Evaluating the interactive impact of acculturative stress and anxiety sensitivity on behavioral health outcomes among Latinx during a period of high COVID-19 impact.

As a multi-systemic disease, COVID-19 infection engendered a rise in co-occurring mental and physical health symptoms, particularly affecting the Latinx population. The current work sought to evaluate the main and interactive influence of acculturative stress and anxiety sensitivity in terms of mental and physical health symptoms among 181 Latinx persons (30.4% female, Mage = 34.1 years, SD = 8.20). Data were collected during a period of high COVID-19 impact (2020-2021) and analyses included five separate, two-step hierarchical regressions that were conducted for each of the criterion variables: (1) fear of coronavirus; (2) somatic symptoms; (3) fatigue severity; (4) anxiety symptoms; and (5) depression symptoms. For all analyses, step 1 covariates included years living in the U.S. COVID-19 impact, gender identity, education, and work life distress and home life distress. Results revealed an interactive effect of anxiety sensitivity and acculturative stress on COVID-19 fear, unique main effects for both anxiety sensitivity and acculturative stress on COVID-19 related fear and somatic symptoms, and main effects for anxiety sensitivity alone in relation to fatigue severity, anxiety, and depression. Overall, this study represents an initial investigation of the associations between acculturative stress, anxiety sensitivity, and a range of salient COVID-19 related outcomes among Latinx persons.

Negative emotional reactivity to minority stress: measure development and testing.

The purpose of the present investigation was to develop and test a measure of negative emotional reactivity to racial/ethnic minoritized stress. In Study 1, we developed item content for a measure of negative emotional reactivity to racial/ethnic minoritized stress. We then evaluated item performance and produced a refined 15-item scale among a large sample of racial/ethnic minority adults (N = 1,343). Results supported a unidimensional construct and high levels of internal consistency. The factor structure and internal consistency were replicated and extended to a sample of Latinx persons who smoke (N = 338) in Study 2. There was evidence of convergent validity of the Emotional Reactivity to Minoritized Stress (ERMS) total score in terms of theoretically consistent and statistically significant relations with indices of mental health problems, social determinants of health, and substance use processes. There was also evidence that the ERMS demonstrated divergent validity in that it was negatively associated with psychological well-being, health literacy, subjective social status in Study 1, and positive abstinence expectancies in Study 2. Overall, the present study establishes the reliability and validity of measuring individual differences in negative emotional reactivity to racial/ethnic minority stress with the ERMS and that such responsivity is associated with behavioral health problems.

COVID-19 worry and smoking processes among Hispanic persons in the United States.

Hispanic persons in the United States (US) experienced a disproportionate proportion of adverse health consequences during the pandemic and are a well-established tobacco disparities population. The tendency to worry is one individual difference cognitive-affective construct that is important to smoking behavior and stress-related experiences during the COVID-19 pandemic. However, there is limited understanding of COVID-19 worry in terms of smoking processes among Hispanic persons who smoke during the pandemic. The present investigation examined if COVID-19 worry during the pandemic (February 2021-July 2021) was associated with several processes linked to the maintenance and relapse of smoking among Hispanic persons who smoke. Participants included 337 Hispanic persons who smoke (≥5 cigarettes per day; Mage = 35.5 years old, 37.3% identified as female). Results indicated that in adjusted models covarying for the effects of sex, age, highest level of education, nativity, average number of cigarettes smoked per day, hazardous drinking, drug use problems, and depression, COVID-19 worry was related to increased risk of cigarette dependence, perceived barriers for quitting smoking, and more severe problems when trying to quit. These data are the first to identify an association between heightened COVID-19 worry and risk processes related to the maintenance and relapse of smoking among the Hispanic population in the US.

Potentially traumatic pandemic stressors and anxiety-related sleep disturbance among Latinx persons.

