnic disparities should increase knowledge in culturally adapted ways, especially regarding professionals and services, and change negative attitudes such as mental health treatment as ineffective or bonus.

The association between patient-provider racial/ethnic concordance, working alliance, and length of treatment in behavioral health settings.

Racial/ethnic concordance between patients and providers concerning the quality of care has received interest over past decades yielding mixed results. Patients seem to prefer clinicians of their own race/ethnicity, but empirical studies have found small or inconsistent effects on the quality of care. Research on the impact of racial/ethnic concordance and treatment duration appears to suggest that racial/ethnic concordance is associated with retention and completion; however, exactly why racial/ethnic concordance improves treatment length remains unexplored. On the other side, the quality of working alliance is a well-established common factor underlying effective treatments. In this study, we examined the interaction between patient-provider racial/ethnic concordance, length of treatment in the therapeutic dyad, and working alliance as evaluated by both patients themselves and objective raters. The study included 312 patients and 74 providers from 13 community and hospital-based outpatient mental health clinics in Massachusetts. Results indicated that among racial/ethnic concordant therapeutic dyads, longer length of treatment was associated with better quality of working alliance as evaluated by objective raters. Implications for clinical practice and future research on racial/ethnic concordance studies linked to the length of treatment are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Centering the Voice of the Client: On Becoming a Collaborative Practitioner with Low-Income Individuals and Families.

Despite current interest in collaborative practices, few investigations document the ways practitioners can facilitate collaboration during in-session interactions. This investigation explores verbatim psychotherapy transcripts to describe and illustrate therapist's communications that facilitate or hinder centering client's voice in work with socioeconomically disadvantaged populations. Four exemplar cases were selected from a large intervention trial aimed at improving shared decision making (SDM) skills of psychotherapists working with low-income clients. The exemplar cases were selected because they showed therapist's different degrees of success in facilitating SDM. Therapist's verbalizations were grouped into five distinct communicative practices that centered or de-centered the voice of clients. Communication practices were examined through the lens of collaborative approaches in family therapy. The analysis suggests that cross-fertilization between SDM and family-oriented collaborative and critical approaches shows promise to illuminate and enhance the challenging road from clinician-led to client-led interactions. This paper also stresses the importance of incorporating relational intersectionality with individuals and families who may not feel entitled to express their expectations or raise questions when interacting with authority figures.

A pesar del interés actual en las prácticas colaborativas, pocas investigaciones documentan las maneras en las que los profesionales pueden facilitar la colaboración durante las interacciones dentro de las sesiones. Esta investigación analiza transcripciones textuales de la psicoterapia para describir e ilustrar las comunicaciones de los terapeutas que facilitan u obstaculizan la centralización de la voz del paciente en el trabajo con poblaciones desfavorecidas socioeconómicamente. Se eligieron cuatro casos ejemplares de un ensayo grande de intervención orientado a mejorar las habilidades para la toma de decisiones compartidas de psicoterapeutas que trabajan con pacientes de bajos recursos. Los casos ejemplares se eligieron porque demostraban los diferentes grados de éxito de los terapeutas a la hora de facilitar la toma de decisiones compartidas. Las verbalizaciones del terapeuta se agruparon en cinco prácticas comunicativas diferentes que centralizaban o descentralizaban la voz de los pacientes. Se examinaron las prácticas de comunicación desde la perspectiva de los enfoques colaborativos en la terapia familiar. El análisis sugiere que la fertilización entre el esquema de decisiones compartidas y los enfoques teóricos críticos y colaborativos orientados a la familia promete iluminar y mejorar el difícil camino desde las interacciones dirigidas por el clínico a las dirigidas por los clientes. Este artículo también acentúa la importancia de incorporar la interseccionalidad relacional con personas y familias que posiblemente no se sientan con derecho a expresar sus expectativas o a hacer preguntas cuando interactúan con figuras de autoridad.

Prevalence and risk factors for suicidality in cancer patients and oncology healthcare professionals strategies in identifying suicide risk in cancer patients.