Latinx persons have endured elevated rates of traumatic stress related to the COVID-19 pandemic. The effect of potentially traumatic pandemic stressors on anxiety-related sleep disturbances, a factor implicated in trauma-related psychopathology, is largely unexamined in this population. The present study evaluated the additive effect of potentially traumatic pandemic stressors (e.g., hospitalization) on anxiety-related sleep disturbances. Further, given within-group disparities across Latinx communities with intersectional identities and COVID-19-related risk factors, comparisons of the likelihood of pandemic stressors, by subgroup (i.e., older persons, individuals with chronic illness, and Black Latinx persons), were evaluated. Participants were 292 (29.8% female, Mage = 35.03 years, SD = 8.72) Latinx adults who completed a questionnaire battery during a period of high contagion (June 2020-July 2021). There were statistically significant differences across groups such that participants who experienced any potentially traumatic pandemic stressors reported elevated scores on indices of anxiety, depressive symptoms, and anxiety-related sleep disturbances compared to those who had not experienced these stressors, ds = 0.54-93. Hierarchical regression analysis revealed that hospitalization was associated with anxiety-related sleep disturbances after controlling for age, sex, chronic illness history, other stressors, anxiety, depressive symptoms, and somatic symptom burden, ΔR2 = .01. Black Latinx identity and chronic illness were significantly associated with potentially traumatic pandemic-related stressors. This is the first empirical work to evaluate the role of potentially traumatic pandemic stressors on sleep disturbances among Latinx persons and indicates that hospitalization in a pandemic context has an incremental effect on sleep disturbances in this minoritized group.

Attentional Control Accounts for the Association Between Anxiety Sensitivity and Sleep Efficiency in Clinic-Referred Youth.

Youth with anxiety disorders report difficulty falling asleep and returning to sleep after sleep onset (i.e., poor sleep efficiency). Anxiety sensitivity, the excessive attention to physical symptoms of anxiety and their threatening interpretations, has been linked to poor sleep efficiency. We tested a conceptual model wherein attentional control, attentional focusing and attentional shifting would account for the relationship between anxiety sensitivity and poor sleep efficiency. 255 youths (6-17 years old, 78% Hispanic/Latino) who presented to a university-based research clinic completed measures on anxiety sensitivity, sleep, and attentional control. Poorer sleep efficiency was significantly correlated with higher anxiety sensitivity and lower attentional control, attentional focusing, and attentional shifting. Higher anxiety sensitivity was significantly correlated with lower attentional control and attentional focusing. Attentional control and attentional focusing, not attentional shifting, accounted for the relationship between anxiety sensitivity and poor sleep efficiency. These findings identify attentional control and attentional focusing as variables that may explain the association between anxiety sensitivity and sleep efficiency in youth.

Sleep disturbance and suicidality in psychiatrically hospitalized adolescents: The role of specific emotion regulation domains.

BACKGROUND: Sleep disturbance is associated with broadband measurements of emotion regulation (ER). The linkage between ER, a multidimensional process, and suicidal ideation and suicide attempt is also documented in theoretical and empirical work. Recent research indicates that distinct profiles of ER are associated with psychiatric outcomes, including adolescent suicidal ideation and attempt. The present study examined whether specific domains of ER would explain the association between sleep disturbance, and ideation and attempt among psychiatrically hospitalized adolescents. METHOD: The sample included 284 adolescents who completed self-report measures on sleep disturbance, ER, suicidal ideation, suicide attempt, and psychiatric symptoms upon inpatient hospitalization. RESULTS: Findings indicated that sleep disturbance was associated with suicidal ideation. Further, a single ER domain (perceived limited access to ER strategies) fully accounted for the significant association between sleep disturbance and suicidal ideation. A reported suicide attempt in the past week was correlated with the nonacceptance of emotional responses, perceived limited access to ER strategies, and emotional clarity, but was not associated with sleep disturbance. DISCUSSION: The current findings highlight the importance of examining narrowband ER and indicate the presence of differential associations between sleep disturbance, ER, and suicide-related outcomes. Findings further elucidate the possible role of impaired cognitive responses to emotional experiences in the co-occurrence of sleep disturbance and youth psychiatric outcomes.

Assessment and Management of Suicide Risk in Children and Adolescents.

This article presents a pragmatic approach to assessing and managing suicide risk in children and adolescents. We first present general recommendations for conducting risk assessments with children and adolescents, followed by an algorithm for designating risk. Risk assessment and designation should be based on both distal (i.e., a prior history of self-harm behaviors) and proximal (i.e., suicide ideation, plans, intent, and preparations) predictors of suicide attempt. We then discuss safety planning as an easy-to-implement approach for intervening and managing suicide risk when working with children and adolescents. We end with a case example illustrating the implementation of risk assessment, risk designation, and safety planning with an adolescent client and her mother.

Immunization with heat-inactivated Staphylococcus aureus induced an antibody response mediated by IgG1 and IgG2 in patients with recurrent tonsillitis.

Currently Staphylococcus aureus is the predominant pathogen isolated from the respiratory tract of patients with recurrent tonsillitis. Because of an increase in multi-drug resistant strains of S. aureus, there is a pressing need for effective treatments and preventive approaches to reduce the risk of invasive and life-threatening infections. A preventive vaccine against S. aureus would have a tremendous clinical impact. However, multiple clinical trials have failed to identify an agent that can induce protective responses. Most trials have been based on subunit vaccines using one or a few purified antigens, which may not be enough to confer protection. Here, the impact of a whole-cell vaccine comprised of heat-inactivated S. aureus was investigated in patients with RT. The vaccine was well tolerated and had no significant local or systemic reactions. Immunization with heat-inactivated S. aureus elicited a significant antibody response characterized by production of IgG1 and IgG2 antibodies and, to a lesser extent, of IgA antibodies. Notably, this response was associated with an important decrease in the incidence of tonsillitis and bacterial colonization of the oropharyngeal mucosa. Our results show that whole-cell inactivated S. aureus is safe and capable of evoking specific antibody responses in patients with recurrent tonsillitis.

Responding to Acute Suicidality Among Latinx Youth From Immigrant Families.

According to the US Centers for Disease Control and Prevention, 17% of Latinx high school students report considering attempting suicide within the United States. Given that a large proportion of Latinx youth have an immigrant caregiver, there is a clinical need to address the sociocultural, practical, and resource-related barriers of immigrant Latinx families who have youth experiencing acute suicide risk. To support effective and culturally aligned clinical approaches at the acute, indicated level of care (eg, emergency department, psychiatric hospitalization), we present 3 recommendations contextualized within the flexible and often time-limited nature of clinical responses to acute youth suicidality. The recommendations assume the presence of suicide risk assessment, safety planning, and disposition planning for a level of care that is optimally therapeutic and least restrictive (referred to as standard care).1.

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.

Mental health services use and social support among Latinx families with adolescents who engage in suicidal behavior.

Latinx communities experience a significant child mental health disparity. Research is needed to examine mental health services use and social support in Latinx adolescents, with particular attention to acculturative factors and youth who have high levels of clinical severity. The current study examined whether acculturation and enculturation, and related proxies, are associated with prior history of services use and social support in Latinx families with adolescents who had a recent suicidal crisis. Participants were 110 youths, recently admitted to psychiatric hospitalization, ages 12 to 17 years and their caregivers. Results indicated that approximately 20% of the overall sample did not access any formal mental health services (e.g., outpatient mental health care, primary care support, school staff support) before high acuity hospital care. First generation status and higher caregiver enculturation were associated with a lower likelihood of formal mental health services use, even when controlling for clinical covariates. Adolescent preference for Spanish was associated with lower social support. Findings suggest that families with higher enculturation and first-generation immigrant families (both caregivers and youth born outside of the U.S.), in the context of severe clinical impairment, experience systemic and sociocultural barriers conducive to limited engagement with mental health support. Implications for improving the accessibility of mental health supports are reviewed.

Self-reported COVID-19 symptoms and perceived likelihood of suicide attempt among Latinx individuals who experience acculturative stress.

The impact of COVID-19 has led to a substantial economic and psychosocial burden on the Latinx population. However, few studies have evaluated how COVID-19 symptoms may exacerbate suicide risk indicators among Latinx persons, or the particular social determinants of health facilitating such detrimental effects. The present study examined the association between self-reported COVID-19 symptoms and suicide likelihood (i.e., self-reported perceived likelihood that one will attempt suicide in the future) among Latinx individuals within a timeframe involving high COVID-19 contagion before the onset of vaccine dissemination. Further, the possible moderating role of acculturative stress in the association between COVID-19 symptoms and suicide likelihood was examined. The sample included 200 Latinx participants (67.5% male, Mage = 34.67 years, SD = 9.15) who completed self-report measures on COVID-19 symptoms, suicide likelihood, acculturative stress, depressive symptoms, trauma symptoms, somatic symptoms, and general COVID-19 emotional impact. Findings indicated that self-reported COVID-19 symptoms were positively associated with suicide likelihood. Further, the association between COVID-19 symptoms and suicide likelihood was moderated by acculturative stress, such that the association was only statistically significant at mean or higher levels of acculturative stress but was not significant among participants with lower acculturative stress. The moderation effect was statistically significant after controlling for sociodemographic factors, depressive symptoms, trauma symptoms, somatic symptoms, and the general emotional impact of the COVID-19 pandemic. The current findings indicate that, among Latinx individuals, acculturative stress is a key social determinant of health for marked psychological distress in the context of the COVID-19 pandemic.