PURPOSE OF REVIEW: The aim of this study was to summarize the literature on prevalence and risk factors for suicidality in cancer patients and to document the research on oncology healthcare professionals' strategies in identifying this risk. RECENT FINDINGS: Cancer patients exhibit increased risk of suicidality compared with the general population. Various risk factors have been identified including sociodemographic factors such as poverty, being male and elderly as well as disease-related attributes such as cancer type and stage. The literature on how healthcare professionals identify suicide risk is sparse. Ten articles were found that focused on two main themes. These included information on systematic strategies in identifying suicide risk and factors that affect healthcare professionals' ability to identify risk in their patients. SUMMARY: Although there is an immense amount of literature documenting the problem of suicidality among patients, the research on how healthcare professionals identify and respond to these indications in patients is nearly nonexistent. Cancer centres should implement standardized and systematic screening of cancer patients for suicidality and research on this patient population should collect and report these data. Ongoing training and education for healthcare professionals who work in the oncology setting on how to identify and respond to suicide risk among cancer patients is urgently needed.

Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences.

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.

Does Assessment Method Matter in Detecting Mental Health Distress among Ashkenazi and Mizrahi Israeli Women with Breast Cancer?

Authors examined differences in assessment method (structured diagnostic interview versus self-report questionnaire) between ethnic groups in the prevalence of mood and anxiety disorders among women with breast cancer. A convenience sample of 88 Mizrahi (Jews of Middle Eastern/North African descent, n = 42) and Ashkenazi (Jews of European/American descent, n = 46) women with breast cancer from oncology units in three health centers across Israel participated in the study. Participants were within eight months of diagnosis. Participants completed the Hospital Anxiety and Depression Scale (HADS) and a structured diagnostic interview, the Mini-International Neuropsychiatric Interview (MINI). Approximately one-third (31.8 percent, n = 28) of participants were diagnosed with at least one mood or anxiety disorder based on the MINI. Significantly more Mizrahi participants (42.9 percent) were diagnosed with at least one mood or anxiety disorder, compared with their Ashkenazi counterparts (21.7 percent). Mean score on HADS was below the optimal cutoff score (≥13) among all participants, with no significant difference in mean score for emotional distress based on HADS between the two ethnic groups. The findings highlight the role of measurement variance in assessing mental health distress among women with breast cancer in general and among ethnic and racial minorities in particular.

Association between Knowledge about How to Search for Mental Health Information and Emotional Distress among Older Adults: The Moderating Role of Immigration Status.

Mental health literacy (MHL) provides a framework to overcome barriers to service use and reduce mental health disparities through public education. Acquiring basic knowledge about mental health problems can guide subsequent help-seeking behavior. Improving knowledge about how to search for mental health information is a critical first step in improving MHL. In this study, we examined the association between knowledge about how to search for mental health information and emotional distress among older adults. We further examined the moderating role of immigration status in this association. A sample of 605 older adults participated in the study (N = 357 Native Israelis; N = 222 Immigrants from the Former Soviet Union). Participants completed self-report measures assessing MHL and emotional distress. Our findings show that Native Israelis reported significantly lower levels of emotional distress and higher levels of knowledge about how to search for mental health information compared to immigrants. Moreover, while among native older adults, increased knowledge about how to search for mental health information was associated with lower emotional distress, among immigrant seniors there was no significant association between these variables. Our findings suggest that differences among immigrant and native older adults can impact the effectiveness of the mental health knowledge that is accessed.

Gathering Diverse Perspectives to Tackle "Wicked Problems": Racial/Ethnic Disproportionality in Educational Placement.

Among students receiving behavioral health and special education services, racial/ethnic minority students are consistently overrepresented in settings separate from general classrooms. Once separated, many young people struggle to improve academically and face significant difficulty upon trying to return to a general education setting. Given the complex, ongoing, and multifaceted nature of this challenge, racial/ethnic disproportionality can be identified as a "wicked problem," for which solutions are not easily identified. Here, we describe our community-engaged research efforts, eliciting perspectives from relevant partners in an ongoing dialogue, to better integrate diverse stakeholders' perspectives when attempting to address such disparities. We conducted focus groups and qualitative interviews with members of three stakeholder groups: community-serving organizations, individuals with lived experience of behavioral health conditions, and state-level policymakers, with a shared interest in addressing racial and ethnic disparities. Participant responses illustrated the "wickedness" of this problem and highlighted the need for additional supports for students, families, and school personnel, increased collaboration across relevant systems and agencies, and reduced barriers related to funding. Overall, this methodology bridged differing perspectives to develop, in concert with our partners, a shared language of the problem and a core set of issues to consider when seeking to effect change.

The Association Between Political Violence and the Connection Between Bullying and Suicidality Among Palestinian Youth.