Parent Accommodation Contemporaneously Mediates the Association Between Youth Irritability and Youth Anxiety Treatment Outcome.

Research documents that child and adolescent (youth) irritability and anxiety have high co-occurrence, and anxious-irritable presentations are associated with greater impairment than anxious nonirritable presentations. This study examines the association between irritability and youth anxiety treatment outcome and tests a conceptual model of the associations among youth irritability, parent accommodation, and youth anxiety severity following cognitive behavioral treatment (CBT). Participants were N = 128 clinic-referred youths ages 6 to 17 years (M = 9.76 years; 57% female) who met criteria for primary anxiety disorder diagnoses and completed a 12- to 14-week CBT anxiety protocol. Parent- and youth-report on youth irritability, parent accommodation of their child's anxiety, and youth anxiety severity were assessed pretreatment and posttreatment. Using parent-report, youth irritability at pretreatment was associated with high parent accommodation of youth anxiety and high youth anxiety severity at posttreatment. The association between irritability and youth anxiety outcome was mediated contemporaneously by parent accommodation at posttreatment. These findings show that parent accommodation of their anxious-irritable children's anxiety may account for high youth anxiety severity following treatment. Developing strategies to target irritability in anxious youth and/or reduce parent accommodation in the presence of youth irritability represent important directions for future research.

Development and initial validation of a parent report measure of youth belongingness and burdensomeness.

OBJECTIVE: The Interpersonal Theory of Suicide (ITS) implicates thwarted belongingness and perceived burdensomeness as casually related to suicide desire. The self-report Interpersonal Needs Questionnaire (INQ) is the most commonly used measure to assess belongingness and burdensomeness, including in youth. No parent-report version of the INQ exists. The current study adapted the ten-item version of the INQ (INQ-10) for parent report of youth belongingness and burdensomeness, thereby moving ITS research in youth to a multi-informant measurement approach, and examined its factor structure and convergent and concurrent validity. METHODS: Participants were 168 clinic-referred youths ages 9-17 years (58.9% female; Mage  = 11.91) and their parents. RESULTS: Findings supported a two-factor structure of the parent INQ. In support of convergent and concurrent validity, parent-reported belongingness and burdensomeness were significantly associated with youth-reported belongingness and burdensomeness, suicide ideation, anxiety symptoms, depressive symptoms, and impairment. CONCLUSIONS: The current study provides initial support the INQ-parent version as a valid measure to complement youth self-reports of belongingness and burdensomeness.

Brief modular approach to target perceived burdensomeness in clinic-referred youth.

INTRODUCTION: Existing CBT protocols for internalizing disorders target thoughts and behaviors related to anxiety and/or depression, but do not explicitly target other identified risk factors for suicide ideation, including perceived burdensomeness toward others. The aims of the current study were to (1) develop a novel, brief module (the "Give program") targeting perceived burdensomeness toward others that can be embedded within existing CBT protocols for youth internalizing disorders, (2) evaluate the acceptability and feasibility of the module with an eye toward intervention refinement, and (3) examine reductions in perceived burdensomeness. METHODS: Participants were 18 clinic-referred youths with anxiety or depressive disorders who endorsed burdensomeness. We used a quasi-experimental interrupted time-series design to evaluate changes in burdensomeness scores following the administration of the module. RESULTS: The module was clinically feasible and well-accepted. Youth burdensomeness scores increased in the first half of the CBT protocol and decreased immediately following the administration of the Give program module. Burdensomeness scores were significantly associated with suicide ideation. CONCLUSION: The current study is the first to develop and evaluate a module targeting burdensomeness in at-risk youth in an outpatient setting, demonstrating that burdensomeness can be efficiently and effectively targeted within existing evidence-based treatment protocols for internalizing disorders in youth.

Low Parental Warmth and High Youth Impairment: A Recipe for Perceived Burdensomeness?