We examined the association between protracted political violence and the connection between bullying and suicidality among Palestinian adolescents. Data were collected from a representative sample of Palestinian students (N = 5,713) from 100 schools in the West Bank and East Jerusalem who completed an in-class survey. Students who were victims of bullying or bully victims who were exposed to political violence were at higher risk for suicide attempts compared to students who were victims of bullying or bully victims but not exposed to political violence. Political violence moderated the association between bullying and suicide attempts after controlling for socio demographic and other mental health variables.

Assessment of diagnostic information and quality of working alliance with clients diagnosed with personality disorders during the mental health intake.

BACKGROUND: A primary purpose of diagnostic systems is to improve care, yet, little is known about how providers use it routine clinical care. AIMS: We investigated specific DSM-IV personality disorders (PDs) diagnostic information therapists collected during intake visits and the association between a therapist PD diagnosis and clients' and therapists' reports of the quality of working alliance during the intake. METHOD: A total of 122 intakes (n = 34, 27.9% were diagnosed with PD) in four community mental health clinics in Israel were audiotaped. Immediately following the intake, clients and therapists completed the working alliance inventory (WAI). Independent clinicians coded the intakes using an information checklist. RESULTS: Despite the relatively high prevalence of PD in regular psychiatric care, very limited PD diagnostic information was directly assessed during the intake. Therapists evaluated the quality of the working alliance when they saw a client they diagnosed with PD as significantly lower than the rating of a client without a PD, while the clients' ratings did not differ as a result of their diagnosis. CONCLUSIONS: Therapists do not collect sufficient explicit diagnostic information to base their PD diagnostic decisions. Yet, the presence of PD diagnosis affects their rapport with their clients as early as the intake.

School engagement, acculturation, and mental health among migrant adolescents in Israel.

This study aimed to explore the role of school engagement and the mediation effect of acculturation in predicting 1.5 and second-generation migrant adolescents' mental health and risk behaviors. Participants included 448 seventh to tenth grade Israeli students (mean age 14.50, 53% boys): 128 non-Jewish 1.5 generation migrant adolescents (children of migrants living in Israel), 118 second-generation migrants (children of migrants born and living in Israel), and an age-matched sample of 202 native-born Jewish adolescents. All participants completed a battery of questionnaires assessing mental health symptoms, engagement in risk behaviors, social adjustment, and school engagement. Both migrant adolescent groups also completed an acculturation questionnaire. Differences between groups in school engagement, mental health symptoms, and risk behavior were examined, and structural equation modeling (SEM) was used to investigate the hypothesized mediating effect of acculturation. Findings revealed substantially higher levels of mental health symptoms (p < .001) and risk behaviors (p = .001) among 1.5 and second-generation migrant adolescents compared with native-born adolescents, with no significant differences between 1.5 generation and second-generation migrants. Migrants' age and gender were associated with mental health symptoms and risk behaviors-older participants engaged in more risk behaviors (p = .02), and females had elevated mental health symptoms (p = .007). Identification with the host country mediated the relationships between school engagement and mental health symptoms (ps .006 and .008) and risk behaviors (ps .001 and .004) in 1.5 generation and second-generation migrants, respectively. The results are discussed in reference to current theories and research, as well as practical implications for prevention and intervention. (PsycINFO Database Record

Assessment of clinical information: Comparison of the validity of a Structured Clinical Interview (the SCID) and the Clinical Diagnostic Interview.

Adaptive functioning is a key aspect of psychiatric diagnosis and assessment in research and practice. This study compared adaptive functioning validity ratings from Structured Clinical Interviews (SCIDs, symptom-focused structured diagnostic interviews), and Clinical Diagnostic Interviews (CDIs, systematic diagnostic interviews modeling naturalistic clinical interactions focusing on relational narratives). Two hundred forty-five patients (interviewed by two independent interviewers) and their interviewers completed the Clinical Data Form which assesses adaptive functioning and clinical information. Both interviews converged strongly with patient-reports, with no significant differences in validity of the interviews in measuring global and specific domains of adaptive functioning variables. Findings suggest that CDIs provide adaptive functioning data comparable to SCIDs (often considered "gold standard" for assessment but difficult to use in practice) and have important implications for bridging the research-practice gap. By incorporating clinicians' everyday methods, CDIs yield information that is psychometrically sound for empirical investigation, diagnostically practical, and clinically meaningful and valid.

Ethnic disparities in mental health treatment gap in a community-based survey and in access to care in psychiatric clinics.

BACKGROUND: Contrasting social status of ethnic groups differentially impacts the use of psychiatric services, including in Israel, despite its universal health system. However, relevant studies are limited. AIMS: To examine ethnic differences in mental health treatment gap and in access to specialized care. METHODS: Data were gathered from two sources. Study I included Mizrahi (Jews of North African/Asian origin, socially disadvantaged, n = 136) and Ashkenazi (Jews of European American origin, socially advantaged, n = 69) who were diagnosed with common mental disorders in the preceding 12 months in the Israeli component of the World Mental Health Survey. Study II included Mizrahi (n = 133) and Ashkenazi (n = 96) service users entering ambulatory mental health care. RESULTS: Study I showed that the treatment gap was larger among Mizrahi compared with Ashkenazi respondents (28% standard error (SE) = 4.1 and 45% SE = 6.2, respectively, sought services) following adjustment for sociodemographic confounders (adjusted odds ratio (AOR) = 2.28, 95% confidence interval (CI) = 1.1-4.8). Study II showed that the access to specialized care lagged over a year among 40% of service users of both ethnic groups. No significant ethnic differences emerged in variables related to delay in accessing care. CONCLUSIONS: Treatment gap was larger among ethnically disadvantaged compared with the advantaged group. However, once in treatment, service users of both ethnic groups report similar barriers to care.

Common mental disorders in immigrant and second-generation respondents: results from the Israel-based World Mental Health Survey.

BACKGROUND: The contrasting social status of ethnic groups differentially impacts the mental health of their members. This may be the case in Israel despite its egalitarian ideology. However, studies are a few and limited in scope. AIM: To study mental health disparities between immigrant and second-generation disadvantaged and advantaged Jewish groups. METHODS: Data were extracted from the Israel World Mental Health Survey. This included the Composite International Diagnostic Interview and the General Health Questionnaire. We compared 547 first-generation immigrants born in North Africa/Asia and 708 born in Europe/America; and 707 second-generation immigrants of North African/Asian origin and 449 of European/American origin. RESULTS: The prevalence rate of common mental disorders in the preceding year was approximately double for respondents of North African/Asian origin compared with their European/American counterparts following adjustment for socio-demographic confounders. Inmigrants: North African/Asian 12.4%, SE = 1.5; European/American 6.4%, SE = 1.0 (AOR = 2.1, 95% CI 1.4-3.4). Second generation: North African/Asian 10.1%, SE = 1.2; European/American 5.4%, SE = 1.1 (AOR = 1.7, 95% CI 1.1-3.2). Significant differences in emotional distress mean scores were observed only among second-generation respondents: North African/Asian respondents reported higher emotional distress (M = 18.7, SE = 0.5) compared with European/American (M = 17.3, SE = 0.4) (Wald F = 13.31, p < .001). CONCLUSIONS: Results showed disparities in the mental health measures in both generations. It is likely that social causation factors, such as restricted opportunities in the context of higher aspirations, partially account for the findings.

The effect of acculturation and discrimination on mental health symptoms and risk behaviors among adolescent migrants in Israel.

This study examines the role of acculturation, perceived discrimination, and self-esteem in predicting the mental health symptoms and risk behaviors among 1.5 and second generation non-Jewish adolescents born to migrant families compared with native-born Jewish Israeli adolescents in Israel. Participants included n = 65 1.5 migrant adolescents, n = 60 second generation migrant adolescents, and n = 146 age, gender, and socioeconomic matched sample of native-born Jewish Israelis. Participants completed measures of acculturation pattern, perceived discrimination, and self-esteem as well as measures of mental health symptoms and risk behaviors. Results show that migrant adolescents across generations reported worse mental health symptoms compared with native-born Jewish Israelis. However, only the 1.5 generation migrants reported higher engagement in risk behaviors compared with second generation migrants and native-born Jewish Israelis. Our findings further showed that acculturation plays an important role in predicting the mental health status of migrant youth, with those characterized with integrated acculturative pattern reporting lower mental health symptoms compared with assimilated acculturation pattern. Importantly, contextual factors, such as higher perception of discrimination in the receiving culture as well as individual factors such as lower self-esteem and female gender were strongly associated with worse mental health symptoms. The findings manifest the complex relationship between contextual factors and individual level variables in the acculturative process of migrants as well as the importance of examining the effect of migration generation on mental health outcomes.

Assessment of co-occurring depression and substance use in an ethnically diverse patient sample during behavioral health intake interviews.