Theory and research document the role of perceived burdensomeness in the development of suicide ideation, including in youth. There is a critical need to identify and evaluate variables that foster perceived burdensomeness in youth, with an eye toward advancing etiological models and informing prevention approaches for at-risk youth who are not yet actively suicidal. The current study examined and replicated a conceptual model wherein the association between low parental warmth and burdensomeness is moderated by youth impairment. Participants were 75 and 150 clinic referred youths in Study 1 and Study 2, respectively, with anxiety-related difficulties. Youth impairment significantly moderated the association between low parental warmth and youth perceived burdensomeness such that the association was negative and statistically significant at high levels of impairment, but not at low levels of impairment. The moderation effect was statistically significant in both studies while controlling for anxiety and depressive symptoms. These findings provide insight into variables that are associated with a sense of burdensomeness toward others in youth, and identify potential targets for preventing or intervening to reduce perceived burdensomeness in clinic-referred youth.

Performance of the interpersonal needs questionnaire in adolescent clinical samples: Confirmatory factor analyses and evaluation of measurement invariance.

OBJECTIVE: This study evaluated the factor structure, internal consistency reliability, construct and criterion validity, and measurement invariance of the Interpersonal Needs Questionnaire (INQ) among adolescents. METHOD: Participants (N = 539) included three distinct samples of youth drawn from two outpatient psychology clinics and an inpatient psychiatric unit. The combined sample was 63.3% female and had a mean age of 14.95 years (SD = 1.31 years). All participants completed the INQ as well as measures of depressive symptoms and suicide ideation. RESULTS: Confirmatory factor analyses indicated that the removal of three items from the thwarted belongingness subscale of the INQ was needed to achieve acceptable model fit. The resulting combined 12-item scale demonstrated good factor structure, internal consistency reliability, construct validity, and criterion validity. The modified 12-item INQ also demonstrated scalar invariance across subgroups defined by sex, race, and age. CONCLUSIONS: Findings support the use of this reduced 12-item version of the INQ among adolescents. Youth may have difficulty accurately responding to changes in item valence; thus, future research with youth should consider using a 12-item version of the INQ that avoids valence changes within subscales.

Aggressive Behaviors and Suicide Ideation in Inpatient Adolescents: The Moderating Roles of Internalizing Symptoms and Stress.

The present study examined a conceptual model in which the association between aggressive behaviors and suicide ideation is moderated by internalizing symptoms and ongoing stress. Participants were 304 psychiatric inpatient adolescents (65.8% girls) ranging in age from 12 to 17 years (Mean age = 14.69). The association between aggressive behaviors and suicide ideation was significantly moderated by internalizing symptoms and ongoing stress; the association was positive in adolescents low in internalizing symptoms or high in ongoing stress, but negative in adolescents high in internalizing symptoms or low in ongoing stress. The three-way interaction between aggressive behaviors, internalizing symptoms, and ongoing stress was not statistically significant. The current findings indicate that in adolescents who display high levels of aggressive behaviors, the presence of high ongoing stress provides a more useful indicator of levels of suicide ideation than the presence of high internalizing symptoms. Implications for case identification and prevention are discussed.

Mindfulness Moderates the Association Between Perceived Burdensomeness and Suicide Ideation in Adults With Elevated Depressive Symptoms.

A conceptual model in which the associations between perceived burdensomeness and suicide ideation, and between thwarted belongingness and suicide ideation, are moderated by mindfulness was examined. Participants were 218 undergraduates (mean age = 20.81) with moderate-to-severe depressive symptoms. Mindfulness significantly moderated the association between perceived burdensomeness and suicide ideation; participants with thoughts of burdensomeness experienced lower levels of suicide ideation if they were high, as opposed to low, in mindfulness. Mindfulness did not significantly moderate the association between thwarted belongingness and suicide ideation. Implications for intervention and elaboration of the interpersonal psychological theory of suicide are discussed.

Depressive Symptoms and Perceived Burdensomeness Mediate the Association between Anxiety and Suicidal Ideation in Adolescents.

A relationship between anxiety disorders and suicide-related behaviors has been demonstrated in adolescents, with a paucity of research examining mediators of this association. The present study hypothesized that anxiety would be associated with suicidal ideation via a serial mediation pathway through depressive symptoms and perceived burdensomeness and/or thwarted belongingness. A sample of 80 adolescents (68.8% female, 65.8% Hispanic), 13-19 years of age (mean = 16.93, SD = 1.66), completed 3 interviews as part of a randomized controlled trial. Results indicated a significant serial mediation from anxiety to suicidal ideation via depressive symptoms and perceived burdensomeness, but not thwarted belongingness. Clinicians and mental health service providers working with adolescents experiencing elevated anxiety should regularly assess for perceived burdensomeness and suicidal ideation.