BACKGROUND: Co-occurring disorders present a challenge for providers who often fail to diagnose them with accuracy. This study explores the assessment process of co-occurring depressive and substance use disorders in community health clinics serving ethnically diverse patients. The goals are to identify how symptoms discussed in intake, as well as patient and provider characteristics, are associated with receiving a diagnosis of co-occurring disorders or not. METHODS: Participation in the study consisted of videotaping the intake, conducting a semi-structured interview, and completing demographic and clinical measures. Quantitative analyses were conducted based on information coded from videotapes of intakes with 119 patients who screened positive for symptoms of depressive disorders and substance use. A subset of cases (28) diagnosed with co-occurring disorders were qualitatively analyzed. RESULTS: Results suggest that being female and any discussion of "depression" as a general term increased the likelihood of receiving a diagnosis of depression. Discussing symptoms of drug and alcohol use increased the likelihood of receiving a substance use disorder diagnosis, and discussing symptoms of substance use only increased the likelihood of receiving a dual diagnosis. Qualitative analyses indicate that providers report conducting more systematic assessments for substance use than depressive disorders, which is not supported by the quantitative findings. CONCLUSIONS: Our results point to discrepancies in the ways providers and patients describe the assessment of dual diagnoses. Factors such as the role of nonverbal information and patient presentation were identified as contributing to complexity of the assessment.

Ethnic differentials in mental health needs and service utilization among persons with cancer.

PURPOSE: Improving the assessment of and access to appropriate care for mental health problems among persons with cancer is essential, particularly for population groups that are at high risk for psychopathology. This study characterized ethnic differentials regarding needs and service utilization by Jewish (n = 1,430) and Arab-Israeli (n = 141) persons with cancer. METHODS: We reviewed 284 randomly selected active medical charts in an oncology clinic in a large public hospital (November 2010-April 2011). RESULTS: While 12% of the charts of the Jewish-Israeli sample included a record of psychiatric disorders or symptoms, only 5% of the charts of the Arab-Israeli sample had a similar record (χ² = 4.4, p < .05). Similarly, in a higher percentage of the charts of the Jewish-Israeli sample, the current utilization of psychotropics (18.2 and 5.6%, respectively; χ² = 6.7; p < .01) and/or psychotherapy (7.8 and 1.4%, respectively; χ² = 3.6; p < .05) was noted compared with the Arab-Israeli sample. Also, in a higher percentage of the charts of the Jewish-Israeli patients, a referral for psychotherapy was recorded compared with their Arab counterparts (9.1 and 4.3% respectively; χ² = 6.3; p < .05). In contrast, 19.1% of the Arab-Israelis were recommended with welfare assistance compared to their Jewish-Israeli counterparts, 10.5% (χ² = 5.35; p < .05). CONCLUSIONS: Despite methodological limitations, findings confirm past research showing that disadvantaged ethnic minorities may receive differential recommendations for mental health problems among persons with cancer. This may contribute to the differential treatment gap in mental health care among persons with cancer of contrasting ethnic groups.

The effect of social identities of service-users and clinicians on mental health disparities: A review of theory and facts.

Mental health disparities are differences in health status, risks and care favoring members of advantaged over disadvantaged social groups. the contrasting social identities of clinicians and service-users may account for potential disparities found in clinical encounters, reflected, for example, in the provision of substandard care. the imputed mechanisms, however, remain unknown. Drawing on social psychological research we delineate a model to assist in identifying those mechanisms. we review the literature on processes rooted in social categorization (outgroup bias) and in social power (impaired perspective taking, making automatic attributions) and suggest that the contrasting social identities of clinicians and service-users can partially account for why discordant, compared to concordant ethnic identities in clinical encounters may produce worse outcomes, measured by the quality of the working alliance and the accuracy of diagnostic decisions. we provide preliminary evidence for the proposed model and submit a research agenda to inform evidence-based interventions to counter the negative outcomes of discordant encounters.

Clinical assessment of attachment patterns and personality disorder in adolescents and adults.

The relevance of attachment theory and research for practice has become increasingly clear. The authors describe a series of studies with 3 aims: (a) to validate measures of attachment for use by clinicians with adolescents and adults, (b) to examine the relation between attachment and personality pathology, and (c) to ascertain whether factor analysis can recover dimensions of attachment reflecting both interpersonal and narrative style. In 3 studies, experienced clinicians provided psychometric data using 1 of 4 attachment questionnaires (2 adolescent and 2 adult samples). Attachment dimensions predicted both personality pathology and developmental experiences in predictable ways. Factor analysis identified 4 dimensions that replicated across adolescent and adult samples on the basis of a combination of interpersonal and narrative indicators: secure, dismissing, preoccupied, and incoherent/disorganized.